Comparative Study of Three Minimally Invasive Surgical Approaches for the Treatment of L5/S1 Lumbar Intervertebral Disc Herniation.

AIM: To compare the efficacy and safety of minimally endoscopic discectomy (MED), percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of L5/S1 lumbar disc herniation (LDH). MATERIAL AND METHODS: From May 2012 to January 2017, 317 patients with L5/S1 LDH treated with MED, PETD or PEID were reviewed. Pre- and postoperative pain was measured using a visual analog scale (VAS; 0 ?10), and functional status was assessed using the Oswestry Disability Index (ODI; 0 ? 100%). Clinical outcomes, SF-36 scores and CK levels were compared between the 3 groups. RESULTS: There were 177 females and 140 males; the ages ranged from 22 to 74 years; and the course of disease was 15 to 85 days, with an average of 42.8 days. The postoperative bed rest time and average hospital stay in the MED group were higher than in the other two groups, and the differences were statistically significant. There was no significant difference in the results evaluated by the MacNab criteria. There were no significant differences in the levels of CK between the three groups before and after surgery (p > 0.05). CONCLUSION: Three minimally invasive surgeries for the treatment of L5/S1 LDH achieved satisfactory clinical outcomes; however, each procedure has its own advantages, disadvantages and indications. Surgeons need to choose the most appropriate surgery according to the individual condition of the patient to achieve the best therapeutic effect.

Self-Locking Stand-Alone Cage Used from Opposite Approach for the Treatment of Adjacent Segment Disease After an Anterior Cervical Corpectomy and Fusion.

AIM: To investigate the efficacy and safety of the self-locking stand-alone cage used from opposite approach for the treatment of adjacent segment disease (ASD) after an anterior cervical corpectomy and fusion (ACCF). MATERIAL AND METHODS: In this study, we retrospectively analyzed the clinical data of 8 cases of ACCF in the treatment of ASD cervical spondylopathy. All patients received self-locking stand-alone cage treatment. At different time points, the clinical status was evaluated using the Japan Orthopedic Association (JOA) score, JOA recovery rate (RR), and Neck Disability index (NDI) score. X-ray measurements included C2-C7 Cobb angle, fusion segment angle (FSA), cervical vertebral bow depth (VBP), and height of surgical segment (HOS). Statistical imaging parameters of sagittal cervical spine. Bone graft fusion in all self-locking stand-alone cage segments was evaluated. RESULTS: All operations were successfully completed, and no infection, epidural hematoma, or rupture of the dura mater were observed in all patients. Compared with pre-operation, the JOA and NDI scores at 3 months and at the last follow-up were significantly improved (p < 0.05). The JOA recovery rate between the final follow-up and preoperatively was 64.8±5.2%. One patient had dysphagia postoperatively, but was resolved after 3 months. Three months after surgery, the sagittal radiographic outcomes improved significantly and were well maintained during the final follow-up. CONCLUSION: The self-locking stand-alone cage is a reliable and effective method used from the opposite approach for the treatment of ASD after ACCF in terms of JOA and NDI scores. The cervical alignment correction is considered satisfactory.

Anterior cervical discectomy with fusion and posterior cervical expansive open-door laminoplasty for multilevel cervical spondylotic myelopathy: its postoperative stability / 中国组织工程研究

BACKGROUND: The treatment of multilevel cervical spondylotic myelopathy (MCSM) aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE: To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS: Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion (group A) or posterior cervical expansive open-door laminoplasty (group B). All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION: (1) The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A (P 0.05). (5) The intraoperative blood loss in the group B was significantly more than that in the group A (P < 0.05). (6) The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. (7) These results suggest that during choosing an appropriate method for MCSM,surgeons' skills and patients' situation should be considered.

Glioma cells promote expression of cancer-related genes in human bone marrow-derived mesenchymal stromal cells in vitro / 中国神经精神疾病杂志

Objective We investigated the expression profile of cancer related genes in hMSCs co-cultured with U251 glioma cells, to evaluate the risk of malignant transformation of hMSCs in glioma environment. Methods hMSCs were co-cultured with U251 glioma cells for 5 days and the expression profile of cancer-related genes were investigated by using microarray assay, followed by Real-time quantitative RT-PCR and Western blot. Results Of the 440 cancer-re?lated genes covered by Oligo GEArray Human Cancer Microarray OHS-802, SPINT2, TK1, STC1, MMP1, CCND1, SORT1, SEPT6, CDC20, SHB, CDK5, RELA, XRCC4, KIT, CTPS, CAPNS1 and ETV6 were significantly upregulated (>3-fold) whereas none was downregulated in hMSCs co-cultured with U251 glioma cells. The upregulation of oncogenes KIT, CAPNS1, TK1, MMP1, CCND1, CDC20, RELA and STC1 in co-cultured hMSCs were confirmed by Real-time quan? titative RT-PCR. The upregulation of protein expression of oncogenes KIT, MMP1, CCND1 and RELA were detected by Western blot. Conclusion The present study demonstrates that co-culture of hMSCs with human glioma cells leads to up?regulation of some important oncogenes in hMSCs, indicating the tumorigenic potential of hMSCs in glioma environment.

Expressions of cancer-related genes in human bone marrow-derived neural stem cells / 中华神经医学杂志

Objective To investigate the expression profile of cancer-related genes in human bone marrow-derived neural stem cells (Md-NSCs) to determine whether there are any characteristics that could help the evaluation of their tumorigenic potentials.Methods Md-NSCs were cultured in vitro and identified (experimental group);fresh human adult bone marrow cells were used as control group (sifting erythrocytes).The expression profiles of 440 cancer-related genes in cells from the two groups were analyzed by Oligo GEArray Human Cancer Microarray OHS-802;real-time quantitative PCR was performed to detect the expressions of oncogene MYC,matrix metalloproteinase 2 (MMP2),Notch congener 2 (Notch2),stanniocalcin 1 (STC1),integrin α3 (ITGA 3),signal transduction and transcriptional activation factor 5b (STA T5b),Ras congene gene family C (RhoC),and wingless-type MMTV integration site family member 1 (Wnt1).Results As compared with those in the control group,the Md-NSCs from experimental group had 66 tumor-related genes with high expressions (＞3 folds).MYC,MMP2,Notch2,STCI,ITGA3,STA T5b,RhoC and Wnt1 expressions in the Md-NSCs from experimental group were significantly higher than those in the control group (P＜0.05),whose results were accorded with genechip detection results,enjoying the folds of 4.35×100,2.84×100,2.87×100,3.41 ×102,2.22×102,6.99× 100,4.92 × 100 and 3.64 ×100,respectively.Conclusion A number of cancer-related genes are over-expressed in Md-NSCs,and the activations of some of these important oncogenes have been proved to promote human tumorigenesis.

Two strengthening pedicle screw techniques and bone cement in lumbar internal fixation / 中国组织工程研究

BACKGROUND:Screw loosening and shedding may occur after osteoporosis associated with lumbar degenerative disease treated with pedicle screw fixation. Application of pedicle screw enhanced with cured materials can improve the therapeutic effect. OBJECTIVE:To compare the clinical effect of pedicle screws enhanced with poly(methyl methacrylate) and injectable calcium sulfate cement in the lumbar internal fixation of osteoporosis. METHODS:Sixty-one patients diagnosed with osteoporosis combined with lumbar spondylolisthesis, lumbar spinal instability, and severe lumbar spinal stenosis were col ected. Al patients were divided into two groups according to the treatment method:poly(methyl methacrylate) bone cement enhanced pedicle screw group and calcium sulfate bone cement enhanced pedicle screw group. RESULTS AND CONCLUSION:There were no significant differences in the operation time, blood loss, preoperative and postoperative visual analog scale score, Japanese Orthopedic Association scores and the Japanese Orthopedic Association score improvement rate between two groups (P>0.05). The results showed that two patients had bone cement leakage in poly(methyl methacrylate) group which had no neurological symptoms caused by new symptoms during fol ow-up period. The bone mineral density was not improved gradual y in poly(methyl methacrylate) group with fol ow-up time prolonging;however, in calcium sulfate group, the bone mineral density was increased significantly after treatment, and the change of bone mineral density was linearly related with Japanese Orthopaedic Association score improvement rate in calcium sulfate group. No screw loosening, pul ing out or neurological dysfunction occurred in both groups. The results indicate that like poly(methyl methacrylate), balcium sulfate bone cement can increase the stability of pedicle screws.

Surgery treatment to the mixed ossification of posterior longitudinal ligament / 中国矫形外科杂志

[Objective]To analyze the effect of the surgical operation for cervical myelopathy due to mixed ossification of posterior longitudinal ligament (OPLL). [Methods]Forty-two patients with mixed OPLL were enrolled from June 2003 to June 2007.Eighteen were treated with posterior laminoplasty combined with anchor nail fixation(group A).Fifteen with laminoplasty (group B) and the other nine with laminectomy(group C).According to the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy,the neural function scores were obtained. The cervical shoulder pain score and the influence factors for prognosis were documented.[Results]All patients were followed for 6 months to 4 years (mean 23 months). The differences between preoperation and post operation were significant among the three different surgery type groups (P