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 feasibility and clinical efficacy of the treatment of lumbar spine steno-sis by modified unilateral approach for bilateral decompression under microendoscope.Method:217 cases with degenerative lumbar spine stenosis from September 2003 to December 2008 were treated by modified unilater-al approach for bilateral decompression of central spinal canal and nerve root canal under microendoscope.A-mong them laminectomy of one segment was done in 163 cases,two segments were done in 54 cases.After surgery,the routine radiograph were carried out and the Nakai criterion was used for assessment.Result:The mean operative time was 48±13min (range,25 to 95min),the average blood loss was 37±9ml (range,25 to 180ml),the average skin incision length was 2.2±0.2cm(1.8 to 2.4cm).2 cases had dural matter tearing,which healed after filling with gelatin foam and 2 weeks bed rest,after that no cerebrospinal fluid leakage was noted after surgery.Mislocation was noted in 1 case.No nerve inury and postoperative infection oceurred.Postoperative CT scan demonstrated complete decompression of the central spinal canal and nerve root canal.All patients were followed-up for an average of 14 months (range,3 months to 24 months).The Nakai criterion at final follow-up showed clinical excellent in 134 cases,good in 63 cases,fair in 16 cases and worse in 4 cases, with the excellent and good rate of 90.8%.No lumbar spine instability was noted.Conclusion:Treatment of de-generative lumbar spine stenosis by modified unilateral approach for bilateral decompression under mieroendo-scope has the merit of minimal invasive,less complications and reliable therapeutical effect.

Objective To evaluate the efficacy and safety of balloon kyphoplasty in the treatment of painful multi-vertebral osteoporotic compression fractures. Methods From October 2002 to April 2007, 42 patients (96 vertebrae) with painful multi-vertebral osteoporotic compression fractures underwent kyphoplasty. The group included 14 men and 28 women with an average age of 72.5 years (range 56-91 years). Each pro-cedure included insertion and insertion of balloon, fracture reduction and cement filling under "C"-arm monitoring. Preoperative and postoperative pain level, SF-36 score, vertebral height restoration, local kypho-sis correction and complications were recorded and analysed. Results All 42 patients tolerated the opera-tion well and were followed up for average 31.4 months (range 12-71 months). The mean VAS pain score decreased significantly from 7.1±2.4 preoperatively to 2.7±1.3 postoperatively, the mean height of anterior and medial vertebral body were (1.8±0.5) cm, (1.6±0.6) cm preoperatively and (2.3±0.6) cm, (2.2±0.7) cm postoperatively. No significant change of posterior vertebral height was recorded postoperatively.The mean correction of local kyphosis was 9.2°at each level. 6 of 8 subscahs measured by SF-36, including physical function, role function, bodily pain, vitality, role emotion, mental health, were significantly improved by the operation. Complications were found in 7 patients including 6 cases of cement leakage with no clinical symptoms (intradiscal cement leakage in two cases, paravertebral vessel leakage in two cases, paravertebral leakage in one case and cement leakage into canal in one case), and 1 case of pulmonary embelization with symptoms relieved after conservative treatment. Conclusion Kyphoplasty is effective and relatively safe for multi-vertebral osteoporotic compression fractures.

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.

Objective To investigate the effect of metformin on the osteogenic differentiation of human mesenchymal stem cells exposed to PMMA particles. Methods Human placental mesenchymal stem cells were iso-lated and cultured in vitro. The effect of metformin with different concentrations on cell viability was determined by CCK8 assay. The effect of metformin on the mRNA expression of osteogenic genes was detected by using real-time RT-PCR. Calcified nodules were stained by alizarin S. The effect of metformin on the expression of eNOS was also detected by using real-time RT-PCR. Results PMMA particles could inhibit the viability of mesenchymal stem cells. Metformin(0.05 mmol/L)could promote the viability of mesenchymal stem cells exposed to PMMA particles. Metformin(0.05 mmol/L)could increase the expression of osteogenic genes,including OCN,RNUX2,and ALP, in human mesenchymal stem cells exposed to PMMA particles. The calcium deposit was also increased after metfor-min treatment. Results of real-time RT-PCR showed that metformin could increase the expression of eNOS in human mesenchymal stem cells exposed to PMMA particles. Conclusions Metformin can increase the osteogenic differentiation of human mesenchymal stem cells exposed to PMMA particles,partially by inducing eNOS expression.

Objective To study the method of percutaneous vertebroplasty (PVP) and investigate its clinical efficacy. Methods Tweenty five cases (13 patients with painful osteoporotic vertebral fractures, 8 cases with metastatic neoplasms and 4 cases with hemangionmas) were treated by the injection of polymethyl methacrykate (PMMA) under DSA fluoroscopic guidance. the time of follow up ranged from 1 15 months. Results The procedure was successful in all patients. Among 25 patients, 18 experinced with complete relief of pain, 6 with conspicuous relief, 1 with no significant change. Two patients showed transient symptom of radiculopathy and no clinical complication in others. Conclusions PVP is a safe and feasible treatment for patients with hemangiomas and vertebral fractures caused by malignancies and osteoporosis.

[Objective]To evaluate the outcome of thoracolumbar fracture with spinal cord injury treated with short-segment pedicle instrumentation.[Method]47 cases of thoracolumbar fracture with spinal cord injury from 1999 to 2004 in our department were collected,all of them were treated with short-segment pedicle instrumentation.The radiologic,neurologic,and functional outcome were assessed.[Result]All of the 47 cases were followed up,the mean follow-up were 51.9 months(18~ 86 months),the average of vertebral anterior and posterior height were corrected from 43.6%,71.4% to 92.2%,96.4%;and 88.3%,93.1% at the last follow-up separately.The Cobb's angle were corrected from 23.5?to 4.3?,and 8.8? at the last follow-up.62.8% of the vertebral canal was occupied pre-operation,and 11.4% post-operation,6.2% at last follow-up.There was significant deference in targets between pre-operation and post-operation(P0.05).Neurologic status improved at least 1 Frankel grade in the patients who had preoperative incomplete paraplegia.61.7% of patients returned to work.[Conclusion]Short-segment pedicle instrumentation can provide good reduction,strong fixation,complete decompression and fusion.The treatment outcome is good.Moreover,it is a less traumatic,simple and safe technique.

[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.