BACKGROUND:In recent years, many scholars adopted a joint non-fusion and fusion spinal fixation for multisegmental cervical spondylotic myelopathy, and achieved good clinical results. However, long-term clinical efficacy and possible related complications also require long-term fol ow-up of more in-depth study.
OBJECTIVE:To review the research and application progress of anterior fusion and non-fusion fixation surgical operation for cervical myelopathy.
METHODS:Computer-based search was conducted in China Journal Ful-text Database and PubMed database by the first author for articles related to anterior fusion and non-fusion fixation surgical operation for cervical myelopathy published between January 2004 and January 2014. The key words were“implant material;cervical spondylotic myelopathy;anterior;surgery;fusion;non-fusion;progress;hybrid;summary”in Chinese and“implant material;cervical spondylotic myelopathy;anterior;surgery/operation;fusion;non-fusion;research progress;hybrid;summary”in English. Final y, 35 articles were included for review.
RESULTS AND CONCLUSION:Fusion and non-fusion fixation methods for cervical spondylotic myelopathy had their own advantages. From the view point of indications, the non-fusion fixation was relatively limited. Currently, the fusion fixation was stil the main method in treatment of cervical myelopathy. Non-fusion method as an emerging fixation method also achieved good short-period results, but it needs a long fol ow-up study. Hybrid fixation integrates the advantages of both methods, and can reduce the pressure. Simultaneously, Hybrid fixation also can reduce fusion segments, and retain the range-of-motion of the cervical spine as much as possible. Hybrid fixation becomes a hot topic in recent studies. However, most current researches on Hybrid fixation are retrospective study, lack of control. The overal fol ow-up time is short. Thus, Hybrid fixation needs to be researched more deeply.

[Objective]To study the curative effect and superiority of one stage anterior-posterior approach total spondylectomy and spinal reconstraction in the treatment of thoracolumbar malignant neoplasms.[Method]Twenty-four thoracolumbar malignant neoplasms patients treated by anterior approach total spondylectomy,spinal reconstractin with titanium mesh cage associated with bone graft or bone cement and posterior approach transpediuclar screw fixation.[Result]The follow-up of postoperation was from 9 to 35 months.All patients achieved relieve of pain after surgery,9 cases with incomplete paraplegia improved by 1.8 grades in average with Frankel neurological classifications,2 cases with dysfunction of urination and defecation were recovered,4 patients decease for metastasis in critical organ,all the patients showed bony fusion at 6~9 months,no internal fixation loosening or breakage case was found,1 case was recrudescent after one year.[Conclusion]Treatment of thoracolnmbar malignant neoplasms by one stage anterior-posterior approach total spondylectomy and spinal reconstraction can remove the neoplasms efficiently,reconstraction the spinal stabilization and improve the quality of life.

[Objective] To analyze the mechanics of neotype retropharyngeal cervical hook-plate(RCHP)for atlantoaxial instability with biomechanical testing.[Methods]Six fresh adult craniocervical specimens(C0～3)used for testing the biomechanical instability were all putted into following five test courses:intact,instability(Type ⅡOdontoid fracture),RCHP,Anterior C1、2 transarticular screw fixation,brooks.Repeated statistical analysis of the data was performed using the SPSS 13.0 software package.Measures were performed with SNK testing method to determine whether significant differences existed,P=0.05.[Results]Biomechanical testing showed that,compared with the controlled group and the injured group,each fixation course significantly decreased ROM in all test modes.In the ROM of flexion,there was no significant difference between RCHP and Brooks(P=0.525),but both of them was higher than anterior C1、2 transarticular screw fixation(P

Objective To assess the efficacy and safety of intraoperative wake-up test during surgery for ossification of the ligamentum flavum(OLF). Methods Between June 2004 and June 2010,35 patients(23 males and 12 females,at age range of 32-71 years,mean 50.5 years) with OLF underwent posterior decompressive laminectomy and excision of OLF.The operation wag performed on the cervical vertebrae in four patients,on the thoracic vertebrae in 24 and on the lumbar spine in seven,with monosegmental OLF in 14 patients and multisegmental OLF in 21.The outcomes were evaluated using Japanese Orthopaedic Association (JOA) scale. Results The operation lasted for mean 190 minutes (120-260 minutes),with the blood loss for mean 350 ml (220-520 ml)and the mean 2.4(1-5) lamin receiving decompression.The follow-up period ranged from 6 to 72 months (mean 29.5 months).The JOA score was improved from 4.302±1.023 preoperatively to 8.327±1.032 at the final follow-up (P<0.01).The neurological symptoms was aggravated during operation in three patients,for whom the muscles force recovered gradually in two patients but one showed no change after special measures.No serious complication was found in the other patients postoperatively. Conclusions The wake-up test can serve as an effective monitoring during the procedure ofthe decompressive laninectomy in the patients with severe OLF and decrease the occurrence of neurologic deficit complications.

Objective To regard the implication of viruses particularly herpes in pemphigus vulgaris,and assess and compare the level of immunoglobulin G (IgG) antibodies against herpes simplex virus types 1 and 2 (HSV1 and HSV2),cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in patients with pemphigus vulgarisand healthy people.Methods In this study,23 patients with pemphigus vulgaris and 26 healthy individuals comprised the experimental and control groups,respectively.Serum samples were taken from both groups;the levels of IgG antibodies against HSV1,HSV2,CMV and EBV were measured using ELISA.Results Immunoglobulin G titer was higher for all four viruses in the patient group in comparison to the control group.This difference was significant for anti-EBV,anti-CMV and anti-HSV2 (t=2.16,P＜0.05;t =4.76,P＜ 0.01;t=3.75,P＜0.01),respectively,but not significant for anti-HSV1 (t=0.52,P＞0.05).Conclusion Viruses including EBV,CMV,and HSV2 probably play a role in the pathogenesis of pemphigus in addition to the effects of genetics,toxins and other predisposing factors.In this study,no statistically significant relationship was observed between HSV1 and pemphigus vulgaris.More studies must be done in this regard.

Objective To study the pathogenesis of osteoporosis in patients with liver cirrhosis following hepatitis B virus(HBV) infection(HBV-liver cirrhosis).Methods Bone mineral density(BMD) was measured by NM-300 sigle-energy X-ray acsorptiometry system for 61 patients with HBV-liver cirrhosis and 30 age-matched healthy controls.Serum levels of calcium regulatory hormones(CRH),1,25-dihydroxycholecalciferol [1,25(OH)_2D_3],parathyroid hormone(PTH),calcitonin(CT),osteocalcin(BGP),interleukin-1?(IL-1?),interleukin-6(IL-6) and tumor-necrosis factor-?(TNF-?),and urine level of crosslaps were measured in these patients and controls.Patients with HBV-liver cirrhosis were divided into two groups,osteoporotic and non-osteoporotic,based on their BMD in the ulna and radius,for comparison.Results BMD of the ulna and radius in patients with HBV-liver cirrhosis were significantly lower than those in controls.Serum levels of 1,25(OH)_2D_3 and BGP in patients with HBV-liver cirrhosis were significantly lower than those in controls,and much lower in osteoporotic group than that in non-osteoporotic one.While urine level of crosslaps increased significantly in patients with HBV-liver cirrhosis than in controls, much more increased in the those with osteoporosis than those without osteoporosis.Serum level of 1,25(OH)_2D_3 correlated with serum levels of BGP and BMD of the ulna and radius.Urine level of crosslaps correlated inversely with BMD of the ulan and radius in osteoporotic patients,but not in non-osteoporotic ones.Serum levels of IL-1?,IL-6 and(TNF-?) and urine level of crosslaps increased significantly in patients with HBV-liver cirrhosis than in controls,as well as increased significantly in those with osteoporosis than in those without osteoporosis.Serum levels of IL-1?,IL-6 and TNF-? and urine level of crosslaps correlated inversely with BMD of the ulna,particularly more significantly in those with osteoporosis than those without osteoporosis.Conclusions Two factors,less osteogenesis and more osteolysis,existed in patients with HBV-liver cirrhosis.Serum level of 1,25(OH)_2D_3 and serum levels of IL-1?,IL-6 and(TNF-?) played an important role in weakened bone formation and in increased bone resorption,respectively.Adequate supplementation of vitamin D_3 and reducing serum levels of IL-1?,IL-6 and TNF-? may be very important for prevention and treatment of hepatic bone disease.

Objective To investigate the effects of high-fat diet on pancreatic acinar cells' IP3 expression and CCK-induced amylase release in rats.Methods Male Wistar rats were divided into high-fat diet group and normal diet group,they were fed for 4 weeks.Blood triglycerides,cholesterol,amylase and glucose levels were determined by automatic biochemical analyzer.Pancreatic tissues were taken for histopathological observations.Pancreatic acinar cells were isolated and cultured,and intracellular inositol 1,4,5-trisphosphate (IP3) was detected using a commercial kit.Amylase release rates were measured after CCK-8 stimulation.Results The rats in high-fat diet group appeared hyperlipidemia,vacuolization of acinar cells and the lymphocytes appeared around the acinar cells can be seen on the pancreatic tissue pathology staining.The levels of IP3 in acinar cells of rats fed a high-fat diet were higher than that of normal rats [(31.807 ± 3.448) pmol/106 cells vs (24.632 ± 3.649) pmol/106 cells,t=7.479,P＜0.001];and amylase release rate in these rats'acinar cells were also higher than those of normal rats [when CCK-8=0.01 nmol/L:( 11.056 ±3.369)％ vs (7.354 ± 2.181) ％,t=3.912,P＜0.001;when CCK-8=1 nmol/L:( 13.854 ± 4.087 ) ％ vs (9.432 ±2.477) ％,t=3.939,P＜0.001 ) after CCK-8 stimulation in different concentrations.Additionally,there was a positive co-relationship between acinar cell's IP3 level and amylase release (r=0.896,P＜0.001 ).Conclusion Chronic high-fat diet induces hypersensitivity for pancreatic acinar cells' exocrine function,and IP3 as a signal molecule may play an important role in this process.

ObjectiveTo evaluate the clinical outcomes of anterior lumbar discectomy and interbody fusion with cage under laparoscopic assistant.MethodsFrom January 2006 to June 2009,37 cases with degenerative low back pain were entered the study,including 22 males and 15 females with an average age of 43.7 years(range,16-55).The responsible discs were determined according to the three dimensional computed tomography of artery and vein angiography of anterior lumbosacral spine and discography,including L5S1 in 21 cases,L4-5 in 11,L3-4 in 2,L2-3 in 2,and L1-2 in 1.All cases underwent anterior lumbar discectomy and interbody fusion with cage under laparoscopic.ResultsThe operation time was 100 min in average (range,60-140),the blood loss was 120 ml in average(range,50-300).There was no case with severe complications of retrograde ejaculation and injury of great vessels or nerves.Delayed intestinal obstruction was discovered in two intraperitoneal route patients.The average follow-up time was 18.7 months(range,6-35).According to the back pain grading criteria of Chinese Medical Association Orthopedics Society of Spine Group,the results were excellent in 23 patients,good in 11,and fair in 3.The interbody fusion was obtained in 3 months later in 23 cases and 6 months later in 12 cases.Cage subsidence occurred in 2 cases in 6months after operation,in which the height loss of intervertebral space was 1.3 mm and 1.9 mm,but no obvious symptoms of discomfort.No fixation displacement or loosening occurred.ConclusionThe anterior discectomy and interbody fusion by internal fixation with laparoscopic technique is feasible with low complications rate,less trauma and shorter bedtime.Postoperative ileus by abdominal approach is relatively common.The surgeons experience and the anatomy of artery and vein of anterior lumbosacral spine should be considered before the choice of surgical approach.

BACKGROUND:Techniques of antedor cervical discectomy and interbody fusion have achieved good clinical outcomes since Robinson and Smith first introduced it in 1955.Currently,microendoscopic approaches have resulted in good clinical effectiveness in treating cervical spondylosis.Cage has also been used widely in the clinic.OBJECTIVE:To find a minimally invasive method that uses microendoscopic technique and Cages to treat cervical spondylosis by anterior approach.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Spinal Surgery,First Affiliated Hospital of University of South China between January 2003 and July 2008.PARTICIPANTS:A total of 25 patients with cervical spondylosis,15 males and 10 females,averaging 39 years of age (range,33-58 years old),who received treatments at the Department of Spinal Surgery,First Affiliated Hospital of University of South China were included in this study.Each of them had unilateral limb pain,numbness or weakness in varying degrees.MRI image showed one-level cervical disc degeneration in 20 patients and two levels in 5 patients.METHODS:Twenty-five patients underwent anterior cervical microendoscopic discectomy and interbody fusion using carbon fiber reinforced polymer (CFRP) Cage.Surgical techniques,neurological outcomes and complications were retrospectively analyzed.The postoperative treatments were just like the conventional approaches.MAIN OUTCOME MEASURES:Improvements in neurological symptoms were assessed using the Japanese Orthopedic Association (JOA) grading system.Postoperative imaging data including lordosis and fusion condition were examined.RESULTS:All patients received treatments successfully.The mean surgical time was 140 minutes (range,80 to 225 minutes).The hospital stay averaged 7 days (range,6 to 10 days).Patients' neurological statuses improved to varying degrees according to the JOA grading system:7.5 pre-operative (range,4 to 9 points) to 12 post-operative (range,8 to 16 points),with the mean improvement rate of 45.6%.All cases were followed up and the mean follow-up period was 18 months (range,6 to 27 months).Postoperative images showed solid bone fusion without implant migration.No vascular injury and infection occurred.Graft collapse was found in 2 patients,and transient hoarse voice in 1 patient.No other complications were found.CONCLUSION:Anterior microendoscopic cervical discectomy and interbody fusion with CFRP Cage in treatment of cervical spondylosis have the advantages of minimal invasion,sufficient decompression,and satisfactory bone fusion,resulting in a significant relief of patients' preoperative clinical symptoms.

Objective This study was performed to investigate the levels of HSP70 in tissue in pemphigus as a possible new theoretical basis for further elucidate the pathogenesis of pemphigus.Methods The expression of HSP70 in 62 patients with pemphigus was determined by immunohistochemistry,and the normal skin was taken as control.Results The results showed that the positive cells of HSP70＞75 ％ in the blisters of pemphigus vulgaris and the positive cells of HSP70＞50％ in the inflammatory cells near the blisters,and the expression of HSP70 was significantly higher than that in normal skin,which was statistically significant(Z=5.42,4.73,P＜0.01).Conclusion The abnormal expression of HSP70 in inflammatory cells and psoriasis of pemphigus patients showed that HSP70 is involved in the pemphigus.