Spinal Nerve Injury Research Articles

A case-control study of minimally invasive transforaminal interbody fusion with the assistance of robot and traditional fluoroscopy in the treatment of single-space lumbar disc herniation

To compare the safety and nail placement accuracy of fluoroscopy-assisted and robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-space lumbar disc herniation. The clinical data of 52 patients with single-space lumbar disc herniation treated by MIS-TLIF from March 2019 to February 2020 were retrospectively analyzed. Among them, 24 patients were treated by robot-assisted MIS-TLIF(group A) and 28 patients were treated by fluoroscopy-assisted MIS-TLIF (group B). The intraoperative blood loss, operation time, intraoperative fluoroscopy times, preoperative and postoperative visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) scores and operation-related complications were recorded in two groups. Gertzbein-Robbins grade according to CT scan was used to evaluate the nail placement after operation. Grade A and B were evaluated as satisfactory nail placement, and grade C, D, and E were evaluated as error placement. Babu's method was used to evaluate the screw's invasion to the superior articular process. The operation time, intraoperative blood loss and intraoperative fluoroscopy times in group A were less than those in group B(P<0.05).VAS and JOA scores of all patients at the final follow-up were significantly improved compared with those before operation(P<0.05), but there was no statistically significant difference between the groups(P>0.05). There were 96 and 112 screws in group A and group B, respectively. Three days after operation, according to the Gertzbein-Robbins grade to evaluate the nail placement accuracy, there were 90 screws of grade A, 5 of grade B, 1 of grade C, no grade D and E in group A;there were 84 screws of grade A, 16 of grade B, 8 of grade C, 4 of grade D, no grade E in group B;the difference between two groups was statistically significant(Z=-3.709, P=0.000). The satisfactory rate of screw placement in group A was 98.96% (95/96), and that of group B was 89.29% (100/112), the difference between two groups was statistically significant (χ2=8.254, P=0.004). Three days after operation, the invasion of superior facet joints by pedicle screws was evaluated according to Babu's method, including 90 screws in grade 0, 4 in grade 1, 2 in grade 2, and 0 in grade 3 in group A;86 in grade 0, 12 in grade 1, 10 in grade 2 and 4 in grade 3 in group B, and the difference was statistically significant(Z=-3.433, P=0.001). There were no serious spinal cord, nerve and vascular injuries and other operation-related complications caused by screw implantation failure in both groups. All patients were followed up from 6 to 12(9.06±1.60) months. The neurological symptoms improved well after operation. During the follow-up period, there was no recurrence of symptoms, loosening or breakage of the internal fixation. Compared with the traditional fluoroscopy-assisted MIS-TLIF, the spinal robot-assisted MIS-TLIF not only has more minimally invasive and safer, but also has higher accuracy in nail placement, lower incidence of upper articular process invasion, and more accurate decompression targets, which can be used for minimally invasive treatment of single-space lumbar disc herniation.

Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case.

BACKGROUNDInjury to the spinal accessory nerve (Acc) results in loss of motor function of the trapezius muscle and leads to severe shoulder problems. A vast number of surgical strategies have been proposed to reinnervate (suture, grafting, and nerve transfers) or compensate (tendon and muscle transfers) the lost function of the trapezius muscle.OBSERVATIONSThe authors report a successful case of Acc reconstruction 5 months after the injury with the anterior C3 levator scapulae motor nerve branch transfer in omotrapezoid triangle of the neck.LESSONSThe advantages of the proposed technique over preexisting nerve transfers were discussed. We believe that this technique can be considered as an alternative to already existing techniques for proximal injuries to Acc.

Percutaneous Vertebroplasty with the Polymethyl Methacrylate - Gelatin Sponge Complex in the Treatment of Patients with Osteoporotic Vertebral Compression Fractures Accompanied by Superior Endplate Injurie.

To explore the clinical efficacy of percutaneous vertebroplasty (PVP) combined with the polymethyl methacrylate-gelatin sponge (PMMA-GS) complex in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs) accompanied by superior endplate injuries MATERIAL and METHODS: A total of 77 OVCF patients with superior endplate injuries who were treated with PVP from January 2017 to December 2020 were retrospectively analyzed. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and injured vertebral height ratio at one day (1d) before surgery, three days (3d) after surgery, and one year (1y) after surgery were compared between both groups. Besides, the surgical duration, PMMA (polymethyl methacrylate) injection volume, PMMA leakage rate, and adjacent vertebral fracture rate were compared between these two groups. Among these patients, there were 39 individuals treated with PVP combined with the PMMA-GS complex (the observation group) and 38 individuals treated with PVP (the control group). These patients in both groups completed the surgery successfully. There were no such complications as pulmonary embolism, hemopneumothorax, rib fracture, spinal cord nerve injuries, and vital organ injuries. In these two groups, the VAS score, ODI, and injured vertebral height ratio 1d before surgery were significantly different from those 3d and 1y after surgery (p < 0.05). However, there was no significant difference in these indexes between both groups (p > 0.05). There was no significant difference in the surgical duration and PMMA injection volume between both groups (p > 0.05). However, the PMMA leakage rate and adjacent vertebral fracture rate in the observation group were significantly lower than those in the control group (p < 0.05). Compared with traditional PVP, this therapy PVP combined with PMMA-GS complex in the treatment of OVCF patients with superior endplate injuries can effectively reduce the incidence of PMMA leakage and the incidence of adjacent vertebral fracture rate.

Preoperative ultrasound accurately characterizes surgically confirmed extracranial spinal accessory nerve injuries.

To determine the accuracy of preoperative ultrasound and MRI in surgically confirmed spinal accessory nerve injuries and present the benefits of a multimodality image review. A retrospective review of 38 consecutive patients referred to a peripheral nerve surgical practice at an academic teaching hospital with surgically confirmed spinal accessory nerve injuries. All cases were reviewed for patient demographics, date and cause of injury, preoperative EMG, and surgical diagnosis and management. Additionally, prospective interpretation of preoperative ultrasound and MRI reports were reviewed for concordance or discordance with the surgical diagnosis. Iatrogenic injury was present in 37 (97%) cases and most commonly a result of an excisional lymph node biopsy (68%). Surgically confirmed spinal accessory nerve injury diagnoses consisted of 25 (66%) stump neuromas and 13 (34%) incomplete nerve injuries. Nine months was the average time from injury to surgery. Twenty-nine patients underwent preoperative ultrasound and/or MRI evaluation: 12 ultrasound only, 10 MRI only, and seven with both ultrasound and MRI. Eighteen (95%) preoperative ultrasound reports compared to four (24%) preoperative MRI reports were concordant with the surgical diagnosis. In the seven cases with both preoperative ultrasound and MRI, six had discordant ultrasound and MRI imaging diagnoses for which the ultrasound was concordant with the surgical diagnoses in all cases. Preoperative ultrasound more accurately characterizes spinal accessory nerve injuries compared to MRI and should serve as the modality of choice when a spinal accessory nerve injury is suspected.

Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar

To evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar. A retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation. The operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B ( P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences ( P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B ( t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant ( P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation ( P>0.05). Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.

258. Epidemiological trends associated with football-related spine injuries

<h3>BACKGROUND CONTEXT</h3> Despite the health-related consequences associated with American football, it remains a ubiquitous part of American athletics. This study investigates trends in football-related spine injuries, focusing on the regional distribution of spine injuries across age demographics. We specifically focus on vulnerabilities in pediatric and adolescent populations, which constitute an overwhelming majority of emergency department (ED) cases. <h3>PURPOSE</h3> To identify age-related trends of football-related spine injuries presenting to the ED and also distinguish independent drivers of hospital admission following presentation for these injuries. <h3>STUDY DESIGN/SETTING</h3> NEISS database is a nationally representative, probability sample of hospital emergency departments (EDs) in the United States. <h3>PATIENT SAMPLE</h3> A total of 7,196 weighted cases of spinal injury associated with playing football were observed in the NEISS database. <h3>OUTCOME MEASURES</h3> National incidence and risk factors for admission to the ED versus discharge following spine fracture or spinal nerve injury associated with playing football. <h3>METHODS</h3> The National Electronic Injury Surveillance System (NEISS) database was queried for annual estimates of spinal injury sustained while playing football that presented to emergency departments across the United States between 2010 and 2019. Data regarding the nature and location of the injury were obtained. Patients' hospital dispositions were tracked as either discharged from ED or admission/transfer to another hospital. A multivariable logistic regression analysis was conducted to identify which factors among the available data were independently associated with admission to the hospital/transfer to another care facility versus discharge from the ED. <h3>RESULTS</h3> A total of 61.60% of football injury patients experienced vertebral fractures, while the other 38.40% of patients experienced spinal nerve injury. 23.29% of all injuries involved the neck/cervical spine, 39.56% affected the upper thoracic spine, and 37.16% involved the lower trunk/lumbar spine. Between ages 9-14, the majority of spinal injury cases involved the thoracic spine (54.86%), whereas ages 15-20 and among those 21 and older, the most common region of spinal injury was the lumbar spine (37.87% & 47.99%, respectively). Age cohort had a significant effect on the region of the spine that was injured (P<0.0001). Of patients who were injured while playing football, 73.2% were directly discharged from the ED, while the other 26.83% required either admission or transfer. Independent predictors of hospital admission/transfer to another hospital following a spinal injury related to playing football included a patient's age between 15 and 20 (OR: 1.960; 95% CI: 1.700 to 2.262) when compared to adults, Black/African American race (OR: 1.537; 95% CI: 1.301 to 1.814) when compared to White race, injury of the cervical spine (OR: 6.853; 95% CI: 5.855 to 7.996) or thoracic spine (OR: 2.810; 95% CI: 2.418 to 3.271) compared to the lumbar spine. <h3>CONCLUSIONS</h3> The pediatric population is more susceptible to injuries involving the thoracic spine while the adolescent and adult populations more commonly sustain injuries afflicting the lumbar spine. In addition to these age and anatomic trends, we found late adolescent age (15-20 years), Black/African American race, cervical spine injuries, and thoracic spine injuries to be independently associated with higher odds of hospital admission. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Overexpression of Reticulon 3 Enhances CNS Axon Regeneration and Functional Recovery after Traumatic Injury.

CNS neurons are generally incapable of regenerating their axons after injury due to several intrinsic and extrinsic factors, including the presence of axon growth inhibitory molecules. One such potent inhibitor of CNS axon regeneration is Reticulon (RTN) 4 or Nogo-A. Here, we focused on RTN3 as its contribution to CNS axon regeneration is currently unknown. We found that RTN3 expression correlated with an axon regenerative phenotype in dorsal root ganglion neurons (DRGN) after injury to the dorsal columns, a well-characterised model of spinal cord injury. Overexpression of RTN3 promoted disinhibited DRGN neurite outgrowth in vitro and dorsal column axon regeneration/sprouting and electrophysiological, sensory and locomotor functional recovery after injury in vivo. Knockdown of protrudin, however, ablated RTN3-enhanced neurite outgrowth/axon regeneration in vitro and in vivo. Moreover, overexpression of RTN3 in a second model of CNS injury, the optic nerve crush injury model, enhanced retinal ganglion cell (RGC) survival, disinhibited neurite outgrowth in vitro and survival and axon regeneration in vivo, an effect that was also dependent on protrudin. These results demonstrate that RTN3 enhances neurite outgrowth/axon regeneration in a protrudin-dependent manner after both spinal cord and optic nerve injury.

Treatment of Pain Due to Winged Scapula with Spinal Cord Stimulation: A Case Report

BACKGROUND: Winged scapula (WS) is a protrusion of the scapula giving the appearance of a wing and can be due to either a musculoskeletal or neurological insult. Pain associated with WS is multifactorial, including myofascial and neuronal mechanisms, and may be difficult to treat. CASE REPORT: In a case of WS refractory to conservative management with physical therapy and medications and not a candidate for nerve repair, we treated the pain with a spinal cord stimulator. We report significant pain reduction and improvement in function with the procedure. CONCLUSION: This case suggests a role for neuromodulation in WS and requires further investigation. KEY WORDS: Winged scapula, spinal accessory nerve injury, spinal cord stimulation, neuromodulation

Intraoperative spinal accessory nerve monitoring in neck dissections.

The identification and preservation of the spinal accessory nerve (SAN) is essential in neck surgeries due to possible complications. We report the technique to intraoperative neuromonitoring (IONM) of SAN in functional neck dissections. SAN was monitored by needle electrodes placed on the trapezius muscle. Preoperative and postoperative nerve mapping was performed. IONM for spinal accessory nerve in patients undergoing neck dissection is a useful technique that can be valuable for neck surgeries where spinal nerve injury is at risk.

Complications after Functional Neck Dissection in Head and Neck Cancer Patients: An Observational, Retrospective, Single-Centre Study

Introduction: Functional neck dissection (FND) represents a surgical procedure usually associated with less morbidity. Methods: An observational, retrospective, analysis of patients diagnosed with any type of head and neck malignancy was designed to summarize and report the incidence of postoperative complications in patients undergoing FND including just those levels described for selective neck dissections in a tertiary university hospital between June 2016 and June 2019. Results: 131 patients met the inclusion criteria. The total number of sides studied was 200. 40.5% of the patients suffer a complication in the postoperative period, being the spinal accessory nerve (SAN) injury the most common complication (10%). We did not find any statistical ­correlation between the previous organ-preservation treatments and surgical complications (p = 0.207). An advanced T stage (p = 0.009) and the need of bilateral FND (p = 0.034) were significantly correlated with a higher risk of surgical complications. Conclusion: FND represents a useful technique. In this study, 40.5% of the patients suffer a complication in the postoperative period, being the SAN injury the most common complication. However, these data contribute to increasing our knowledge about surgical complications related to FND.

Three-Dimensional Mapping of Retrograde Multi-Labeled Motor Neuron Columns in the Spinal Cord

The quantification and distribution characteristics of spinal motor neurons play important roles in the study of spinal cord and peripheral nerve injury and repair. In most research, the sole retrograde labeling of each nerve or muscle could not simultaneously obtain the distributions of different motor neuron subpopulations. Therefore, it did not allow mapping of spatial relationships of different motor neuron columns for disclosing the functional relationship of different nerve branches. Here, we combined the multiple retrograde labeling, optical clearing, and imaging for three-dimensional (3D) visualization of motor neurons of multiple brachial plexus branches. After screening fluorescent tracers by the labeling feasibility of motor neurons and fluorescence compatibility with optical clearing, we performed mapping and quantification of the motor neurons of ulnar, median, and radial nerves in the spinal cord, then disclosed the relative spatial distribution among different neuronal subpopulations. This work will provide valuable mapping data for the understanding of the functional relationships among brachial plexus branches, hopefully facilitating the study of regeneration of axons and remodeling of motor neurons in peripheral nerve repair.

Rapid elevation of brain-derived neurotrophic factor production in the bilateral trigeminal ganglia by unilateral transection of the mental nerve in mice.

Previous spinal nerve injury studies have reported brain-derived neurotrophic factor (BDNF) mRNA upregulation in either the ipsilateral dorsal root ganglion (DRG) neurons or both the contralateral and ipsilateral DRG neurons from early period after peripheral nerve injury. This BDNF elevation induces hyperalgesia in the injured and/or uninjured sites, but this detailed mechanism remains unknown. This study aimed to investigate the BDNF mRNA expression in bilateral DRG neurons caused by unilateral nerve injury and to explore the possible mechanisms by which nitric oxide (NO) mediates BDNF production in the DRG, resulting in contralateral hyperalgesia. Early changes in BDNF mRNA expression in the bilateral trigeminal ganglia, within 1 day after mental nerve transection, were examined. Additionally, the effects on BDNF production of the NO synthase inhibitor N(ω)-nitro-l-arginine methyl ester (L-NAME) were investigated in the bilateral trigeminal ganglia. The relationship between injured neurons and BDNF production in the trigeminal ganglia was then assessed using immunohistochemical and retrograde tracing methods. Reverse transcription-PCR analysis demonstrated that unilateral transection of the mental nerve induced a rapid elevation of BDNF mRNA expression, which was inhibited by the intracerebroventricular administration of L-NAME prior to nerve transection. This effect was observed in both the ipsilateral and contralateral sides to the nerve transection. BDNF immunostaining combined with FluoroGold retrograde tracing revealed two types of BDNF-reactive neurons, FluoroGold-labelled and non-FluoroGold-labelled neurons, in the ipsilateral and contralateral sides of the trigeminal ganglia. BDNF-positive cells were also observed in the trigeminal ganglia of other trigeminal nerve branches. Unilateral nerve injury upregulates BDNF production in the bilateral trigeminal ganglia by NO-mediated and/or indirect activation of afferent neurons, resulting in contralateral hyperalgesia.

Effect of electroacupuncture on angiopoietin-1 in spinal cord of rats with neuropathic pain

To observe the effect of electroacupuncture (EA) on the behavior, histomorphology and the expression of angiopoietin-1 (Angpt-1) in rats with spinal nerve injury, so as to explore its mechanism on neuropathic pain. Forty-five male SD rats were randomly divided into sham, model and EA groups (n=15 rats in each group). Spinal nerve ligation (SNL) of the L5 lumbar vertebra was performed to establish a rat model of neuropathic pain. The rats in the EA group were given EA at "Zusanli" (ST36) and "Kunlun" (BL60) of the operation side with continuous wave at a frequency of 2 Hz and an intensity of 1.5 mA once a day, 30 minutes each time for 7 days. The sham group only exposed L5 spinal nerves without ligation. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were observed and recorded before modeling and on days 3,5,7,10,12 and 14 after modeling. L4-L6 segments of spinal cord were taken and the morphological changes of spinal dorsal horn were observed by HE staining. The changes of spinal dorsal horn nerve fiber structure were observed by silver plating staining. Angpt-1 expression was detected by Western blot and immunohistochemistry. Compared with the sham group, the model group had significant reductions in MWT and TWL at each time point (P<0.01); compared with the model group, the EA group had significant increases in MWT and TWL on days 10,12 and 14 after intervention (P<0.05, P<0.01). HE staining showed that in the model group, the spinal dorsal horn showed degeneration and necrosis of neurons, nuclear fixation and shrinkage, and loose surrounding tissues. The degree of tissue damage of the EA group was milder than that of the model group. The silver staining results showed the model group had obvious neuronal fibrillary tangles, while there were fewer neuronal fibrillary tangles in the EA group. Compared with the sham group, the Angpt-1 expression in the model group was significantly decreased (P<0.01), and compared with the model group, the EA group had a significant increase in the expression of Angpt-1 (P<0.01). EA can promote the recovery of nerve function in SNL rats by up-regulating Angpt-1 expression.

S100A4 in Spinal Substantia Gelatinosa from Dorsal Root Ganglia Modulates Neuropathic Pain in a Rodent Spinal Nerve Injury Model.

PurposeTo detect the spatio-temporal expression of S100A4 in a spinal nerve ligation (SNL) rat model. Also to figure out which other molecules directly interact with S100A4 to explore the possible mechanisms which might be involved in neuropathic pain.MethodsSeven-week-old male SD rats were used for the SNL model construction. Immunofluorescence and Western blotting were used to detect the spatio-temporal expression of S100A4 in the model. S100A4 was co-labeled with a number of related molecules and marker molecules that can distinguish between cell types. After intrathecal injection of S100A4 neutralizing antibody, the behavioral changes of SNL rats were recorded, and molecular changes compared. The direct interaction between S100A4 and other related molecules was verified by co-immunoprecipitation (co-IP) to explore its possible mechanism.ResultsAfter spinal nerve ligation, the content of S100A4 in the dorsal root ganglion (DRG) and spinal dorsal horn increased significantly. Intrathecal injection of S100A4 neutralizing antibody could effectively relieve the mechanical pain in rats. co-IP revealed a direct interaction between S100A4 and RAGE.ConclusionThe content of S100A4 in the DRG and spinal dorsal horn of SNL rats increased, compared with that of the control group. Intrathecal injection of S100A4 neutralizing antibody could effectively relieve the mechanical pain in SNL rats. S100A4 may be involved in the production of neuropathic pain through RAGE or other ways, but the specific mechanism needs to be further studied.

Preparation of Poly(3-hydroxybutyrate-co- 3-hydroxyvalerate) Nanofiber Catheter and Its Mechanism of Nerve Injury in Patients with Cervical Spine Injury.

At present, surgical suture treatment can be performed for spinal patients after nerve injury, but nerve regeneration and functional recovery require comprehensive treatment including drug treatment. However, there is still a lack of adjuvant therapeutic drugs that can effectively promote nerve regeneration and functional recovery. Drug treatment after nerve injury is the basis of nerve injury treatment and an important supplement to surgical treatment. Finding an effective method for treating spinal nerve injury and studying its mechanism of action may have important basic and clinical significance. The nanofiber catheter material simulates the nano/sub-micron level collagen fiber bundle structure of cells in the body, so it has been more and more widely used in the field of tissue engineering. Therefore, in this study, PHBV nanofiber catheter was successfully prepared by electrostatic spinning method, and the nanofiber catheter was characterized by SEM and DSC tests. The PHBV nanofiber catheter prepared by this research method has excellent characteristics such as porosity, large specific surface area, stable structure, thermal stability, and good mechanical properties. At the same time, adult male SD rats were selected to establish an animal model of cervical spine injury in this experiment. The expressions of three inflammation-related factors (IL-1α, IL-10 and TNF-1) were analyzed by ELISA. The results showed that in the spinal injury group, the expression of the three inflammatory factors all showed a significant increase over time and then reached a peak, then decreased and stabilized. This showed that the PHBV nanofiber catheter repairs cervical spine injury by affecting the inflammatory response, which is conducive to repairing cervical spine injury. RT-PCR was used to detect the expression of CNTF, GAP-43, and Tubulin-related proteins. During the neural regeneration process in rats, the expressions of both backbone proteins continued to be expressed, and they were first up-regulated and then flattened. This indicated that in the early stage of neural regeneration, a large number of skeletal proteins are synthesized, and they continue to be expressed at low levels over time, laying a foundation for the axon skeleton reconstruction.

Graphene oxide-composited chitosan scaffold contributes to functional recovery of injured spinal cord in rats.

The study illustrates that graphene oxide nanosheets can endow materials with continuous electrical conductivity for up to 4 weeks. Conductive nerve scaffolds can bridge a sciatic nerve injury and guide the growth of neurons; however, whether the scaffolds can be used for the repair of spinal cord nerve injuries remains to be explored. In this study, a conductive graphene oxide composited chitosan scaffold was fabricated by genipin crosslinking and lyophilization. The prepared chitosan-graphene oxide scaffold presented a porous structure with an inner diameter of 18-87 μm, and a conductivity that reached 2.83 mS/cm because of good distribution of the graphene oxide nanosheets, which could be degraded by peroxidase. The chitosan-graphene oxide scaffold was transplanted into a T9 total resected rat spinal cord. The results show that the chitosan-graphene oxide scaffold induces nerve cells to grow into the pores between chitosan molecular chains, inducing angiogenesis in regenerated tissue, and promote neuron migration and neural tissue regeneration in the pores of the scaffold, thereby promoting the repair of damaged nerve tissue. The behavioral and electrophysiological results suggest that the chitosan-graphene oxide scaffold could significantly restore the neurological function of rats. Moreover, the functional recovery of rats treated with chitosan-graphene oxide scaffold was better than that treated with chitosan scaffold. The results show that graphene oxide could have a positive role in the recovery of neurological function after spinal cord injury by promoting the degradation of the scaffold, adhesion, and migration of nerve cells to the scaffold. This study was approved by the Ethics Committee of Animal Research at the First Affiliated Hospital of Third Military Medical University (Army Medical University) (approval No. AMUWEC20191327) on August 30, 2019.

Treatment of Thoracic Ossification of Posterior Longitudinal Ligament with One-Stage 360 Degree Circumferential Decompression Assisted by Piezosurgery

Objectives To evaluate the safety and clinical efficacy of One-Stage 360 degree circular decompression for thoracic ossification of the posterior longitudinal ligament (TOPLL) assisted by piezosurgery. Materials and methods The present study enrolled 36 patients with TOPLL between August 2016 and February 2019. The average intraoperative bleeding volume of all 36 patients in this study is 1058.61 ±737.66 ml. Results All patients did not experience any intraoperative complications such as spinal cord and nerve injuries, and 22 other complications related to decompression of OPLL cited in other literature; all of which were relieved after treatment. The resection time of single laminectomy was 3.43 ±0.49 min, and circular decompression was 42.06 ±14.22 min. At the last follow-up, the modified Japanese Orthopaedic Association (mJOA) score was 8.89 ±1.56, the recovery rate of spinal cord function was 64.2 ±21.2%, and the number of cases of spinal cord function deterioration was 0 (0%). The mJOA score of the last follow-up was negatively correlated with the time of circular decompression (r = 0.368, p ＜ 0.01) and age (r = 0.412, p = 0.026). The recovery rate of the spinal cord function was negatively correlated with the operation time of circular decompression (r = -0.325, p = 0.041) and the amount of intraoperative blood loss (r = -0.555, p = 0.028). Conclusions The use of piezosurgery can safely and effectively complete one-stage simple posterior TOPLL with 360-degree circular decompression. The incidence of complications is not high, and a good outcome can be obtained.

Short-term effectiveness comparison of unipedicular versus bipedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures with posterior wall broken

To compare the short-term effectiveness and safety of unipedicular versus bipedicular percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) with posterior wall broken. The clinical data of 68 patients with OVCF with posterior wall broken and without posterior ligament complex injury and spinal cord nerve injury between June 2013 and December 2018 were retrospectively analyzed. According to the different operative approaches, the patients were divided into two groups: group A (36 cases received PKP via bilateral pedicle puncture) and group B (32 cases received PKP via unilateral pedicle paracentesis). There was no significant difference between the two groups in gender, age, fracture vertebra distribution, time from injury to operation, preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), and height of injured vertebra ( P>0.05). The operation time, intraoperative fluoroscopy times, and bone cement volume were recorded and compared between the two groups. The VAS score and ODI score were used to evaluate the effectiveness before operation, at 1 day and 6 months after operation; the height of injured vertebra was measured on the lateral X-ray film, and the recovery height of injured vertebra at 1 day after operation and the loss height of injured vertebra at 6 months after operation were calculated; the intraoperative and postoperative complications of the two groups were recorded. The operation time, intraoperative fluoroscopy times, and bone cement volume of group B were significantly less than those of group A ( P<0.05). All patients were followed up 10-35 months, with an average of 18 months. During the operation, there were 2 cases (5.56%) of cement leakage in group A and 9 cases (28.13%) in group B, showing significant difference ( χ 2=4.808, P=0.028). There was no adverse reactions of bone cement, iatrogenic spinal cord injury, infection of puncture port, or other complications in the two groups. During the follow-up period, there were 3 cases (8.3%) of adjacent vertebral fractures in group A and 2 cases (6.3%) in group B, showing no significant difference between the two groups ( χ 2=0.027, P=0.869). The height of injured vertebra of the two groups at 1 day and 6 months after operation were significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the height of injured vertebrae and the recovery height of injured vertebra at 1 day after operation between the two groups ( P>0.05). However, at 6 months after operation, the height of injured vertebra in group B was significantly lower than that in group A ( P<0.05), and the loss height of injured vertebra in group B was significantly higher than that in group A ( P<0.05). The VAS score and ODI score at 1 day and 6 months after operation were significantly improved when compared with preoperative ones in both groups ( P<0.05), but there was no significant difference between the two groups ( P>0.05). Both bipedicular and unipedicular PKP can obtain satisfactory effectiveness for the treatment of OVCF with posterior wall broken, but the former may have advantages of lower cement leakage rate and less height loss.

The Modified Eden-Lange Tendon Transfer for Lateral Scapular Winging Secondary to Spinal Accessory Nerve Injury

Trapezius paralysis following injury to the spinal accessory nerve can be a debilitating complication resulting from lymph node biopsy, radical neck dissection, or penetrating trauma in the region of the posterior cervical triangle. Disruption of the delicate muscular balance in the shoulder girdle may result in lateral scapular winging, ipsilateral upper extremity radiculopathy, and limited shoulder function and range of motion. Spontaneous recovery with nonoperative management is possible in some patients, and restoration of function after reparative neural procedures has been observed in patients undergoing timely repair. However, extended delays from the time of injury to surgery are common and may necessitate various muscle transfers to reestablish the complex biomechanics and balance of the shoulder girdle. We describe a modification to the classic Eden-Lange procedure with lateral transfer of the levator scapulae and rhomboid minor to the scapula spine and rhomboid major transfer with a small wafer of bone to the scapula body for chronic lateral winging of the scapula following injury to the spinal accessory nerve as the result of a cervical lymph node biopsy.

69. Ischemic spinal nerve root injury secondary to herniated lumbar intervertebral disc

BACKGROUND CONTEXT The painful clinical sequelae associated with sciatica secondary to intervertebral disc herniation have been traditionally attributed to mechanical compression of the spinal nerve root. More recent studies have also implicated inflammatory mediators and microvascular changes in the pathogenesis of acute sciatica. The application of nucleus pulposus (NP) to a spinal nerve root has been shown to induce thrombus formation in the associated nerve microvasculature and result in greater injury to the axons in the center than in the periphery, suggesting an ischemic mechanism of injury. The spinal nerve blood flow changes that are associated with nerve dysfunction seen in acute sciatica offer a potential target for therapeutic intervention. The VEGF angiogenic cytokines have been demonstrated to be potent stimulators of the differentiation and function of vascular endothelial cells after injury. PURPOSE To determine the relationship between the severity of spinal nerve root injury in patients with acute sciatica secondary to lumbar disc herniation (AS/LDH) undergoing surgical discectomy and the levels of VEGF-A and VEGF-B in serum, spinal nerve root lavage and disc tissue homogenate. STUDY DESIGN/SETTING ELISA cytokine immunoassay. PATIENT SAMPLE Twenty-four patients with AS/LDH of less than 16 weeks duration, undergoing laminectomy discectomy surgery. OUTCOME MEASURES VEGF-A and VEGF-Bconcentrations (pg/ml) in herniated nucleus pulposus homogenate (HNP-H), spinal nerve root lavagate (SN-L) and serum. METHODS At the time of surgery, the spinal nerve root was lavaged with 5 cc of saline, the extruded disc tissue removed surgically and serum samples were obtained. Disc and lavagate samples were stored in physiological buffer with protease inhibitors at -80° C. The concentrations of VEGF-A and VEGF-Bin disc tissue homogenate, serum and lavagate samples were measured in triplicate using ELISA immunoassay. Research ethics committee approval was obtained. RESULTS In AS/LDH patients, VAS pain and significant spinal nerve root deficit scores (3.0 - 4.0/5) correlated closely with serum and HNP-H tissue levels of VEGF-A and VEGF-B (Pearson r=0.78). In 11/24 patients, elevated VEGF-A and B concentrations correlated to a moderate degree with TNFα and IL-2, 6 and 8 inflammatory cytokine levels (r=0.61). Low concentrations of VEGF and inflammatory cytokine concentrations were seen in all SN-L test samples. CONCLUSIONS In patients with acute sciatica secondary to lumbar disc herniation, the severity of spinal nerve injury appears to be related to a combined mechanism, involving ischemic and inflammatory components. This research study was funded by grants from the National Institutes of Health, Bethesda, USA and from the University of British Columbia Orthopaedic Research Excellence Fund. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.