Analyzing the morphologic characteristics of pedicle-facet joints in lumbar spondylolysis: correlation with spinopelvic parameters and its clinical relevance / 中华骨科杂志

Objective:To delineate the morphological features of pedicle-facet joints in lumbar spondylolysis patients, correlating these with spinopelvic parameters to explore their mechanisms and clinical implications.Methods:This study enrolled 121 patients with L 5 spondylolysis (IS group), 108 with L 4, 5 degenerative spondylolisthesis (DS group), and 100 with normal L 4, 5 but L 5S 1 lumbar disc herniation (NL group), who underwent radiography and multislice spiral CT from May 2020 to January 2023. Parameters including vertebral slip percentage (SP) and spinopelvic alignments, such as sacral slope and lumbar lordosis, were quantified using standing lateral lumbar radiographs. Morphological parameters of the L 4 and L 5 facet joints were measured on 3D reconstructed lumbar CT images, including the facet joint angle (FJA), pedicle-facet joint angle (PFA), facet joint osteoarthritis (OA), and facet joint tropism (FT). Results:The analysis revealed significant variances in SS and LL among the groups ( F=21.910, P<0.001; F=22.439, P<0.001). The IS group exhibited the highest SS and LL, followed by the DS and NL groups. Morphological assessments showed the largest L 4 FJA in the IS group, with progressive decreases in the DS and NL groups ( F=344.791, P<0.001). Conversely, L 4 PFA was greatest in the DS group ( F=193.725, P<0.001). Notably, L 4 OA was markedly more severe in the DS group compared to IS and NL groups ( H=467.925, P<0.001), with no significant disparity between IS and NL groups ( P>0.05). Correlation analyses within each cohort highlighted a negative association of sacral slope and lumbar lordosis with facet joint angles, yet a positive correlation with pedicle-facet joint angles both with statistical significance ( P<0.05). Furthermore, L 4 facet joint angles were consistently smaller than those at L 5, and L 4 pedicle-facet joint angles were larger than L 5 ( P<0.05). Osteoarthritis at L 5 was more pronounced in the IS group compared to L 4 ( Z=7.043, P<0.001), a trend inversely observed in the DS group ( Z=11.868, P<0.001), while the NL group showed no significant osteoarthritic variance between levels ( Z=0.556, P=0.578). Conclusion:Patients with lumbar spondylolysis demonstrate elevated sacral slope and lumbar lordosis, indicative of increased localized biomechanical stress in the lumbar spine. These alterations in the morphology of the pedicle-facet joints highlight the distinctive structural adaptations and potential strain distributions within this cohort.

Correlation between intervertebral disc degeneration and hyperuricemia / 中国组织工程研究

BACKGROUND:Hyperuricemia is a common metabolic disease,and the main clinical manifestation of patients with hyperuricemia is the formation of uric acid crystals leading to gout.Previous studies have only reported that uric acid crystals lead to intervertebral disc degeneration,but there are fewer studies on the correlation between hyperuricemia and intervertebral disc degeneration. OBJECTIVE:To retrospectively analyze the characteristics of intervertebral disc degeneration in patients with hyperuricemia and the correlation between serum uric acid level and intervertebral disc degeneration. METHODS:A retrospective analysis was performed in all patients diagnosed with intervertebral disc degeneration admitted at the Department of Orthopedics,the Affiliated Hospital of Southwest Medical University from January 2021 to December 2022.There were 97 hyperuricemia patients in the hyperuricemia group and 194 non-hyperuricemia patients in the control group according to sex and age in a ratio of 1:2.Blood uric acid test results were collected,and Pfirrmann scoring was performed for the degree of disc degeneration in patients based on the whole spinal MRI images.The difference in the degree of disc degeneration between the two groups was compared,and the correlation between the serum uric acid level and the degree of intervertebral disc degeneration was analyzed. RESULTS AND CONCLUSION:The Pfirrmann score in the hyperuricemia group was higher than that in the control group,and the total number of disc degeneration in the hyperuricemia group was also significantly higher than that in the control group(P<0.05).Spearman correlation analysis showed that the degree of disc degeneration in male patients was positively correlated with serum uric acid level at many spinal segments in the hyperuricemia group(C3/4:r=0.317,C4/5:r=0.333,C5/6:r=0.309,L2/3:r=0.443,P<0.05);the degree of disc degeneration in female patients was also positively correlated with serum uric acid level(C3/4:r=0.354,C4/5:r=0.388,C6/7:r=0.312,T7/8:r=0.282,T9/10:r=0.305,T11/12:r=0.277,L4/5:r=0.319,L5-S1:r=0.367,P<0.05).In the control group,there was no significant correlation between the degree of disc degeneration and serum uric acid level in male and female patients(P>0.05).To conclude,in patients with hyperuricemia,the higher serum uric acid level indicates the more serious intervertebral disc degeneration.Therefore,hyperuricemia is one of the risk factors for intervertebral disc degeneration.

Morphological characteristics of L 4, 5 facet joints in degenerative lumbar spondylolisthesis / 中华骨科杂志

Objective:To observe the morphological characteristics of L 4, 5 facet joints in patients with degenerative lumbar spondylolisthesis (DLS) of different spinopelvic types based on Roussouly classification. Methods:We retrospectively analyzed 142 patients with DLS who visited the department of orthopaedics in the Affiliated Hospital of Southwest Medical University from August 2018 to May 2022. There were 33 males aged 65.0±10.7 years and 109 females aged 61.8±9.6 years. The following morphological parameters of the L 4, 5 facet joint were measured on the CT images: facet joint angle (FJA), pedicle facet angle (PFA), facet joint tropism (FT) and facet joint osteoarthritis (OA) degree; the sacral slope (SS), lumbar lordosis (LL) and percentage of L 4 slip distance (SDP) were measured on preoperative standing neutral lumbar radiographs. According to the Roussouly classification, the patients were divided into four groups (type I, type II, type III, and type IV). The differences of morphological parameters of the facet joints and SDP were compared among the four groups, and the correlation between the FJA and PFA was analyzed. Results:There were 142 patients, including 28 type I, 50 type II, 43 type III, and 21 type IV according to the Roussouly classification. The SDPs of type I, type II, type III, and type IV were 19.1%±3.4%, 18.6%±3.9%, 21.7%±3.9%, 25.0%±2.4%, respectively. Except for types I and II, there were statistically significant differences in pairwise comparison among all other types ( P<0.05). The FJAs in type I and type II (31.4°±6.3°, 35.2°±6.8°) were larger than those in type III (28.4°±5.6°) and type IV (23.4°±4.5°), and the FJA in type III was larger than that in type IV. Conversely, the FJA in type I was smaller than that in type II. These differences were statistically significant ( P<0.05). The PFAs in type I and type II (113.9°±4.9°, 111.3°±5.6°) were smaller than those in type III (116.3°±4.4°) and type IV (121.8°±3.5°), and the PFA in type III was smaller than that in type IV, while, the PFA in type I was larger than that in type II. These differences were statistically significant ( P<0.05). The degree of OA in both type I and type II was lower than that in type III and type IV, with statistically significant differences ( P<0.05). However, there were no statistically significant differences in the degree of OA between type I and type II and between type III and type IV ( P> 0.05). Additionally, there were no statistically significant differences ( F=0.40, P=0.752) in the FT values among type I, type II, type III, and type IV (5.8°±2.3°, 5.6°±2.4°, 6.1°±1.8°, 5.9°±1.9°). Pearson correlation analysis showed that FJA was negatively correlated with PFA ( r=-0.68, P<0.001). Conclusion:In the slip segment of DLS, the facet joint morphology was part of the joint configuration in different spinopelvic types, not just the result of joint remodeling after DLS. Morphological characteristics of the facet joints and DLS interacted with each other.

Efficacy and possible mechanism study of low-intensity focused ultrasound therapy for neuropathic pain in mice / 中华超声影像学杂志

Objective:To study the efficacy of low-intensity focused ultrasound (LIFU) on neuropathic pain (NP) in mice, and its effect on the activation of astrocytes and the expression of pro-inflammatory cytokines were discussed.Methods:Thirty-six male C57BL/6J mice were randomly divided into three groups: sham operation (Sham) group and chroinc constriction injury (CCI) model group and treatment (CCI+ LIFU) group, 12 mice in each group.NP model was established by CCI on the sciatic nerve. The group of CCI+ LIFU received LIFU treatment for the anterior cingulate cortex (ACC) on the 7th day after surgery, the mechanical withdrawal threshold (MWT) on the affected side of mice was measured at preoperation 3, 6, 12, 18, 24, and 27 days after operation, respectively, H&E staining was used to observe pathological morphological changes in the ACC region, the expression levels of ACC region AQP4 and GFAP protein were detected by Western Blot and immunofluorescence, and the expression levels of ACC region pro-inflammatory cytokines IL-1β and TNF-α were detected by enzyme-linked immunosorption assay.Results:Compared with Sham group, MWT in the CCI group decreased from the 3rd day until the 27th day after surgery( P<0.05); Compared with the CCI group, the MWT in the CCI+ LIFU group increased on the 24th day after surgery, and was significantly higher than that of the CCI group on the 24th and 27th day after surgery ( P<0.05); LIFU stimulation did not produce significant pathological changes in the ACC region; Western Blot and immunofluorescence showed that AQP4 and GFAP protein expression in the ACC region were upregulated ( P<0.05) after peripheral nerve injury, while AQP4 and GFAP protein expression was downregulated after LIFU treatment ( P<0.05); Enzyme-linked immunosorbents showed that the expression of pro-inflammatory cytokines IL-1β and TNF-α in the region of ACC was upregulated ( P<0.05) after peripheral nerve injury, while the expression of IL-1β and TNF-α was downregulated after LIFU treatment ( P<0.05). Conclusions:LIFU can effectively relieve mechanical pain sensitivity symptoms in mice induced by CCI, possibly by inhibiting activation of astrocytes and neuro-inflammatory responses.

Application of ultrasonic osteotome in the posterior lumbar interbody fusion surgery by unilateral fenestration and bilateral decompression in the treatment of degenerative lumbar spinal stenosis / 中国修复重建外科杂志

Objective: To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis. Methods: The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups ( P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients' lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients' lumbar and back function improvement before operation and at 6 months after operation. Results: The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B ( P0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups ( Z=-0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference ( χ2=0.001, P=0.979 ). Conclusion: The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.