Intervertebral Disc Lesions Research Articles

Study on the role and molecular mechanism of METTL3-mediated miR-29a-3p in the inflammatory response of spinal tuberculosis

BackgroundSpinal Tuberculosis (STB) is a common cause of spinal malformation caused by extrapulmonary tuberculosis in developing countries, which seriously affects the quality of life of patients. It was found that the expression of miRNAs in macrophages was stable, specific and readily available after Mycobacterium tuberculosis (MTB) infection. Our research group determined the differential expression of miR-29a-3p in the vertebra of spinal tuberculosis and intervertebral disc lesions through RNAs chip screening and bioinformatics analysis. However, the specific molecular mechanism of miR-29a-3p in the inflammatory response of spinal tuberculosis remains unclear. ObjectiveIn this study, we mainly discussed the expression of miR-29a-3p in the focal tissue of spinal tuberculosis and the role and molecular mechanism of miR-29a-3p mediated by METTL3 in the inflammatory response of spinal tuberculosis. MethodsThe tissues of 15 cases of lumbar degenerative diseases and vertebral lesions of spinal tuberculosis were collected, and the THP-1 macrophage model infected by Mycobacterium tuberculosis was constructed, and verified by qRT-PCR, Western blot, fluorescence in situ hybridization, immunohistochemistry, Cell fluorescence and ELISA. Results and conclusionWe found that the expression of miR-29a-3p was significantly down-regulated in the vertebral body and disc lesion tissues of patients with spinal tuberculosis. Overexpression of miR-29a-3p inhibited the levels of inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6), and inhibition of miR-29a-3p expression promoted the release of the levels of TNF-α, IL-1β and IL-6 inflammatory factors. Our study also shows that knockout of methyltransferase 3 (METTL3) can significantly reduce the expression of miR-29a-3p and promote the release of pro-inflammatory cytokines in macrophages.

Stab lesion of the L4/L5 intervertebral disc in the rat causes acute changes in disc bending mechanics

Low-back pain often coincides with altered neuromuscular control, possibly due to changes in spine stability resulting from injury or degeneration, or due to effects of nociception. The relative importance of these mechanisms, and their possible interaction, are unknown. In spine bending, the bulk of the load is borne by the IVD, yet the acute effects of intervertebral disc (IVD) injury on bending mechanics have not been investigated. In the present study, we aimed to quantify the acute effects of a stab lesion of the disc on its mechanical properties, because such changes can be expected to elicit compensatory changes in neuromuscular control. L4/L5 spinal segments were collected from 27 Wistar rats within two hours after sacrifice and stored at −20℃. Following thawing, bending tests were performed to assess the intersegmental angle-moment characteristics. Specimens were loaded in right bending, left bending and flexion, before and after a stab lesion of the IVD fully penetrating the nucleus pulposus. In the angle-moment curves, we found reduced moments at equal bending angles after IVD lesion in left bending, right bending and flexion. Peak stiffness, peak moment, and hysteresis were significantly decreased (by 7.8–27.7 %) after IVD lesion in all directions. In conclusion, L4/L5 IVD lesion in the rat caused small to moderate acute changes in IVD mechanical properties. Our next steps will be to evaluate the longer term effects of IVD lesion on spine mechanics and the neural control of trunk muscles.

Correction loss following short-segment posterior fixation for traumatic thoracolumbar burst fractures related to endplate and intervertebral disc destruction

BackgroundThere has been widespread use of short-segment posterior fixation (SSPF) for traumatic thoracolumbar burst fractures. The relationship between the destruction of the vertebral endplate and adjacent disc and postoperative correction loss has been studied in only a few studies. This study investigated the risk factors for correction loss following SSPF.MethodsForty-eight patients (mean age 35.0 years) who underwent SSPF for thoracolumbar burst fractures were enrolled. The mean follow-up period was 25.7 months (12–98 months). The neurological status and postoperative back pain were assessed by the medical records. Segmental kyphotic angle (SKA) and anterior vertebral body height ratio (AVBHR) were measured radiographically to assess indirect vertebral body reduction and local kyphosis. Preoperative Sander’s traumatic intervertebral disc lesion (TIDL) classification and AO classification were used to evaluate the severity of disc and vertebral endplate injury. The corrective loss was considered present if ΔSKA was ≥10°. A multivariate logistic regression analysis was performed to identify the risk factors associated with postoperative loss of correction.ResultsThe fracture distribution was as follows: 10 at T12, 17 at L1, 10 at L2, 9 at L3, and 2 at L4. Vertebral fractures were classified in the following way: A3 in 13 patients, A4 in 11, B1 in 11, and B2 in 13. In 47 patients (98%), a union of the fractured vertebrae was achieved. SKA and AVBHR improved significantly after surgery from 11.6° to 3.5° and from 67.2 to 90.0%, respectively. However, the correction loss at follow-up was 10.4° and 9.7%, respectively. Twenty patients (42%) had severe TIDL (grade 3). Postoperative ΔSKA and ΔAVBHR were significantly higher in patients with TIDL grade 3 than with TIDL grade 0–2. The presence of cranial TIDL grade 3 and older age were significant risk factors for ΔSKA ≥10° on multivariate logistic regression analysis. All patients could walk at follow-up. TIDL grade 3 and ΔSKA ≥10° were associated with severe postoperative back pain.ConclusionsRisk factors for loss of correction after SSPF for thoracolumbar burst fractures were severe disc and endplate destruction at the time of injury and older age.

Vojta Therapy and Conservative Physical Therapy versus Physical Therapy Only for Lumbar Disc Protrusion: A Comparative Cohort Study from Romania

Background: Lumbar disc herniation (LDH) is a common condition caused by degenerative lesions of the lumbar intervertebral discs, due to aging or lifting weights. For patients with LDH, a comparative study was conducted to understand the benefits of Vojta therapy and conservative physical therapy versus physical therapy only. The aim of this paperwork was to help physicians select interventions which are most appropriate for this disease. Methods: Seventy-seven patients with LDH from two cohorts were included in analysis (Group A and Group B). Group A benefited from 30 min of Vojta therapy procedures, in addition to the usual physical therapy treatment, and group B received a conservatory physical therapy program. The subjects were assessed with the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), mobility tests, muscle strength tests and the Nottingham Health Profile (NHP) questionnaire. Results: Pain intensity and disability decreased in both groups (p = 0.000 in experimental group and 0.047 in control group for VAS score and p = 0.000 for ODI score in both groups). Moreover, mobility, strength and health-related quality of life scores increased significantly both in groups A and B (p = 0.000 in both). Conclusions: After two weeks of interventions, we saw greater differences in pain intensity, disability level, mobility, strength, and health-related quality of life scores in both study groups, but not across the groups. This was not the case between the groups.

Research progress of finite element analysis in lumbar fusion surgery for lumbar degenerative diseases

Lumbar degenerative disease (LDD) refers to the normal strain of the body involving lumbar bone, ligament, intervertebral disc, thereby protruding lumbar intervertebral disc, slippage, spinal stenosis and other lesions. Lumbar fusion surgery has been proved to be an effective strategy for the treatment of LDD. At present, a variety of fusion methods such as anterior and posterior have been reported. This article aims to review and discuss the reported strategies of fusion surgery for LDD and related biomechanical studies and analyze the development and significance of the finite element method (FEM) in lumbar biomechanics. To investigate the influence of different surgical strategies on lumbar spine biomechanics from the perspective of biomechanics and to provide a reference for selecting clinical surgical strategies.

Circ_0072464 Shuttled by Bone Mesenchymal Stem Cell-Secreted Extracellular Vesicles Inhibits Nucleus Pulposus Cell Ferroptosis to Relieve Intervertebral Disc Degeneration

Ferroptosis, as an iron-dependent form of necrotic cell death, has been reported to affect activities of nucleus pulposus cells (NPCs). However, its role in the pathogenesis of intervertebral disc degeneration (IDD) is largely unknown. Notably, our bioinformatics analysis predicted that circ_0072464 was downregulated in nucleus pulposus of IDD mice. Therefore, this study is aimed at clarifying the mechanisms of extracellular vesicle- (EV-) encapsulated circ_0072464 derived from bone marrow mesenchymal stem cells (BMSCs) in NPC ferroptosis in IDD. EVs were extracted from mouse BMSCs (BMSC-EVs) and then cocultured with IL-1β-induced NPCs, followed by detection of matrix synthesis, proliferation, and ferroptosis of NPCs based on gain- or loss-of-function experiments. It was found that the uptake of BMSC-EVs by NPCs alleviated IDD. circ_0072464 and NRF2 were downregulated, and miR-431 was upregulated in IDD. Mechanistically, circ_0072464 competitively bound to miR-431, which targeted and inhibited NRF2 expression. BMSC-derived EVs carrying circ_0072464 inhibited NPC ferroptosis to promote matrix synthesis and proliferation of NPCs by inhibiting miR-431 and upregulating NRF2. Besides, in vivo experiments also confirmed that BMSC-EVs alleviated intervertebral disc lesions in mice with IDD through the circ_0072464/miR-431/NRF2 axis. Collectively, BMSC-EV-loaded circ_0072464 inhibited NPC ferroptosis to relieve IDD via upregulation of miR-431-mediated NRF2, therefore providing a potential therapeutic target against IDD.

Injectable hydrogel with nucleus pulposus-matched viscoelastic property prevents intervertebral disc degeneration.

Background/ObjectiveIntervertebral disc (IVD) degeneration (IVDD) that greatly affected by regional biomechanical environment is a major cause of low back pain. Injectable hydrogels have been commonly studied for treatment of IVDD due to their capability of mimicking extracellular matrix structure to support cellular behavior and clinical prospects in minimally invasive treatment. However, most hydrogels suffer from complicated chemistry, potential uncertainty and toxicity from in-situ gelation, and mismatch with IVD mechanical environment that limit their therapeutic effects or clinical translation in IVDD or intervertebral disc defect repair. For IVD lesion repair, the study aims to develop a novel hydrogel with shear-thinning enabled injectability, high bio-safety, and mechanical properties adaptable to the IVD environment, using a simple chemistry and method. And therapeutic efficacy of the novel hydrogel in the treatment of IVDD or intervertebral disc defect will be revealed.MethodsA glycerol cross-linked PVA gel (GPG) was synthesized based on multiple H-bonds formation between glycerol molecules and PVA chains. The rheological and mechanical properties were tested. The swelling ratio was measured. The micro-architecture was observed through scanning and transmission electron microscopes. Nucleus pulposus (NP) cells were cultured in GPG-coated plates or silicone chambers treated under hydrostatic or dynamic loading in vitro, and examined for proliferation, vitality, apoptosis, expression of catabolic and anabolic markers. GPG was injected in needle puncture (IDD) or NP discectomy (NPD) models in vivo, and examined through magnetic resonance imaging, micro-computed tomography scanning and histological staining.ResultsGPG had a highly porous structure consisting of interconnected pores. Meanwhile, the GPG had NP-like viscoelastic property, and was able to withstand the cyclic deformation while exhibiting a prominent energy-dissipating capability. In vitro cell tests demonstrated that, the hydrogel significantly down-regulated the expression of catabolic markers, maintained the level of anabolic markers, preserved cell proliferation and vitality, reduced apoptotic rate of NP cells under pathologically hydrostatic and dynamic loading environments compared to cells cultured on untreated plate or silicone chamber. In vivo animal studies revealed that injection of GPG efficiently maintained NP structural integrity, IVD height and relative water content in IDD models, and stimulated the fibrous repair in NPD models.ConclusionThis study showed that GPG, with high injectability, NP-like viscoelastic characteristics, good energy-dissipating properties and swelling capacities, preserved NP cells vitality against pathological loading, and had therapeutic effects on IVD repair in IDD and NPD models.The translational potential of this articleEffective clinical strategy for treatment of intervertebral disc degeneration (IVDD) is still lacking. This study demonstrates that injection of a hydrogel with nucleus pulposus-matched viscoelastic property could remarkably prevent the IVDD progress. Prepared with simple chemistry and procedure, the cell/drug-free GPG with high bio-safety and shear-thinning enabled injectability bears great translational potential for the clinical treatment of IVDD via a minimally invasive approach.

Wiltse Approach Versus Conventional Transforaminal Interbody Fusion for Unstable Thoracolumbar Fracture with Intervertebral Disc Lesions.

ObjectiveTo compare the clinical results of two surgical techniques, Wiltse approach and conventional transforaminal interbody fusion, for the treatment of unstable thoracolumbar fracture associated with traumatic intervertebral disc lesion (TIDL).MethodsA total of 76 patients with unstable thoracolumbar fracture associated with TIDL treated by posterior pedicle screw fixation and transforaminal thoracolumbar interbody fusion from June 2010 and July 2016 were reviewed retrospectively. These patients including 48 male and 28 female patients were divided into Wiltse approach transforaminal thoracolumbar interbody fusion (W‐TLIF) group (n = 38) and conventional transforaminal thoracolumbar interbody fusion (C‐TLIF) group (n = 38). Patients were followed up for about 33 months. Clinical and radiological records, kyphotic angle, fractured vertebral body height, visual analogue score (VAS), Oswestry Disability Index (ODI), complications, neurological improvement and fusion rate were compared between two groups.ResultsAll patients underwent posterior surgery successfully. Blood loss, operation time and hospital stay in the W‐TLIF group was 437.84 ± 143.98 ml, 118.64 ± 20.55 min and 12.32 ± 2.87 days, respectively. While those parameters in the C‐TLIF group was 862.70 ± 300.24 ml, 141.35 ± 31.72 min and 15.51 ± 2.08 days, respectively. Average operation time and hospital stay time were significantly shorter, and blood loss was significantly less in the W‐TLIF group than in the C‐TLIF group (P < 0.05). VAS and ODI in the W‐TLIF group were significantly less than those in the C‐TLIF group at 1 week after operation and final follow‐up. The kyphotic angle and vertebral body height were improved. There was 1–2 grade improvement in patients with neurological deficit. Thirty‐three patients in the W‐TLIF group and 32 patients in the C‐TLIF group had achieved fusion during follow‐up. No internal fixation failure was observed in two groups.ConclusionsThe both techniques of W‐TLIF and C‐TLIF were feasible and effective for unstable thoracolumbar fracture with TIDL. Compare to C‐TLIF, The technique of W‐TLIF was a relatively less invasive way to decompress the neural elements and an easy method to reconstruct the anterior column using the same posterior approach.

Therapeutic Strategies for IVD Regeneration through Hyaluronan/SDF-1-Based Hydrogel and Intravenous Administration of MSCs.

Intervertebral disc (IVD) degeneration involves a complex cascade of events, including degradation of the native extracellular matrix, loss of water content, and decreased cell numbers. Cell recruitment strategies for the IVD have been increasingly explored, aiming to recruit either endogenous or transplanted cells. This study evaluates the IVD therapeutic potential of a chemoattractant delivery system (HAPSDF5) that combines a hyaluronan-based thermoreversible hydrogel (HAP) and the chemokine stromal cell derived factor-1 (SDF-1). HAPSDF5 was injected into the IVD and was combined with an intravenous injection of mesenchymal stem/stromal cells (MSCs) in a pre-clinical in vivo IVD lesion model. The local and systemic effects were evaluated two weeks after treatment. The hydrogel by itself (HAP) did not elicit any adverse effect, showing potential to be administrated by intradiscal injection. HAPSDF5 induced higher cell numbers, but no evidence of IVD regeneration was observed. MSCs systemic injection seemed to exert a role in IVD regeneration to some extent through a paracrine effect, but no synergies were observed when HAPSDF5 was combined with MSCs. Overall, this study shows that although the injection of chemoattractant hydrogels and MSC recruitment are feasible approaches for IVD, IVD regeneration using this strategy needs to be further explored before successful clinical translation.

Effects of neural mobilization in patients after lumbar microdiscectomy due to intervertebral disc lesion

BackgroundNeural mobilization (NM) techniques have been shown to improve the neural tissue's viscoelastic properties that may lead to recover of the function of the nerve after lumbar spine surgery. This study aimed to determine the effects of NM in addition to standard rehabilitation on lumbar and sciatic pain intensity, disability level, and quality of life in patients after receiving a microdiscectomy of the intervertebral lumbar disc (IVD). MethodsTwenty-four participants (age 41.3 ± 8.3 years old) within 3–4 weeks of a microdiscectomy of an IVD were randomly allocated to control (CTRL; n = 12) or NM group (n = 12). The CTRL group received ten standard rehabilitation sessions. The NM group received the same rehabilitation sessions with the addition of NM techniques. The intensity of lumbar and sciatic pain (visual analogue scale), disability level (Oswestry disability index), and health-related quality of life (SF-36 questionnaire) were measured before and after the intervention. ResultsWithin-group analysis revealed a significant reduction in lumbar (p < 0.05) and sciatic pain intensity (p < 0.001), disability level (p < 0.001), and improvement in the physical function and problems, vitality, emotional well-being, and pain SF-36 items (p < 0.05) in both groups. There were no statistical differences between groups in all outcomes. ConclusionA standard rehabilitation protocol alone or in combination with NM techniques are equally effective in reducing pain and disability level, as well as improving quality of life in patients after a microdiscectomy due to intervertebral lumbar disc lesion.

Piriformis syndrome. Treatment under control of CT fluoroscopy

To demonstrate one of the effective methods of treatment of the piriformis syndrome under the control of a highly technological visualization method. Eight patients (7 women and 1 man), aged 44 to 63 years, with piriformis syndrome, were studied from 2016 to 2018. The main complaints of the patients were pain in the lumbosacral spine with irradiation to the gluteal region and/or legs. All patients underwent MRI and/or MSCT of the lumbosacral spine, the pelvic ultrasound, according to the results of which 1 patient was diagnosed with uterine myoma, 5 with lesions of intervertebral discs in the L4-L5 and L5-S1 segments of varying severity in combination with changes in posture. For therapeutic purposes, all patients under the control of CT fluoroscopy were administered to xeomin (n=3), dexamethasone (n=1) or betamethasone (n=4). In all patients, a positive therapeutic effect was observed after 4-12 months for xeomin injections, 2-3 weeks for dexamethasone and up to 3 months for betamethasone. No complications during the manipulations were observed. The authors present a clinical case to describe the botulinum therapy technique under the control of CT fluoroscopy, which allows effective treatment of the piriformis syndrome. In the treatment of the piriformis syndrome it is necessary to apply an integrated approach, the leading of which are methods of local impaction on the suffering muscle. Only a methodologically correct injection can increase the effectiveness of treatment in these patients and reduce the risk of complications.

Cervical arthroplasty: 5-year follow-up

Research objective: analysis of the early and long-term outcomes of cervical intervertebral disc prosthetics, assessment of the amount of movement and of the regression of radicular symptoms within 5 years. Materials and methods. Thirty patients (19 women and 11 men, average age 35.8 years) were operated on for a single-level degenerative lesion of the intervertebral disk. The amount of movement was assessed based on functional X-ray data. Regression of radicular pain symptoms was assessed using visual analogue scale (VAS). Results. Good and excellent results were obtained. In the long-term period (60 months), local cervical pain syndrome ranged from 0 to 3 VAS points, with initial estimation at 6–8 points. Radicular pain was estimated at 0–2 VAS points, initially 5–8 points. Conclusion. Arthroplasty is a highly effective method for the treatment of degenerative lesions of cervical intervertebral discs. The technique can definitely compete with rigid stabilization systems and proves its efficacy in treatment of the disease of the adjacent segment.

Dysregulation of the Inflammatory Mediators in the Multifidus Muscle After Spontaneous Intervertebral Disc Degeneration SPARC-null Mice is Ameliorated by Physical Activity.

A longitudinal case-control animal model. The aim of this study was to investigate the inflammatory pathways active in the multifidus muscle after spontaneous intervertebral disc degeneration (IDD), and whether these IDD-related muscle changes can be ameliorated by exercise. A pro-inflammatory response is present in the multifidus muscle after an intervertebral disc lesion and has been proposed to drive the structural alterations present during low back pain. However, it is not known whether spontaneous IDD produces an inflammatory response. Furthermore, exercise/physical activity produces a strong anti-inflammatory response, but its effectiveness in ameliorating inflammation in the multifidus is unknown. We assessed the inflammatory profile of the multifidus and the effectiveness of physical activity as a treatment using an animal model of spontaneous model of IDD. Wild-type and SPARC null mice that were sedentary or housed with a running wheel were used in this study. Multifidus muscle segments were harvested from L2-L6 from the mice at 9 months of age after they had undergone a magnetic resonance imaging (MRI) scan to determine levels with IDD. The inflammatory profile of the multifidus was examined using quantitative polymerase chain reaction (PCR) assays. Spontaneous IDD in the SPARC-null mice caused a dysregulation of interleukin (IL)-1β, IL6, transforming growth factor-beta (TGFβ1), and adiponectin expression. More specifically, the proximity and degree of IDD was related to levels of IL-1β expression. Physical activity reduced the pro-inflammatory response to IDD in the multifidus. IL-1β, tumor necrosis factor (TNF), IL-10, adiponectin, and leptin levels were lower in the physically active group. These results reveal that spontaneous IDD causes dysregulation of the inflammatory pathways active in the multifidus muscle. These alterations were related to the severity of IDD and were prevented by physical activity. N/A.

Treatment of Fractures of the Thoracolumbar Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU).

Study Design: consensus paper with systematic literature review.Objective:The aim of this study was to establish recommendations for treatment of thoracolumbar spine fractures based on systematic review of current literature and consensus of several spine surgery experts.Methods:The project was initiated in September 2008 and published in Germany in 2011. It was redone in 2017 based on systematic literature review, including new AOSpine classification. Members of the expert group were recruited from all over Germany working in hospitals of all levels of care. In total, the consensus process included 9 meetings and 20 hours of video conferences.Results:As regards existing studies with highest level of evidence, a clear recommendation regarding treatment (operative vs conservative) or regarding type of surgery (posterior vs anterior vs combined anterior-posterior) cannot be given. Treatment has to be indicated individually based on clinical presentation, general condition of the patient, and radiological parameters. The following specific parameters have to be regarded and are proposed as morphological modifiers in addition to AOSpine classification: sagittal and coronal alignment of spine, degree of vertebral body destruction, stenosis of spinal canal, and intervertebral disc lesion. Meanwhile, the recommendations are used as standard algorithm in many German spine clinics and trauma centers.Conclusion:Clinical presentation and general condition of the patient are basic requirements for decision making. Additionally, treatment recommendations offer the physician a standardized, reproducible, and in Germany commonly accepted algorithm based on AOSpine classification and 4 morphological modifiers.

Magnetic resonance imaging evaluation of intervertebral disc injuries can predict kyphotic deformity after posterior fixation of unstable thoracolumbar spine injuries.

The aim of the present study is to identify factors correlated with kyphotic deformity after thoracolumbar spine injuries. We performed a retrospective case–control study with data from thoracolumbar spine fracture patients who were treated with posterior spinal fixation. Patients with a follow-up period shorter than 6 months and who experienced low-energy trauma were excluded. Intervertebral disc injuries (IDIs) were graded from 0 to 3 upon admission in accordance with Sander's classification of traumatic intervertebral disc lesions. Vertebral wedge angles (VWAs) and local kyphosis angles (LKAs) were also measured. Patients were allocated to kyphosis and control groups if they had LKA correction losses of ≥10° and <10°, respectively. Forty-eight patients followed over a median period of 25 months were included. The median correction loss at the site of the injured vertebral body was 2.0°. The median LKA correction loss was 9.0°. Twenty-three and 25 patients were allocated to the kyphosis and control groups, respectively. Univariate analysis revealed that the median age was significantly lower in the kyphosis (35 years) than control group (56 years). The level of injury and IDI severity also significantly differed between groups, with a significantly greater proportion of more severe IDI cases in the kyphosis than control group. Finally, significantly more patients in kyphosis group underwent fusion (kyphosis, 19 vs control, 13) and implant removals (kyphosis, 19 vs control, 10). Multiple regression analysis revealed that IDI severity according to Sander's classification (P = .005; odds ratio, 5.263; 95% confidence interval [CI], 1.637–16.927) and implant removal (P = .011; odds ratio, 7.980; 95% CI, 1.603–39.728) were significantly associated with kyphotic deformity. IDI severity at initial magnetic resonance imaging (MRI) evaluation and implant removal are associated with kyphotic deformity after posterior fixation of thoracolumbar spine injuries. Thus, initial MRI evaluation of IDIs could be used to predict of recurrent kyphosis.

Influence of vitamin D deficiency on T cell subsets and related indices during spinal tuberculosis.

The present study investigated the effects of vitamin D deficiency on T cell subsets in patients with spinal tuberculosis. In addition, the influence of vitamin D deficiency was investigated on the expression of cytokines IL-1β, IL-6 and TNF-α in intervertebral disc lesions of patients. One hundred and seventeen patients with spinal tuberculosis who received operative treatment in the Department of Orthopedics in Wuhan City Third Hospital from March 2012 to March 2015 were collected. The patients were divided depending upon vitamin D content into the control group (64 cases, vitamin D content <25 nmol/l) and experimental group (53 cases, vitamin D content >50 nmol/l). Immunofluorescence method was applied to determine the content of T cell subsets in both groups of patients. Intervertebral disc lesion tissues of two groups of patients were obtained during surgery then treated with HE staining and immunohistochemical staining. The values of average optical density obtained under light microscope were observed as the expression quantities of IL-1β, IL-6 and TNF-α, to explore the relationship between vitamin D and the expression of cytokines. When vitamin D is lacking, the expression of T lymphocyte subsets in patients with spinal tuberculosis significantly decreased. Compared with experimental group, the difference was statistically significant (P<0.05). Further, the expression of cytokines IL-1β, IL-6 and TNF-α in intervertebral disc lesion tissues of patients with spinal tuberculosis were significantly higher than those of patients with spinal tuberculosis whose vitamin D content was normal (P<0.05). In the control group, vitamin D content was negatively correlated with the expression of IL-1β, IL-6 and TNF-α. The expression of T lymphocyte subsets in patients with vitamin D deficiency was significantly reduced, and the immune function decreased. The expression of IL-1β, IL-6 and TNF-α in lesions were significantly higher than those of patients with normal vitamin D content. In addition, the lower the content of vitamin D was, the more active the expression of inflammatory factors were, which was not conducive to the recovery of tuberculosis lesions.

Effects of intervertebral disc lesion and multifidus muscle resection on the structure of the lumbar intervertebral discs and paraspinal musculature of the rat

The aim of this study was to investigate whether elimination of multifidus muscle in rats causes intervertebral disc (IVD) degeneration similar to that found after IVD lesion. Data were obtained from 36 male Wistar rats randomly assigned to one of three groups: (i) IVD lesion, in which the L4/L5 IVD was stabbed; (ii) multifidus muscle resection, in which all multifidus tissue between L3 and L6 was excised bilaterally; (iii) control, in which no intervention was applied. At 7, 14, and 28 days post-intervention, L4/L5 IVDs were harvested for histological analysis; left and right multifidus fascicles between L3 and S1 (from control and IVD lesion animals) and medial longissimus between L1 and S3 (from all animals) were dissected and weighed. ANOVA indicated significant group differences and a significant interaction between group and days for relative nucleus pulposus area and for multifidus mass normalized to body mass. No significant effects were observed for whole IVD area. At 14 days post-op, the IVD lesion group had a significantly smaller relative nucleus pulposus area than control and multifidus resection groups. Nucleus pulposus size did not differ from control at 7 and 28 days. At 7 days post-intervention, normalized multifidus mass was significantly lower (20%) in the IVD lesion group. For longissimus mass, no between-group differences were found. These results indicate that, in rats, IVD recovers quickly after lumbar IVD lesion and multifidus disruption does not cause IVD degeneration within the time studied.

Comparison of Intervertebral Disc Injuries Caused By Different Diode Laser Wavelengths

Background: Laser discectomy or laser nucleotomy comprises an increasingly important place in less invasive spinal procedures, but the ideal laser is still a subject of study. This research was aimed to compare the action of diode laser at different wavelengths, as well as the volume of the vaporization lesion caused by the different wavelengths in the percutaneous decompression procedures of the intervertebral disc (nucleotomy). Methods: Six pigs' lumbar columns had their intervertebral discs (region L1 to L5) underwent punctureinduced injury. The columns were then subjected to the nuclear magnetic resonance (MR) for pre-irradiation analysis. Later, the discs were irradiated with a laser at the wavelengths of 808 nm (G808), 980 nm (G980), 1470 nm (G1470) and 1908 nm (G1908), or not irradiated (Control group). The columns were then destined for MR and then immersed in 10% buffered formalin for histological analysis. After being decalcified the intervertebral discs were dissected and processed for paraffin embedding. Transverse sections of the disks were stained with hematoxylin and eosin for histomorphometry and carbonized and bubble areas were measured. Results: The lesions were equivalent within each group and there was no difference between the groups in the pre-irradiation. In the post-irradiation evaluation, the MR showed that the volume of the intervertebral disc lesion was smaller in the G1470 and G1908 groups compared to the other groups. The G808 and G980 groups showed a higher thickness of carbonized area compared to groups G1470 and G1908. In addition, G980 presented higher thickness bubble area compared to the other groups. These lesions were more pronounced and more localized in the G808 and G980 groups, compared the 1470 nm and 1908 nm lasers, which caused broader but less intense lesions. Conclusion: The intervertebral disc lesions caused by the 808 nm and 980 nm laser are more intense but more focal, compared to the 1470 nm and 1908 nm laser.

Алгоритм хирургического лечения стенозирующих процессов позвоночного канала и дурального мешка на поясничном уровне

A number of tasks were set: how to develop a morphometric method for diagnosing stenosing processes that would allow us to specify the localization of the pathological process, its volume and extent; to develop a classification of stenosing processes depending on the stenosis coefficient Z n ; to develop a new method of latent instability of the vertebral-lumbar segment of the lumbar spine; to study the nature of multilevel lesions of intervertebral discs in osteochondrosis leading to stenosing processes of the spinal canal. Improvement of diagnostic methods in stenosing processes allowed the authors to develop new ways of diagnostics and surgical treatment of this pathology and to offer new medical technologies for practical health care. All of the above is the basis for the development of an algorithm for the surgical treatment of stenosing processes of the spinal canal and dural sac, which is the subject of this work. 416 patients underwent various surgical procedures depending on the severity of clinical and neurological disorders, the stenosis coefficient, the instability in the vertebral-motor segments, the magnitude of the extensional-flexion amplitude, the nature of the pathological process and the degree of its compensation. Of 416 patients, 179 patients underwent decompressive-stabilizing intervention with the installation of a dynamic system using a mini-invasive approach with a minimally invasive reconstruction of the spinal canal. Decompression-stabilizing intervention with rigid interspinous fixation, minimally invasive access to the vertebral canal with its minimally invasive reconstruction was performed in 96 patients. 141 patients underwent decompressive-stabilizing intervention with transpedicularfixation, with extended minimally invasive reconstruction of the spinal canal with its minimally invasive approach.

Osteoporotic vertebral body fractures of the thoracolumbar spine: indications and techniques of a 360°-stabilization.

Unstable vertebral body fragility fractures of the thoracolumbar spine can occur with or without relevant trauma. Initially, a standardized diagnostic algorithm including magnetic resonance tomography is recommended to detect accompanied further vertebral body fractures, to interpret the individual fracture stability, and to screen for relevant traumatic intervertebral disc lesions. Aim of the therapy is to assure fast mobilization and to maintain spinal alignment. Unstable fracture morphology is defined by vertebral body fractures including a relevant defect of the posterior vertebral cortex as well as type B or C fractures. With respect of type A fractures, a combined anterior-posterior approach including a primary cement-augmented posterior stabilization and anterior spondylodesis is indicated in those patients with relevant intervertebral lesions or in those suffering from high-energy accidents resulting in unstable burst-type fractures. The others will benefit from hybrid stabilizations including cement-augmented posterior stabilizations and cement augmentation (kyphoplasty) of the fractured level to gain a ventral transosseous stability. In addition, individually adapted antiosteoporotic therapy is essential.