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Background: Gliomas are the most common malignant tumor of the central nervous system(CNS). Dysregulated pseudogene expression was significantly associated with the prognosis of glioma patients. However, the role of abnormal methylation of pseudogenes in glioma prognosis has not yet been studied. This study aimed to develop a novel six-methylated pseudogenes signature to predict the prognosis of glioma patients. Methods: Based on lasso regression analysis, a risk signature for six methylated pseudogenes was constructed. Next, a prognostic nomogram including grade, age, gender, and radiation was constructed. Besides, the immune cell infiltration analyses of patients based on the six-methylated pseudogenes were performed. Meanwhile, consensus cluster analysis of six methylated pseudogenes identified two glioma patient subgroups. Furthermore, GO, KEGG and GSEA were used to analyze related genes. Finally, the ability of glioma to proliferate, migrate and invade was used to verify subsequent functions. Results: In this study, six gene models consisting of methylated pseudogenes were identified and validated, and showed strong prognostic power in the training dataset, validation dataset, and entire dataset. The calibration diagram showed good predictive performance. In addition, the proportion of B cells and CD4+T cells was significantly higher in the high-risk group, while the proportion of mono cells was lower. By silencing the expression of SBF1P1 and SUMO1P1, the ability of glioma to proliferate, migrate, and invade can be inhibited. Conclusions: The six-methylated pseudogene signature may be a novel predictor for prognostic assessment of glioma patients, which could accurately predict patient prognosis.

Background: Long non-coding RNAs (lncRNAs) are tissue-specific expression patterns and dysregulated in cancer, how they are regulated is still unclear. We aimed to investigate the functions of glioma-specific lncRNA LIMD1-AS1 activated by super-enhancer (SE) and identify the potential mechanisms. Methods: To investigate the clinical significance of LIMD1-AS1, we analyzed its expression levels in a publicly available dataset and 43 glioma samples from our cohort. Functional assays, including the CCK8, colony formation, and transwell assays, were used to determine the oncogenic role of LIMD1-AS1 in human glioma progression. Furthermore, RNA pull-down, mass spectrometry, Chromatin immunoprecipitation, dCas9-KRAB interference, and Dual-Luciferase Reporter Assays were used to determine the mechanism of LIMD1-AS1 in glioma progression. Animal experiments were used to determine the role of LIMD1-AS1 in glioma tumorigenicity in vivo. Results: In this paper, we identified a SE-driven lncRNA, LIMD1-AS1, which is expressed at significantly higher levels in glioma than in normal brain tissue. High LIMD1-AS1 levels were significantly associated with a shorter survival time of glioma patients. LIMD1-AS1 overexpression significantly enhanced glioma cells proliferation, colony formation, migration, and invasion, whereas LIMD1-AS1 knockdown inhibited their proliferation, colony formation, migration and invasion, and the xenograft tumor growth of glioma cells in vivo. Mechanically, inhibition of CDK7 significantly attenuates MED1 recruitment to the super-enhancer of LIMD1-AS1, and then decreases the expression of LIMD1-AS1. Most importantly, LIMD1-AS1 could directly bind to HSPA5, leading to the activation of interferon signaling. Conclusions: Our findings support the idea that CDK7 mediated-epigenetically activation of LIMD1-AS1 plays a crucial role in glioma progression, and provides a promising therapeutic approach for patients with glioma.

Background Our previous study demonstrated that M1 macrophages could impair tight junctions (TJs) between vascular endothelial cells by secreting interleukin-6 (IL-6) after spinal cord injury (SCI). Tocilizumab, as a humanized IL-6 receptor (IL-6R) monoclonal antibody approved for the clinic, has been applied in the treatment of neurological diseases in recent years, but the treatment effect of Tocilizumab on the TJs restoration of the blood-spinal cord barrier (BSCB) after SCI remains unclear. This study aimed to explore the effect of Tocilizumab on the restoration of TJs between vascular endothelial cells and axon regeneration after SCI. Methods In this study, the mouse complete spinal cord crush injury model was used, and Tocilizumab was continuously injected intrathecally until the day of sample collection. A PBS injection in the same location was included as a control. At 14 days postinjury (dpi) and 28 dpi, spinal cord tissue sections were examined via tissue immunofluorescence. The Basso Mouse Scale (BMS) scores and footprint analysis were used to verify the effect of Tocilizumab on the recovery of motor function in mice after SCI. Results We demonstrated that depletion of macrophages has no effect on axon regeneration and motor functional recovery after SCI, but mice subjected to Tocilizumab showed a significant increase in axon regeneration and a better recovery in motor function during the chronic phase after SCI. Moreover, our study demonstrated that at 14 and 28 dpi, the expression of claudin-5 (CLDN5) and zonula occludens-1 (ZO-1) between vascular endothelial cells was significantly increased and the leakage of BSCB was significantly reduced in the injured core after daily intrathecal injection of Tocilizumab. Notably, the infiltration of CD68+ macrophages/microglia and the formation of fibrotic scar were decreased in the injured core after Tocilizumab treatment. Tocilizumab treatment could effectively reduce the IL-6 expression in macrophages in the injured core. Conclusion The application of Tocilizumab to antagonize IL-6R can effectively reduce the expression of IL-6 in macrophages and facilitate TJs restoration of the BSCB, which is beneficial for axon regeneration and motor functional recovery after SCI. Hence, Tocilizumab treatment is a potential therapeutic strategy for SCI.

The purpose of the study was to investigate the feasibility and preliminary effects of unilateral biportal endoscopic extreme transforaminal lumbar interbody fusion(UBE-eXTLIF) with large cage combined with endoscopic unilateral pedicle screw fixation for lumbar degenerative diseases.Patients with lumbar degenerative diseases who received UBE-eXTLIF with large cage combined with endoscopic unilateral pedicle screw fixation from June 2022 to July 2022 were retrospectively analyzed, including 4 females and 1 males. The clinical symptoms and signs were consistent with the imaging changes. We recorded operation time, length of postoperative hospital stay, and complications. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and modified Macnab scale was used to evaluate the clinical efficacy at preoperative, postoperative 1 month, and the last follow-up.The operation was successfully completed in all cases. The operation time was 150-180 min, with an average of 164.60 ± 12.03 min. No serious complications such as dural tears and vascular and nerve injuries occurred during operation. All the patients got out of bed 1-3 days after surgery and were hospitalized 4-5 days after surgery, with an average of 4.20 ± 0.45 days. Preoperative VAS scores of low back pain were 6.20 ± 0.84 and respectively decreased to 2.20 ± 0.45 and 1.40 ± 0.55 at postoperative 1 month and at the last follow-up, and the difference was statistically significant (P 0.05). Preoperative VAS scores of lower limb pain were 4.60 ± 2.61 and respectively decreased to 1.00 ± 0.71 and 0.60 ± 0.55 at postoperative 1 month and at the last follow-up, and the difference was statistically significant (P 0.05). Preoperative ODI scores were 62.00 ± 3.16 and respectively decreased to 38.00 ± 1.41 and 32.40 ± 3.29 at postoperative 1 month and at the last follow-up, and the difference was statistically significant (P 0.05). According to the modified Macnab criteria, the final outcome was excellent in 4 cases and good in 1 case. Five patients could return to normal activities within 3 weeks.UBE-eXTLIF with large cage combined with endoscopic unilateral pedicle screw fixation can achieve excellent clinical results and may become a new minimally invasive endoscopic fusion method for lumbar degenerative diseases.

ObjectiveThe purpose of the study was to investigate the feasibility and effects of unilateral biportal endoscopic decompression for lumbar posterior apophyseal ring separation (PARS).MethodsPatients with lumbar PARS who received unilateral biportal endoscopic decompression from June 2020 to September 2021 were analyzed, including 11 females and 15 males. The clinical symptoms were consistent with the imaging findings. Operation time, length of postoperative hospital stay and complications were recorded, and the clinical efficacy was evaluated by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified Macnab scale at preoperative, postoperative 1, 3, 6 months and the last follow-up.ResultsPreoperative VAS scores of low back pain were (5.04 ± 1.37) and respectively decreased to (2.81 ± 0.75), (2.35 ± 0.98), (1.65 ± 0.69) and (1.15 ± 0.68) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 127.317, P = 0.000). Preoperative VAS scores of lower limb pain were (6.92 ± 1.38) and respectively decreased to (2.88 ± 1.07), (2.54 ± 1.03), (1.81 ± 0.80) and (1.00 ± 0.69) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 285.289, P = 0.000). Preoperative ODI scores were (60.47 ± 8.89) and respectively decreased to (34.72 ± 4.13), (25.80 ± 3.65), (17.71 ± 3.41) and (5.65 ± 2.22) at postoperative 1, 3, 6 months and at the last follow-up, and the difference was statistically significant (F = 725.255, P = 0.000). According to the modified Macnab criteria, the final outcome was excellent in 22 cases, good in 3 cases, fair in 1 cases. 26 patients could return to work or normal activities within 3 weeks.ConclusionsUnilateral biportal endoscopic decompression has the advantages of clear and wide field of vision, large operating space, relatively simple need of surgical instrument and convenient and flexible operation procedure. It can achieve excellent clinical results with favorable efficacy and safety and may become a new minimally invasive endoscopic treatment for lumbar PARS.

Background: Lumbar posterior apophyseal ring separation is a common disease with the lumbar disc herniation in adolescents. Over the years, there has been a lack of acknowledged treatment plan. The purpose of the study was to investigate the feasibility and effects of unilateral biportal endoscopic decompression for lumbar posterior apophyseal ring separation.Methods: Patients with lumbar posterior apophyseal ring separation who received unilateral biportal endoscopic decompression from June 2020 to September 2021 were analyzed, including 11 females and 15 males.The clinical symptoms were consistent with the imaging findings.Operation time, length of postoperative hospital stay and complications were recorded, and the clinical efficacy was evaluated by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified Macnab scale at preoperative, postoperative 1, 3, 6 months and the last follow-up. Results: All patients were followed up for more than 6 months, with an average of (13.27±3.96) months. The operation time was (45-104)min with an average of (78.27±18.58) min. Complications included dural sac tears in 1 case. No serious complications such as vascular and nerve injury occurred after operation. All the patients got out of bed 1-3d after surgery, and were hospitalized (3-9)d after surgery, with an average of (4.58±1.42)d. Preoperative VAS scores of low back pain were (5.04±1.37) and respectively decreased to (2.81±0.75) ,(2.35±0.98) ,(1.65±0.69)and (1.15±0.68) at postoperative 1,3 ,6months and at the last follow-up, and the difference was statistically significant ( F =127.317，P=0.000) . Preoperative VAS scores of lower limb pain were (6.92±1.38) and respectively decreased to (2.88±1.07) ,(2.54±1.03) ,(1.81±0.80)and (1.00±0.69) at postoperative 1,3 ,6months and at the last follow-up, and the difference was statistically significant ( F =285.289，P =0.000 ) .Preoperative ODI scores were (60.47±8.89) and respectively decreased to (34.72±4.13) ,(25.80±3.65) ,(17.71±3.41)and (5.65±2.22) at postoperative 1,3 ,6months and at the last follow-up, and the difference was statistically significant ( F =725.255，P =0.000 ) . According to the modified Macnab criteria, the final outcome was excellent in 22 cases, good in 3 cases, fair in 1 cases. 26 patients could return to work or normal activities within 3 weeks. Conclusions: Unilateral biportal endoscopic decompression can achieve excellent clinical results with favorable efficacy and safety and may become a new minimally invasive endoscopic treatment for lumbar posterior apophyseal ring separation.

Background: Gliomas are the most common malignant tumor from the central nervous system(CNS). Dysregulated pseudogene expression was significantly associated with the prognosis of glioma patients. However, the role of abnormal methylation of pseudogenes in glioma prognosis has not yet been studied. This study aimed to develop a novel six-methylated pseudogenes signature to predict prognosis of glioma patients.Methods: Based on multiple screening, a risk signature for six-methylated pseudogenes was constructed, and then classified glioma patients into high-risk and low-risk groups. Next, a prognostic nomogram including grade, age, gender, and radiation was constructed. Besides, the immune cell infiltration analyses of patients based on the six-methylated pseudogenes in two risk groups were performed. Meanwhile, consensus cluster analysis of six methylated pseudogenes identified two glioma patient subgroups (cluster1/2). Furthermore, Gene Ontology (GO) , Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene set enrichment analysis (GSEA) were used to analyzed related genes. Finally, the ability of glioma to proliferate, migrate and invade were used to verify subsequent functions. Results: In this study, six gene models consisting of methylated pseudogenes were identified and validated, and showed strong prognostic power in the training dataset, validation dataset, and entire dataset. The calibration diagram showed good predictive performance. In addition, the proportion of B cells and CD4+T cells was significantly higher in the high-risk group, while the proportion of Mono cells was lower. By silencing the expression of SBF1P1 and SUMO1P1, the ability of glioma proliferation, migration and invasion can be inhibited.Conclusion: The six-methylated pseudogenes signature may be a novel predictor for prognostic assessment of glioma patients, which could accurately predict patient prognosis.

Background Excessively deposited fibrotic scar after spinal cord injury (SCI) inhibits axon regeneration. It has been reported that platelet-derived growth factor receptor beta (PDGFRβ), as a marker of fibrotic scar-forming fibroblasts, can only be activated by platelet-derived growth factor (PDGF) B or PDGFD. However, whether the activation of the PDGFRβ pathway can mediate fibrotic scar formation after SCI remains unclear. Methods A spinal cord compression injury mouse model was used. In situ injection of exogenous PDGFB or PDGFD in the spinal cord was used to specifically activate the PDGFRβ pathway in the uninjured spinal cord, while intrathecal injection of SU16f was used to specifically block the PDGFRβ pathway in the uninjured or injured spinal cord. Immunofluorescence staining was performed to explore the distributions and cell sources of PDGFB and PDGFD, and to evaluate astrocytic scar, fibrotic scar, inflammatory cells and axon regeneration after SCI. Basso Mouse Scale (BMS) and footprint analysis were performed to evaluate locomotor function recovery after SCI. Results We found that the expression of PDGFD and PDGFB increased successively after SCI, and PDGFB was mainly secreted by astrocytes, while PDGFD was mainly secreted by macrophages/microglia and fibroblasts. In addition, in situ injection of exogenous PDGFB or PDGFD can lead to fibrosis in the uninjured spinal cord, while this profibrotic effect could be specifically blocked by the PDGFRβ inhibitor SU16f. We then treated the mice after SCI with SU16f and found the reduction of fibrotic scar, the interruption of scar boundary and the inhibition of lesion and inflammation, which promoted axon regeneration and locomotor function recovery after SCI. Conclusions Our study demonstrates that activation of PDGFRβ pathway can directly induce fibrotic scar formation, and specific blocking of this pathway would contribute to the treatment of SCI.

After spinal cord injury (SCI), endogenous angiogenesis occurs in the injury core, unexpectedly accompanied by continuous leakage of the blood-spinal cord barrier (BSCB), which may be caused by destruction of the tight junctions (TJs) between vascular endothelial cells-an important structure of the BSCB. Blood-derived macrophages infiltrate into the spinal cord, aggregate to the injury core and then polarize toward M1/M2 phenotypes after SCI. However, the effect of macrophages with different polarizations on the TJs between vascular endothelial cells remains unclear. Here, we demonstrated that from 7 days postinjury (dpi) to 28 dpi, accompanied by the aggregation of macrophages, the expression of claudin-5 (CLN-5) and zonula occludens-1 (ZO-1) in vascular endothelial cells in the injury core was significantly decreased in comparison to that in normal spinal cord tissue and in the penumbra. Moreover, the leakage of the BSCB was severe in the injury core, as demonstrated by FITC-dextran perfusion. Notably, our study demonstrated that depletion of macrophages facilitated the restoration of TJs between vascular endothelial cells and decreased the leakage of BSCB in the injury core after SCI. Furthermore, we confirmed that the endothelial TJs could be impaired by M1 macrophages through secreting IL-6 in vitro, leading to an increased permeability of endothelial cells, but it was not significantly affected by M0 and M2 macrophages. These results indicated that the TJs between vascular endothelial cells were impaired by M1 macrophages in the injury core, potentially resulting in continuous leakage of the BSCB after SCI. Preventing M1 polarization of macrophages or blocking IL-6 in the injury core may promote restoration of the BSCB, thus accelerating functional recovery after SCI.

Recent research indicates that after spinal cord injury (SCI), microglia accumulate at the borders of lesions between astrocytic and fibrotic scars and perform inflammation-limiting and neuroprotective functions, however, the mechanism of microglial migration remains unclear. Fascin-1 is a key actin-bundling protein that regulates cell migration, invasion and adhesion, but its role during SCI has not been reported. Here, we found that at 7–14 days after SCI in mice, Fascin-1 is significantly upregulated, mainly distributed around the lesion, and specifically expressed in CX3CR1-positive microglia. However, Fascin-1 is not expressed in GFAP-positive astrocytes, NeuN-positive neurons, NG2-positive cells, PDGFRβ-positive cells, or blood-derived Mac2-positive macrophages infiltrating into the lesion core. The expression of Fascin-1 is correspondingly decreased after microglia are specifically depleted in the injured spinal cord by the colony-stimulating factor 1 receptor (CSF1R) inhibitor PLX5622. The upregulation of Fascin-1 expression is observed when microglia are activated by myelin debris in vitro, and microglial migration is prominently increased. The inhibition of Fascin-1 expression using small interfering RNA (siRNA) markedly suppresses the migration of microglia, but this effect can be reversed by treatment with myelin. The M1/M2-like polarization of microglia does not affect the expression of Fascin-1. Together, our results suggest that Fascin-1 is highly expressed specifically in microglia after SCI and can play an important role in the migration of microglia and the formation of microglial scars. Hence, the elucidation of this mechanism will provide novel therapeutic targets for the treatment of SCI.

The failure of axonal regeneration after spinal cord injury (SCI) results in permanent loss of sensorimotor function. The persistent presence of scar tissue, mainly fibrotic scar and astrocytic scar, is a critical cause of axonal regeneration failure and is widely accepted as a treatment target for SCI. Astrocytic scar has been widely investigated, while fibrotic scar has received less attention. Here, we review recent advances in fibrotic scar formation and its crosstalk with other main cellular components in the injured core after SCI, as well as its cellular origin, function, and mechanism. This study is expected to provide an important basis and novel insights into fibrotic scar as a treatment target for SCI.

Clearance of myelin debris caused by acute demyelination is an essential process for functional restoration following spinal cord injury (SCI). Microvascular endothelial cells, acting as "amateur" phagocytes, have been confirmed to engulf and degrade myelin debris, promoting the inflammatory response, robust angiogenesis, and persistent fibrosis. However, the effect of myelin debris engulfment on the function of endothelial tight junctions (TJs) remains unclear. Here, we demonstrate that myelin debris uptake impairs TJs and gap junctions of endothelial cells in the lesion core of the injured spinal cord and in vitro, resulting in increased permeability and leakage. We further show that myelin debris acts as an inducer to regulate the endothelial-to-mesenchymal transition in a dose-dependent manner and promotes endothelial cell migration through the PI3K/AKT and ERK signaling pathways. Together, our results indicate that myelin debris engulfment impairs TJs and promotes the migration of endothelial cells. Accelerating myelin debris clearance may help maintain blood-spinal cord barrier integrity, thus facilitating restoration of motor and sensory function following SCI.

Platelet derived growth factor receptor β positive (PDGFRβ+) pericytes form fibrotic scar, which prevents axonal regeneration after spinal cord injury (SCI). However, the mechanism by which PDGFRβ+ pericytes migrate to the injury core is unclear. Here, we investigated the effect and mechanism of macrophages polarization on PDGFRβ+ pericytes migration after SCI. Macrophages were closely related to the spatiotemporal distribution of PDGFRβ+ pericytes in the injury core at 3, 7, and 14 days postinjury (dpi). Macrophages appeared M2 polarization at 3 and 7 dpi while M1 polarization at 14 dpi. The expression of platelet derived growth factor B (PDGFB) was significantly increased after SCI and after macrophages M2 polarization. The promoting effect of exogenous PDGFB and M2 macrophages conditioned medium on PDGFRβ+ pericytes migration could be blocked by SU16f, a PDGFRβ specific inhibitor. These findings indicate that M2 macrophages can secrete PDGFB acting on PDGFRβ to promote PDGFRβ+ pericytes migration, which can be blocked by a PDGFRβ specific inhibitor SU16f. The PDGFB/PDGFRβ pathway is a promising new target for the treatment of SCI.

Platelet derived growth factor receptor β positive (PDGFRβ+) pericytes form fibrotic scar, which prevents axonal regeneration after spinal cord injury (SCI). However, the mechanism by which PDGFRβ+ pericytes migrate to the injury core is unclear. Here, we investigated the effect and mechanism of macrophages polarization on PDGFRβ+ pericytes migration after SCI. Macrophages were closely related to the spatiotemporal distribution of PDGFRβ+ pericytes in the injury core at 3, 7, and 14 days postinjury (dpi). Macrophages appeared M2 polarization at 3 and 7 dpi while M1 polarization at 14 dpi. The expression of platelet derived growth factor B (PDGFB) was significantly increased after SCI and after macrophages M2 polarization. The promoting effect of exogenous PDGFB and M2 macrophages conditioned medium on PDGFRβ+ pericytes migration could be blocked by SU16f, a PDGFRβ specific inhibitor. These findings indicate that M2 macrophages can secrete PDGFB acting on PDGFRβ to promote PDGFRβ+ pericytes migration, which can be blocked by a PDGFRβ specific inhibitor SU16f. The PDGFB/PDGFRβ pathway is a promising new target for the treatment of SCI.

Background To study the effects of hypoxia and nutrition deficiency mimicking degenerated intervertebral disc on the biological behavior of human nucleus-derived pulposus mesenchymal stem cells (hNP-MSCs) and the role of PI3K/Akt pathway in the process in vitro. Methods hP-MSCs were isolated from lumbar disc and were further identified by their immunophenotypes and multilineage differentiation. Then, cells were divided into the control group, hypoxia and nutrition deficiency group, the LY294002 group, and insulin-like growth factor 1 (IGF-1) group. Then cell apoptosis, the cell viability, the caspase 3 activity, and the expression of PI3K, Akt, and functional genes (aggrecan, collagen I, and collagen II) were evaluated. Result Our work showed that isolated cells met the criteria of International Society for cellular Therapy. Therefore, cells obtained from degenerated nucleus pulposus were definitely hNP-MSCs. Our results showed that hypoxia and nutrition deficiency could significantly increase cell apoptosis, the caspase 3 activity, and inhibit cell viability. Gene expression results demonstrated that hypoxia and nutrition deficiency could increase the relative expression of PI3K and Akt gene and inhibit the expression of functional genes. However, when the PI3K/Akt pathway was inhibited by LY294002, the cell apoptosis and caspase 3 activity significantly increased while the cell viability was obviously inhibited. Quantitative real-time PCR results showed that the expression of functional genes was more significantly inhibited. Our study further verified that the above-mentioned biological activities of hNP-MSCs could be significantly improved by IGF1. Conclusions PI3K/Akt signal pathway may have protective effects on human nucleus pulposus-derived mesenchymal stem cells against hypoxia and nutrition deficiency.

Objectives Pedicle location and recognition play important roles in spinal morphology analysis and orthodontic screw implantation, which can help doctors avoid injuring the pedicle during screw implantation. However, because of the complex spatial structures of vertebrae and the close connection between the pedicle and other parts of the vertebrae, it is challenging to locate and recognize the pedicle of the vertebral arch in 2D or 3D vertebral images. Methods In this paper, based on deep learning technology, we propose a method for automatically recognizing the vertebral pedicle in individual vertebral models and drawing pedicle contours. The goal is to provide references so doctors can simulate the pedicle screw implantation operation to prevent screw deviation and further enhance the automation of our team's scoliosis-correction assistive system. First, we preprocess the individual vertebral models to obtain their point clouds. Then, we use a modified PointNet model to segment the pedicle areas from the individual vertebral point clouds. We use the segmentation results to automatically fit the cross-sections of pedicles and finally generate the pedicle contours as surgical references. Results The experiments show that the method can generate contours quickly and accurately with a small amount of manual adjustment and can provide good references for simulating screw placement. Conclusions The efficiency of generating pedicle contours during the process of simulated screw placement is greatly improved, and the difficulty of using our simulation system has also been greatly reduced, both of which play essential roles in pedicle screw implantation and the formulation of surgical plans.

Ten years ago, endoscopic techniques began to prevail in clinical treatment of lumbar disc herniation (LDH), but to date, few studies have reported the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in treating adolescent LDH. This study aimed to evaluate the surgical outcomes of PTED in treating adolescent patients with LDH. Between June 2012 and June 2016, retrospective analysis of 43 adolescent patients diagnosed with single-segment LDH at spine surgery at the Second Affiliated Hospital of Anhui Medical University. The patients’ lower limb pain was evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). The VAS is the most commonly-used quantitative method for assessing the degree of pain in clinical practice. The measurement method is to draw a 10 cm horizontal line on a piece of paper, 1 end of which is 0, indicating no pain, while the other end is 10, which means severe pain, and the middle part indicates different degrees of pain. The clinician then asks the patient to make a mark on the line to indicate the degree of pain based on how he or she feels. The ODI is the most widely-used assessment method internationally for lumbar or leg pain at present. The ODI questionnaire is composed of 10 questions, covering pain intensity, independent living, carrying, walking, sitting, standing, sleep, travel, sex, and social life. Every category comprises 6 options, with the highest score for each question being 5 points. Thus the 1st option is worth 0 points, the last option scores 5 points, and higher scores represent more serious dysfunction. Patient satisfaction was evaluated using the modified MacNab score. Clinical outcomes were measured preoperatively, and at 3 days, 6 months, and 12 months postoperatively. All 43 patients were followed up for 12 to 24 months. The average follow-up time was 18.33 months. The VAS scores and ODI scores at 3 days, 6 months, and 12 months postoperatively were significantly lower than before surgery. The difference was statistically significant (P

Whether radical debridement is necessary for the treatment of thoracic and lumbar tuberculosis is still questionable. The objective of this prospective randomized study was to compare the outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar tuberculosis. Seventy-four thoracic and lumbar tuberculosis patients with a neurological function of grade D and E underwent surgery and received the same chemotherapy regiment from January 2009 to October 2014. All patients were divided into group A and B by taking the drawing of lots. In group A, radical debridement, bone graft, and instrumentation were performed. Isolated posterior instrumentation without debridement were performed in group B. The operative time, blood loss, visual analogue score (VAS), erythrocyte sedimentation rate (ESR), kyphotic angle, Frankel grading, fusion rate, and complications were evaluated. Group B had a better clinical outcome with regard to the operative time, blood loss, VAS score first week post-operatively, and the ESR value in the third and sixth month post-operatively than group A, and the differences between the two groups about those values all presented a significant difference (P

The aim of this study was to compare the early efficacies of interbody fusion using autologous bone graft or an interbody fusion cage in a modified transforaminal lumbar interbody fusion (TLIF) in patients of different ages with degenerative lumbar instability. Data from 33 patients with double-segment degenerative lumbar instability treated with a modified TLIF combined with a posterior fixation system from December 2008 to June 2014 were retrospectively analyzed. The two segments separately received an interbody bone graft fusion and an interbody fusion cage. Patients were divided by age into group A (middle-aged and elderly group, age ≥ 55 years, n = 13) and group B (young adult group, age

[Purpose] The aim of this study was to evaluate the effect of oscillating electrical field stimulation on motor function recovery and myelin regeneration in rats with spinal cord injury. [Subjects and Methods] A rat model of spinal cord injury was constructed by using the Allen weight-drop method. These rats were randomly divided into normal, spinal cord injury, and spinal cord injury + oscillating electrical field stimulation groups. The experimental group received the intervention with oscillating electrical field stimulation, and the control group received the intervention with an electrical field stimulator without oscillating electrical field stimulation. Each group was then randomly divided into seven subgroups according to observation time (1, 2, 4, 6, 8, 10, and 12 weeks). Basso-Beattie-Bresnahan score and inclined plate test score evaluation, motor evoked potential detection, and histological observation were performed. [Results] In the first 2 weeks of oscillating electrical field stimulation, the oscillating electrical field stimulation and inclined plate test scores of spinal cord injury group and spinal cord injury + oscillating electrical field stimulation group were not significantly different. In the fourth week, the scores of the spinal cord injury group were significantly lower than those of the spinal cord injury + oscillating electrical field stimulation group. The motor evoked potential incubation period in the spinal cord injury + oscillating electrical field stimulation group at the various time points was shorter than that in the spinal cord injury group. In the sixth week, the relative area of myelin in the spinal cord injury + oscillating electrical field stimulation group was evidently larger than that in the spinal cord injury group. [Conclusion] Oscillating electrical field stimulation could effectively improve spinal cord conduction function and promote motor function recovery in rats with spinal cord injury, as well as promote myelin regeneration.

Objective Scoliosis is a complex spinal deformity in 3D space that commonly occurs in teenagers, especially teenage girls, and judging the actual deformed spine situation using only CT images is difficult. However, using 3D finite element models to help doctors analyse the deformed spine is also time-consuming and laborious. Therefore, software that can quickly and easily perform scoliosis correction analysis is needed. To achieve rapid preoperative simulation of scoliosis correction in 3D space and help doctors construct surgical programmes faster, a morphology-based system was developed for simulating scoliosis correction performance. Methods The simulation system first takes advantage of the centre point of each vertebra on the entire spine model to fit a space curve. Then the system obtains information from the models and the space curve, and finally, uses the information to simulate scoliosis correction. The deformed spine model in the system can be corrected to a better state. Results During the simulation process, doctors can easily and clearly see how the vertebral models move, and the deformed spine parameters are also updated and shown. Using this system, doctors can easily simulate scoliosis correction according to their experience and quickly construct a surgical programme. Conclusions The experimental results show that this system is capable of simulating scoliosis correction according to a doctor's own experience to speed up the operation and provides a scientific basis for the development of surgical programmes.

Some controversies about the optimal therapy for multiple myeloma (MM) spinal cord compression are still presented. This study was conducted to investigate the efficacy of partial tumor resection combined with chemotherapy for MM spinal cord compression. Eleven patients were diagnosed with MM spinal cord compression. Radiological examinations manifested 12 spinal lesions on 11 patients. All patients were treated with partial tumor resection with adjuvant chemotherapy. The mean procedure time, the mean blood loss, visual analog scale score, Oswestry Disability Index (ODI) score, neurological status, complication, recurrence, and quality of life were evaluated. Eleven patients were followed up with a mean of 25.1 months. The mean procedure time was 152.6 ± 30.4 min, and the mean blood loss was 396.4 ± 82.7 ml. Overall pain control rate was 89 %, with complete pain relief in 64 %, and partial pain relief in 25 %. The median pre-ODI values of 85 % significantly improved to 12 % at the last follow-up. Neurological improvement of one to two grades was observed 6 months postoperatively. Complications included pleural effusion, titanium cage loose, and thrombocytopenia in three patients each. Local recurrence was 18.2 %. One patient died of pulmonary infection. Quality of life improved from 39 % before surgery to 81 % in ten survivors at the last follow-up. Partial tumor resection combined with chemotherapy seems to be an effective treatment for MM spinal cord compression owing to the minor surgical trauma, fewer complications, and effective pain control. Total resection of the tumor is not necessary for MM of the spine.

Surgical treatment is often recommended for traumatic iliopsoas hematoma. Open surgeries lead to severe surgical trauma, and minimally invasive surgeries cannot completely remove the hematoma. A new treatment protocol for traumatic iliopsoas hematoma by retroperitoneoscopic approach has been introduced. The goal of this study was to determine the safety and efficacy of retroperitoneoscopic approach used to remove iliopsoas hematoma. Between January 2009 and July 2012, 13 patients were diagnosed of traumatic iliopsoas hematoma. Retroperitoneoscopic surgeries were performed on all patients to remove the hematomas after admission. The size of hematoma, VASA score and neurologic status were dynamic evaluated before and after surgery. Soft tissue damage and complications caused by retroperitoneoscopic approach also were recorded and evaluated. We performed retroperitoneoscopic surgery to remove traumatic iliopsoas hematoma successfully on 13 patients without complications. The mean procedure time was 52.5 ± 13.4 min, and mean blood loss was 30.7 ± 9.2 ml. Hematoma was completely removed confirmed by ultrasound after surgery. Pain in the affected lower abdominal and thigh immediately was relieved totally for ten patients and partly for three patients after surgery. Quadriceps strength was restored to grade 5 and pain completely disappeared 2 months postoperatively on all patients. Numbness along the femoral nerve distribution disappeared for 11 patients and improved for 2 patients until the last follow-up. None of 13 patients suffered from infection or a new hematoma during follow-up. Retroperitoneoscopic approach is a safe and effective procedure alternative to conventional surgical approach for treating traumatic iliopsoas hematoma in terms of complete removal of hematoma, minimal invasiveness, absence of radiation, and rapid recovery.

Traumatic posterior dislocation of the upper thoracic spine without neurological deficit has rarely been reported previously in the literature and most surgeons have less experience for surgical treatment for this kind of injury. We described a case of complete posterior dislocation of the T3 thoracic spine without neurological deficit, and its management with pedicle screw fixation and reduction through an posterior approach.

A 9-year-old girl was stabbed by aquarium glass fragments in her back, which entered adjacent to the S1 vertebra and stayed within the spinal canal adjacent to the L5 vertebra. Surgical removal of the glass fragments in the acute phase was performed to decrease the risks of delayed complications associated with the presence of the sharp and pointed glass inside the spinal canal and cauda equina and nerve roots compression. Surgical intervention should be considered in patients with evolving neurologic deficits with the goal of decompressing the spinal cord and optimizing the recovery of function.

Although several studies have demonstrated good results with open reduction and internal fixation of intercondylar fractures of the distal humerus, few have specifically addressed the results of such surgical fixation in young adults. The purpose of this study was to compare the clinical outcomes in patients with intercondylar fractures of the distal humerus treated using two different double-plating methods. Twenty-five patients with distal humeral fractures classified as type C according to the Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification system, who were admitted to the Second Hospital Affiliated to Anhui Medical University (Hefei, China) from October 2008 to October 2011, were included in the study. The patients were treated with two different double-plate fixation and olecranon osteotomy methods. Thirteen patients were treated by perpendicular plating (group I) and twelve patients by Y-shaped double-plating in the coronal plane (group II). All the patients were followed up for 12–38 months, with an average of 19.2±7.1 months in group I and 18.3±4.0 months in group II. All the osteotomies and fractures had healed by the final follow-up. Complications developed in 4 patients in group I and 3 patients in group II. According to the Mayo Elbow Performance Scores (MEPS), 84.6% of patients in group I and 83.3% in group II had excellent or good scores. No significant differences were identified between the clinical outcomes of the two plating methods. The olecranon osteotomy approach with double-plate fixation is a good choice for the surgical treatment of type C intercondylar fractures in young adult distal humeri. The two plating methods provide solid fixation, permit early rehabilitation and result in satisfactory clinical outcomes.

BACKGROUND: The purpose of this paper is to determine the early incidence of disc de- generation adjacent to the vertebral body of osteoporotic fracture treated with percutaneous vertebroplasty or balloon kyphoplasty and whether adjacent disc degeneration is accelerated by this two procedures. METHODS: 182 patients with painful vertebral compression fractures were treated. A total of 97 patients were enrolled in this prospective study. 97 patients with a mean age of 65.3 years were classified into control group and surgical treatment group of non-random. 35 patients were in control group and 62 patients who were performed percutaneous vertebroplasty or balloon kyphoplasty in treatment group. X-ray and Magnetic resonance imaging were done at the first and final visit. The grade of disc degeneration above the fractured vertebral was confirmed by evaluation of bony oedema in the fat suppressed sequences and T2-weighted image of magnetic resonance imaging. The height of degenerative disc was measured on X-ray film. RESULTS: All patients were followed up two years after the first visit and the follow-up rate was 90.7% (88/97). The incidence of degeneration of adjacent disc above the fractured vertebral was 29.0% (9/31) in control group and 52.6% (30/57) in treatment group. It presented a statistically significant difference between two groups about the incidence of adjacent disc degeneration (P=0.033). The percentage of adjacent disc height reduction in control group was 13.5% and 17.6% in treatment group. Statistically significant difference of VAS score and ODI was not found between the first evaluation postoperatively and the final follow-up in treatment group (P>0.05). CONCLUSIONS: Disc degeneration adjacent to the fractured vertebral is accelerated by VP and BK procedures in the early stage, but clinical outcomes has not been weakened even in the presence of accelerated disc degeneration.