The early treatment principles of spinal cord injury (SCI) included early drug using, early surgery and early rehabilitation.The literatures on how to use drug early and how to control the time for SCI before surgery were reviewed.

Objective To evaluate the long term outcome of spondylolytic spondylolisthesis treated with Steffee system and posterolateral fusion. Methods Thirty- four patients were followed up for an average of 77.2 months. The follow- up study include slipping percentage, slipping angle, heights of intervertebral space and foramen, fusion rate, screw broken rate and clinical outcomes. Results 1) Solid fusion was obtained in 88.2％ of patients. screw broken rate was 2.9％ . 2) Comparison of pre- and post- operative slip showed correction rate of 45.1％ . The heights of intervertebral space and foramen increased, slipping angle decreased. 3) During the period of follow- up, recurrence of deformity was found. 4) The subjective outcome was better than the objective outcome. Conclusion 1) Lumbar spondylolytic spondylolisthesis with radicular symptom need complete decompression and reduction as much as possible. 2) A positive slipping angle indicates significant shearing force and the need of an interbody fusion to restore the weight- bearing capacity. 3) Objective criteria is more suitable to evaluate surgical outcome.

BACKGROUND:Percutaneous vertebroplasty has been extensively applied in treatment of osteoporotic vertebral compression fractures, and now it is also used in spinal metastatic tumor. OBJECTIVE:To evaluate the effectiveness of percutaneous vertebroplasty for metastatic tumor of thoracic lumbar vertebrae by bone cement perfusion at different times and temperature gradient. METHODS:A total of 24 cases (38 vertebrae) of metastatic tumor receiving percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient were reviewed retrospectively. Al patients were classified into group A (11 vertebrae in 9 cases) featured with apparent vertebral compression (≥ 1/4) and group B (27 vertebrae in 15 cases) of no obvious compression (<1/4). The percutaneous vertebroplasty was conducted with C-arm fluoroscopy positioning. Bone cement was injected by perfusion at different times and temperature gradient method. Visual Analogue Scales and Owestry Disability Index were recorded to assess pain al eviation and functional restoration before and after bone cement injection at different times and temperature gradient. The height of treated vertebrae was also analyzed. Fol ow-up was performed for 12 to 56 months. RESULTS AND CONCLUSION:Al 24 patients successful y underwent percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient. Bone cement (4±1) mL was averagely injected into each thoracic vertebra. Bone cement (5±1) mL was injected into each lumbar vertebra. Postoperative recheck radiographs revealed good bone cement distribution, no nerve root injury or spinal compression occurred. Vertebral height was significantly higher posttreatment compared with pretreatment in both groups (P<0.05). Visual Analogue Scales and Owestry Disability Index scores were significantly lower at 1 day, 1 month after treatment and during final fol ow-up compared with preoperation in al patients (P<0.05). No significant difference in Visual Analogue Scales and Owestry Disability Index scores was detected between two groups at the same time point. Results suggested that percutaneous vertebroplasty and bone cement perfusion at different times and temperature gradient for metastatic tumor of thoracic lumbar vertebrae could reduce the occurrence of bone cement leakage, and could ease the pain quickly for apparent and non-apparent compressed tumor metastatic vertebrae. It is an effective method to treat metastatic tumor of vertebrae.

Objective To investigate the anti-chronic stress effect of bone marrow mesenchymal stem cell (BMSCs) transplantation in rats with spinal cord injury.Methods Forty-eight adult SD rats were divided into control group,model group and treatment group according to the random number table,with 16 rats each.In model and treatment groups,lower thoracic (T10) spinal cord injury were constructed using the modified Allen's method.In control group,only laminectomy was performed.After 7 days,100 μl Hank's buffer suspension containing 1.0 × 106 BMSCs was injected into the subarachnoid space of L4-5 intervertebral space of rats in control group and treatment group.While in model group,only the equal volume of Hank's buffer was used.Basso-Beattie-Bresnahan (BBB) scale was performed to evaluate hindlimb motor function in rats.At postoperative 14 and 28 days,blood samples were collected to measure adrenocorticotropic hormone (ACTH),norepinephrine (NE),epinephrine (E) and corticosterone (CORT) using the ELISA method;brains were harvested for the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor proteins GluR1 and GluR2 immunohistochemical staining.Results After injury,BBB scores in model and treatment groups were similar,but both were lower than that in control group (P ＜ 0.05).After BMSCs transplantation,BBB score in treatment group [21 d:(9.85 ± 0.82)points and 28 d:(11.23 ±0.68)points] improved continuously compared to model group [21 d:(8.42 ± 0.39) points and 28 d:(8.84 ± 0.25) points],but all were lower than that in control group [(21.00 ±0.00)points,P ＜0.05].ACTH contents in model and treatment groups at 14d [(104.80±6.16) and (98.50 ± 4.07) pg/ml] and 28 d [(101.40±2.33) and (96.50± 2.28) pg/ml] were higher than those in control group [(90.40 ± 1 1.36) and (83.20 ± 5.22) pg/ml] (P ＜ 0.05).CORT contents in model and treatment groups [(44.40 ± 1.44) and (43.30 ± 1.17) ng/ml] was lower than that in control group [(48.20 ± 2.27) ng/ml] at 14 d,but were found to be elevated [(70.40 ± 1.90) and (61.40 ± 1.83) ng/ml] compared to control group [(46.40 ± 1.49) ng/ml] at 28 d (P ＜ 0.05).Meanwhile,the CORT content in treatment group was lower than that in model group (P ＜ 0.05).Changes in NE and E contents among the groups were similar with ACTH.Immunohistochemical staining suggested the amounts of GluR1 and GluR2 positive cells in treatment group lowered compared to control group (P ＜ 0.05),but increased in model group compared to control group (P ＜ 0.05).Conclusion BMSCs transplantation can improve the hindlimb motor function,contribute to reducing the secretion of stress-related hormones ACTH,CORT,NE and E,and down-regulate the expression of AMPA receptor proteins GluR1 and GluR2 in rats with spinal cord injury,suggesting a potential role in antichronic stress.

[Objective]To investigate the feasibility of the placement of pedicle screws in the thoracolumbar vertebrae under X-ray fluoroscopy step by step.[Method]Eight human cadaveric thoracolumbar spines(T9~L5) were selected and classified into group A and group B randomly,each having 4 specimens.Pedicle screws in group A were placed under X-ray fluoroscopy step by step.CT scanned the specimens of group A and measured the half pedicle length,full pedicle length and the pedicle screw passage length.The "e" angle and "f" angle of pedicle were measured on CT images.When the guide wire was pricked to the half of pedicle length,the wire tip was located at the middle line of the pedicle projection in the standard posterior-anterior image.When the wire was pricked to the full pedicle length in lumbar vertebrae,its tip was located at 3/4 line of the pedicle projection in the standard posterior-anterior image.When the wire was pricked to the full pedicle length in thoracic vertebrae,its tip was located at between 1/2 line and 3/4 line of the pedicle projection.When the wire was pricked into vertebrae,the depth of the wire and the "e" angle were noted in standard lateral image.Pedicle screws were placed by the track of the guide wire.Pedicle screws in group B were placed by traditional technique.The accuracy and feasibility of the method under X-ray fluoroscopy step by step were evaluated by observation of the position of the pedicle screws in group A and group B.[Result] Four of 72(5.56%) pedicle screws were found to have perforated the pedicle wall in group A,and 19 of 72(26.38%) pedicle screws perforated the pedicle wall in group B.The result of group A was superior to that of group B(P

[Objective]To evaluate the effects of transpedicular internal fixation system for occipitocervical fusion.[Method]From Jan.2004 to Jan.2007,occipitocervical fusion was performed in 21 patients(12 male,9 female,mean age 45.3 years) with transpedicular internal fixation system(Sofamor Danek Company).There were 14 with upper cervical tumor,3 with cervical congenital malformation and 4 with dens axis fracture combined with atlantoaxial dislocation.The clinical outcomes were investigated by clinical observations,radiologic studies and statistical analysis.[Result]All the patients were followed up for 6 to 40 months with an average of 21 months.The result of X-ray showed that bony fusion was successful in 16 patients at 3 months and 5 patients at 6 months of follow-ups.There was no deterioration of spinal cord injury.The JOA scores of neurofunction increased from 5-17 points(mean 12.6 points) to 8-17 points(mean 15.8 points),with the improvement of 72%.All patients were partly limited in rotation movement.Seventeen patients had a rotatain of 100?,three was 80?,and one was 50?.[Conclusion]Transpedicular internal fixation system has multiaxial screw of three-column fixation and plastic rods,which offers strong fixation and good fusion.It can also benefit the maintenance of cervical curve.It is an effective and reliable method for reconstruction of upper cervical stability.

[Objective]To study the prophylactic effects of high dose methylprednisolone(MP) for perioperative surgical treatment of thoracic spinal stenosis.[Method]From July 2003 to December 2007,a retrospective study of 40 patients who underwent simply posterior thoracic vertebral canal decompression was made.The patients were divided into 2 groups according to the application of MP or none-MP at perioperation.Twenty-one patients in MP group were treated with MP stoss(30 mg/kg,iv 15 min) 30 min prior to the decompression and then 45 min later MP(5.4 mg/kg/h) was continuted for 23 hours.Nineteen patients in the control group were treated with dexamethasone(DX) 15 mg 30 min prior to the decompression and then DX(10 mg/d,iv) was given for 3 days after operation.Neurological function improvement rates were evaluated according to the JOA scores(postoperative JOA scores-preoperative JOA scores /17﹣preoperative JOA scores)?100% at 3d,7d,3d and 12 months after operation.Complication were observed.[Result]Neurological function recovery rates were 33.54?10.01% in MP group and 28.29?8.73% in the control group at 3 days after operation.The difference was found to be significant(P0.05).Neurological deficit was found in 5 in control group,while no one in the MP group.[Conclusion]High dose of MP used perioperatively for thoracic stenosis can protect spinal cord and improve operative security,while it does not increase serious adverse complications.

[Objective]To develop an animal pulmonary cement embolism model,by which the effect of polymethylmethacrylate(PMMA),calcium phosphate cement(CPC) and silk fibroin/calcium phosphate cement composite(SF/CPC) on the hemodynamic change,respiratory function and the antithrombin activity were measured after the pulmonary embolism caused by cement injection.The efficiency of SF reducing the risk of cardiovascular complication was evaluated.[Method]Twenty-four pigs were assigned to 3 groups randomly,with 8 pigs in each group.After general anesthesia,animals were endotracheal intubated and mechanically ventilated by a respirator.The pulmonary trunk was exposed via sternotomy and each kind of cement was injected into the main pulmonary artery.Hemodynamic parameters were continuously monitored.Blood samples were drawn at certain time points for blood gases analyzing and measurement of AT Ⅲ.Postmortem lungs were subject to computer tomography(CT) examination along with three-dimensional reconstructions of cement casts.[Result]The injection of CPC caused severe pulmonary hypertension and arterial hypotension,with a maximum elevation of 20.93?5.04 mmHg in PAP(20 min post-injection) and a maximum decrease of-26.59?6.8 mmHg in MABP(50 min post-injection).The changes in SF/CPC group were relatively slighter,which is similar with PMMA group,having a statistically significant difference from CPC groups(P

0.05). Conclusion The study of the characteristic of track of percutaneous transpedicular puncture is good for the safe procdure under image guidance. The standard track is safe for transpedicular or parapedicular puncture. The percutaneous transpedicular puncturing sites can be located according to the spinous process.

Objective To investigate therapeutical methods on lumbar disc herniation with posterior edge separation of the vertebral body. Methods Different methods were applied to 31 patients, including 24 males and 7 females whose ages ranged from 18 to 61 years. Except that 2 patients with mild lumbar pain were treated with conservative therapy, the other 29 patients were treated with operation. The operations were made according to the relationship between compressive hernia and vertebral canal. For instance, for cases that the herniated mixtures were lateral, decompression with fenestration or amplified fenestration was applied to the trouble side; for cases that mixtures were central or paracentral, the same treatment was applied to both sides; and posterior lumbar interbody fusion(PLIF) or transforaminal lumbar interbody fusion (TLIF) was applied to those that the mixtures occupied most part of the front canal. Results The follow-up studies were made for all the patients for 1 to 4 years with an average period of 2.6 years. For the two patients treated with conservative therapy, one was fully recovered and the other, who took no effect from former therapy, was finally recruited after decompression with fenestration on the trouble side. Among the patients who were treated with operation, those with lateral herniated mixtures received significant effect, while only 60% of those with central or paracentral mixtures recovered (the unrecovered or even worsened patients after operation finally recruited by PLIF), and for those with mixtures occupying most part of the front canal, satisfactory effect were achieved. Conclusion Operation treatment should be applied to patients as early as possible when conservative therapy has no obvious effect. Different operation methods should be taken according to the relationship between compressive hernia and vertebral canal: 1) Decompression with fenestration or amplified fenestration on the trouble side be applied to those with lateral herniated mixtures; 2) Decompression with fenestration on both sides be applied to those with paracentral mixtures but no lateral crypt narrowness, and PLIF or TLIF to those with central mixtures or lateral crypt narrowness; 3) PLIF or TLIF be applied to those with mixtures occupying most part of the front canal.