OBJECTIVE To observe the effects of sodium hyaluronate on nerve root adhesion after operation of lumbar disc protrusion (LDP). METHODS From April 1996 to June 2001, 152 cases with LDP were performed the removal of nucleus pulposus under endoscope. After operation, 2 ml of sodium hyaluronate were injected. The clinical results were evaluated by clinical symptom, straight leg raising test, patient’s satisfaction degree and back pain. RESULTS All the patients were followed for 1 month to 3 years. The average angle of straight leg raising test increased from 26 degree preoperatively to 62 degree postoperatively. The patient’s pain were markedly relieved. Patient’s satisfactory degree were 86.8%. CONCLUSION The injection of sodium hyaluronate after operation of LDP has effect on preventing postoperative nerve root adhesion.
Objective To retrospectively analyze the clinical and imaging features of multi-segmental lumbar intervertebral disc protrusion and its treatment with the limited recessive decompression operation. Methods Twenty two patients (14 males and 8 females, aged 49-68 years) were admitted to hospital from March 1999 to March 2004. They suffered from multisegmental lumbar intervertebral disc protrusion that involved L1S1 and were treated with the limited recessive decompression operation. Results The follow-up for 4-21 months showed that 16 of the patients had an excellent outcome, 5 had a good outcome, and 1 had fair outcome. There were nosuch operative complications as nerve root lesions and putamen lesions. Conclusion The limited recessive decompression operation is one of the available good treatments for multi-segmental lumbar intervertebral disc protrusion. It solves problems of herniation and stenosis and maintains stability ofthe spine.
Objective To evaluate the effect and safety of the conservative treatment for the protrusion of cervical vertebra intervertebral disc. Methods We searched CBM disk (1978~2007), CNKI (1979~2007), VIP (1989~2007). Telephone interviewed the original authors of claimed randomized controlled trials(RCTs) to identify whether they are truly RCTs. Only true RCTs and quasi-randomized controlled trials were included and the quality of them was critically assessed. Results Five RCTs and eleven quasi-randomized controlled trials were identified and included. It showed that lifting-massage, massage combining with traction or acupuncture, articulus mobilization combining with traction and electrotherapy, traction combining with computer intermediate frequency therapeusis and injectio ad acumen combining with massage have marked improvement. But it could hardly draw a conclusion that all the combining therapies had better curative effect. Conclusions Weak evidence shows that combining conservative treatment can improve the curative effect of the protrusion of cervical vertebra intervertebral disc. The results need to be supported by well designed and high quality trials.
Degenerative disc disease is a prevalent chronic disease that orthopaedic surgeons currently face as a difficulty. Tissue engineering represents the most promising possible therapeutic strategy for disc repair and regeneration. Surgery is the primary treatment for degenerative disc disease, but there are still inherent limits in practical practice. Electrospinning technique is a method for manufacturing nanoscale fibers with varied mechanical properties, porosity, and orientation, which can imitate the structural qualities and mechanical properties of natural intervertebral discs. Therefore, electrospinning materials can be utilized for disc regeneration and replacement. This article reviews recent advancements in disc tissue engineering and electrostatically spun nanomaterials typically utilized for the fabrication of disc scaffolds, as well as present and future techniques that may enhance the performance of electrostatically spun fibers.
Objective Platelet-rich plasma (PRP) can stimulate intervertebral disc cell proliferation, promote extracellular matrix synthesis, and inhibit annulus fibrosus cell apoptosis. To investigate the effects of autologous PRP on the treatment of the early intervertebral disc degeneration (IDD) so as to provide the experimental basis for its clinical application. Methods Forty-five healthy New Zealand white rabbits (male or female, weighing 2.5-3.0 kg) were randomly divided into the experimental group (n=15), the control group (n=15), and the sham group (n=15). PRP was prepared from the arterial blood of rabbit’s ears of the experimental group with Landesberg’s method. The platelet concentrations in both whole blood and PRP were detected. The rabbit model of early IDD was established by annulus fibrosus puncture (L4, 5, L5, 6) in both the experimental group and the control group; 100 ?L autologous PRP and 100 ?L PBS were injected into the degenerative intervertebral discs respectively after 2 weeks of models creation. In sham group, intervertebral discs were separated and exposed without treatment. The general conditions of the rabbits were observed after building models; at 2 weeks after degeneration, 1 and 2 weeks after intervention, 5 rabbits were selected randomly from each group respectively for MRI observation, histological observation by using HE staining and collagen type II immunohistochemical staining. The signal of lumbar MRI was assessed and the contents of collagen type II were detected. Results The platelet concentration of PRP was about 4.92 times as much as that of the whole blood. All the animals survived to the end of the experiment. At 2 weeks after degeneration, a lower T2 signal was observed in both the experimental group and the control group; the nucleus pulposus cells decreased and extracellular matrix degenerated; and the expression of collagen type II decreased in both the experimental group and control group. The degenerative grade of lumbar MRI in the experimental group and control group were significantly higher than that in the sham group (P lt; 0.05), and the content of collagen type II were significantly lower than that in the sham group (P lt; 0.05). At 1, 2 weeks after intervention, disc degeneration in the experimental group was significantly lower than that in control group (P lt; 0.05), and significant difference was found between experimental group and sham group (P lt; 0.05). The nucleus pulposus cells and chondroid matrix in the experimental group were more than those in the control group, showing slight stromal fibrosis; but the expression of collage type II was significantly higher than that in the control group (P lt; 0.05). Conclusion The disc injection of autologous PRP may terminate or even reverse the progress of rabbit early IDD, which may be associated with the role of multiple growth factors of PRP in regulating cell function, improving the tissue microenvironment, and promoting tissue regeneration.
Objective To develop a modified short time inversion recovery (STIR) sequence grading system for lumbar intervertebral disc degeneration based on MRI STIR sequences, and to test the validity and reproducibility of this grading system. Methods A modified 8-level grading system for lumbar intervertebral disc degeneration based on routine sagittal STIR sequences and modified Pfirrmann grading system was developed. Between April 2011 and February 2012, 60 patients with different degrees of lumbar intervertebral disc degeneration were selected as objects of study, including 32 males and 28 females with an average of 50 years (range, 17-85 years). T2 weighted and STIR sequence images were obtained from the lumbar discs of L1, 2-L5, S1 of each object (total, 300 discs). All examinations were analyzed independently by 3 observers and a consensus readout was performed after all data collected. The validity and reproducibility were analyzed by calculating consistent rate and Kappa value. Results According to the grading system, there were 0 grade 1, 83 (27.7%) grade 2, 87 (29.0%) grade 3, 66 (22.0%) grade 4, 31 (10.3%) grade 5, 15 (5.0%) grade 6, 12 (4.0%) grade 7, and 6 (2.0%) grade 8. Intra-observer consistency was b (Kappa value range, 0.822-0.952), and inter-observer consistency was high to b (Kappa value range, 0.749-0.843). According to the consensus analysis, the total consistent rate was 82.7%-92.7% (mean, 85.6%). A difference of one grade occurred in 13.9% and a difference of two or more grades in 0.5% of all the cases. Conclusion Disc degeneration can be graded by using modified STIR sequence grading system, which can improve the accuracy of grading different degrees of lumbar intervertebral disc degeneration.
Objective To explore the osteogenic potential of cervical intervertebral disc fibroblasts in vitro, to investigate the regulatory factors of recombinant human bone morphogenetic protein 2(rhBMP-2) and tumor necrosis factor α(TNF-α) on osteogenic phenotype of fibroblasts and to discuss the condition that facilitates osteogenesis of fibroblasts. Methods Theannulus fibroblasts cell lines of experiment goats were established in vitro and the biologicspecificity was found. According to different medias, 4 groups were included in this experiment: control group, TNF-α group ( 50 U/ml TNF-α), rhBMP-2 group (0.1 μg/ml rhBMP-2) and TNF-α+rhBMP-2 group (50 U/ml TNF-α+0.1 μg/ml rhBMP-2). Thefibroblasts were incubated in the media for about 3 weeks,and then the markers for osteogenic features were investigated by biochemistry, histochemistry observations. Results rhBMP-2 and TNF-α had no effect on the proliferation of fibroblasts from the experiment goats. rhBMP-2 or TNF-α could stimulate fibroblasts to secrete alkaline phosphatase and collagen type Ⅰ. The combined use of rhBMP-2 and TNF-α or the single use of rhBMP-2 could make fibroblasts to secrete osteocalin and the morphological changes of the fibroblasts were very obvious. Histochemical study of the nodules with specific new bone labeler(Alizarin red S) revealed positive reaction, denoting that the nodules produced by the fibroblasts werebone tissues. There was statistically significant difference(Plt;0.05) inALP activity between 3 experimental groups and control group and in secretion of osteocalcin between rhBMP-2 group, TNF-α+rhBMP-2 group and control group. Conclusion The results point out clearly that rhBMP-2 can induce theosteogenic potential of annulus fibroblasts in vitro.
ObjectiveTo review the research progress of the role and mechanism of adipokines in intervertebral disc degeneration (IVDD) in recent years.MethodsThe domestic and foreign literature related to adipokines in the process of IVDD was extensively reviewed. The types and functions of adipokines, the role and mechanism in the process of IVDD, and the application prospects of intervertebral disc biotherapy were reviewed.ResultsAs a kind of bioactive substance secreted by adipose tissue, adipokine plays an important role in bone and joint diseases, metabolic diseases, and breast cancer. During IVDD, most adipokines can activate multiple signaling pathways by binding to autoreceptors, cause the proliferation and apoptosis of cells and proinflammatory and anti-inflammatory factors parasecretions in the intervertebral disc, and lead to imbalance of intradiscal metabolism and establishment of the initial inflammatory environment, and finally cause the IVDD.ConclusionAdipokines, as a biologically active substance with metabolic and immunomodulatory functions, play important roles in the occurrence, development, and biological treatment of IVDD.
Objective To observe the effect of titanium mesh cage with self-locked titanium plate on the cervicalinter-body fusion after anterior discectomy of multilevel cervical intervertebral disc protrusion. Methods The therapeuticeffect of 18 patients who received the treatment of titanium mesh cage with self-locked titanium plate from September 2004 to June 2007 were retrospectively analyzed, including 11 males and 7 females (aged 32-75 years, 54 years on average). The course of disease was 6 months to 15 years (5.8 years on average). Sixteen patients suffered sensory dysfunction in l imbs. Concerning the muscle strength of extremities, 3 cases were on the second level, 12 were on the third level, 1 was on the fourth level, and 2 were on the fifth level. Sixteen cases had pyramidal sign, 13 had retention of urine and feces, 8 had sexual dysfunction, and 7 combined with symptoms of nerve root type. Twelve cases were consecutive multilevel and 6 cases were discontinuous multilevel. The mean JOA scores were 8.30 ± 1.21 preoperatively. X-ray films and MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord preoperatively. The height of involved intervertebral space was (6.40 ± 0.87) mm on X-ray films preoperatively. Results All the incisions were healed by first intention. All the patients were followed up for 6-36 months (18 months on average). The recovery of extremities motor function was better than that of sensory function at the early stage after operation. Muscular tension decreased after operation and mobil ity of l imbs was improved. The operated segments were instantly stable and sol id fusion was observed at 3-6 months after operation. JOA scores at 6 months after operation was 12.60 ± 0.78 with an improvement rate of 51.8%, indicating significant difference wasevident when compared with the JOA scores before operation (P lt; 0.05). The height of involved intervertebral space increased significantly to (8.20 ± 0.46) mm postoperatively, indicating the difference was significant (P lt; 0.05). According to Odom’s evaluation scale, 17 patients were graded as excellent and 1 as good. No death and compl ications of spinal cord, nerve, trachea and esophagus were observed. The cage witnessed no translocation. Conclusion Titanium mesh cage with self-locked titanium plate is more stable and effective for the treatment of multilevel cervical intervertebral disc protrusion.
Low back pain caused by intervertebral disc degeneration is a common clinical chronic disease. The regenerative ability of intervertebral disc tissue is extremely poor. Meanwhile, current treating methods can not fundamentally solve such problems. With the increasing awareness of the mechanism of disc degeneration and the rapid development of the fields of cellular and molecular biology, gene and materials engineering, using stem cells and tissue engineering technology to slow down or reverse the progress of disc degeneration may become possible. The author reviewed the application of stem cells for treating degenerative discs from present researching status and concepts for the future in the combination of researches reported both at home and abroad.