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Patients with degenerative cervical myelopathy (DCM) often present with atypical symptoms such as vertigo, headache, palpitations, tinnitus, blurred vision, memory loss, and abdominal discomfort. This study aims to investigate the relationship between atypical symptoms of DCM and the segments of spinal cord compression. The 166 DCM patients with atypical symptoms admitted to our institution from 2019 to 2020 were divided into vertigo, headache, blurred vision, tinnitus, and palpitations groups according to their atypical symptoms, while the typical group was 214 DCM patients with typical symptoms only. Differences in segments of compression were compared among the groups. Results of more than 1-year of follow-up were further summarized for nonsurgical and surgical treatment of DCM patients with atypical symptoms. The incidence of vertigo, headache, blurred vision, tinnitus, and palpitations of all DCM patients was 37%, 18%, 15%, 11%, and 11%, respectively. Compared with the typical group, patients in the blurred vision and tinnitus group were older (P < 0.05) and the incidence of spinal cord compression at C3-5 in the vertigo group, C4-5 in the headache group, and C6-7 in the palpitation group was higher (P < 0.05). The scores of vertigo, headache, and palpitations decreased after surgical decompression (P < 0.05), whereas only vertigo and headache scores decreased after nonsurgical treatment (P < 0.05). Atypical symptoms were common in patients with DCM, and the segments of spinal cord compression might be associated with specific atypical symptoms. Surgical treatment is effective in relieving some of the atypical symptoms. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF)., Methods: The clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P >0.05). The VAS score and ODI score were used to evaluate the improvement of patients' symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded., Results: The injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups ( t =1.018, P =0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups ( χ 2 =4.334, P =0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation ( P <0.05), and there were significant differences among the postoperative time points ( P <0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group ( P <0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up ( P >0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups ( P >0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant ( χ 2 =4.105, P =0.043; χ 2 =4.661, P =0.031)., Conclusion: Bone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.

Objective: To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture., Methods: A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability ( P >0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade., Results: The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group ( P <0.05), but no significant difference was found in hospitalization days between 2 groups ( P >0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up ( P >0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) ( P >0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group ( P <0.05), but no significant difference was found in Greenough low-back outcome score, VAS score, and ASIA grade between 2 groups ( P >0.05)., Conclusions: Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.

Objective: To detect the expressions of IL-1 and IL-6 in the degenerative intervertebral discs of patients with discogenic low back pain (DLBP), record the modified Japanese Orthopedic Association (mJOA) scores and analyze the correlation between the expressions and the scores., Methods: The study chose 30 cases of DLBP aged between 45-65 years old from the same race and district and 10 control cases of vertebral fractures scheduled for surgical treatment but with no history of low back pain within one year and no disc degeneration based on imaging data. The degree of DLBP was evaluated by mJOA scores. Immunohistochemistry and Western blotting were used to observe the expressions of IL-1 and IL-6 in the discs. The relationship between the IL-1, IL-6 expressions and the mJOA scores was revealed by Pearson linear correlation analysis., Results: Compared with the control group, the expressions of IL-1 and IL-6 in the discs of DLBP patients increased significantly as immunohistochemistry and Western blotting indicated. The highest mJOA score of DLBP group was 16 points and the lowest was 7 points before operation. The expressions of IL-1 and IL-6 were negatively correlated with the mJOA scores of low back pain., Conclusion: The expressions of IL-1 and IL-6 in the discs of DLBP patients were significantly elevated and negatively correlated with the mJOA scores of low back pain.

Objective: To explore the possibility of constructing tissue engineered cartilage complex three-dimensional nano-scaffold with collagen type II and hyaluronic acid (HA) by electrospinning., Methods: The three-dimensional porous nano-scaffolds were prepared by electrospinning techniques with collagen type II and HA (8 : 1, W : W), which was dissolved in mixed solvent of 3-trifluoroethanol and water (1 : 1, V : V). The morphology were observed by light microscope and scanning electron microscope (SEM). And the porosity, water absorption rate, contact angle, and degradation rate were detected. Chondrocytes were harvested from 1-week-old Japanese white rabbit, which was disgested by 0.25% trypsin 30 minutes and 1% collagenase overlight. The passage 2 chondrocytes were seeded on the nano-scaffold. The cell adhesion and proliferation were evaluated by cell counting kit 8 (CCK-8). The cell-scaffold composites were cultured for 2 weeks in vitro, and the biological morphology and extracelluar matrix (ECM) secretion were observed by histological analysis., Results: The optimal electrospinning condition of nano-scaffold was 10% electrospinning solution concentration, 10 cm receiver distance, 5 mL/h spinning injection speed. The scaffold had uniform diameter and good porosity through the light microscope and SEM. The diameter was 300-600 nm, and the porosity was 89.5% +/- 25.0%. The contact angle was (35.6 +/- 3.4) degrees, and the water absorption was 1 120% +/- 34% at 24 hours, which indicated excellent hydrophilicity. The degradation rate was 42.24% +/- 1.51% at 48 days. CCK-8 results showed that the adhesive rate of cells with scaffold was 169.14% +/- 11.26% at 12 hours, and the cell survival rate was 126.03% +/- 4.54% at 7 days. The histological and immunohistochemical staining results showed that the chondrocytes could grow well on the scaffold and secreted ECM. And the similar cartilage lacuma structure could be found at 2 weeks after co-culture, which suggested that hyaline cartilage formed., Conclusion: The collage type II and HA complex three-dimensional nano-scaffold has good physicochemical properties and excellent biocompatibility, so it can be used as a tissue engineered cartilage

Objective: To summarize the advancement of cytoskeleton and axon outgrowth of neuron., Methods: The recent literature concerning cytoskeleton and axon outgrowth of neuron was reviewed and summarized., Results: The actin filaments and microtubules in neuron were highly polarized and dynamic structures confined to the tips of axons and the reciprocal interactions between these two major cytoskeletal polymers was also dynamic. Attractive or a repulsive cue whose final common path of action was the growth cone cytoskeleton mediated the growth of axons of neuron by intracellular signaling cascades. Regulating the actin filament and microtubule dynamics as well as their interactions in growth cones played a key role in neurite outgrowth and axon guidance. Rho-GTPases and glycogen synthase kinase 3beta (GSK-3beta), the two major intracellular signaling pathways had emerged in recent years as candidates for regulating the dynamics of actin filaments and microtubules., Conclusion: The axon outgrowth and guidance depend on well-coordinated cytoskeletal and reciprocal interaction dynamics which also mediate axon regeneration after spinal cord injury. Regulating activity of Rho-GTPases and GSK-3beta simultaneously may acts as key role to regulate the dynamics of cytoskeletal and to determine axon outgrowth.

Objective: Neuron purification is essential to procedure of various nerve cell experimental research, however, at present there is few reports on the effect of various factors on neural axons during purification. To find out a simple method of neuron purification, and to investigate the influence factors of corresponding purification culture in dorsal root ganglion (DRG) tissue culture on beta3-tubulin positive axon., Methods: The DRGs were obtained from the 3 days neonatal SD rat microscopically and were made into cell suspension. Then, the amount of attached DRG neurons and nonneuronal cells in poly-D-lysine (PDL) group, PDL/Laminin (PDL/LN) group and collagen-I (Col I) group was observed from 10 to 100 minutes. Then, the extension and arborization of beta3-tubulin positive axons were observed after 72 hours completely randomised DRG tissue culture for the research of the influences among culture substrates (PDL, PDL/LN, and Col I), FBS (0, 5%, and 10%), 5 fluorouracil (5-Fu, 0, 20, and 40 micromol/L), and cytarabine (Ara-C, 0, 10, and 20 micromol/L)., Results: Adherent cells were observed instantly after inoculation by inverted phase contrast microscope and inverted fluorescence microscope; after cell suspension was removed, adherent growth of DRGn cells and non-DRGn cells were still seen. In PDL group, the amount of NSE negative cells was significantly higher than that of NSE positive cells at 10 and 30 minutes (P < 0.05); the amount of NSE positive cells was significantly higher than that of NSE negative cells at 80, 90 and 100 minutes (P < 0.05). In PDL/LN group, there was no significant difference (P > 0.05) in the amount of NSE negative cells and NSE positive cells at 10, 20, 30, 40, and 50 minutes; the amount of NSE positive cells was significantly higher (P < 0.05) than that of NSE negative cells at 60, 70, 80, 90, 100 minutes. In Col I group, the amount of NSE negative cells was higher than that of NSE positive cells at 10-40 minutes, but showing no significant difference (P > 0.05); the amount of NSE positive cells was significantly higher (P < 0.05) than that of NSE negative cells at 70-100 minutes. At 72 hours after DRG tissue culture, the best result of beta3-tubulin positive axon extension and arborization was obtained when the substrate level was PDL/LN, and the average length of PDL/LN level was significantly larger than that of other two substrates (P < 0.05). The highest number of beta3-tubulin positive axon distal end was obtained at 5% concentration level of FBS (P < 0.05), but showing no significant differences in beta3-tubulin positive axon length among three levels (P > 0.05). Both the most of beta3-tubulin positive axon distal ends and the longest beta3-tubulin positive axon average length were obtained at 0 micromol/L concentration level of 5-Fu, showing significant differences between 0 micromol/L level and 20, 40 micromol/L levels (P < 0.05). A similar result of 33-tubulin positive axon distal end was got at the 0 micromol/L level and 10 micromol/L level of Ara-C, which was significantly higher than that of 20 micromol/L level (P < 0.05)., Conclusion: A purified DRG neuron suspension for neuron culture could be obtained via PDL differential attachment for 30 minutes. When DRG neuron culture, neuron special medium, PDL/LN substrate and 10 micromol/L Ara-C are recommended in beta3-tubulin positive axon research.

Objective: To study the clinical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis., Methods: From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including 13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were complicated with neural symptom of the lower limbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were complicated with iliac abscess, 3 cases with psoas abscess, 3 cases with sacroiliac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogenous iliac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogenous iliac bone fragment grafting, and anterior focus debridement was performed., Results: The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroiliac joint tuberculosis achieved sacroiliac joint fusion. For those 7 patients with combinations of the neural symptom of the lower limbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P < 0.05)., Conclusion: The modified Galveston technology is helpful to reconstruct the stability of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.

Objective: To explore the advantage and indication of combined anterior and posterior surgeries for lumbarsacral junction tuberculosis., Methods: Eleven cases of the lumbarsacral junction tuberculosis were treated with combined anterior (radical debridement and autograft) and posterior (instrumentation and fusion) surgeries in one stage between January 2002 and December 2006. There were 9 males and 2 females with the age of 20-56 years old. The course of disease was 4 to 15 months, 6 months on average. The lessons were located at L5, S1 in 7 patients, at L4,5, S1 in 2 patients and at L5, S2 in 2 patients. The involved vertebral bodies were at 2 segments in 7 patients; and 3 segments in 5 patients. The preoperative kyphosis was 5 to 8 degrees with an average 9 degrees. The sinus was associated in 3 patients, 3 patients had radiculopathy; 4 had paeumonophthisis and 9 had abscess., Results: The followed-up period was from 6 months to 3 years, 18 months on average. According to Chen score, among the 11 cases, there were excellent in 9, good in 2. All incisions were healed up primarily. After operation, spinal fusion was achieved in 10 cases within 5 months to 7 months, 6 months on average, and pseudoarthrosis in 1 case was found by the CT examination. The postoperative kyphosis was 0 to 4 degrees with the mean of 2 degrees and the radiculopathy in 3 cases all got nerve function recovery., Conclusion: Lumbarsacral junction tuberculosis treated with this surgical technique can achieve a high satisfactory rate with restoring the spinal stability, arresting the disease early, providing early fusion, correcting the kyphosis and preventing progression of kyphosis particularly if lumbosacral spine tuberculosis is associated with sinus or preoperative diagnosis cannot exclude suppurative spondylitis.

Objective: To investigate the therapeutic effects of transplanting allogeneic marrow mesenchymal stem cells (MSCs) via subarachnoid space on spinal cord injury(SCI) and the T cell subpopulation., Methods: Density gradient centrifugation was used to isolate and expand MSCs from bone marrow of 10 six-week-old SD rats. The SCI model was produced by weight-beating from 60 eight-week-old female SD rats. Forty survival SCI rats, which BBB scores were zero, were divided randomly into 2 groups:experimental group (group A) and control group (group B). In addition, 20 normal eight-week-old SI) rats were used as blank group (group C). In group A, 1 ml cells suspention containing MSCs (the 6th generation, 2 x 10(6)/ml) was injected via subarachnoid space. In group B, equal volume of L-DMEM was injected in the same way. The BBB score was obtained after 1st, 2nd and 3rd weeks of injection. At the same time,T cell subpopulation was detected by flow cytometry., Results: The BBB score in group A was better than that in group B, but fewer than that in group C in the 3rd week. CD4+ T cells in group A were less than those in groups B and C in the 1st, 2nd, and 3rd weeks. CD8+ T cells in group A were less than those in groups B and C in the 2nd and 3rd weeks. The ratio of CD4+/CD8+ T cells in group A was less than those in groups B and C in the 1st week. Above differences showed statistically significant difference (P < 0.05). However, there were no statistically significant differences in the ratio of CD4+/CD8+T cells between group A and groups B, C in the 2nd and 3rd weeks (P>0.05)., Conclusion: The above results suggest that allogeneic MSCs transplantation via subarachnoid space is beneficial to SCI to some extend, do not result in rejection in vivo. Furthermore, it can lead to immunosuppression in short time. So, it provides clues to apply MSCs to treat SCI and other diseases.