Objective To study the adenovirus-mediated human bone morphogenetic protein-2 gene （Ad-hBMP-2）transferred to the intervertebral disc cells of the New Zealand rabbit in vitro. Methods The cells of New Zealand white rabbitswere isolated from their lumbar discs. The cells were grown in the monolayer and treated with an adenovirus encoding the LacZ gene (Ad-LacZ) and Ad-hBMP-2 (50,100, 150 MOI,multiplicity of infection) in the Dulbecco’s Modified Eagle Medium and the Ham’s F-12 Medium in vitro. Three days after the Ad-hBMP-2 treatment,the expression of hBMP-2 in the cells that had been infected by different dosesof MOI was determined by immunofluorescence and the Western blot analysis, and the expression was determined in the cells with the Ad-LacZ treatment in a dose of 150 MOI. Six days after the Ad-hBMP-2 treatment, mRNA was extracted for the reverse transcription polymerase chain reaction (RT-PCR) and the difference was detected between the control group and the culture group that was treated withAd-hBMP-2 in doses of 50, 100 and 150 MOI so that the expressions of aggrecan and collagen ⅡmRNA could be observed. Results The expression of hBMP-2 in the cells was gradually increased after the transfection in an increasing dose, which was observed by immunofluorescence and the Western blot analysis. At 6 days the aggrecan and collagen type Ⅱ mRNA expressions were up-regulated by Ad-hBMP-2 after the transfection at an increasing viral concentration in the dosedependent manner. Conclusion The results show that Ad-hBMP-2 can transfect the rabbit intervertebral disc cells in vitro with a high efficiency rate and the expression of hBMP-2 after theinfection is dose-dependent in the manner. AdhBMP-2 after transfection can up-regulate the expression of aggrecan and collagen Ⅱ mRNA at an increasing viral concentration.
Objective To evaluate the effect of remote controlled injection manipulator system (RCIM) assisted percutaneous kyphoplasty (PKP) for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture by comparing with intermittent hand bolus injection of bone cement during operation. Methods Between September 2010 and January 2016, a retrospective analysis was made on the clinical data of 48 senile patients with single segment rupture of the posterior vertebral osteoporotic thoracolumbar fracture undergoing PKP who accorded with the inclusion criteria. Of 48 patients, 22 received intermittent hand bolus injection of bone cement in the control group, and 26 received RCIM assisted bone cement perfusion in the trial group. There was no significant difference in age, gender, duration of disease, causes of injury, implicated vertebral bodies, bone mineral density T value, pain duration, preoperative visual analogue scale (VAS), relative vertebral body height in the anterior part, and posterior convex Cobb angle between groups (P>0.05). The bone cement perfusion time, the radiation dose of both doctors and patients, and the amount of bone cement injection were recorded; treatment effects were evaluated based on VAS score, posterior convex Cobb angle, relative ver-tebral body height in the anterior part, ratios of bone cement diffusion area and bone cement leakage rate. Results The patients were followed up for 6 months; no complications of toxic effect of bone cement, spinal cord or nerve root injuries, infection and vascular embolization occurred during follow-up period. There was no significant difference in bone cement injection amount and radiation dose of doctors between groups (P>0.05), but bone cement perfusion time, ratios of bone cement diffusion area, and radiation dose of patients were significantly lower in the trial group than the control group (P<0.05). Bone cement leakage was observed in 6 cases of the control group (27.27%) and 2 cases of the trial group (7.69%), showing significant difference between groups (χ2=4.850,P=0.029); no cement leakage into the spinal canal was found in both groups. VAS score, relative vertebral body height in the anterior part, and posterior convex Cobb angle were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05), but no significant difference was observed in the above indexes between groups at 3 days and 6 months after operation (P>0.05). Conclusion Satisfactory effectiveness can be achieved by applying RCIM assisted PKP for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture. RCIM can shorten perfusion time, reduce radiation dose, and decrease incidence of bone cement leakage.
ObjectiveTo explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis.MethodsThe clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from −3.4 to −2.1, with an average of −2.3. Lesion segments: T11 in 2 cases, T12 in 6 cases, L1 in 8 cases, L2 in 1 case, T11, 12 in 1 case, T12, L1 in 2 cases, and T12, L2 in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up.ResultsNo complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up (P<0.05). There was no significant difference between at 1 week after operation and at last follow-up (P>0.05). There was no significant difference in LL before and after operation (F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points (P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation.ConclusionTransintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients’ quality of life.
Objective To assess the clinical application value of tranforaminal unilateral approach for bilateral decompression by comparing the short-term effectiveness of bilateral decompression via unilateral approach of intervertebral foramen with via small surgical incision of bilateral spinous process in lumbar interbody fusion for the treatment of lumbar spinal stenosis. Methods Between July 2014 and June 2015, 48 patients with lumbar spinal stenosis underwent decompression and internal fixation by unilateral approach in 24 cases (trial group) and by bilateral small incision approach in 24 cases (control group). There was no significant difference in gender, age, disease duration, disease type, involved segment, combined medical diseases, preoperative level of creatine phosphokinase (CPK), the visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, and the incidence of complications were recorded. The CPK levels were evaluated at 1, 3, and 7 days after operation. VAS score and ODI were used to evaluate the effectiveness, and lumbar X-ray film or CT scanning to determine the intervertebral bony fusion. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization time between 2 groups (P>0.05), but significant difference was found in postoperative drainage (t=5.547,P=0.000). At 1 day after operation, the level of CPK in the trial group was significantly lower than that in the control group (t=3.129,P=0.005), but there was no significant difference at 3 and 7 days after operation between 2 groups (P>0.05). The patients were followed up 12-24 months (mean, 17 months). All the wounds healed primarily. Heart failure occurred in 1 case of the trial group, and cerebrospinal fluid leakage and pulmonary infection, and nerve root injury occurred in 1 case of the control group respectively. There was no significant difference in the incidence of complications between 2 groups (χ2=0.273,P=0.602). The interbody fusion rate was 95.8% (23/24) in the trial group and was 91.7% (22/24) in the control group, showing no significant difference (χ2=0.356,P=0.551). No cage sink, dislocation or plate and screw loosening and breakage was found in 2 groups. No adjacent segment degeneration occurred during the follow-up, and there was no change of scoliosis and lumbar sagittal curvature. At 3, 6, and 12 months after operation, the VAS score and ODI were significantly improved when compared with the preoperative scores in 2 groups (P<0.05), and the VAS score and ODI of the trial group were significantly better than those of control group (P<0.05). Conclusion The bilateral decompression via unilateral approach of intervertebral foramen and small surgical incision of bilateral spinous process in lumbar interbody fusion have satisfactory efficacy for the treatment of lumbar spinal stenosis, but the tranforaminal unilateral approach has the advantages of less trauma, avoidance of bilateral muscle stripping and soft paraspinal muscle injury, retention of posterior spinal structure, faster postoperative recovery, shorter hospital stay and good short-term effectiveness.
Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
With the development of three-dimensional (3D) printing technology, more and more researches have focused on its application in the region of intervertebral fusion materials; the prospects are worth looking forward to. This article reviews the researches about 3D printing technology in spinal implants, and summarizes the materials and printing technology applied in the field of spinal interbody fusion, and the shortcomings in the current research and application. With the rapid development of 3D printing technology and new materials, more and more 3D printing spinal interbodies will be developed and used clinically.
Objective To investigate the effectiveness and long-term stability of small fenestration vertebral bone grafting and transpedicular bone grafting in the treatment of Denis types A and B thoracolumbar burst fractures. Methods Between January 2012 and February 2014, 50 patients with Denis type A or B thoracolumbar burst fractures were treated with vertebroplasty and pedicle screw rod fixation system, and the clinical data were retrospectively analyzed. Small fenestration vertebral bone grafting by trans-interlaminar approach was used in 30 cases (group A), and bone grafting by unilateral transpedicular approach was used in 20 cases (group B). X-ray and CT examinations of the thoracolumbar vertebrae were performed routinely before and after operation. There was no significant difference in sex, age, cause of injury, time from injury to operation, fracture type, injury segment, and preoperative Frankel classification, the percentage of the anterior body height of the injured vertebra, and visual analogue scale (VAS) score between two groups (P>0.05). There was significant difference in preoperative Cobb angle of kyphosis between two groups (P<0.05). The Cobb angle of kyphosis, the percentage of the anterior body height of the injured vertebra, and the recovery of neurological function were recorded and compared between two groups. Results The patients were followed up for 16-31 months (mean, 19.1 months) in group A and for 17-25 months (mean, 20.2 months) in group B. Primary healing of incisions was obtained in the two groups; no nerve injury and other operative complications occurred. The neurological function was improved in varying degrees in the other patients with neurological impairment before operation except patients at grade A of Frankel classification. The lumbar back pain was relieved in two groups. There was significant difference in VAS score between before operation and at 3 months after operation or last follow-up in two groups (P<0.05), but no significant difference was found between at 3 months and last follow-up in two groups and between two groups at each time point after operation (P>0.05). X-ray examination showed that there was no breakage of nail and bar, or dislocation and loosening of internal fixation during follow-up period. The bone grafts filled well and fused in the fractured vertebra. The vertebral height recovered well after operation. The percentage of the anterior body height of the in-jured vertebra and Cobb angle of kyphosis at 1 week, 3 months, and last follow-up were significantly better than preope-rative ones in two groups (P<0.05), but there was no significant difference between different time points after operation (P>0.05), and between two groups at each time point after operation (P>0.05). Conclusion For Denis types A and B thoracolumbar burst fractures, vertebral bone grafting and pedicle screw internal fixation through interlaminal small fene-stration or transpedicular approach can restore the vertebral height, correct kyphosis, and maintain the vertebral stability, which reduce the risk of complications of loosening and breakage of internal fixators. The appropriate bone grafting approach can be chosen based on the degree of spinal canal space occupying, collapse of vertebral and spinal cord injury.
Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.
ObjectiveTo investigate the safety and effectiveness of debridement and interbody fusion via posterior pedicle lateral approach in treatment of ankylosing spondylitis with thoracolumbar Andersson lesion (AL).MethodsBetween October 2011 and January 2017, 10 patients of ankylosing spondylitis with thoracolumbar AL were treated with debridement via posterior pedicle lateral approach and interbody fusion with bone grafting. There were 8 males and 2 females with an average age of 48.8 years (range, 31-79 years). The disease duration was 1.5-48.0 months (mean, 10.6 months). All patients were single-segment lesion, including 3 cases of T10, 11, 4 cases of T11, 12, and 3 cases of T12, L1. The preoperative visual analogue scale (VAS) score was 8.0±0.8, the Oswestry disability index (ODI) was 68.8%±5.5%, and the Cobb angle of local kyphosis was (26.3±7.1)°. According to American Spinal Injury Association (ASIA) scoring system, neurological impairment was assessed in 1 case of grade C, 4 cases of grade D, and 5 cases of grade E.ResultsAll the operations of 10 patients completed successfully. The operation time was 120-185 minutes (mean, 151.5 minutes), and the intraoperative blood loss was 300-750 mL (mean, 450.0 mL). Dural sac tear occurred in 1 case during operation and was repaired, with no cerebrospinal fluid leakage after operation. All patients were followed up 24-50 months (mean, 31.2 months). At last follow-up, the VAS score was 1.9±0.9 and ODI was 13.0%±3.0%, showing significant differences when compared with preoperative ones (t=17.530, P=0.000; t=31.890, P=0.000). Neurological function was improved significantly at 24 months after operation, and rated as ASIA grade E. The Cobb angles were (12.6±4.6)° at 3 days and (13.6±4.6)° at 24 months after operation, which were significantly different from those before operation (P<0.05); there was no significant difference between 3 days and 24 months after operation (P>0.05). At 24 months after operation, the grafted bone obtained good fusion at AL segment. During the follow-up, there was no failure of internal fixation such as nail withdrawal, broken nail, and broken rod.ConclusionDebridement and interbody fusion via posterior pedicle lateral approach for the ankylosing spondylitis with thoracolumbar AL can achieve satisfactory effectiveness, good fusion, and a certain correction of local kyphosis.
Objective To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. Methods A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups (n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups (P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. Results The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group (P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased (P<0.05). And there was no significant difference in VAS score between the two groups at each time point (P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups (P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation (P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation (P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation (P>0.05). Conclusion Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.