Objective To analyze the influence of Wiltse approach and conventional transmuscular approach on the mul?tifidus muscle by imageology, histology and electrophysiology assessment following short?segment pedicle fixation on thoracolum?bar fractures. Methods 76 patients with thoracolumbar fractures without neurological deficits who had undergone short?segment pedicle fixation between June 2010 and August 2012. Wiltse approach 36 cases, conventional transmuscular approach 40 cases. The perioperative parameters, Visual Analogue Scale scores (VAS), and radiologic parameters, esp the imageology, histology and electrophysiology changes of multifidus muscle were compared. Results 20 cases were fellowed up over 1 year in the Wiltse ap?proach group (20/36, 56%). 25 cases were fellowed up over 1 year in the conventional transmuscular approach group (25/40, 62.5%). No significant differences were found in terms of gender, age, fracture type, injured segment and follow?up period. Till the last follow?up, all patients with vertebral fractures were healed. No loosening or breaking of internal fixation was observed. Com?pared to the conventional transmuscular approach, the Wiltse approach was significantly advantageous in terms of operation time, the amount of bleeding, hospital stays and VAS scores after the surgery but the length of incision, besides, the Wiltse approach group had less incidence of multifidus atrophy and less fatty infiltration, and in conventional transmuscular approach group electro?myography demonstrated that the multifidus muscles median frequency values and average amplitude value were significantly low?er than Wiltse approach group. Conclusion The Wiltse approach for thoracolumbar fractures, retaining the posterior ligament complex, is an effective and minimally invasive treatment, with less trauma, less bleeding, less operation time, the advantages of re?liable clinical results. Especially less incidence of multifidus atrophy and less fatty infiltration.

Objective To observe the effect on Foxg1 gene expression in the subgranular zone (SGZ) of cerebral tissue from neonatal rats with hypoxic-ischemic brain damage (HIBD) after transplantation of neural stem cells (NSCs) derived from umbilical cord blood.Methods Mononuclear cells separated from umbilical cord blood by density gradient centrifugation were cultured with orientated induction to differentiate the NSCs.The neuronal phenotype was identified using immunocytochemical methods.A total of 150 Sprague-Dawley rats were randomly divided into a sham-operation group,an HIBD group and an HIBD-NSCs group.Rats in the HIBD group and the HIBD-NSCs group were subject to ligation of the left carotid artery and then kept in a box under 8％ oxygen and 92％ nitrogen for 2.5 hours to establish the HIBD animal model.The artery was separated but not ligated in the sham operation group,which was not subjected to hypoxia.Twenty-four hours after the operation,the cultivated NSCs were transplanted by caudal vein injection into the rats in the HIBD-NSCs group.Rats were then sacrificed on the 3rd,7th,14th,21st and 28th days after the operation.Foxg1 gene expression in the SGZ was examined using in-situ hybridization methods.Results The number of Nestin-positive cells peaked on the 6th day of cultivation and then decreased by the 9th day.The Foxg1 gene was expressed in the SGZs of each group.The expression increased by the 3rd day after surgery in the HIBD and HIBD-NSCs groups,and peaked on 7th day after the operation,then declined gradually.The average expression level of Foxg1 in the HIBD group was significantly lower than that in the HIBD-NSCs group on the 7th day and thereafter.Conclusions Human umbilical cord blood mesenchymal stem cells can be induced and differentiated into neural stem cells.Foxg1 genes can still be present in the SGZ after birth.HIBD can induce the expression of Foxg1 genes.Transplanting NSCs can promote the expression of Foxg1 genes and improve morphological and functional recovery after HIBD,at least in neonatal rats.

Objective To explore the possible pathological essence of HIZ in lumbar intervertebral disc by means of CT,MRI and histomorphology analysis.Methods All of 41 patients of low back pain with the HIZ in the lumbar disc on MRI were identified.There is 23 males and 18 females with mean age of 38 years (range 33-50 years).All the patients were divided into 2 groups according to the characteristics of HIZ on MRI:group A,29 patients with high intensity on MRI T2WI and low intensity on MRI T1WI; group B,12 patients with high intensity both on T2WI and T1WI.All these patients underwent X-rays and CT scan on the targeted level.26 patients in group A were performed discography and pain provocative test.15 patients in group A and 7 patients in group B underwent operation and those samples of HIZ region were excised for HE staining and immunohistochemical analysis.Results All the patients in group A were proved intervertebral disc degeneration on CT and MRI.21 patients in 26 who underwent discography and pain provocative test were proved positive and 15 of them underwent operation(Transforaminal lumbar interbody fusion or posterior lumbar interbody fusion).Histomorphology examination showed annular tear combined with granulation tissue in the samples of HIZ region which were excised in operation.Neoformative blood capillary could be seen through CD34 staining.Macrophage could be found in CD68 staining,but the regions off the HIZ were less stained.In group B,all those targeted discs showed calcified or ossified lesion on the posterior annular on CT scan,HE staining showed calcification or ossification of the posterior annulus fibrosus with frontier line.Conclusion The HIZ on MRI T2WI with low intensity zone on T1WI possibly refers to annular tear combined with granulation in-growth.But the HIZ both on MRI T2WI and T1WI might be calcification or ossification.The conventional concept of HIZ might be modified as HIZ on MRI T2WI,but low intensity zone on MRI T1WI.In addition,CT scan might be helpful in the distinguished diagnosis.

Objective To identify the effective results of ultrasound in degradation of polymeric nanoparticles released DNA .Polymeric nanoparticles was made by dehydration of polyacetylglutamicacid (PLGA, polylactic-co-glycolic acid)solution. Method Green Fluorescent Protein (GFP) was enclosed by PLGA. Different kinds of ultrasound mode and different duct cycle and power ones were used to radiate PLGA solution for 90 s, 9 min, 20 min separately after the solution prepared for 2 hrs,then putted the solution on centrifugal machine at 13000 r/m. Using Choloroform to get rid of fat-soluble impurity,then applied nanodrop to survey the releasing rate of DNA. Finally the effect of cell expression were observed by fluorescent microscope. Results The amount of DNA released from PLGA in groups which were exposed to ultrasound were significantly different from the groups which were not exposed to ultrosound. The releasing amount of former groups had upper limitation. The releasing rate was increased with the increment of the irradiation time,frequency of ultrasound;The effect of the DNA releasing and PLGA degradation by continuous-wave irradiation was stronger than pulsed-wave ultrasound. Conclusion Ultrasound can promote the degradation of PLGA, and do help in DNA releasing and expression in vitro.

Objective To assess incidence rate of different types of cement leakage in percutaneous kyphoplasty (PKP) with or without intravertebral clefts and to determine whether basivertebral foramen could be connected with intravertebral cleft.Methods 270 vertebrae in 224 consecutive patients who underwent percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures were classified into two groups on preoperative radiographs,computed tomography scans,and/or magnetic resonance images of the treated levels:Cleft group with an intravertebral cleft in vertebral body and trabecular group without intravertebral clefts.On direct postoperative images,the patterns of cement leakage were classified as 5 types:through a cortical defect into paraspinal soft tissues (type A),through the basivertebral foramen (type B),via the needle channel (type C),through a cortical defect into the disc space (type D),via the paravertebral vein (type E).The incidence of different types of cement leakage between two groups was analyzed.Results In 72 of 270 vertebrae,an intravertebral cleft was confirmed on preoperative images.Leaks through basivertebral foramen as type B (42,15.5％) and through cortical defects into the disc space as type D leaks (21,7.8％) were more common than other types.The incidence of type B leakage in the cleft group (23.6％) was higher than the incidence in the trabecular group (12.6％),which made a statistical significance (P=0.028).There was no statistical difference between the trabecular pattern and the cleft pattern on other types of leaks.Conclusion Type B leaks were more common in vertebrae with the presence of an intravertebral cleft,which support the presence of the connection between an intravertebral cleft and the basivertebral foramen.Thus,care must be taken when PKP was performed in these patients to avoid cement leakage into spinal canal through basivertebral foramen directly.

Objective To investigate a reliable and practicable model of intraoperative neurophysiological monitoring (IONM) in oblique lateral interbody fusion (OLIF) combined with posterior transpedicle internal fixation.Methods A total of 34 consecutive patients who underwent OLIF combined with posterior transpedicle internal fixation with IONM at the SRRSH from November 2014 to July 2016 were collected and follow-up at least for 3 months postoperative.The intraoperative somatosensory evoked potentials (SEP),motor evoked potentials (MEP),dermatomal somatosensory evoked potential (DSEP) and spontaneous electromyography (sEMG) were used and evaluated,besides,triggered electromyography (tEMG) was used to monitor the implantation of pedicle screws,the possible reasons and treating procedures of monitoring alerts were summarized.Results A total of 34 cases of patients were effectively monitored during OLIF combined with posterior transpedicle internal fixation.SEP monitoring was successful in all patients,and no abnormal SEPs were observed in all cases.DSEP monitoring was successful in 20 cases (58.8％),and no abnormal DSEPs were observed in these patients.MEP was successfully monitored in all cases,eliminating the anesthesia factor,no abnormal MEPs were observed in all cases.The sensitivity and positive predictive value of SEP,MEP,DSEP were 0％.3 cases had abnormal sEMG reactions during the channel establishment which disappeared after adjustment of channel,and 2 cases which appeared abnormal wave recovered after brief observation.Among the 5 patients with abnormal wave,one case got numbness,one patient felt pain in front of the thigh postoperative.Among the other 29 patients without abnormal wave during channel establishment,one case appeared numbness.These 3 patients with neurologic symptoms recovered in 3 months after conservative treatment.The sensitivity and specificity of sEMG was 66.7％ and 90.3％ respectively,negative predictive value and positive predictive value were 96.6％ and 40％ respectively.6 screws got tEMG response after tapping even the intensity was less than 10mA,which showed broken codex of pedicle according to postoperative CT scan.Cornclusion Intraoperative application of sEMG monitoring in OLIF can obviously reduce the incidence of the neurological deficit,which was an effective method,tEMG monitoring during lumbar pedicle screw fixation can detect the mal-positioned screws and protect the nerve roots.SEP,MEP and DSEP did not seem well suited for OLIF.

Objective To investigate characteristics of cage migration after transforaminal lumbar interbody fusion (TLIF) and related risk factors.Methods A retrospective study was conducted to review cage migration in 512 patients who had undergone TLIF procedure from January 2010 to June 2011 in 5 spinal research centers.There were 255 males and 257 females,aged from 37 to 77 years (average,54.7 years).All patients were followed up at 3,6,12 months after operation.The clinical outcomes were evaluated using the visual analogue scores (VAS) and Oswestry disability index (ODI).X-rays and 3D CT scans were used to analyze the incidence and related risks factors of cage migration in these patients.Results Cage migration was found in 6 of 512 patients,the total incidence was 1.17％.Significant difference was found between each center.Cages with different shapes had different incidence.The analysis showed that the incidence of migration of rectangular-shaped cage (3.11％,5/161) was significantly higher than that of kidney-shaped cage (0.28％,1/351).The cage in double-segment TLIF (5.75％,5/87) was easier to migrate than that in monosegment TLIF (0.24％,1/425); furthermore,linear type endplate(3.50％,5/143) was remarkably easier to migrate than concave-concave one (0.27％,1/369).Conclusion Difference in operative skills,cage shape,number of fused segments,adjacent endplate shape,and lumbar spondylolisthesis might be risk factors for cage migration after TLIF.

Objective To evaluate the early clinical outcomes and complications of oblique lateral interbody fusion (OLIF) in the treatment of degenerative lumbar diseases.Methods All of 83 patients,29 males and 54 females with ages from 32 to 83 (average 60.8± 13.7 y),underwent OLIF with or without posterior pedicle screw-rod instrumentations from October 2014 to February 2017.The index diagnosis was discogenic back pain in 17 cases,spondylolisthesis in 23,lumbar spinal canal stenosis in 25,and degenerative lumbar spinal kyphoscoliosis in 18 cases.The distribution of operative level was 5 at L1,2,13 at L2,3,38 at L3,4,and 69 at L4,5.The mean number of fusion level for each case was 1.5 segments.The operative duration,blood loss during operation,intra-operative and post-operative complications,the length of post-operative hospital stay were recorded.Clinical outcomes were evaluated using visual analogue scale (VAS) and Oswestry disability index (ODI).All patients were followed up for at least 3 months.Lumbar X-ray and CT scans were taken and the clinical outcomes were re-assessed during follow-up.Results Fifty-one in the 83 patients underwent supplementary posterior pedicle screw-rod instrumentation with OLIF procedures.The operation lasted for 43-295 min,with a mean duration of (153 ± 72) min.Mean operation time for each OLIF segment was 43± 12 min.Blood loss during the operation was 30-800 ml,with a mean of 125±74 ml.Mean blood loss for each OLIF segment was 27±13 min.Average length of stay was 5.6 ± 3.2 d,ranging from 3-15 d.The VAS for back pain and leg pain and ODI scores were decreased apparently for each patient.The total incidence of complications was 22.9％ (19/83),including 6.0％ (5/83) of intra-operative complications (4 cases of cage subsidence,1 case of segmental artery injury) and 16.9％ (14/83) of post-operative ones.The latter consisted of ipsilateral hip flexor weakness in 6,ipsilateral anterolateral thigh pain in 2,ipsilateral lateral thigh numbness in 1,contralateral pain in flexion of hip in 1,ipsilateral sympathetic chain injury in 2,and pain in area of iliac bone donor site in 2.All symptoms were released or disappeared during follow-up.Conclusion OLIF as a novel minimally invasive technique can act as a safe and effective treatment for degenerative lumbar diseases,which can also reduce approach-related complications.

Objective To investigate the indirect decompression effect of oblique lateral interbody fusion (OLIF) in the treatment of mild to moderate degenerative lumbar stenosis.Methods From October 2014 to November 2016,23 patients with mild to moderate lumbar spinal stenosis underwent OLIF combined with or without posterior pedicle screw fixation;9 males and 14 females with average age of 59.2±11.6 years old;8 cases at L3,4 segment and 15 cases at L4,5 segment.All cases were followed up for more than 6 months.Thin layer scanning of CT and two-dimensional reconstruction images were used to measure the vertical diameter and area of intervertebral foramen.Intervertebral disc height and spinal canal anteroposterior diameter were measured on median sagittal MRI sequence,and the anteroposterior diameter and the cross-sectional area of the spinal canal were measured on cross-sectional MRI sequence.The clinical effects were assessed by the visual analogue score (VAS) and the Oswestry disability index (ODI) for low back pain,lower limb pain and lower limb numbness.Results Compared with those measurements pre-operatively,the post-operative intervertebral disc height increased by 78.6％±13.4％.The post-operative left vertical diameter of intervertebral foramen increased by 36.7％±7.8％,and the post-operative left area of intervertebral foramen increased by 36.6％± 8.7％,and the post-operative right vertical diameter of intervertebral foramen increased by 40.7％±9.6％,and the post-operative right area of intervertebral foramen increased by 40.0％±8.9％.The post-operative anteroposterior diameter of sagittal spinal canal were increased 32.6％ ± 5.9％,and the post-operative anteroposterior diameter of cross-sectional spinal canal were increased 34.4％±6.8％,and the post-operative cross-sectional area of the spinal canal were increased 47.5％±7.2％.All of the differences were statistically significant between pre-operative and post-operative measurements.The VAS score for low back pain was 6.2± 1.7 pre-operatively,and 1.1±0.5 post-operatively.The ODI for low back pain was 81.2％± 18.2％ pre-operatively,and 6.1％±2.0％ post-operatively.The VAS score for lower limb pain was 5.6±1.4 pre-operatively,and 0.8±0.3 post-operatively.And the VAS score for lower limb numbness was 6.6±2.0 pre-operatively,and 3.4± 1.2 post-operatively.All of the differences were statistically significant between pre-operative and post-operative evaluations.Conclusion There were obvious radiological evidences and remarkable clinical effect of indirect decompression using OLIF technique in treatment of mild to moderate lumbar spinal stenosis at early post-operative stage.However further long-term follow-up studies with multicenter large sample were still needed.

Objective To evaluate the clinical outcomes of oblique lateral interbody fusion (OLIF) in the treatment of adult degenerative scoliosis (ADS).Methods From January 2015 to May 2016,17 ADS patients,4 males and 13 females were enrolled with ages from 46 to 80 (average 69.5±9.2 years).The Cobb angle of all was greater than 10°.According to Lenke-Silva classification systems:Ⅰ level,2 cases,decompression alone;Ⅱ level,2 cases,decompression and limited instrumented spinal fusion;Ⅲ levels,4 cases,decompression and lumbar curve instrumented fusion;Ⅳ levels,5 cases,decompression with anterior and posterior spinal instrumented fusion;Ⅴ level,4 cases,thoracic instrumentation and fusion extension.The operation time,blood loss,blood transfusion,and preoperative and postoperative complications were recorded.Clinical and radiological outcomes were evaluated using visual analogue scale (VAS),Oswestry disability questionnaire (ODI) scores,sagittal vertical axis (SVA) and coronal Cobb.All cases were followed up in 3,6,12 and 24 months.Results All of 17 cases underwent OLIF,one level 4 cases,two levels 2 cases,three levels 7 cases and four levels 4 cases.Alone OLIF was 5 cases (2 case of Ⅰ level,1 case of Ⅱ level,1 case of Ⅲ level and 1 case of Ⅳ level).OLIF combined with posterior approach was 12 cases and the interval time were 1-2 weeks,the mean were 1.7±0.5 weeks.Among these 12 cases,posterior fixation was 6 cases,posterior fixation and decompression was 2 cases,and L5/S1 interbody fusion was 4 cases.The operation lasted for 50-460 min,with a mean duration of 230.6± 132.0 min.Blood loss during the operation was 30-640 ml,with a mean of 306.5±213.8 ml.No patient had blood transfusion.The follow-up was 12-28 months and the mean was 17.9±4.5 months.The preoperative Cobb angles were 16.2°-37.7°,the mean was 29.1°±6.4°.The postoperative Cobb angle were 1.5°-10.2°,and the mean were 5.6°±2.4°.The Cobb of all cases improved significantly.The SVA was returned to the normal level in 4 cases of Lenke-Silva V level.The VAS and ODI score decreased from 7.1 ±0.7 preoperatively to 2.4±0.9 at last follow-up,and from 37.9±2.5 to 10.9±3.0,respectively,and both of them were improved significantly.2 cases of OLIF had cage malposition.Left hip flexor weakness occurred in 5 cases and recovered completely within 2 weeks.Left anterior thigh pain occurred in 1 case and disappeared within 2 weeks.Left sympathetic chain injury happened in 1 case and recovered at last follow-up.Conclusion OLIF as a management of ADS showed excellent short-term outcomes.Clinical and radiological results,such as VAS,ODI and Cobb angle,were improved in all cases.OLIF will be a good choice for the treatment of ADS.