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Objectives: To retrospectively analyze the treatment of lumbar spondylolisthesis using minimally invasive and open transforaminal lumbar interbody fusion (TLIF), and compare the clinical results of two techniques., Methods: From June 2006 to May 2010, 371 patients with lumbar spondylolisthesis grade 1 and 2 were treated with TLIF, pedicle screw fixation and followed up. The mean age was 50.4 years (range, 37 - 85 years). There were 172 patients who underwent minimally invasive TLIF and percutaneous pedicle screw fixation were set as the MIS-TLIF group, 199 patients who underwent open TLIF and pedicle screw fixation were set as the OTLIF group. The operative time, blood loss, X-ray exposure time and complications were compared between the two groups. Clinical outcome was assessed using the visual analog scale (VAS) and the Oswestry disability index (ODI). Fusion rates were determined by using CT scan reconstruction and dynamic lumbar radiography in last fellow-up., Results: The average follow-up duration was 32.7 months with a range of 12-58 months. The gender, age, classification of spondylolisthesis and level of fusion showed a identical pattern in both groups. The mean intra-operative blood loss (310 ± 75) ml and postoperative blood loss (38 ± 13) ml in MIS-TLIF group were significantly superior to the intra-operative blood loss (623 ± 156) ml and postoperative blood loss (184 ± 72) ml in OTLIF group (t = 2.836 and 3.274, P < 0.01). Comparing with the OTLIF group (20 ± 10) s, the MIS-TLIF group had a significantly longer radiation time (51 ± 19) s (t = 2.738, P < 0.01). There was no statistical difference in operating time, lower back pain VAS scores, ODI scores and incidence of complication between the two groups., Conclusions: Comparing with open TLIF, minimally invasive TLIF is a safe and reliable procedure for treatment of lumbar spondylolisthesis grade 1 and 2 with potential advantages.

Aim: To approach the expression and its significance of connection tissue growth factor in articular cartilage during repair after full-thickness cartilage injury in young rabbit model., Methods: Young rabbit model of spontaneous healing of full-thickness cartilage defect in the medial femoral knee condyle was reproduced in present study. A total of twenty-five young New Zealand white rabbit were randomly divided into five groups: control group, 24 hour group, 1 week group, 4 week group and 8 week group after full-thickness cartilage injury (5 each). The mRNA and protein expression of CTGF were detected with RT-PCR and immunohistochemistry, respectively., Results: The morphologically good repairs with hyaline-like cartilage appearance were observed at 8 weeks after injury. The expression of CTGF mRNA was detected in all groups. Expression of CTGF mRNA was significantly higher in all groups after cartilage injury than in control group(P<0.05).The immunohistochemistry results showed that the expression of CTGF was positive in all groups, and immunolocalization was observed in the middle and deep zone., Conclusion: The up-regulated expression of CTGF is accompanied with spontaneous healing of full-thickness cartilage defect in young rabbit, and CTGF may play a role in the repair of articular cartilage injury.

Objective: To evaluate the results of micro-endoscopic revision surgery for recurrent disc herniation, and compare the results of disc excision with and without interbody fusion., Methods: A total of 32 patients included who had undergone micro-endoscopic revision discectomy for recurrent disc herniation with or without interbody fusion has been surveyed to assess their clinical outcome. The 27 patients who had been followed were divided into two groups; the micro-endoscopic discectomy alone 14 cases, the micro-endoscopic discectomy with interbody fusion 13 cases. With an average follow-up of 25.5 months. Clinical symptoms were assessed based on the VAS scores and Nakai criteria. All medical and surgical records were examined and analyzed, including intraoperative blood loss, length of surgery, and postsurgery hospital stay et al., Results: The statistical difference in the postoperative back pain and leg pain score compared with preoperative score were significant (P < 0.05) or very significant (P < 0.01). Clinical outcomes were excellent or good in 92.8% of patients undergoing a micro-endoscopic discectomy alone, and in 85.5% of patients with interbody fusion. The statistical difference between the fusion and non-fusion groups was insignificant (P = 0.793). But the two groups intraoperative blood loss, length of surgery, length of hospitalization and expenses were significantly less in patients undergoing discectomy alone than in patients with interbody fusion., Conclusions: Micro-endoscopic revision surgery for recurrent disc herniation is very effective and safety. Micro-endoscopic discectomy alone is first choice for managing recurrent disc herniation.

Objective: To investigate the pathological expression and significance of VEGF in patients with active ankylosing spondylitis., Methods: The expression of VEGF in the synovial tissues of cacroiliac joint of patients with active AS was detected by using in situ hybridization and the results were compared with those in the patients with pelvic fracture using image analysis system., Results: The positive expressions of VEGF in the synovial tissues of cacroiliac joint of patients with active AS were stronger than those in the control group (P<0.01)., Conclusion: VEGF are important factors in patients with active AS. They are tightly correlated with the process of osteoclasia and pathological new bone formation in the cacroiliac joint of patients with active AS. If we can reduce the expressions of VEGF in the patients with active AS, the process of osteoclasia and pathological new bone formation will be interrupted and this provides a new strategy for the treatment of ankylosing spondylitis.

Objective: To observe the significance of excision of presacral tumor after two sides hypogastric artery ligation and tissue dissociation with laparoscope., Methods: Twenty-one patients with sacral tumor were performed excision of presacral tumor after two sides hypogastric artery ligation and tissue dissociation with laparoscope., Results: All sacral tumor were removed successfully, the mean volume of operative blood was 800 ml (range 500-1900 ml), and all the patients were followed up 3-25 months, averaged time 11 months. One patient was recurred after 2 months of operation (the patient was Ewing's sarcoma, and refused to accept radiotherapy and chemotherapy after operation), 1 patents died of brain metastases after 9 months of operations. There were no recurrence in the others patients., Conclusions: The excision of presacral tumor after two sides hypogastric artery ligation and tissue dissociation with laparoscope is an effective operation method, with the advantages of decreasing the operative blood and difficulty of sacral tumor excision, and diminishing the operation wound.

Objective: To evaluate the surgical procedure of unilateral transforaminal discectomy, bone grafting, cage (Telamon) insertion and Dylanok pedicle screw fixation using X-tube operation system for the treatment of lumbar disc herniation combined with segmental instability and Spondylolysis with pars defect., Methods: From 2004 to 2006, 42 patients including 17 male and 25 female were treated in our department. The age range from 22 to 77 (mean: 51.6). Etiologies including lumbar disc herniation combined with segmental instability and Spondylolysis with pars defect., Result: Of these 42 patients, the mean operation time was 240 min (110 - 320 min), the average blood loss was 140 ml (80 - 420 ml), the average incision length was 3 cm (2.8 - 3.2 cm) and the average hospitalization time was 12.5 days (5 - 25 days). Nakai criteria, Excellent in 23 cases (62.2%), good in 11 cases (29.2%) and fair in 3 cases (8.6%). 5 patients had postoperative complication (complication rate: 16.3%)., Conclusions: The surgical procedure has shown predominant benefits: small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery which makes it a valuable alternative to conventional surgical procedures.

Objective: To study the effects of unilateral graded facetectomy on lumbar stability through biomechanical analysis. The primary clinical results of unilateral facetectomy, posterior lumbar interbody fusion and unilateral pedicle screw instrumentation using X-tube system were also evaluated., Methods: 5 functional spinal units (FSU) from fresh cadavers of 5 adults were made, divided into 5 groups to remain intact, or with the lateral 1/4, 1/2, or 3/4 or the whole of the left L4/5 articular process, and then put in the biomechanical testing apparatus to evaluate the effects of operation on the lumbar motion range of flexion, extension, lateral bending and axial rotation. Twenty-three patients, 16 males and 7 females, aged 47.7 (32 - 74), underwent unilateral facetectomy, posterior lumbar interbody fusion, and unilateral pedicle screw instrumentation using X-tube system. The clinical outcomes of the 23 patients were assessed by use of the visual analog score (VAS), Oswestry disability index (ODI), and Nakai criteria., Result: The experiment of the 5 FSUs showed that no significantly negative effects on the change in lumbar motion range of flexion, extension after unilateral graded facetectomy (all P > 0.05), and the stability of lateral bending and axial rotation had been greatly affected with the range of graded facetectomy exceeding 1/2 (P < 0.05). According to the Nakai criteria, the clinical effect was excellent in 15 cases (65.2%), good in 6 cases (26.1%), and fair in 2 cases (8.7%). The excellent and good cases accounted for 91.3% with a fusion rate of 95.6%., Conclusion: The lumbar stability is significantly affected if the range of graded facetectomy exceeds 1/2. The use of procedures of unilateral facetectomy, diskectomy, spinal nerve root decompression, autologous bone grafting, and unilateral pedicle screw fixation using X-tube is an optional strategy for minimally invasive spine technique.

Objective: To compare the traumatic responses following microendoscopic discectomy (MED) and open discectomy., Methods: Forty-four patients with single level lumbar disk herniation underwent MED (Group A, n = 22) or open discectomy (Group B, n = 22). The intra-operational blood loss, duration of operation, intra-operative blood loss, and post-operational hospital stay were noted and the pain severity of incision was evaluated by visual analog scale (VAS). Serum levels of IL-6, C-reactive protein (CRP) and creatine kinase (CK) were measured before operation and 24 h and 48 h after operation. The clinical outcomes were evaluated by Oswestry disability index (ODI) before operation and 6 months after operation., Results: The intra-operative blood loss of Group A was 47.50 +/- 11.62 ml, significantly less than that of Group B (129.11 +/- 71.75 ml, P < 0.01), the duration of operation of Group A was 64.77 +/- 17.83, significantly shorter than that of Group B (78.18 +/- 24.32, P < 0.05). The postoperative hospital stay of Group A was 6.09 +/- 2.22 days, significantly shorter than that of Group B (8.73 +/- 3.53, P < 0.01). The scores of VAS 1, 2, and 3 days after the operation were all significantly lower than those of Group B (all P < 0.001). The rate of remarkable symptomatic improvement of Group A was 94.7%, not significantly different from that of Group B (94.4%, P > 0.05) The serum IL-6 showed no significant difference between these 2 groups pre-operationally, and peaked 24 h after operation and decreased 48 h after operation in both groups, returning to the pre-operational level in Group A. The IL-6 level 24 h and 48 h post-operationally of Group A was 31.6 +/- 9.88 pg/ml and 26.25 +/- 9.30 pg/ml respectively, both significantly lower than those of Group B (39.16 +/- 11.14 pg/ml and 32.55 +/- 8.83 pg/ml respectively, both P < 0.05) The serum CK showed no significant difference between these 2 groups pre-operationally, and peaked 24 h after operation and decreased 48 h after operation, but still higher than those before operation, in both groups. The serum CK 24 h and 48 h after operation of Group A were 167.91 +/- 51.85 and 131.50 +/- 52.70 U/L respectively, both significantly lower than those of Group B (401.55 +/- 108.86 and 260.32 +/- 64.98 U/L, both P < 0.01). The serum CRP level showed no significant difference between these 2 groups pre-operationally, and increased post-operationally, peaked 24 h after operation and then decreased in Group A, however, continued to increase in Group B. The serum levels of CRP 24 h and 48 h post-operationally of Group A were 12.68 +/- 7.10 and 10.77 +/- 5.25 pg/ml, both significantly lower than those of Group B (20.82 +/- 8.79 and 29.95 +/- 14.85 pg/ml, both P < 0.01). The clinical outcomes 6 months after operation of these two groups were all satisfying., Conclusion: Both MED and open discectomy show good clinical outcomes in treatment of single level lumbar disk herniation, however, the less responses of serum IL-6, CRP, and CK show that the MED procedure is less traumatic.

Objective: To explore the genetic diversity of different farm races of Morinda officinalis on molecular level., Methods: The molecular biological technique-random amplified polymorphic DNA (RAPD) were used., Results: Of the 40-mer arbitary primers, 14 were found to amplify polymorphic products. 3-5 polymorphic bands were amplified by each polymorphic primer on the average. Using UPGMA method all the tested accesions can be clustered into two groups: 4 accessions of Daye were classified as one group, 1 accession of Xiaoye be another group., Conclusion: There actually existed much genetic diversity on molecular level among the different farm races of Morinda officinalis.

Objective: To discuss the surgical technique, indication and the clinical effects of the Microscope Endoscopic Tubular Retractor System (METRx) for microendoscopic lumbar diskectomy with the preservation of the ligamentum flavum., Methods: Two hundred and eleven patients underwent single-segment METRx, with ligamentum flavum preservation in 65 patients (Group A), and without preservation in 146 patients (Group B). The two groups were compared clinically. All the patients suffered from low back pain and radicular syndrome to some extent, and the diagnosis was affirmed by CT and/or MRI. After exposed the interlaminar space regularly, the superior, inferior and lateral edge of the ligamentum flavum was released, the 3-sided dissociative ligament pacth was retracted medially during the spinal manipulation and restored anatomically after disc removal and the decompression of the nerve root., Results: According to the results of two groups, ligamentum flavum preservation technique was feasible under endoscope and helpful in reducing the scar formation in the spinal canal., Conclusions: The ligamentum flavum preservation technique enable the surgeons to preserve the natural barrier. It is feasible to perform METRx, and it is helpful in reducing the epidural fibrosis.

Objective: To observe the effect of vascular endothelial growth factor (VEGF) in fracture healing and to investigate the influence of VEGF and VEGF antibody in fracture healing., Methods: One hundred and five rabbits were used to make fracture model in the left radius and randomly divided into control group, VEGF group and VEGF antibody group. VEGF and VEGF antibody were used in the VEGF group and VEGF antibody group respectively, then the blood flow of the fracture ends was measured by single photon emission computed tomography (SPECT) 8, 24, 72 hours, 1, 3, 5 and 8 weeks after fracture, the X-ray films of the fracture sites were taken after 1, 3, 5 and 8 weeks to observe the fracture healing., Results: The blood flow of the fracture ends in the VEGF group increased during a period from 8 h to 3 wk after fraction when compared with that of the control group, and no obvious difference was seen on the X-ray films between the two groups. In the VEGF antibody group, the blood flow of the fracture ends decreased obviously when compared with that of the control group. The fracture healing process was interfered seriously and nonunion change was seen in the fracture site., Conclusion: The lack of VEGF will interfere with the fracture healing process and result in nonunion in the fracture site. Administration of ectogenous VEGF may promote fracture healing by increasing the blood flow of the fracture ends.