BACKGROUND:Currently,the main purpose of surgical treatment for lumbar compression fractures is to improve symptoms,reduce pain,improve quality of life,minimize surgical risks,and reduce surgical exposure time.OBJECTIVE:To explore the safety and clinical efficacy of percutaneous vertebroplasty via Kambin's triangle in the treatment of senile spinal deformity accompanied by osteoporotic vertebral compression fractures.METHODS:A retrospective analysis was conducted on 31 patients with spinal deformity and osteoporotic vertebral compression fractures who were admitted to Tianjin Union Medical Center from January 2019 to December 2022.There were 21 males and 10 females,aged between 60 and 84(70.0±10.3)years old.The duration of illness ranged from 1 to 6(3.5±1.7)weeks.A total of 35 vertebral segments were affected.The distribution of vertebral compression fractures included:10 cases of L1 fracture,12 cases of L2 fracture,2 cases of L1+L2 fracture,5 cases of L3 fracture,and 2 cases of L1+L3 fracture.Based on the surgical approach,patients were divided into two groups:group A(via Kambin's triangle approach)with 15 cases,and group B(via traditional pedicle puncture)with 16 cases.Unilateral approach vertebroplasty was performed on both groups.The surgical duration,number of radiation exposures,presence of bone cement leakage,occurrence of complications such as nerve and vascular injuries were recorded in both groups.Postoperative CT scans were used to observe the dispersion and hardening of bone cement.RESULTS AND CONCLUSION:(1)In the group A,the surgical duration was 21-30 minutes per vertebra,with an average of(25.0±5.7)minutes.In the group B,the surgical duration was 25-43 minutes per vertebra,with an average of(33.0±7.2)minutes.The surgical duration for puncturing a single vertebra was significantly longer in the group B compared to the group A,with a statistically significant difference(P＜0.05).(2)The average number of radiation exposures per vertebra during surgery was(6.2±1.6)in the group A and(9.3±1.8)in the group B,with a statistically significant difference between the two groups(P＜0.05).(3)In the group A,no bone cement leakage was found.In group B,2 cases had bone cement leakage,and 1 case had bone cement entering the spinal canal,but no obvious neurological symptoms were observed.The leakage rate was 13％.Both groups had 1 case of subcutaneous hematoma.(4)Postoperative CT scans for observing the distribution of bone cement in the vertebral body showed that the rates of uniform dispersion of bone cement within the vertebrae were 71％and 33％in the groups A and B,respectively,with a statistically significant difference between the two groups(P＜0.05).(5)It is suggested that percutaneous vertebroplasty via Kambin's triangle approach offers advantages such as shorter surgical duration,better dispersion and filling of bone cement within the vertebrae,lower risk of complications,reduced radiation exposure,and satisfactory results with unilateral puncture.

Objective To evaluate the clinical efficacy of selective expansive open-door laminoplasty(SEOLP)with preservation of C7 spinous process in the treatment of multisegmental cervical spondylotic myelopathy and its impact on changes in sagittal parameters of cervical spine.Methods A retrospective analysis was conducted on the clinical data and radiological information of 73 patients who underwent expansive open-door laminoplasty(EOLP)for cervical spondylotic myelopathy in our department between March 2018 and June 2022.Patients were divided into the SEOLP group(n=35)and the EOLP group(n=38)based on the surgical method.Follow-up was conducted for one year.The operation time,blood loss,axial symptom scores,JOA scores,VAS scores and neck disability index(NDI)were recorded in two groups of patients.Radiological data were also recorded for both groups during the perioperative period,and the C2-7 Cobb angle,C2-7 SVA and T1 slope were measured.The cervical curvature index(CCI)and cervical range of motion(ROM)were calculated.The perioperative clinical outcomes and changes in cervical sagittal parameters were observed,and their correlations were analyzed.Results There were no significant differences in blood loss,operation time,JOA scores at various follow-up time points between the two groups(P＞0.05).During postoperative follow-up,axial symptoms were observed in 5 patients in SEOLP group and 14 patients in EOLP group.There were statistically significant differences in axial symptom scores,incidence and severity of axial symptoms between the two groups(P＜0.05).The NDI indices at one year after operation were 21.1±2.3 for SEOLP group and 24.8±3.5 for EOLP group respectively(P＜0.01).There were no statistically significant differences in T1 slope and C2-7 Cobb angle at various follow-up time points after surgery between the two groups(P＞0.05).One year after operation,CCI indices for two groups were(13.4±2.7)and(12.1±2.4),respectively,with a statistically significant difference(t=2.178,P＜0.05).The C2-C7 SVA values for two groups at one year after operation were(22.4+3.8)mm and(26.7±5.9)mm,respectively(t=3.667,P＜0.01).The results of the correlation analysis showed that there was a significant negative correlation between clinical functional improvement(NDI)and changes of the radiological parameter C2-C7 SVA in both groups of patients.Conclusion After SEOLP,the recovery of C2-C7 SVA is faster and has less impact on cervical spine function,and the occurrence degree and incidence of axial symptoms are lower.

lumbar fusion surgery is one of the commonly used surgical interventions and treatments for lumbar degenerative diseases.A small proportion of patients still experience complications such as low back pain after lumbar fusion surgery.Spinal-pelvic parameters are closely related to the occurrence of complications in patients after lumbar fusion surgery.This article reviews the commonly used lumbar fixation and fusion surgical techniques and mainstream sagittal spinal-pelvic parameters.Additionally,it summarizes the research progress and current status regarding the relationship between sagittal spinal-pelvic parameters and various postoperative complications,including low back pain.

Objective To evaluate the clinical efficacy of selective expansive open-door laminoplasty(SEOLP)with preservation of C7 spinous process in the treatment of multisegmental cervical spondylotic myelopathy and its impact on changes in sagittal parameters of cervical spine.Methods A retrospective analysis was conducted on the clinical data and radiological information of 73 patients who underwent expansive open-door laminoplasty(EOLP)for cervical spondylotic myelopathy in our department between March 2018 and June 2022.Patients were divided into the SEOLP group(n=35)and the EOLP group(n=38)based on the surgical method.Follow-up was conducted for one year.The operation time,blood loss,axial symptom scores,JOA scores,VAS scores and neck disability index(NDI)were recorded in two groups of patients.Radiological data were also recorded for both groups during the perioperative period,and the C2-7 Cobb angle,C2-7 SVA and T1 slope were measured.The cervical curvature index(CCI)and cervical range of motion(ROM)were calculated.The perioperative clinical outcomes and changes in cervical sagittal parameters were observed,and their correlations were analyzed.Results There were no significant differences in blood loss,operation time,JOA scores at various follow-up time points between the two groups(P＞0.05).During postoperative follow-up,axial symptoms were observed in 5 patients in SEOLP group and 14 patients in EOLP group.There were statistically significant differences in axial symptom scores,incidence and severity of axial symptoms between the two groups(P＜0.05).The NDI indices at one year after operation were 21.1±2.3 for SEOLP group and 24.8±3.5 for EOLP group respectively(P＜0.01).There were no statistically significant differences in T1 slope and C2-7 Cobb angle at various follow-up time points after surgery between the two groups(P＞0.05).One year after operation,CCI indices for two groups were(13.4±2.7)and(12.1±2.4),respectively,with a statistically significant difference(t=2.178,P＜0.05).The C2-C7 SVA values for two groups at one year after operation were(22.4+3.8)mm and(26.7±5.9)mm,respectively(t=3.667,P＜0.01).The results of the correlation analysis showed that there was a significant negative correlation between clinical functional improvement(NDI)and changes of the radiological parameter C2-C7 SVA in both groups of patients.Conclusion After SEOLP,the recovery of C2-C7 SVA is faster and has less impact on cervical spine function,and the occurrence degree and incidence of axial symptoms are lower.

BACKGROUND:Currently,the main purpose of surgical treatment for lumbar compression fractures is to improve symptoms,reduce pain,improve quality of life,minimize surgical risks,and reduce surgical exposure time.OBJECTIVE:To explore the safety and clinical efficacy of percutaneous vertebroplasty via Kambin's triangle in the treatment of senile spinal deformity accompanied by osteoporotic vertebral compression fractures.METHODS:A retrospective analysis was conducted on 31 patients with spinal deformity and osteoporotic vertebral compression fractures who were admitted to Tianjin Union Medical Center from January 2019 to December 2022.There were 21 males and 10 females,aged between 60 and 84(70.0±10.3)years old.The duration of illness ranged from 1 to 6(3.5±1.7)weeks.A total of 35 vertebral segments were affected.The distribution of vertebral compression fractures included:10 cases of L1 fracture,12 cases of L2 fracture,2 cases of L1+L2 fracture,5 cases of L3 fracture,and 2 cases of L1+L3 fracture.Based on the surgical approach,patients were divided into two groups:group A(via Kambin's triangle approach)with 15 cases,and group B(via traditional pedicle puncture)with 16 cases.Unilateral approach vertebroplasty was performed on both groups.The surgical duration,number of radiation exposures,presence of bone cement leakage,occurrence of complications such as nerve and vascular injuries were recorded in both groups.Postoperative CT scans were used to observe the dispersion and hardening of bone cement.RESULTS AND CONCLUSION:(1)In the group A,the surgical duration was 21-30 minutes per vertebra,with an average of(25.0±5.7)minutes.In the group B,the surgical duration was 25-43 minutes per vertebra,with an average of(33.0±7.2)minutes.The surgical duration for puncturing a single vertebra was significantly longer in the group B compared to the group A,with a statistically significant difference(P＜0.05).(2)The average number of radiation exposures per vertebra during surgery was(6.2±1.6)in the group A and(9.3±1.8)in the group B,with a statistically significant difference between the two groups(P＜0.05).(3)In the group A,no bone cement leakage was found.In group B,2 cases had bone cement leakage,and 1 case had bone cement entering the spinal canal,but no obvious neurological symptoms were observed.The leakage rate was 13％.Both groups had 1 case of subcutaneous hematoma.(4)Postoperative CT scans for observing the distribution of bone cement in the vertebral body showed that the rates of uniform dispersion of bone cement within the vertebrae were 71％and 33％in the groups A and B,respectively,with a statistically significant difference between the two groups(P＜0.05).(5)It is suggested that percutaneous vertebroplasty via Kambin's triangle approach offers advantages such as shorter surgical duration,better dispersion and filling of bone cement within the vertebrae,lower risk of complications,reduced radiation exposure,and satisfactory results with unilateral puncture.

lumbar fusion surgery is one of the commonly used surgical interventions and treatments for lumbar degenerative diseases.A small proportion of patients still experience complications such as low back pain after lumbar fusion surgery.Spinal-pelvic parameters are closely related to the occurrence of complications in patients after lumbar fusion surgery.This article reviews the commonly used lumbar fixation and fusion surgical techniques and mainstream sagittal spinal-pelvic parameters.Additionally,it summarizes the research progress and current status regarding the relationship between sagittal spinal-pelvic parameters and various postoperative complications,including low back pain.

Objective:To explore the clinical effects of endoscopic sinuvertebral nerves neurotomy for discogenic low back pain.Methods:Based on the anatomical research of sinuvertebral nerves, a total of 40 patients, including 9 males and 21 females aged 35±10 (24-55) years, with single-segment discogenic low back pain were treated with endoscopic sinuvertebral nerves neurotomy in our hospital from July 2018 to February 2019. The operating section included 4 cases of L 3,4 (10.0%, 4/40), 31 cases of L 4, 5 (77.5%, 31/40), and 5 cases of L 5S 1 (12.5%, 5/40). The preoperative visual analogue scale (VAS) score was 4.5±0.9 with the preoperative Oswestry disability index (ODI) score 49.7%±14.0%. For diagnostic nerves block, lidocaine (0.1-0.3 ml of 0.05 g/L) was successfully injected into the intersection of the lateral edge of the bilateral pedicle projection and the upper edge of the intervertebral disc projection. The initial segment of the sinuvertebral nerves was destroyed by a radiofrequency blade or a nerve dissector after bilateral percutaneous transforaminal endoscopic. All cases were followed up at 1, 3, 6 and 12 months after surgery, observing the changes in VAS and ODI. Results:Filamentous lumbar sinuvertebral nerve was observed under endoscope with its main trunk tranversed into the spinal canal against the intervertebral disc. The deputy trunk crossed at the posterolateral edge of the intervertebral disc and entered the intervertebral disc or the posterior edge of the vertebral body. By moving along with postcentral branches of spinal artery, the main trunk of sinuvertebral nerve was with tension and was capable of moving with the nerve root. In spite of moving the working channel along the main trunk of the sinuvertebral nerve laterally, the starting point of the sinuvertebral nerve at the ventral ganglion could be observed. All 40 patients successfully completed the sinuvertebral nerve destruction. The VAS was reduced to 1.7±0.9, 1.3±0.9, 1.2±0.8, 1.3±0.7 at 1, 3, 6 and 12 months after sugery respectively, which were significantly lower than those at pre-operation ( F=116.7, P=0.00). The improvement rate of VAS in 40 cases was 68.9%± 17.1% (33.3%-100.0%) at 12 months after operation. The VAS score in 6 cases was higher at 12 months after surgery than that preoperatively ( t=4.2, P=0.48), namely 1 case of L 3, 4, 2 cases of L 4, 5, and 3 cases of L 5S 1. In all cases, the ODI was reduced to 18.3%±5.2%, 14.5%±4.3%, 13.6%±3.7%, 12.8%±3.0% points at 1, 3, 6 and 12 months after surgery respectively, which were significantly lower than those before surgery ( F=237.7, P=0.00). The improvement rate of ODI was 72.0%±11.6% (33.3%-88.9%) at 12 months after surgery in all cases. Conclusion:The destruction of sinuvertebral nerve after transforaminal endoscope could improve the pain and function in patients with discogenic low back pain at L 3,4 and L 4, 5 segments within 12 months. For patients with discogenic low back pain at L 5S 1 segment, the clinical effects could be better within 6 months.

BACKGROUND: The treatment of multilevel cervical spondylotic myelopathy (MCSM) aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE: To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS: Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion (group A) or posterior cervical expansive open-door laminoplasty (group B). All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION: (1) The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A (P < 0.05). (2) The cervical curvature index in the group A was significantly improved (P < 0.05), but the index had no significant change in the group B. (3) The axial systems were significantly improved in both groups, especially in the group A (P < 0.05). (4) The neurological function was significantly improved in both groups (P < 0.05), which showed no significant difference between two groups (P > 0.05). (5) The intraoperative blood loss in the group B was significantly more than that in the group A (P < 0.05). (6) The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. (7) These results suggest that during choosing an appropriate method for MCSM,surgeons' skills and patients' situation should be considered.

Objective We investigated the expression profile of cancer related genes in hMSCs co-cultured with U251 glioma cells, to evaluate the risk of malignant transformation of hMSCs in glioma environment. Methods hMSCs were co-cultured with U251 glioma cells for 5 days and the expression profile of cancer-related genes were investigated by using microarray assay, followed by Real-time quantitative RT-PCR and Western blot. Results Of the 440 cancer-re?lated genes covered by Oligo GEArray Human Cancer Microarray OHS-802, SPINT2, TK1, STC1, MMP1, CCND1, SORT1, SEPT6, CDC20, SHB, CDK5, RELA, XRCC4, KIT, CTPS, CAPNS1 and ETV6 were significantly upregulated (>3-fold) whereas none was downregulated in hMSCs co-cultured with U251 glioma cells. The upregulation of oncogenes KIT, CAPNS1, TK1, MMP1, CCND1, CDC20, RELA and STC1 in co-cultured hMSCs were confirmed by Real-time quan? titative RT-PCR. The upregulation of protein expression of oncogenes KIT, MMP1, CCND1 and RELA were detected by Western blot. Conclusion The present study demonstrates that co-culture of hMSCs with human glioma cells leads to up?regulation of some important oncogenes in hMSCs, indicating the tumorigenic potential of hMSCs in glioma environment.

Objective To investigate the expression profile of cancer-related genes in human bone marrow-derived neural stem cells (Md-NSCs) to determine whether there are any characteristics that could help the evaluation of their tumorigenic potentials.Methods Md-NSCs were cultured in vitro and identified (experimental group);fresh human adult bone marrow cells were used as control group (sifting erythrocytes).The expression profiles of 440 cancer-related genes in cells from the two groups were analyzed by Oligo GEArray Human Cancer Microarray OHS-802;real-time quantitative PCR was performed to detect the expressions of oncogene MYC,matrix metalloproteinase 2 (MMP2),Notch congener 2 (Notch2),stanniocalcin 1 (STC1),integrin α3 (ITGA 3),signal transduction and transcriptional activation factor 5b (STA T5b),Ras congene gene family C (RhoC),and wingless-type MMTV integration site family member 1 (Wnt1).Results As compared with those in the control group,the Md-NSCs from experimental group had 66 tumor-related genes with high expressions (＞3 folds).MYC,MMP2,Notch2,STCI,ITGA3,STA T5b,RhoC and Wnt1 expressions in the Md-NSCs from experimental group were significantly higher than those in the control group (P＜0.05),whose results were accorded with genechip detection results,enjoying the folds of 4.35×100,2.84×100,2.87×100,3.41 ×102,2.22×102,6.99× 100,4.92 × 100 and 3.64 ×100,respectively.Conclusion A number of cancer-related genes are over-expressed in Md-NSCs,and the activations of some of these important oncogenes have been proved to promote human tumorigenesis.