The Efficacy of Scouting Technology in Pedicle Screw Placement in the Patients With Degenerative Scoliosis.

Objective: To investigate the curative effect of ball tip technology in pedicle screw placement in the patients with degenerative scoliosis (DS), as compared to traditional freehand technique. Methods: A total of 90 patients with degenerative scoliosis who were admitted to Affiliated Hospital of Hebei Engineering University from October 2019 to October 2021 were selected as the objects in this prospective study. They were randomly divided into an experimental group and a control group with 45 cases in each. The clinical indications, the accuracy of pedicle screw placement, the occurrence of surgical complications, the measurement of spinal and pelvic parameters, the recovery of spinal function and pain degree were recorded and compared within the two groups. Results: After treatment, the operation time, intraoperative blood loss, total number of screws, and time of screwing were compared between the two groups, and the difference was not significant (P > .05). However, the bedding time and the hospital stay were shorter in the experimental group than the control group with difference (P < .05). There was no significant difference in clinical standards and poor implantation in the Gertzbein-Robbins A-E classification between the two groups (P > .05). While the number of perfect placement of screws in the experimental group was higher (P < .05). Before treatment, the Cobbs angle and pelvic incidence-lumbar lordosis (PI-LL) levels of the two groups were comparable (P > .05); after treatment, the Cobbs angle and PI-LL levels of the two groups were lower than those before treatment, and the difference was significant (P < .05). There was no significant difference in Cobbs angle and PI-LL levels between groups (P > .05). Before treatment, the JOA and DOI scores of the two groups were comparable (P > .05); after treatment, the JOA and DOI scores of the two groups were improved (P < .05); the improvement of JOA and DOI scores of the experimental group were better than those in the control group (P < .05). Before treatment, there was no significant difference in the pain degree between the two groups (P > .05); after treatment, the pain of the two groups was improved compared with that before treatment, and the pain degree of the experimental group was lower than that of the control group (P < .05). The incidence of postoperative complications in the experimental group was lower than that in the control group, but there was no significant difference in the total incidence of postoperative complications between the two groups (P > .05). Conclusion: The scouting technique-assisted screw placement can effectively improve the spinal function of patients with degenerative scoliosis, with obvious curative effect and high safety.

Percutaneous Endoscopic Surgery for Lumbar Discal Cyst: Two Case Reports.

Discal cyst is a rare disease, the pathogenesis is not yet clear and its symptoms are very similar to lumbar disc herniation. Although some cases may regress spontaneously, most cases of lumbar discal cysts are treated surgically. At present, there is no consensus on the treatment of this disease. The authors report the clinical usefulness of the percutaneous endoscopic transforaminal surgery technique in two patients with the lumbar 4-5 discal cyst. The clinical symptoms of both patients were unilateral lower extremity pain and lower back pain. Magnetic resonance imaging of the lumbar spine revealed lumbar discal cysts, causing compression to the spinal dura and roots. Both patients received conservative treatment for more than 6 months, but the clinical symptoms persisted so surgical treatment by percutaneous endoscopic transforaminal surgery without additional discectomy was performed under local anesthesia. The symptoms were relieved immediately after removal of the discal cysts. Postoperative magnetic resonance imaging showed that both patients had complete excision of discal cysts and complete decompression of the treated segmental. There were no recurrent lesions and complications during the follow-up period. We believe that percutaneous transforaminal endoscopic surgery could be a safe, mini-invasive and appropriate method for the treatment of discal cysts.

Pterostilbene inhibits reactive oxygen species production and apoptosis in primary spinal cord neurons by activating autophagy via the mechanistic target of rapamycin signaling pathway.

Autophagy is an important self-adaptive mechanism that is involved in inhibiting reactive oxygen species (ROS) in spinal cord neurons. Pterostilbene, a natural plant extract, has been demonstrated to possess antioxidant effects; however, it has not yet been investigated whether pterostilbene could activate autophagy and protect spinal cord neurons from oxidative stress. In the present study, primary spinal cord neurons of Sprague Dawley rats were cultured. Cell counting kit­8 analysis was used to detect cytotoxicity of pterostilbene. Cells were treated with various doses of pterostilbene for 24 and 48 h, respectively, and H2O2 was used to induce ROS production. Western blot analysis was performed to assess the protein expression of microtubule­associated protein 1 light chain 3 (LC3)­II, Beclin­1, p62, p­p70S6K and p­mechanistic target of rapamycin (mTOR). Furthermore, the green fluorescent protein (GFP)­LC3 assay was used to detect the level of autophagy level and activation mechanism. 2',7'­Dichlorofluorescin diacetate and MitoSOX Red staining were used to detect ROS production, and Terminal deoxynucleotidyl­transferase­mediated dUTP nick end labelling assay was used to analyze apoptosis percentage. ATG5 small interfering (si)RNA transfection was used to analyze the involvement of autophagy. A dose­dependent increase in the expression of LC3­II and Beclin­1, as well as the p62 decline, were observed in the pterostilbene­treated neurons; however, p­p70S6K and p­mTOR expression was inhibited by pterostilbene. Pterostilbene increased the expression of LC3­II in H2O2­treated cells, and GFP­LC3 analysis demonstrated an increased number of autophagosomes. Furthermore, pterostilbene significantly inhibited the ROS production and apoptosis induced by H2O2; however, ATG5 siRNA transfection significantly reversed the protection of pterostilbene. These results indicate that pterostilbene may inhibit the ROS production and apoptosis in spinal cord neurons by activating autophagy via the mTOR signaling pathway.

Parathyroid hormone 1­34 inhibits senescence in rat nucleus pulposus cells by activating autophagy via the m­TOR pathway.

Osteoporosis is closely associated with intervertebral disc degeneration. While parathyroid hormone (PTH) 1­34, which is an established drug used to treatosteoporosis, is thought to inhibit the disc degeneration associated with osteoporosis, the precise mechanism involved remains unclear. In the present study, primary Sprague­Dawley rat nucleus pulposus cells (NPCs) were cultured, phenotyped and then treated with dexamethasone (DXM) for 48 h. Cell area analysis and ß­galactosidase staining were used to investigate the effect of DXM on the senescence of NPCs. In addition, the protein levels of LC3­II, Beclin­1, P62, p­mTOR and p­p70S6k were determined by western blotting and analyzing the regulatory effect of PTH upon autophagy and the mTOR signaling pathway in cells treated with DXM. Following autophagic inhibition induced by ATG5 siRNA transfection, the regulatory effect of PTH on senescence in NPCs were investigated in addition to the potential role of autophagy. As the concentration of DXM increased, the size of the NPCs was significantly enlarged and the proportion of cells with positive ß­galactosidase staining increased significantly (P<0.05). In terms of protein expression, PTH treatment led to an increase in LC3­II and Beclin­1 proteins, a reduction in P62 protein, and inhibited p­mTOR and p­p70S6k protein expression in DXM­treated NPCs (P<0.05). PTH attenuated the effect of DXM according to the cell size and percentage of ß­galactosidase­positive cells. However, the inhibition of autophagy via ATG5 siRNA transfection reversed the protective effect of PTH on cell senescence (P<0.05). Collectively, the present findings suggest that PTH may inhibit the senescence of NPCs induced by DXM by activating autophagy via the mTOR pathway.