Conceptual development of lateral approach percutaneous spinal endoscopy / 西安交通大学学报(医学版)

Lateral approach percutaneous spinal endoscopy， one of the most representative spinal endoscopic procedures， has ranked among the mainstream spinal operations that are facilitated to be understood and mastered by surgeons. The surgeries possess advantages of precise curative effect and wide scope of application after a series of conceptual innovations and reforms including YESS technology， TESSYS technology， eccentric trepan technology， visualized plasty technology， full-endoscopic visualization technology， and spinal endoscopy technology from the perspective of open surgery. Moreover， lateral approach percutaneous spinal endoscopy has formed a technology cluster that is inclusive with broad development prospects based on the introduction of high-tech technologies such as artificial intelligence and various navigation technologies.

Comparison of early clinical outcome of Endo-ULBD technique and PLIF technique on the treatment of multi-segmental lumbar central spinal stenosis / 西安交通大学学报(医学版)

【Objective】 Compare the early outcome and safety of endoscopy-unilateral laminectomy for bilateral decompression （Endo-ULBD） and posterior lumbar interbody fusion （PLIF） in the treatment of multi-segment lumbar central spinal stenosis. 【Methods】 We retrospectively analyzed 68 patients with multi-segment central lumbar spinal stenosis treated between October 2019 and October 2020 in the Department of Spine Surgery， Affiliated Hospital of Qingdao University. Of them 33 patients were treated with Endo-ULBD and 35 ones were treated with PLIF. We compared the operation time， times of intraoperative fluoroscopy， estimated intraoperative blood loss， incision length， postoperative time to get out of bed， postoperative hospital duration， complications， visual analogue scale （VAS）， Oswestry dysfunction index （ODI） score before and 1 day， 1 month， and 3 months after operation， Japanese Orthopedic Association Assessment Treatment Score （JOA）， and modified MacNab score 3 months after operation between the two groups of patients. 【Results】 Compared with PLIF group， Endo-ULBD group had significantly shorter operation time， smaller incision length， less intraoperative blood loss， shorter postoperative bed time and postoperative hospital stay， and fewer surgical complications （all P0.05）. However， after treatment Endo-ULBD group outperformed PLIF group in lower back pain VAS， ODI， JOA and the 3-month follow-up excellent and good rates （P<0.05）. 【Conclusion】 For patients with multi-segment central lumbar spinal stenosis， Endo-ULBD treatment can achieve better early clinical outcome than PLIF surgery， with less bleeding， shorter operation time， faster postoperative recovery， and fewer complications.

Unique Complications of Percutaneous Endoscopic Lumbar Discectomy and Percutaneous Endoscopic Interlaminar Discectomy.

BACKGROUND: Percutaneous endoscopic discectomy (PED) includes 2 main procedures: percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy (PEID), both of which are minimally invasive surgical procedures that effectively deal with lumbar degenerative disorders. Because of the challenging learning curve for the surgeon and the individual characteristics of each patient, preventing and avoiding complications is difficult. The most common complications, such as nucleus pulposus omission, nerve root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative dysesthesia, posterior neck pain, and surgical site infection, are difficult to avoid; however, more focus on these issues perioperatively may be in order. Additionally, unique and unexpected complications can also occur, such as retroperitoneal hematoma (RPH), intraoperative seizures, and thrombophlebitis, among others. OBJECTIVE: We aim to delineate unique complications during PED and accumulate strategies to prevent significant morbidity and improve surgical techniques. STUDY DESIGN: A retrospective cohort study of patients undergoing PEID or PELD from October 2014 to January 2016. SETTING: Affiliated hospitals of Qingdao University. METHODS: Patients with lumbar disc herniation (LDH) who underwent PEID and PELD were retrospectively analyzed. Complications were recorded and analyzed pre and postoperatively. We assessed clinical outcomes using the visual analog scale (VAS) and Oswestry Disability Index (ODI) and classified the results into "excellent," "good," "fair," or "poor" based on the modified MacNab criteria. All of the patients were followed for more than one year to evaluate their recovery from complications. RESULTS: From October 2014 to January 2016, 426 patients with LDH underwent PEID (106 cases) or PELD (320 cases). Common complications and occurrence rates were as follows: the incomplete removal of herniated discs was 1.4% (6/426), recurrence 2.8% (12/426), nerve root injury 1.2% (5/426), dural tear 0.9% (4/426), and nerve root induced hyperalgesia or burning-like nerve root pain 2.3% (10/426); no posterior neck pain or surgical site infection occurred. Unique complications included: passage of the working channel through the spinal canal into the disc space (one case), super-elastic nerve hook caught by exiting nerve root (one case), epidural hematoma (one case), radicular artery injury and massive bleeding (one case) which was revised by micro-endoscopic discectomy, and intraoperative seizure (one case). No serious consequences occurred after active medical intervention, and most patients had good recovery by 3 months postoperatively with physical therapy. LIMITATIONS: The main limitations of this study are the retrospective study design, limited case number, and short follow-up period. CONCLUSIONS: PEDs are effective and minimally invasive methods for the surgical treatment of LDH, causing fewer complications due to the very minimal operational trauma for the muscle-ligament complex and stability of the spine. Nevertheless, because of the difficult learning curve for surgeons, lack of experience with the requisite surgical techniques, and enhanced clinical responsibility, a variety of problems may occur. Especially concerning are the unique complications mentioned here, which potentially lead to severe injury for the patient and require diligent preventive measures. KEY WORDS: Unique complications, epidural, hematoma, interlaminar, transforaminal, PEID, PELD.

Construction and identification of lentiviral vector encoding human survivin gene / 中国组织工程研究

BACKGROUND:Inhibiting the apoptosis of intervertebral disc cel s can postpone the degenerative process of intervertebral disc. Survivin has a strong function of regulating cel proliferation and anti-apoptosis. OBJECTIVE:To construct and identify the lentiviral vector encoding survivin gene of human. METHODS:The survivin gene of human (BIRC5) was synthesized through the gene synthesis technology, amplified by PCR and analyzed by electrophoresis. The target gene was cloned into lentiviral expression plasmid to obtain the recombinant lentiviral vector Lenti-BIRC5. After transformation into competent E. coli cel s, the candidate clones were identified by PCR firstly. The positive clones were identified by gene sequencing. The lentivirus plasmid containing target gene was transfected into 293T cel s, and the expression of recombinant lentiviral vector Flag-Survivin fusion protein was detected through western blot analysis. RESULTS AND CONCLUSION:The PCR results of electrophoresis and DNA sequencing showed that lentiviral vector containing human survivin gene was constructed successful y. Western blot analysis results showed that the target gene was transfected successful y and over-expressed in cultured cel s. The lentiviral expression vector of human survivin gene Lenti-BIRC5 was constructed successful y, which lays a foundation for the study addressing the anti-apoptotic effects of survivin on human nucleus pulposus cel s.

A finite element modeling of posterior atlantoaxial fixation and biomechanical analysis of C2 intralaminar screw fixation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The objective of this study was to use three-dimensional finite element (FE) models to analyze the stability and the biomechanics of two upper cervical fixation methods: the C2 intralaminar screw method and the C2 pedicle screw method.</p><p><b>METHODS</b>From computed tomography images, a nonlinear three-dimensional FE model from C0 (occiput) to C3 was developed with anatomic detail. The C2 intralaminar screw and the C2 pedicle screw systems were added to the model, in parallel to establish the interlaminar model and the pedicle model. The two models were operated with all possible states of motion and physiological loads to simulate normal movement.</p><p><b>RESULTS</b>Both the C2 intralaminar screw method and the C2 pedicle screw method significantly reduced motion compared with the intact model. There were no statistically significant differences between the two methods. The Von Mises stresses of the internal and external laminar walls were similar between the two methods. Stability was also similar.</p><p><b>CONCLUSIONS</b>The C2 intralaminar screw method can complement but cannot completely replace the C2 pedicle screw method. Clinicians would need to assess and decide which approach to adopt for the best therapeutic effect.</p>

Exogenous cardiotrophin-1:The possibility to protect PC12 cells and Schwann cells / 中国组织工程研究

BACKGROUND:Restoration of neurological functions after the damaged peripheral nerve is reconstructed is a hot topic in existing research. Within a short term fol owing peripheral nerve injury, nerve and muscle begin to develop irreversible degeneration. Restoration of the damaged nerve requires delayed degeneration and basic microenvironment. OBJECTIVE:To investigate the protective effect of cardiotrophin-1 on PC12 cells and Schwann cells. METHODS:Schwann cells and PC12 cells were obtained and cultured in complete medium, serum-free medium and 50 ℃ medium, respectively. cells in cardiotrophin-1 group were treated with exogenous cardiotrophin-1 solvent, while those in the control group were treated with equivalent Dulbecco’s modified Eagle’s medium, for 24 hours. The survival rate for PC12 cells and Schwann cells was determined using cellCounting Kit-8 colorimetric method. The lactate dehydrogenase activity in supernatant was detected by lactate dehydrogenase kit, and the malondialdehyde content and superoxide dismutase activity were measured by thiobarbituricaicd and xanthine oxidese method respectively. RESULTS AND CONCLUSION:The survival rate of PC12 cells and Schwann cells in cardiotrophin-1 group was obviously increased, lactate dehydrogenase releasing and malondialdehyde content were obviously decreased, superoxide dismutase activity was dramatical y improved compared with control group. Exogenous cardiotrophin-1 reduces the injury caused by ischemia and heat stress stimulation for PC12 cells and Schwann cells. The mechanism of protection may be related to the expression of anti-apoptosis protein activated by the combination of cardiotrophin-1 and its receptors.

Ascending paralysis after thoracolumbar fracture: 3 cases reports and related literature review / 中华骨科杂志

ObjectiveTo investigate the clinical features and treatment of ascending paralysis after thoracolumbar fracture.MethodsThree male patients with 2 fracture levels at T12 and one at L1 were retrospectively studied.Their mean age was 41.3 years(range,39-42 years).All 3 cases were undertaken open decompression,reduction and internal fixation.Paralysis level began to ascend at 2-5 days after injury,with 2 cases up to C2,3 and 1 case up to T7.Two patients suffered irritating pain over the paralysis level before onset of ascending.Postoperative MRI images demonstrated well reduction and no compression of spinal cord.In the early phase after ascending,MRI obviously showed swelling in spinal cord and long T1 and long T2 signals shaped patchy and stripy distribution in the central area.One patient's MRI displayed that the spinal cord shrinked 16 days after trauma with abnormal high signal in the central area.ResultsTwo cases died of respiratory muscle paralysis and 1 case suffered paraplegia with no recovery 5 years after surgery.ConclusionAscending paralysis after thoracolumbar fracture is a rare complication with very poor prognosis.MRI is available for evaluating operational effects and affected level.The exact mechanism and effective treatment are still unclear and need further investigated.

Acute epidural hematoma after thoracic spine surgery / 中华骨科杂志

Objective To investigate the risk factors and preventive measures for acute epidural hematoma after posterior thoracic spine surgery.Methods A retrospective study of 14 patients who developed acute epidural hematoma after thoracic spine surgery from May 2002 to May 2012 was conducted.There were 6 males and 8 females,aged from 41 to 69 years (average,61.2 years).There were 10 cases of thoracic spinal canal stenosis,3 cases of thoracic spinal meningioma,and 1 case of thoracic metastasis.About 3-14 h (average,6.6 h) after posterior thoracic spine surgery,the neurological deterioration was found,and according to the American Spinal Injury Association (ASIA) classification,there were 5 cases of grade A and 9 cases of grade B.The neurological function before evacuation of hematoma was compared with that after evacuation of hematoma and that at final follow-up.The correlations between hematoma compression time,neurological improvement rate and neurological function before evacuation of hematoma were statistically analyzed.Results After evacuation of hematoma,the ASIA classification of 14 patients was as follows:grade B in 1 case,grade C in 2 cases,grade D in 4 cases,and grade E in 7 cases.The hematoma compression time of 3 patients with grade B or C was more than 10 hours.Obvious difference of neurological function was found before and after evacuation of hematoma.The neurological improvement rate was 63.7％±23.3％ after evacuation of hematoma,which was negatively correlated with hematoma compression time and positively correlated with preoperative neurological function.The neurological function before evacuation of hematoma was significantly different from that at final follow-up.The neurological improvement rate was 86.97％±17.58％ at final follow-up,which was negatively correlated with hematoma compression time and positively correlated with preoperative neurological function.Conclusion The acute epidural hematoma after thoracic spine surgery could cause severe neurological deterioration.The neurological improvement was negatively correlated with hematoma compression time.Evacuation of hematoma must be done as soon as possible once progressive neurological deterioration is found.

Effects of synthetic peptides FG loop on PC12 cells proliferation and apoptosis / 中国组织工程研究

BACKGROUND: FG loop (FGL) is a core active peptide fragment of neural cell adhesion molecule (NCAM), which can directly act on fibroblast growth factor receptor 1 (FGFR1) to activate NCAM signal pathway.OBJECTIVE: To observe the effects of synthetic peptides FGL on PC12 cells proliferation and apoptosis.METHODS: ①PC12 cells proliferation and apoptosis: The cultured PC12 cells were divided into control group and experiment group. The experimental group was added with 1% FGL peptide solution. The control group was pre-coated with poly-lysine plates. The cells were cultured 1, 3, 5, 7, 9 d respectively to detect cell proliferation by using Cell Counting Kit-8. ②PC12 apoptosis and nuclear factor kappa B mRNA detection: The PC12 cells were divided into normal group, experimental group and injury group. H2O2 was added into the injury group for 16 hours stimulation. In the experimental group, H2O2 and FGL were used for 16 hours stimulation. The cell apoptosis were detected by flow cytometry; mRNA expression of nuclear factor kappa B was detected by quantitative fluorescent polymerase chain reaction.RESULTS AND CONCLUSION: PC12 cells cocultured with FGL peptide grow well, which indicates that FGL peptides can promote PC12 cell proliferation and inhibit PC12 cell apoptosis, as well as decrease mRNA expression of nuclear factor kappa B.

The VEGF production by dedifferentiated chondrocytes under synovial fluid stimulation from coxarthrosis and femoral neck fracture patients / 中华骨科杂志

Objective To investigate the vascular endothelial growth factor (VEGF) expression level by chondrocytes isolated from patients with osteoarthritis (OA) in hip or femoral neck fracture (FNF) and explore the effect of synovial fluid from OA or FNF on secretion of VEGF. Methods The cartilage tissues were collected from 12 patients with OA in hip and 8 patients with FNF. Cartilage was stained with HIM and Safranin O/Fast Green (S/F) method. The damage of cartilage was evaluated using Mankin scores.Cathepsin B which was selected for cell dedifferentiation monitoring marker and VEGF level was detected in the supernatant fluid. The synovial fluid from OA, FNF and DMEM were respectively added to the culture medium to explore their effects on regulating VEGF. Results Cartilage the Mankin scores of OA group were higher than that of FNF group. Chondrocytes gradually lost their original spherical appearance, with Cathepsin B upregulated while VEGF downregulated. The OA synovial fluid can stimulate chongdrocytes to secrete more VEGF than the one from patients with FNF. However, chondrocytes gradually produced less VEGF after passaging. Conclusion Mankin scores had good correlation with chondrocytes' VEGF production in the early stage of primary culture. Chondrocytes showed quick dedifferentiation characteristics in vitro. OA synovial fluid showed abig ger capability in stimulating chondrocytes to express more VEGF, which might indicate that OA synovial fluid participated in the pathological process of OA.

Trans-facet joints approach to treat thoracic degenerative diseases with anterior compression / 中华骨科杂志

Objective To investigate the clinical outcomes of trans-facet joints approach to treat thoracic degenerative disease with anterior compression.Methods From January 2003 to December 2009,22 patients with thoracic myelopathy caused by anterior compression were studied retrospectively.The patients included 16 males and 6 females,aged from 36 to 72 years(average 54.2 years).There were thoracic ossification of posterior longitudinal ligament(OPLL)in 11 cases,thoracic disc protrusion with ossification in 8 cases,thoracic vertebra posterior osteophytes in 2 cases,ankylosing spondylitis with thoracic pseudoarthrosis in 1 cases.Preoperative Japanese Orthopaedic Association(JOA)score was 5.2(range,2-9).The characteristic of thoracic degeneration was analyzed by CT and MRI examination.Posterior decompressive laminectomies were performed by the technique of "cap uncovering".The facet joints were removed bilaterally.Anterior ossified compressions were cut via posterior-lateral approach,and then intervertebral bone graft and bilateral pedicle screws were implanted.Results All patients were followed up for 8 to 38 months.According to the revised Epstein standard,there were excellent in 7 patients,good in 9,fair in 4,and poor in 2.The total effective rate was 90.9%(20/22).The excellent and good rate was 72.7%(16/22).The mean postoperative JOA score was 8.7(range,2-11).Surgical complications included dural laceration in 1 patient,pleura injury in 1 patient,epidural hematoma in 2 patients.There were no cases of spinal instability or deep infection.Conclusion The anterior compression can be solved completely via trans-facet joints approach in thoracic degenerative disease patients.