[Objective]To assess whether the canal compromise and the location of conus medullaris determine neurological deficit in burst fracture of the first lumbar vertebra(L1).[Method]Twenty-seven consecutive patients with L1 burst fracture were collected in the study.The compressive ratios of anterior and posterior heights of fractured vertebral bodies,the remains to the estimated ones of the original vertebral bodies were measured on the radiogram,the extent of spinal canal compromise was assessed by computed tomography,and the location of conus medullaris was determined by the MRI examination.The neurological status was evaluated according to the standard neurological classification of spinal cord injury(ASIA).[Result]The compressive ratio of the anterior height was 0.63,the posterior height was 0.91,the stenotic ratio of the canal mid-sagital diameter was 0.69,the stenotic ratio of the distance between pedicles was 1.14,and the stenotic ratio of canal area was 0.83.The group having the stenotic ratio of canal area below 0.5 was at significant risk of neurologic involvement than the control [above(or equal to) 0.5(P=0.049)],and the group with lower conus medullaris had more serious neurological deficit than the upper ones(P=0.046).[Conclusion]There is a significant difference of neurological deficit between the groups with the spinal canal stenosis level of more than 50% and less 50%,and the group with lower conus medullaris had more serious neurological deficit than the upper one.

ObjectiveTo observe the effect of surgical management on the thoracolumbar Chance fracture.Methods12 cases with thoracolumbar Chance fracture who accepted surgical management were followed-up 12 to 42 months(the mean was 21 months). ResultsDistraction deformity of posterior element were reduced significant in all patients, meanwhile, compression of anterior column was restored. Neurological function of all incomplete paraplegia patients improved their ASIA classification at least one grade. ConclusionSurgical treatment and internal fixation were suitable for stabilization of Chance fracture, neurological recovery and early rehabilitation.

Objective To investigate the effect of problem- based learning (PBL) combined with evidence- based medicine (EBM) on clinical teaching for postgraduates of spinal cord injury rehabilitation. Methods Postgraduates who studied in our ward between April 2010 to March 2012 were enrolled as control group (n=12) and received traditional teaching. Postgraduates who studied in our ward between April 2012 to March 2014 were enrolled as test group (n=12) and received PBL combined EBM in addition. Their achievement of academic and practical (case analysis) tests were compared, and they were investigated with questionnaire of satisfaction. Results There was no significant difference between the groups in achievement of academic and practical (case analysis) tests (P>0.05). The score of progressive knowledge was significantly higher in the test group than in the control group (P<0.01). The results of questionnaire showed that the level of literature retrieval, English, self-learning and analyzing-summarizing improved more in the test group than in the control group (P<0.05). There was no significant difference between the groups in terms of improvement of clinical thinking, nor of the satisfaction about teacher and teaching method (P>0.05). Conclusion PBL combined with EBM can improve the teaching for postgraduates majored in spinal cord injury rehabilitation.

ObjectiveTo study the mechanisms and related factors and preventive managements of the stress ulcer complicating with acute cervical spinal cord injury. MethodsThe clinical findings of eight cases of the acute cervical spinal cord injury with stress ulcer were reviewed retrospectively.ResultsFive cases were cured by conservative treatment, one case was cured after operations, two cases died of breath and circulation failure.ConclusionStress ulcer is a critical complication of acute cervical spinal cord injury. It should be prevented actively.

3 cases with esophageal fistula following anterior cervical fixation were reported. The diagnosis, treatment, nursing and prevention were summarized with literature.

ObjectiveTo investigate the effect of both conservative and surgical treatment on cervical spinal cord injury without fracture and dislocation.MethodsResultsAll patients had some recovery after both surgical and conservative treatment(P<0.05),but the patients after surgical treatment had a better outcome than those after conservative treatment(P<0.01).ConclusionThe effect of early surgical treatment on cervical spinal cord injury without fracture and dislocation is superior to conservative.

BACKGROUND:The majority of studies focus on the lesions of spinal cord injury, while little evidence is available on the change of morphology and structure of distal nerve, muscle and motor endplates fol owing spinal cord injury.
OBJECTIVE:To investigate the time window change of the morphology of motor neurons and skeletal muscles caudal to the lesion after spinal cord injury in rats.
METHODS:Fifty healthy adult Sprague-Dawley rats were randomly divided into three groups:control group (n=5;without treatment), sham operation group (n=10), and spinal cord injury group (n=35). The sham operated rats only received laminectomy. In the spinal cord injury group, rats were subject to complete T 10 spinal cord injury by total laminectomy and cord transverse resection. Then the morphological change including sciatic nerve, motor endplate and median gastrocnemius was observed for each group at 1, 2, 4, 12, 24 weeks after injury.
RESULTS AND CONCLUSION:(1) The myelin sheath layers of sciatic nerve were separated partial y at 4 weeks in rats with spinal cord injury, the myelin sheaths were fragmented with the regeneration of thin-myelinated and unmyelinated axons at 12 weeks. There was a decrease in myelinated axons and an increase in thin-myelinated and unmyelinated axons at 24 weeks. (2) The synaptic gutters of motor endplate, the presynaptic and postsynaptic membrane and synaptic space were distinct at 4 weeks in rats with spinal cord injury, the degenerated motor endplates coexsisted with the intact ones at 12 weeks. The motor endplate disappeared at 24 weeks. (3) There was a slight decrease in muscle cross-sectional area at 2 weeks in rats with spinal cord injury, but no structural change was found, the membrane of myocytes was partial y weakened at 4 weeks, the border of myocytes was obscure with hyperplasia of connective tissue at 12 weeks, and myocytes gathered and in fusion at 24 weeks. As natural history of completely transected spinal cord injury in rats, there were significant changes in morphology of peripheral nerve, motor endplate and skeletal muscles caudal to the lesion at 12 weeks, and the changes were destructive at 24 weeks.

Objective To explore the factors related with bladder function after surgical intervention in patients with first lumbar burst fractures uniting isolated conus medullaris syndrome (CMS). Methods 25 patients complicated CMS in 618 patients with Ｌ1 burst fracture were analyzed retrospectively. Results The recovery rate of patients with saddle sensation weakness was higher than the patients with saddle sensation disappeared (P<0.05). There was no difference in bladder function between patients accepted surgery within 2 weeks and more than 2 weeks (P>0.05). Conclusion Saddle sensation before surgery related with the recovery of bladder function.

Objective To evaluate the efficacy of intravertebral augmentation which including transpedicular bone graft, transpediclebody augmenter and vertebroplasty in preventing the correction loss and implant failure of short-segment pedicle instrumentation for thoracolumbarfractures through meta-analysis. Methods Experimental studies (randomized controlled trails, non-randomized controlled trails)and observational studies (cohort studies, case control studies) related with application of posterior short-segment pedicle instrumentationwith intravertebral augmentation for thoracolumbar fractures were searched from Pubmed, EMBASE and CNKI according to the inclusionand exclusion criteria, and hand-searched in Chinese and English journals. RevMan 5.0.18 provided by Cochrane was used to analyse the data.Results 1 randomized controlled trail and 7 observational studies were included. There were 442 patients, in which 216 patients werewith and 226 patients without intravertebral augmentation. There was no significant difference in correction loss and risk of implant failurebetween these two groups. Conclusion Intravertebral augmentation does little about the risk of correction loss and implant failure associatedwith posterior short-segment pedicle instrumention for patients with thoraculumbar fractures.

Objective To investigate the effect of basic fibroblast growth factor (bFGF) on the synthesis of extracellular matrixc (ECM)and expression of chondromodulin in human intervertebral disc cells. Methods 4 intervertebral discs (IVDs) obtained from patients in thetreatment of disc degenerative disease were used for cell culture. The secondary generation of intervertebral disc cells were cultured for 7days, then different concentration of bFGF (0, 0.1 ng/ml, 1 ng/ml, 10 ng/ml)were added to the medium and treated for 72 hours. Real-timeRT-PCR was used to detect the change of Aggrecan and type Ⅱ collagen mRNA expression. The effect of FGF on the expression of ChM-1,a cartilage derived anti-angiogenic factor, was also used by means of Real-time RT-PCR and Western blot. Results Real-time RT-PCRshowed that bFGF can significantly inhibit the expression of Aggrecan and type Ⅱ collagen mRNA. Both Real-time RT-PCR and Westernblot showed that the expression of ChM-1 was down-regulated by administration of bFGF with dose-dependent way. Conclusion bFGFserves primarily as a catabolic factor and induce the angiogenesis in the process of intervertebral disc degeneration.