Objective:To further study the pathogenesis of classic Schm orl′s nodes based on clinical practice.Methods:A patient with severe low back pain was found that the irregularity of the endplates and the presence of Schm orl′s nodes in L2 - 3 and L3- 4spaces in lumbar radiographs.Two painful intervertebral discs with Schm orl′s nodes in their superior or inferior endplates were identified by discography and pain provocation.Two foci of Schnorl′s nodes were rem oved in en bloc via a retroperitoneal approach for histological examination.Meanwhile,anterior intervetebral body fusion of painful discs were undertaken.Results:The radiographic manifestation of Schmorl′s nodes was the end- plate indentation.Schmorl′s nodes in CT scan was shown as a round- like or multicystic irregular zone of bone density with an indistinct sclerotic margin beneath the cartilaginous endplate,which was sim ilar to the typical CT changes of osteonecrosis.The histological examinations of en bloc slices of Schm orl′s nodes revealed subchondral osteonecrosis.Conclusion:The current study indicate classic Schm orl′s node shown in radiograph is osteonecrosis zone beneath cartilaginous endplate,suggesting the necessity of further study on Schmorl′s node form ation. [

Objective To study the pathologic characteristics and clinical significance of high intensity zone (HIZ) of lumbar intervertebral disc in the patients with discogenic low back pain. Methods 52 patients with low back pain without disc herniation underwent MRI and following discography of lumbar vertebrae. All patients previously were treated conservatively without relief of their symptoms for more than 6 months. Specimens of lumbar intervertebral discs containing HIZ in the posterior annulus from 11 patients with discogenic low back pain during posterior lumbar interbody fusion (PLIF) were collected to investigate the morphologic patterns and clinical significance. Results In all of 142 discs in 52 patients at discography, 17 discs in 17 patients presented HIZ, all showed painful reproduction and abnormal morphology with annular tears extending either well into or through the outer third of the annulus fibrosus. The histologic study of the consecutive sagittal slices in the HIZ lesions revealed that the normal lamellar structure was replaced by disorganized, vascularized granulation tissue that consisted of small round cells, fibroblasts, and newly formed blood vessels around the tears extending from the nucleus pulposus to the outer region of the annulus fibrosus. Blood vessel proliferation and inflammatory cell infiltration were seen extending along the margins of the tears into the middle and inner annulus, and sometimes the tears were bridged with granulation tissue. Ingrowth of vascularized tissue was sometimes observed to end abruptly at the junction between the inner third of the annulus and the nucleus pulposus. There was also matured scarring collagenous tissue. Conclusion The HIZ in the lumbar disc in the patients with symptomatic low back pain can be considered as a reliable marker of painful outer annular disruption.

Objective The theory of chemical radiculitis was put forward about 30 years ago, but it has not been proved by clinical study so for. The current study was initiated to assess whether the annular tear in painful disc was the cause of radiating leg pain (radiculopathy) in patients with discogenic low back pain. Methods Forty-two patients with chronic low back pain in single level and shooting leg pain in unilateral or bilateral lower limbs without lumbar disc herniation on CT and MR imaging were treated (age range, 19-52 years; mean age, 34.9 years; 27 males, 15 females). All patients showed annular disruption and pain reproduction on injection of the contrast during discography at single disc level (not including patients who had two or three levels disc disease). CT scan was performed to identify the location of annular tears after discography. The examinations of electromyography(EMG) and motor nerve conduction velocity (MCV) were performed in all patients, which were used to analyze the degree of nerve root injury and the relation with radiating leg pain. Results The patients with posterolateral annular disruption in single side mainly presented single lower limb radiation pain, in contrast, the patients with posterolateral annular disruption in two sides or posterior midline annular disruption mainly presented dual lower limb radiation pain. There was a significant positive correlation between the site of annular tear and the side of radiation pain. The examinations of EMG in all 42 cases found that there were abnormal insertional activities such as fibrillation potentials and positive sharp waves in 32 cases(76%). Of the 23 patients with unilateral lower limb radiation, nerve root lesions were found on the symptomatic side in 17 cases(74%). Of the 19 cases with bilateral lower limb radiation pain, root lesions were suggested in 15 patients(79%). The conduction velocities of common peroneal nerve and tibial nerve decreased with a statistically significant difference in symptomatic side compared with normal side. Conclusion Inflammatory chemical mediators and cytokines produced in painful disc leaking into epidural space through annular tear could lead to the injury to adjacent nerve roots, which might be primary pathophysiologic mechanism for the production of chemical radiculitis.

Purpose: Through the analysis of 202 cases of spondylolisthesis treated with surgery, the different types of surgical procedures were reevaluated. Material and Method: Patients with spondylolisthesis were divided into 3 groups based upon their pathology and different surgical procedures were used accordingly. The results were evaluated after follow-up of more than one year. Group Ⅰ consisted of 38 patients with degenerative spondylolisthesis with back pain and isthmic spondylolisthesis of less than 33%; they were treated with anterior intervertebral body fusion. Group Ⅱ consisted of 99 cases of mild isthmic spondylolisthesis with unilateral sciatica, and were treated with semi-laminectomy and decompression of symptomatic side; interlaminar and interspinous process fusion of the opposite side was performed for 99 cases of mild isthmic spondylolisthesis with unilateral sciatica. Group Ⅲ consisted of 65 cases of spondylolisthesis more than 33% with sciatica and they were treated with decompression, reduction of sliding vertebra and posterior intervertebral body fusion. Result: In group Ⅰ, solid fusion was in 20 cases giving a fusion rate of 91%. In group Ⅱ, the satisfactory rate was as high as 91.5%. In group Ⅲ, the satisfactory rate and fusion rate reached 91.8% and 95.9% respectively. Conclusion: Reduction of spondylolisthesis could increase the fusion contact area, restore normal mechanics and saggital curve of the lumbar spine, relieve neural compression and improve the extemal appearance and function. For the surgical treatment of spondylolisthesis, the major goal should toward a solid fusion between the sliding vertebra and its adjacent vertebrae and laminectomy alone is not a procedure of choice.

Objective To study the short-term outcome of transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in patients with discogenic low back pain. Methods A total of 25 patients with discogenic low back pain,who were diagnosed by provocative discography,received transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in our hospital. The VAS scores determined before and 6 months after the operation were compared in the patients. Their MacNab scores were also evaluated at 6 months postoperation. Results After the surgery,2 patients who had ruptured intervertebral discs (L5-S1) developed sunburn syndrome,and then was relieved by pulsed electrical stimulation for one week. The patients were followed up for 6-10 months,during which no other postoperative complications occurred. The mean VAS score of this series decreased significantly after the treatment,and kept being reduced in 6 months [preoperation:6.24?0.97,1,3,6 months after the operation:0(0~2); Kruskal-Wallis rank-sum test,H=61.680,P=0.000]. Four patients showed lower limbs pain before the treatment and were relieved after the surgery. The evaluation of MacNab score showed excellent in 11 pateints,good in 12,and fair in 2,suggesting an effective rate of 92.0%(23/25). Conclusions Transforaminal posterolateral endoscopic discectomy plus radiofrequency annuloplasty is effective for discogenic low back pain in a short term.

In this study the relation between the extent and type of disc protrusion and the clinical severity of symptoms of low back pain was observed. Our series consisted of 300 consecutive cases of lumbar disc protrusion,with their diagnosis confirmed by intraoperative observation. Preoperative pain severity was assessed using a back pain scale that combined the symptoms of back pain and sciatica. Intraoperaative pathological findings of disc were documented and comparesd with preoperative symptoms and signs. The pathological changes of disc were classified as following four subtypes: bulging disc (85 cases), protruding disc (104 cases), extruded disc (72 cases) and sequestered disc (39 cases). Our results suggest that severity of pain in patients with herniated lumbar disc is related to position of herniation rather than magnitude and exent of herniation. Inflammed intraspinal tissues are significantly associated with low back pain and sciatica.

ObjectiveTo introduce the design of the instrument for percutaneous posterolateral foraminoplasty and analyze long-term outcomes of percutaneous foraminoplasty and transforaminal endoscopic discectomy in the treatment of non-contained lumbar disc herniation.MethodsFifty-six patients with noncontained lumbar disc herniation confirmed by symptom,physical sign and concordant imaging underwent percutaneous foraminoplasty and transforaminal endoscopic discectomy,including 7 cases of L3-4,30 of L4-5 and 19 of L5S1.The visual analogue scales(VAS) of pre- and post-operative low back pain and sciatica were compared,and the Macnab scores were also evaluated.ResultsAll of the procedures were performed successfully,with mean operation time of 60 min(range,40-120 min),and a mean blood loss of 30 ml (range,20-50 ml).The follow-up time was more than 36 months.Postoperative VAS of low back pain and sciatica were significantly decreased compared with preoperative VAS (P＜0.01).There were 44 cases of excellent,10of good,and 2 of fair according to Macnab score system,with total successful rate (excellent and good) up to 96.4％.Only 5 cases with L5S1 disc herniation were found complicated with sun-burn syndrome,which were relieved by pulsed electro-stimulant therapy for 1 week.ConclusionPercutaneous foraminoplasty and transforaminal endoscopic discectomy is an effective and safe minimally invasive treatment alternative for non-contained lumbar disc herniation.

Background Diabetic retinopathy (DR) is one of the common complications of diabetes.Retinal pigment epithelium (RPE) cells,as important constituent cells of the retina,play important roles in the development and progression of DR.Objective This study was to investigate the suppressive effects of autophagy inhibitor 3-MA on the proliferation of human retinal pigment epithelium cells (hRPECs) following high glucose culture.Methods HRPECs were divided into control group,high-glucose group and 3-MA+high glucose group.The cells were cultured by the DMEM/F12 with 5 mmol/L glucose in the control group,and by the DMEM/F12 with 5 mmol/L glucose in the high glucose group and by the DMEM/F12 with 10 mmol/L 3-MA (for 1 hour firstly) and 30 mmol/L glucose in the 3-MA+high glucose group.The cells were inoculated into 24-well plate with the content of 1 ×105/well,and then the cells were consecutively cultured for 24 hours with DMEM/F12 containing 0.5％ fetal bovine serum after achieved attached 80％ confluence.The morphology and uhrastructure of the cells were examined by optics microscope and transmission electronic microscope.The proliferative rate of the cells was assayed by CCK-8 kit.The expression of autophagy-related gene microtubule associated protein light chain 3B (LC3B) in the cells was detected by Western blot and LC3B-Ⅱ/LC3B-Ⅰ value was quantitatively evaluated among the groups.Results The cells grew well with uniform size and regulatory arrangement in the control group.The cells in the high glucose group enlarged and the number of cells evidently increased.In the 3-MA+high glucose group,the cells decreased with a disorder arrangement.Under the transmission electron microscope,the cells were normal with the round-or oval-like nucleus and normal organelles in the control group,and autolysosome could be seen in the cells in the high glucose group.In the 3-MA+high glucose group,some autophagic bodies were found.The proliferative rate of the cells was (100.0±2.0) ％,(116.9-±5.2)％ and (103.7 ±4.7)％ in the control group,high glucose group and 3-MA+high glucose group respectively,showing a significant difference among the groups (F =13.526,P =0.006).The proliferative rate was considerably raised in the high glucose group compared with the control group and 3-MA+high glucose group (both at P＜0.05),but there was no significant difference in the proliferative rate of the cells between the control group and 3-MA+high glucose group (P＞0.05).Compared with the control group,the expressing intensity of LC3B-Ⅰ protein was weakened and that of LC3-Ⅱ protein was enhanced,and the expression intensity of LC3B-Ⅰ and LC3B-Ⅱ proteins in the 3-MA+high glucose group was similar to that in the control group.The LC3-Ⅱ/LC3-Ⅰ ratio was 0.131 ±0.065,2.504±0.097 and 0.274±0.007 in the control group,high glucose group and 3-MA+high glucose group,respectively,with significant differences among the groups (F =1 694.676,P =0.000),and the LC3-Ⅱ/LC3-Ⅰ ratio was increased in the high glucose group in comparison with the control group and the 3-MA+high glucose group (all at P＜0.05).No significant difference was found in the LC3B-Ⅱ/LC3B-Ⅰ ratio between the control group and 3-MA + high glucose group (P ＞ 0.05).Conclusions High glucose culture of hRPECs can activate autophagy process and promote cell proliferation.3-MA,an autophagy inhibitor,suppresses the high glucoseinduced growth of HRPECs by inhibiting autophagy process.

Objective To examine the expression of stromal cell-derived factor-1 (SDF-1) in a rat model of retinal ischemia-reperfusion injury (RIRI),and investigate the protective effect of 17β-Estradiol (E2) on RIRI and explore the mechanism.Methods The RIRI model was established in Sprague-Dawley rats by increasing the intraocular pressure.Relative expression levels of SDF-1 mRNA and protein in the retina at 6 hours,12 hours and 24 hours following reperfusion was determined by RT-PCR and Western blot,respectively.E2 was administered to investigate the effects of estrogen on SDF-1 expression,and the estrogen receptor antagonist ICI 182-780 was administered to investigate the effect of estrogen receptor on the expression of SDF-1.Results SDF-1 expression in RIRI 6 hours group,12 hours group and 24 hours group was increased compared with normal control group (all P ＜ 0.05),with maximum expression at RIRI 12 hours group.As expected,pretreatment of RIRI rats with E2 had a protection on RIRI retina;SDF-1 expression was increased in RIRI + E2 group compared with IR control group and RIRI + vehicle group (all P ＜ 0.05).RIRI + E2 + ICI 182-780 group could decrease SDF-1 expression compared with RIRI + E2 group(all P ＜ 0.05).Conclusion E2 offers protection against RIRI by inducing an up-regulation in SDF-1 expression through activation of the estrogen receptor.

OBJECTIVETo investigate the characteristics of bone fractures from road traffic accidents and analyze their injury mechanisms so as to provide reference for the research and medical care of traffic trauma.

METHODSThree hundred and six patients with fractures from road traffic accidents were included into this study. A total of 507 fractures were identified and the injury mechanism, location distribution and frequency were analyzed.

RESULTSThe most common location of fractures was the lower extremities, followed by the upper extremities, skull and maxillofacial region, and the rarest was the spine. A total of 56% of the patients suffered from multiple fractures. The fractures of the patella, femur and pelvis and the fractures of the olecranon, humerus and shoulder often happened simultaneously.

CONCLUSIONSThe injury mechanisms can be classified into four types: impact, incoordinate movement, stretch injury and crush and extrusion. The fractures from traffic accidents have the following characteristics: centrifugal distribution of the injuries, multiple fractures, force transmission and ipsilateral occurrence.

Accidents, Traffic ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Fractures, Bone ; epidemiology ; etiology ; Humans ; Injury Severity Score ; Male ; Middle Aged