OBJECTIVE: To investigate the effect of midazolam on pain in lumbar disc herniation model rats based on p38 MAPK signaling pathway. METHODS: Fifty SPF-grade Sprague-Dawley healthy rats, half male and half female, were selected and randomly divided into normal group, model group, and low-dose, medium-dose, high-dose groups. Model group and low-dose, medium-dose, high-dose groups were initially modeled for lumbar disc herniation. Intraperitoneal injection of saline was performed in rats of normal and model groups; and in the low-dose, medium-dose, and high-dose groups, intraperitoneal injection of midazolam was performed with doses of 30, 60, and 90 mg/kg, respectively. Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), substance P (SP), neuropeptide Y (NPY) were detected in the serum of rats by enzyme-linked immunoassay. The expression of p38 MAPK and matrix metalloproteinase-3(MMP-3) protein were detected by Western blot in the tissues of rats of each group. RESULTS: The levels of TNF-α, IL-1β and β-EP were higher and the level of 5-HT was lower in the model group than in the normal group(P<0.05);the levels of TNF-α, IL-1β and β-EP were lower and the level of 5-HT was higher in the low-dose, medium-dose and high-dose groups than in the model group(P<0.05). The levels of SP and NPY increased in the model group compared with the normal group (P<0.05) and the levels of SP and NPY decreased in the low-dose, medium-dose and high-dose groups compared with the model group (P<0.05). The expression of p38 MAPK and MMP-3 increased in the model group compared with the normal group (P<0.05); the expression of p38 MAPK and MMP-3 decreased in the low-dose, medium-dose and high-dose compared with the model group(P<0.05). CONCLUSION Midazolam may ameliorate the immune inflammatory response in rats with a model of lumbar disc herniation, possibly regulated through the p38MAPK signaling pathway.
Rats ; Male ; Female ; Animals ; Intervertebral Disc Displacement/pathology* ; Rats, Sprague-Dawley ; Matrix Metalloproteinase 3/metabolism* ; Midazolam ; Tumor Necrosis Factor-alpha/metabolism* ; Serotonin/metabolism* ; MAP Kinase Signaling System/physiology* ; Pain ; p38 Mitogen-Activated Protein Kinases/metabolism*

STUDY DESIGN: A retrospective study. PURPOSE: Our objectives were to determine the association between the pathological changes of disc herniation and the interval between primary and revision surgeries and to investigate the frequency and site of the dural laceration in the primary and revision surgeries. OVERVIEW OF LITERATURE: Among 382 patients who underwent microsurgical lumbar discectomy, we investigated 29 who underwent revision surgery to analyze recurrent herniation pathologies and complications to determine the manner in which lumbar disc herniation can be more efficiently managed. METHODS: Of 29 patients, 22 had recurrent disc herniation at the same level and site. The pathological changes associated with compression factors were classified into the following two types depending on intraoperative findings: (1) true recurrence and (2) minor recurrence with peridural fibrosis (>4 mm thickness). The sites of dural laceration were examined using video footage and operative records. RESULTS: The pathological findings and days between the primary and revision surgeries showed no statistical difference (p=0.14). Analysis of multiple factors, revealed no significant difference between the primary and revision surgery groups with regard to hospital days (p=0.23), blood loss (p=0.99), and operative time (p=0.67). Dural lacerations obviously increased in the revision surgery group (1.3% vs. 16.7%, p < 0.01) and were mainly located near the herniated disc in the primary surgery group and near the root shoulder in the revision surgery group, where severe fibrosis and adhesion were confirmed. To avoid dural laceration during revision surgery, meticulous decompressive manipulation must be performed around the root sleeve. CONCLUSIONS: We recommend that meticulous epidural dissection around the scar formation must be performed during revision surgery to avoid complications.
Cicatrix ; Diskectomy ; Fibrosis ; Humans ; Intervertebral Disc Displacement ; Lacerations ; Operative Time ; Pathologic Processes ; Pathology ; Recurrence ; Reoperation ; Retrospective Studies ; Shoulder

As a self-protective mechanism of cells, autophagy of cells can maintain cell stability by degrading self-aging substances, and it can be highly induced. The ability of autophagy to degraded cells will decrease with age. The resorption phenomenon after lumbar disc herniation is one of the effective mechanisms in conservative treatment of lumbar disc herniation. The degenerative lesion of intervertebral disc is one of the main reasons of lumbar disc herniation. Cell autophagy is extensive participation in the degeneration of lumbar intervertebral disc, delaying the occurrence of degenerative disease. Futhermore, cell autophagy can potentially induce the occurrence of reabsorption. The study of cell autophagy has great significance to the degenerative disease of intervertebral disk and the reabsorption of lumbar disc herniation. And it is also of great significance for the clinical treatment of patients with lumbar disc herniation. For this reason, we should pay more attention to the study of cell autophagy in resorption.
Autophagy ; Humans ; Intervertebral Disc ; cytology ; pathology ; Intervertebral Disc Displacement ; pathology ; Lumbar Vertebrae ; pathology

OBJECTIVETo evaluate the clinical outcome of percutaneous endoscopic lumbar discectomy with target foraminoplasty in treating migrated lumbar disc herniation.

METHODSFrom June 2015 to January 2016, 25 patients with migrated lumbar disc herniation were treated with percutaneous endoscopic lumbar discectomy with target foraminoplasty. A total of 14 males and 11 females, aging from 23 to 52 years old (average: 37.6) were enrolled in this study. Discectomy occurred in L₂,₃ of 1 case, L₃,₄ of 3 cases, L₄,₅ of 12 cases, L₅S₁ of 9 cases. Preoperative, 1-week and 1-year postoperative visual analogue scale (VAS) scores were collected to evaluate lower back and leg pain; Oswestry Disability Index(ODI) was used to assess the lumbar function.

RESULTSAll the patients were followed up for 12 to 19 months with an average of 15.2 months. The mean operation time was 108.6 min. No injury of dura, nerve root, or wound infection were found. Preoperative, 1-week and 1-year postoperative visual analogue scale(VAS) scores of lower back pain were 5.8±0.5, 2.5±0.4, 0.9±0.2, respectively, with significant differences among each other(<0.05);VAS scores of leg pain were 7.1±0.6, 1.5±0.4, 0.7±0.6, respectively, with significant differences among each other(<0.05). Lumbar ODI scores were 69.2±1.8, 22.5±4.7, 10.2±2.4 at the above time points and showed significant differences among each other(<0.05).

CONCLUSIONSPercutaneous endoscopic lumbar discectomy with target foraminoplasty for migrated lumbar disc herniation showed advantages of less injuries, bleeding and complication. It also promotes rapid recovery, being curative safely and effectively.

Adult ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

STUDY DESIGN: Prospective clinical study. PURPOSE: To observe the usefulness of anterior cervical osteophytes as intrinsic markers for spinal level localization (SLL) during sub-axial cervical spinal surgery via the anterior approach. OVERVIEW OF LITERATURE: Various landmarks, such as the mandibular angle, hyoid bone, thyroid cartilage, first cricoid ring, and C6 carotid tubercle, are used for gross cervical SLL; however, none are used during cervical spinal surgery via the anterior approach. We present our preliminary assessment of SLL over anterior vertebral surfaces (i.e., intrinsic markers) in 48 consecutive cases of anterior cervical spinal surgeries for the disc-osteophyte complex (DOC) in degenerative diseases and granulation or tumor tissue associated with infectious or neoplastic diseases, respectively, at an ill-equipped center. METHODS: This prospective study on patients undergoing anterior cervical surgery for various sub-axial cervical spinal pathologies aimed to evaluate the feasibility and accuracy of SLL via intraoperative palpation of disease-related morphological changes on anterior vertebral surfaces visible on preoperative midline sagittal T1/2-weighted magnetic resonance images. RESULTS: During a 3-year period, 48 patients (38 males,10 females; average age, 43.58 years) who underwent surgery via the anterior approach for various sub-axial cervical spinal pathologies, including degenerative disease (n= 42), tubercular infection (Pott's disease; n=3), traumatic prolapsed disc (n=2), and a metastatic lesion from thyroid carcinoma (n=1), comprised the study group. Intrinsic marker palpation yielded accurate SLL in 79% of patients (n=38). Among those with degenerative diseases (n=42), intrinsic marker palpation yielded accurate SLL in 76% of patients (n=32). CONCLUSIONS: Intrinsic marker palpation is an attractive potential adjunct for SLL during cervical spinal surgeries via the anterior approach in well-selected patients at ill-equipped centers (e.g., those found in developing countries). This technique may prove helpful when radiographic visualization is occasionally inadequate.
Clinical Study ; Female ; Humans ; Hyoid Bone ; Intervertebral Disc Displacement ; Osteophyte ; Palpation ; Pathology ; Prospective Studies ; Spine* ; Spondylosis ; Thyroid Cartilage ; Thyroid Neoplasms

OBJECTIVES: To study the characteristics of the relationship between injury and disease in forensic identification cases of cervical trauma with cervical vertebra degeneration, and to explore the problems about how to identify the participation rates of injury and disease using the clinical information, forensic examination and imaging examination. METHODS: Seventeen forensic identification cases of cervical trauma with cervical vertebra degeneration were collected. The age distributions, injury formations, injury severities and imaging findings of these cases were analyzed and the relationship between injury and disease was evaluated comprehensively. RESULTS: Middle-aged and elderly were common in 17 cases and every case was involved with intervertebral disc herniation. The main reasons of injuries were hyperextension. The degree of injury severity and vertebra degeneration were graded according to the imaging findings. The participation rates of injury and disease were also calculated comprehensively. CONCLUSIONS The forensic identification cases of cervical trauma with cervical vertebra degeneration should be evaluated with clinical information, forensic examination and imaging finding.
Adult ; Age Distribution ; Aged ; Cervical Vertebrae/pathology* ; Humans ; Intervertebral Disc Degeneration/pathology* ; Intervertebral Disc Displacement/pathology* ; Middle Aged

OBJECTIVE: To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. RESULTS: The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. CONCLUSION: Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cervical Vertebrae/pathology/*radiography ; Female ; Humans ; Intervertebral Disc Displacement/*radiography/therapy ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Multidetector Computed Tomography/*methods ; Observer Variation ; Young Adult

OBJECTIVE: To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O2-O3) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. MATERIALS AND METHODS: A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O2-O3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) x 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O2-O3 therapy was determined. RESULTS: Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. CONCLUSION: This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.
Adult ; Aged ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Intervertebral Disc Displacement/*diagnosis/*therapy ; Lumbar Vertebrae/*pathology ; Male ; Middle Aged ; Oxygen/therapeutic use ; Ozone/therapeutic use ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Treatment Outcome ; Young Adult

PURPOSE: Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. MATERIALS AND METHODS: This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. RESULTS: The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. CONCLUSION: PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.
Adult ; Aged ; Back Pain/etiology/*surgery ; Dura Mater/*pathology ; Female ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Spinal Stenosis/complications/*pathology ; Tissue Adhesions/*surgery ; Treatment Outcome ; Visual Analog Scale

OBJECTIVETo investigate the effect of supplementing qi, activating blood circulation and tonifying kidney therapy on the postoperative outcomes of patients undergoing lumber intervertebral disc herniation.

METHODSFrom January 2010 to May 2012, 120 patients with lumbar intervertebral disc herniation undergoing surgical treatment in Nanfang hospital were randomized into two equal groups to receive routine therapy (control group) and additional treatment with Yiqi Houxue Bushen Decoction (treatment group). The effect of the interventions was evaluated by assessing the Visual Analogue Scale(VAS), Japanese Orthopedic Association Scores (JOA), WHO Quality of Life-BREF (WHOQOL-BREF), length of hospital stay and adverse event.

RESULTSAll the 120 patients were followed up and analyzed. Significant differences were found between the treatment and control groups in VAS, JOA Scores, and WHOQOL-BREF (P<0.01) at 2, 4, and 8 week and at 6 and 12 months after the surgery. At 6 and 12 months postoperatively, the JOA Scores (P<0.01), but not the VAS and WHOQOL-BREF, differed significantly between the two groups.

CONCLUSIONBlood-activating and kidney-nourishing therapy is effective in promoting postoperative recovery and helps reduce the clinical symptoms and minimize the adverse events in patients undergoing surgery for lumber intervertebral disc herniation.

Drugs, Chinese Herbal ; therapeutic use ; Humans ; Intervertebral Disc Displacement ; surgery ; therapy ; Lumbar Vertebrae ; pathology ; Medicine, Chinese Traditional ; Postoperative Period ; Qi ; Quality of Life