Root Pain Research Articles

Post extraction complications - An institution based retrospective study

Tooth extraction is one of the most common procedures undertaken in the dental clinic. As with any surgical procedure, even a simple tooth extraction can result in complications. Post extraction complications can be annoying to the patient, thereby causing mild morbidity and have an impact on their quality of life. Complications are wide starting from common ones like alveolitis and root fracture, dry socket, infraction, halitosis, pain, trismus and uncommon ones like displacement of root fragments within the sinus and oral antral fistula. The aim of this study was to evaluate post-extraction complications among patients visiting saveetha dental college. This is a retrospective study. We reviewed patient records and analysed the data of 86000 patients between June 2019 and March 2020. From a pooled sample size of 23000 extractions done during this period, data of patients reporting for post-extraction complications were segregated and analysed. The statistical analysis was done using SPSS Version 20 by IBM. The results were analysed using the chi-square test. In this study, we observed that among a sample of 23000 simple extractions, only 42 patients had reported back with post-extraction complications (0.18%). These complications were more in males than in females. When compared between maxillary and mandibular arch, the mandible had more incidence with 54.16%. The most common complication was dry socket (58.34%). Pain as a complication was more in males than in females. Within the limits of the study, the incidence of post-extraction complication is more in males than females. Higher incidence of complication was seen in a mandibular arch (54.16%) than in maxillary arch (45.84%).

Progress in clinical trials of cell transplantation for the treatment of spinal cord injury: how many questions remain unanswered?

Spinal cord injury can lead to severe motor, sensory and autonomic nervous dysfunctions. However, there is currently no effective treatment for spinal cord injury. Neural stem cells and progenitor cells, bone marrow mesenchymal stem cells, olfactory ensheathing cells, umbilical cord blood stem cells, adipose stem cells, hematopoietic stem cells, oligodendrocyte precursor cells, macrophages and Schwann cells have been studied as potential treatments for spinal cord injury. These treatments were mainly performed in animals. However, subtle changes in sensory function, nerve root movement and pain cannot be fully investigated with animal studies. Although these cell types have shown excellent safety and effectiveness in various animal models, sufficient evidence of efficacy for clinical translation is still lacking. Cell transplantation should be combined with tissue engineering scaffolds, local drug delivery systems, postoperative adjuvant therapy and physical rehabilitation training as part of a comprehensive treatment plan to provide the possibility for patients with SCI to return to normal life. This review summarizes and analyzes the clinical trials of cell transplantation therapy in spinal cord injury, with the aim of providing a rational foundation for the development of clinical treatments for spinal cord injury.

A Short Note on Spinal Arthritis

Spinal arthritis leads to inflammation of the facet joints in the spine or sacroiliac joints between the spine and pelvis. It causes stiffness and low back pain upon waking up in the morning. Fluid built up in the joint due to inactivity overnight causes more swelling. Pain is mostly > 80% - in the back, runs into the buttocks, and often really feels like it’s in the hip. As it gets even worse people will feel burning on the outer aspect of the thigh, and sometimes pain down the leg and nerve root pain some times.

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Significance of Plain Xray Findings in Neck Pain with Relation to Cervical Radiculopathy and Myelopathy

Introduction: Pain neck is a very common symptom and associated with cervical spondylosis prevails in all individuals. Though this is an era of advanced MRI, the old technology of plain X-ray cervical spine still gives useful information in patients with pain neck. Objective: To study the plain X-ray findings in pain neck cases of neural causes. Materials and Method: This was the cross sectional study conducted at Sri Manakula Vinayagar Medical College and Hospital over three years( January 2017-December 2019). Informed consent was obtained from all the patients included in the study. Institutional ethical committee clearance was obtained. All patients visiting the Out Patient Department (OPD) with the complaint of neck pain and back were advised to have plain X-ray cervical spine AP and Lateral views. The findings were recorded. Results Of the 148 patients, 91 patients that are 61% of the patients with the neck pain, the plain X-rays were normal, except for mild Spondylotic changes.25.6% (38 patients) had single level interbody space narrowing and in those patients common complaint was typical root pain. 4% (6 patients) had 2 or more level narrowing. 6% (8 patients) had cervical ribs of whom it was bilateral in 40% (3 patients). There were 2 cases of Klippel Feil interbody fusion (1.4%) and 3 cases had Spina Bifida (2%). Severe spondylosis with more than 3 level interspace narrowing was seen in 12 cases (8.1%) and all of them was over the age of 55. Conclusion: Not all cases with neck pain need an MRI study. Plain X-ray cervical spine that is freely available even at the periphery can give valuable findings like interbody fusion, Spondylosis, cervical rib, congenital anomalies and those cases can be managed easily without unnecessary referrals in the initial stage.

Fully Guided Tooth Autotransplantation Using a Multidrilling Axis Surgical Stent: Proof of Concept

IntroductionDigital technology has been progressively introduced into tooth autotransplantation to enhance both treatment planning and surgery. The aim of this report was to describe a novel protocol for fully guided tooth autotransplantation. MethodsThis report includes 10 consecutive patients treated with a complete virtual planning and a multidrilling axis surgical guide in combination with the computer-aided rapid prototyping model. ResultsAll transplanted teeth fulfilled the criteria for success over a mean follow-up duration of 13.1 months. No signs of progressive root resorption or pain were found during follow-up. One case required minimal adjustment of the surgical stent to allow correct seating, whereas a second case could not be performed fully guided because of limited mouth opening. ConclusionsOur protocol for fully guided tooth autotransplantation is a viable option that involves minimal bone preparation in a short surgical time. Future research should focus on further investigation of the benefits of this novel protocol in a larger sample.

Treatment of cervical spodylotic radiculopathy with posterior intervertebral foraminal discectomy via Delta channel

To explore the clinical efficacy and safety of posterior intervertebral foraminal discectomy via Delta channel for cervical spondylotic radiculopathy in the early phase. From September 2017 to July 2018, 10 patients with cervical spondylotic radiculopathy underwent posterior intervertebral foraminal discectomy via Delta channel. There were 6 males and 4 females, aged from 30 to 62 years old with an average of (41.5±4.3) years old. All of them had unilateral symptoms caused by cervical nerve root compression, including 2 cases of C4,5, 5 cases of C5,6 and 3 cases of C6,7. CT and MRI examination of all the patients did not show ossification of posterior longitudinal ligament or calcification of ligamentum flavum, and no cervical spine instability was present in dynamic radiographs. The clinical outcome was poor after more than 6 weeks of systematic non-surgical treatment. The VAS score, JOA score, NDI score, the cervical spine physiological curvature, and the height and stability of the compressed cervical vertebrae were measured before operation and at the latest follow-up. All patients successfully completed the surgeries without any spinal cord, nerve root or major blood vessel injury. The operation time was 70 to 120 min with an average of 90 min. Intraoperative blood loss ranged from 30 to 90 ml with an average of 40 ml. All the 10 patients were followed up for 6 to 14 months with an average of 9 months. Postoperative nerve root pain got relievd and nerve function was improved in all patients. VAS score decreased from 7.15±2.01 before surgery to 1.59±0.83 at the latest follow-up;JOA score increased from 12.57±1.24 before surgery to 16.42±0.58 at the latest follow-up;NDI score increased from 41.82±4.71 before surgery to 9.59±3.52 at the latest follow-up. All the results above presented significant difference between latest follow-up and preoperative (P< 0.05). The D value of cervical physiological curvature increased from (8.21±0.84) mm before surgery to(10.89±0.96) mm at the latest follow-up, and the difference was also statistically significant (P<0.05). The height of the diseased vertebrae was (5.62± 0.59) mm before surgery and (5.60±0.57) mm at the latest follow-up, with no statistically significant difference(P>0.05). At the latest follow-up, no cervical instability was observed on dynamic radiographs. Treatment of cervical spondylotic radiculopathy by posterior intervertebral foraminal discectomy via Delta channel can obtain a satisfactory clinical outcome without affecting the stability of cervical vertebra. The surgery is safe, reliable and worthy of clinical application.

Comparison of acellular dermal matrix allograft (ADMA) and a subepithelial connective tissue graft (SCTG) for the treatment of gingival recession.

Background This study aimed to evaluate the effect of acellular dermal matrix allograft (ADMA) for the treatment of gingival recession as a substitute for subepithelial connective tissue graft (SCTG).Methods In this controlled clinical trial, 18 teeth were selected in nine subjects with bilateral gingival recession. One side was treated with SCTG and a coronally displaced flap as the control group, and the other side was treated with ADMA and a coronally displaced flap as the test group. Probing pocket depth (PPD), clinical attachment level, vertical recession depth, recession width, gingival thickness, keratinized tissue width, and the root coverage percentage were measured before the surgery and at 1-, 3-, and 6-month postoperative intervals. The healing index, pain index, and patient satisfaction were also investigated. The data were analyzed with a general linear model (GLM) repeated measures and paired t-test.Results All the parameters improved except for PPD; however, a comparison between the groups did not reveal statistically significant differences. Only root coverage percentage and pain index were significantly lower in the test group. The average percentage of root coverage in the control and test groups were 82.01±16.62% and 64.44±9.4%, respectively. Conclusion Both methods resulted in improvements in the clinical results. However, the use of the ADMA led to less pain and root coverage in comparison with the SCTG method.

The Evaluation of a Combined Surgical Approach Without Decompression for the Management of Grade 3 and 4 Spondylolisthesis in Adolescents

IntroductionThere are multiple surgical approaches for correcting high grade spondylolisthesis (slip percentage greater than or equal to 50%) in adolescents, however there is no consensus on treatment. We hypothesize that a combined, two step approach, consisting of an anterior lumbar interbody fusion (ALIF) at L5‐S1 followed by a posterior spinal fusion at the pedicles of L5 and S1 will improve patient outcomes. The purpose of this study is to determine if this surgical approach can effectively decrease the patient’s slip angle and reduce the slip percentage below 50%.MethodsThe initial approach to surgery is performing an ALIF at the level of L5‐S1. A pfannenstiel incision is followed by transperitoneal exposure of the L5‐S1 disc between the common iliac vessels. The surgeon completes a discectomy at L5 and inserts a lordotic cage. The lordotic cage is filled with recombinant human bone morphogenetic protein 2 (RHBMP2). The second approach involves posterior exposure of L5‐S1 through a midline incision. There is no removal of the posterior elements of L5, or nerve root decompression. Pedicle screws with any necessary instrumentation are inserted at L5 and S1 only. The segment is mildly compressed to prevent column elongation. The L5‐S1 vertebrae and posterior instrumentation are fused with donor bone graft.ResultsSince 2003, this unique surgical approach has been performed successfully on fourteen patients (mean age 15.5 +/− 3.5 years). All had preoperative MRI scans that showed normal signal in the L4/L5 disc. Follow up confirmed a slip angle reduction in all fourteen patients. The slip percentage was successfully reduced from high grade to a grade of I (0–25%) or II (25–50%). There was no loss of reduction or cage displacement seen post‐operatively. At follow up appointments, patients did not report experiencing any pseudoarthrosis, symptoms of nerve root pain or lesion, cauda equina lesions, sexual dysfunction, retrograde ejaculation, nor the need for a re‐operation. All patients had a solid anterior fusion visualized on x‐ray during follow up. There were two surgical wound infections reported, which required incision and drainage or wound dehiscence. No other surgical complications were reported.ConclusionThe results of this study demonstrate that a combined, anterior‐posterior surgical approach, with anterior insertion of lordotic cage, posterior pedicle screw fixation, and bone graft fusion, effectively reduces slip percentage (to &lt;50%) and restores a normal slip angle. Decompression and fusion of the healthy L4‐L5 segment can be avoided.Support or Funding InformationChildren’s Hospital New OrleansAnterior surgical approach and exposure of L5‐S1 disc for discectomyFigure 1

A clinical comparison of the effectiveness of two types of orthodontic aligning archwire materials: a multicentre randomized clinical trial.

To compare the heat-activated nickel titanium (HANT) with superelastic nickel-titanium (SENT) archwires in terms of their effectiveness of aligning teeth, possibility of inducing root resorption, and perception of pain. Orthodontic patients aged 12 years or over with mandibular anterior crowding of 3-6 mm, who required treatment without extractions were randomly allocated (a simple non-stratified randomization) to the HANT and SENT archwires groups with a 1:1 allocation ratio. The archwire sequence in both groups was 0.014-inch and 0.016-inch, respectively. Each archwire was placed for 4 weeks. The outcome measures included the amount of crowding assessed blindly using Little's irregularity index (LII), apical root resorption, and pain perception. The effectiveness of alignment was tested using 2 × 2 mixed factorial analysis of variance (ANOVA) model, while root resorption and pain perception were tested by the Mann-Whitney U-test and Wilcoxon signed-rank test (P < 0.05). Thirty-four patients were randomized and recruited from four centres, of those 31 were analysed (15 participants for the HANT and 16 for the SENT groups) with an overall mean age of 19.13 ± 5.73 years. The total reduction in the LII was 2.69 mm and 2.74 mm for the HANT and SENT groups, respectively. This did not reach the level of statistical (P = 0.809) or clinical significance. Similarly, root resorption and pain perception showed non-significant difference between groups. However, there was a slight increase in root resorption with the SENT group. A long-term evaluation of root resorption is required. Both HANT and SENT archwires were equally effective in the aligning stage of orthodontic treatment. Root resorption with SENT wires should be monitored throughout treatment. The trial was registered with ClinicalTrials.gov on 18 September 2019, registration number: NCT04090931.

Microsurgical treatment of cervical spinal hemangioblastoma

BackgroundHemangioblastoma is a rare intracranial vascular tumor, mostly found in the cerebellum. Cervical spinal hemangioblastoma (CSHB) has rarely been reported, and microsurgical treatment even less. ObjectiveTo present our experience with CSHB and conduct a literature review, in order to provide a systematic approach to diagnosis and microsurgical treatment. MethodsThe study included 11 patients with CSHB treated by total tumor resection from January 2005 to December 2015. We analyzed clinical and radiological data, surgical outcome, and pathological examination results. ResultsAll patients were treated by total tumor resection. All preoperative nerve root pain resolved completely. Four patients had associated numbness, which improved in 2 and persisted in 2. All patients were in good postoperative health. There were no recurrences during follow-up of 6–48 months. ConclusionPreoperative magnetic resonance imaging (MRI) and computed tomography angiography (CTA) can be used for diagnosis of CSHB. Finding and blocking the nutrient arteries during surgery is necessary reduce bleeding. Total tumor resection requires accurately identifying and separating the proliferative area around the tumor.

SCIATICA (IRQ-UN-NASA) IN MODERN AND UNANI PERSPECTIVE

Sciatica is a type of neuropathic pain and commonest variation of low back pain. It is known by a range of terms in the literature, such as lumbo sacral radicular syndrome, radiculopathy, nerve root pain and nerve root entrapment or irritation etc. The intense leg pain may be accompanied by neurological changes of muscle weakness and wasting, sensory changes in the nerve root distribution. There may be intra-spinal, intra-pelvic and extra-pelvic causes compressing the nerve and producing inflammation. In Unani medicine the term “Irq-un-Nasa” is used to describe such pain that initiates from lower back and radiates up 4,5 to knee or ankle joint posterolaterally. Most of the Unani scholars have mentioned it as a subtype of Wajaul Mafasil. The most common cause is the infiltration (nufooz) of abnormal homours in the fluid of hip joint, such as Ghair tabayi Balgham, Safra or Dam or admixture of Balgham and Safra, such infiltration for a prolonged period result into Tahajjur-e-Mafasil and even Irq-un-Nasa. Whenever the nerve becomes weak due to any reason the susceptibility for the accumulation of any morbid matter is increased. There may be sue mizaj damwi/ safravi/ balghami/ saudawi as active cause of Irq-un-Nasa. By now it is understood that this is the disease of nerve, and it is diagnosed and managed accordingly.

Distribution of Rothia species in root canals in a Japanese population

Rothia species are components of the normal oral microflora, which have been recognized as emerging opportunistic pathogens in immune compromised hosts. This study was performed to investigate the distribution of Rothia species in infected root canals. The correlations of clinical findings with the presence of Rothia species were also evaluated. A total of 200 root canal samples, including 92 primary infections and 108 secondary infections, were collected from 200 Japanese patients. Polymerase chain reaction (PCR) targeting the 16S rRNA gene was performed to detect three Rothia species, i.e., Rothia mucilaginosa, Rothia aeria, and Rothia dentocariosa. The detection frequencies of R. mucilaginosa, R. aeria, and R. dentocariosa were 49/200 (24.5%), 95/200 (47.5%), and 55/200 (27.5%), respectively. There were no significant differences in the detection frequencies between primary and secondary endodontic infections. The detection frequency of R. mucilaginosa in cases with gingival swelling was 42.9%, and there were significantly more cases positive than negative for this species (P = 0.042). The presence of R. aeria also showed correlations with radiolucency around the root apex (P = 0.001) and pain on percussion (P = 0.044). Quantitative real-time PCR revealed that the relative abundance of R. mucilaginosa in total bacterial counts ranged from 0.04% to 91.8%. These results indicated that Rothia species colonize root canals at relatively high frequency, and that root canals are potential reservoirs of these pathogens. The results also suggest that Rothia species are involved in the pathogenesis of apical periodontitis.

Acetaminophen combined with tramadol is more effective than acetaminophen or tramadol to reduce neuropathic root pain: an experimental study with application of nucleus pulposus in a rat model.

Various drugs are used to treat patients with neuropathic pain; however, optimal treatment using acetaminophen (A) and/or tramadol (T) remains unclear. The evidence supporting the drug choice and the timing of administration is insufficient. Therefore, the objective of the present study was to investigate the effect of T and/or A on pain-related behavior in a nucleus pulposus (NP) rat model. Sprague-Dawley rats (n = 180) were divided into NP-A (52mg/kg), NP-T (6mg/kg), NP-AT (combined A and T), NP-S (saline), and sham groups (n = 36 per group). The rats received 0.2mL of treatment solution orally once daily for 7days after application of NP on the left L5 dorsal root ganglion (DRG). Behavioral testing and immunohistochemistry analysis for some markers' expressions in DRGs and the spinal cord were performed. Pain thresholds in the NP-AT group did not significantly differ from the sham at all time points, while those were significantly lower in the NP-A and in the NP-T groups at D7 and/or D14 (p < 0.05). Tumor necrosis factor-α in the NP-S group was significantly higher at D2 and D7 (p < 0.05). Among the three treatment groups, activating transcriptional factor 3 and growth-associated protein 43 showed a tendency toward an increase at D7-D21. Combined administration of acetaminophen and tramadol maintained in the pain threshold in the rat NP model. These findings suggest that the combination of acetaminophen and tramadol might be a potential therapeutic modality for patients with lumbar disc herniation. These slides can be retrieved under Electronic Supplementary Material.

Expression of NaV-1.7, TNF-α and HSP-70 in experimental flare-up post-extirpated dental pulp tissue through a neuroimmunological approach

BackgroundDental caries continue to represent a major problem which, if left untreated, will cause irreversible pulpitis. Root canal treatment constitutes one potential treatment intended to preserve teeth afflicted with irreversible pulpitis. During root canal treatment, pain or swelling, referred to as flare-ups, can occur at any point in the process. AimTo analyze the molecular aspect of the phenomenon of flare-up in vital dental pulp tissue following mechanical and bacterial trauma (extirpation and lipopolysaccharide [LPS] induction respectively) through a neurological approach, based on the expression of NaV-1.7 in neuron cells, and HSP-70, TNF-α in macrophage cells. MethodThis laboratory experimental study was conducted using 15 Spraque Dawley rats as subjects which were divided into three groups of five subjects: a control group, a pulp tissue extirpation group and an LPS induction followed by extirpation of pulp tissue group. Test samples were collected from the apical field of the mandibular incisor and subsequently examined using immunohistochemical methods. ResultsThere were significant differences in NaV1.7, HSP70 and TNFα expression between the treatment groups. While a marked increase in the expression of HSP70 occurred, both Nav1.7, and TNFα expression decreased significantly. ConclusionExtirpating the dental pulp tissue will induce a more pronounced flare-up response from the molecules of the pulp tissue in vital teeth than those in inflamed vital pulp tissue.

Clinical features of low back pain in an outpatient clinic

To determine the clinical features of low back pain and the conditions associated with this symptom in family medicine center in Bishkek, Kyrgyzstan. The study was included medical reports of patients with LBP at the age of 18-75 years attending in family medicine center №7 in Bishkek from 2017 to 2018.The examination included a consultation of a neurologist, magnetic resonance imaging (MRI) of the spine, and blood tests. During the study period 184 (85 men and 99 women) had LBP. Among these patients 11 (5,98%) of them had a specific cause of back pain: 3 - a traumatic spinal injury, 3 - a tumor lesion of the spine, 3 - rheumatoid polyarthritis and tuberculosis were present in 2 patients. The remaining 173 (94,02%) patients had a nonspecific cause of back pain associated with degenerative spinal disease and included low back pain -94 (54,33%), low back pain with nerve root pain suggestive of disk herniation 73 (42,2%), and low back pain with nerve root pain and lumbar spinal stenosis -6 (3,47%). When clarifying the anamnesis, it was revealed that the main initiating factor was inadequate physical activity and emotional stress. The obtained data once again emphasize the importance of careful collection of anamnesis and a physical examination to identify “red flags” to excluding specific back pain. In connection with the growing role of outpatient care in our country, there is a need to develop common approaches to correct evaluation of pain syndrome, determination the scope of the examination and choice the effective treatment tactics.

Clinical application of Tunnel-Plasty on modified pedicle subtraction osteotomy

Objective To summarize the technical points and clinical efficacy of pedicle subtraction osteotomy (PSO) in tunneling and to explore the related complications of this technique. Methods A total of 67 cases of old vertebral fractures of the thoracolumbar region from June 2012 to June 2017 were collected. According to the inclusion and exclusion criteria, a total of 41 cases were included in the study. There were 19 males and 22 females; aged 37-67 years, mean 60.1±12.7 years; 15 cases of non-surgical treatment after trauma, 13 cases of failure after surgery and 13 cases of osteoporosis. Injury segment: 9 cases of T11, 22 cases of T12, 8 cases of L1, 2 cases of LS. Preoperative patients were diagnosed by X-ray, CT plain and 3D reconstruction combined with MRI. There were 23 cases of intractable back pain, 16 cases of lower extremity root pain, and 2 cases of intermittent claudication. Patients were divided into the traditional PSO treatment group (21 cases) and modified PSO treatment group (20 persons) according to the random number method. The traditional group were treated with the egg shell technique, and the improved group were treated with tunnel forming technology. The procedure was divided into four steps: exposure (step 1), nail placement and resection of the posterior column complex (step 2), vertebral osteotomy (step 3), orthopedics and bone grafting (step 4). The operation time, bleeding volume and complications of each step were compared between the two groups. The clinical efficacy was evaluated using the visual analogue scale (VAS) score and the Oswestry disability index (ODI). The X-ray spine Cobb angle was measured to evaluate the Keloid deformity correction, and the bone graft fusion was observed by CT examination. Results All patients were followed up for 12 to 24 months. The total operation time of the traditional group was 273.3±21.1 min, and the total operation time of the modified group was 178.1±12.5 min, the difference between the two groups was statistically significant (t=8.981, P=0.0019). The differences between the two groups in steps 2 and 3 were statistically significant (t2=4.614, P2=0.036; t3=9.089, P3=0.020) . The difference in the total bleeding volume was statistically significant (t=8.529, P=0.011). The differences in the bleeding volume between the two groups in step 2 and step 3 were statistically significant (t2=11.933, P2=0.016; t3=6.972, P3=0.013). The Cobb angles of the traditional group before surgery, 1 week after surgery and half year after surgery were 40.2°±8.9°, 12.5°±6.8°, 10.4°±2.5°, respectively. The Cobb angles of the modified group before surgery, 1 week after operation and half year after surgery were 39.5°±6.3°, 10.4°±3.5°, 9.5°±1.9°, respectively. The differences in the Cobb angle between the preoperative, postoperative 1 week and postoperative half year were statistically significant(Fmodified group=189.573, Pmodified group=0.021; Ftraditional group=194.699, Ptraditional group=0.029). The bone fusion time in the osteotomy area was 3-6 months, with an average of 4.8 months. The VAC and ODI scores of half-year post operation of the traditional group were 2.1±0.3 and 34.1±4.3, and the improved group were 2.2±1.1 and 28.3±6.8, respectively, and the difference was not statistically significant. In the improved group, there were 1 case of over-excavation and 1 case of over-underexcavation (2/20), which were corrected in time during operation. In the traditional group, 4 cases (4/21) of dural tear occurred during the operation, and were repaired in time. Bone fusion was obtained half a year later. No clinical deaths, and no cases of surgical infection occured. Conclusion Tunnel forming technology is an alternative surgical procedure for treating old fractures of the thoracolumbar region with PSO, which can shorten the operation time, reducd intraoperative bleeding and reduce surgical complications. Key words: Osteotomy; Orthopedic procedures; Spinal fractures

Effects of swimming on pain and inflammatory factors in rats with lumbar disc herniation.

The aim of the present study was to identify the effect of swimming on nerve root pain in rats with lumbar disc herniation (LDH). A total of 72 male Sprague Dawley rats (215±15 g) were randomly divided into three groups (n=24/group): The sham operation, model and exercise intervention groups, with the latter undergoing 4 weeks of swimming training. On days 0, 7, 14 and 28 following surgery, the changes in the post-limb mechanical claw threshold, the phospholipase A2 (PLA2), interleukin (IL)-6 and tumor necrosis factor (TNF)-α mRNA expression levels, the secretory PLA2 (sPLA2) expression, the IL-6 and TNF-α content, the nuclear factor (NF)-κBp65 protein expression level in the nucleus pulposus, and the apoptotic rate of the nucleus pulposus cells were detected. The results demonstrated that, in the model group, the threshold of hind paw withdrawal was decreased, and that the sPLA2 expression, IL-6 and TNF-α content, PLA2, IL-6 and TNF-α mRNA and NF-κBp65 protein expression levels in the nucleus pulposus were increased. The apoptotic rate of the nucleus pulposus cells was increased from day 7 following surgery, as compared with the sham operation group. In the exercise intervention group, the hind paw withdrawal threshold increased and the TNF-α and IL-6 content, sPLA2 expression and PLA2, IL-6 and TNF-α mRNA and NF-κBp65 protein expression levels were decreased from day 14 following surgery, and the apoptotic nucleus pulposus cells were decreased from day 7 following surgery, as compared with the model group. Collectively, the present data suggest that swimming can significantly reduce nerve root pain and inhibit inflammatory reaction in LDH, which can have positive effects on the treatment of LDH.

Clinical profile of multiple myeloma in a tertiary medical college northern Kerala, India

Introduction: Multiple myeloma is a clonal plasma cell disorder which varies its clinical course ranging from relatively indolent form to frankly aggressive neoplasia. Objectives: To study the clinical profile of Multiple myeloma. Materials and Methods: Descriptive study was conducted at a tertiary medical College in Kerala. 70 patients of Multiple myeloma was found with help of laboratory work up including urine Bence Jones with heat coagulation method. Serum albumin, calcium, uric acid was also done using standard biochemical kits. X-ray of Thoracic, Lumbar spine, Humerus, Hip region was evaluated. The frequency of variables was expressed as proportions and analysed. Results: The mean age of males was 62 and females 59 appropriately. The male/female ratio of Multiple myeloma was found to be 1.6:1. The associated neurological symptoms were root pain for 14.3% of patients. Almost 8.6% had paraparesis and 2.9% were suffering from paraplegia and 1.4% had quadriplegia, paraesthesia, buldging right eye and diplopia. Anemia was found in 87.1% and ESR was raised above 30 in 92.8% of patients. The total count more than Eleven thousand was found for 10% and less than four thousand for 1.4% of patients. Easnophilia was seen among 7.1%, 1.4% of patients had Peripheral smear >10% and Electrophoresis M band was seen in 78.6% of patients. Lytic lesions on X- Ray Skull neck were found in 62.9% and X Ray Spine were found in 1.4% of patients. Conclusion: 70 cases detected at a tertiary Medical College at Northern Kerala in a year indicate significant incidence of the disease. Professional Medical Associations should give importance to this topic and case studies of Multiple Myeloma should be included in medical conferences to raise the competence of doctors regarding the disease. Keywords: Multiple Myeloma, Northern Kerala.

Clinical evaluation of minimally invasive transforaminal lumbar interbody fusion for severe lumbar spinal stenosis

To investigate the clinical results and complication prevention of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-segment severe lumbar spinal stenosis (LSS). The clinical data of 112 patients with severe LSS treated with MIS-TLIF between January 2010 and January 2017 were retrospectively analyzed. There were 43 males and 69 females, aged 52-81 years, with an average age of 65.3 years. The disease duration ranged from 4 to 126 months, with an average of 10.5 months. Clinical manifestations: 104 cases of low back pain, 91 cases of nervous intermittent claudication of both lower limbs, 21 cases of unilateral nerve root pain and/or numbness, and 5 cases of cauda equina nerve injury. The 112 cases were all severe central spinal stenosis, including 32 cases with lateral recess stenosis, 20 cases with foramen stenosis, 9 cases with ossification of ligamentum flavum, 38 cases with disc herniation; 14 cases with two complications and 5 cases with three. Stenosis segment: L 3, 4 in 6 cases, L 4, 5 in 89 cases, and L 5, S 1 in 17 cases. Surgical methods included bilateral decompression through bilateral approach (60 cases), bilateral decompression through unilateral approach (15 cases), and unilateral decompression (37 cases). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI) score, fusion rate, and surgical complications were recorded. At last follow-up, the lumbar fusion was evaluated by Bridwell method, grades Ⅰ and Ⅱ were expressed as fusion. The operation time was 83-186 minutes (mean, 126.8 minutes), and the intraoperative blood loss was 65-630 mL (mean, 163.1 mL). All the 112 patients were followed up 25-49 months, with an average of 35.1 months. The VAS score of low back pain and leg pain and ODI score at each time point after operation were significantly improved when compared with preoperative scores ( P<0.05). There was no significant difference between the VAS score of low back pain and leg pain and ODI score at the other time points except 1 month after operation ( P<0.05). At last follow-up, 2 cases of cauda equina nerve injury recovered and 3 cases partially recovered. According to Bridwell classification criteria, 58 cases were grade Ⅰ, 47 cases were grade Ⅱ, and 7 cases were grade Ⅲ. The fusion rate was 93.8%. Perioperative complications included 5 cases of incision complications (superficial infection in 3 cases, hematoma formation in 2 cases), 19 cases of internal fixator complications (intraoperative end plate fracture in 8 cases, fusion cage sinking in 11 cases at last follow-up), and 15 cases of neurological complications (dural sac tear in 10 cases, transient neurological symptoms of lower extremities aggravated in 5 cases). MIS-TLIF treatment of single-level severe LSS can achieve good clinical results, while there is a risk of serious complications. Full understanding of the clinical and imaging features of the disease and reasonable and careful operation are helpful to control the occurrence of cauda equina nerve damage.