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Study design A systematic review and meta-analysis. Objective This study was performed to evaluate the effects of different rehabilitation interventions in spinal cord injury. Summary of background data Several activity-based interventions have been widely applied in spinal cord injury in the past, but the effects of these rehabilitation exercises are controversial. Methods Publications were searched from databases (PubMed, Embase, Cochrane, the database of the U.S. National Institutes of Health and World Health Organization International Clinical Trials Registry Platform) using the searching terms like spinal cord injury, transcranial magnetic stimulation, functional electrical stimulation, activity-based therapy, and robotic-assisted locomotor training. Randomized controlled trials and controlled trials were included. The primary outcomes included functional upper/lower extremity independence, walking capacity, spasticity, and life quality of individuals with spinal cord injury. Meta-analysis was performed using Revman 5.0 software. Results Thirty-one articles were included. Meta-analysis showed that transcranial magnetic stimulation improved walking speed (95% confidence interval [CI] 0.01, 0.16) and lower extremity function (95% CI 1.55, 7.27); functional electrical stimulation significantly increased upper extremity independence (95% CI 0.37, 5.48). Robotic-assisted treadmill training improved lower extremity function (95% CI 3.44, 6.56) compared with related controls. Conclusion Activity-based intervention like transcranial magnetic stimulation, functional electrical stimulation, and robotic-assisted treadmill training are effective in improving function in individuals with spinal cord injury.Level of Evidence: 1.

This study aimed to evaluate the clinical effects of percutaneous vertebroplasty (PVP) combined with postoperative radiotherapy (RT) in the treatment of spinal metastases. Nine patients (4 males and 5 females, mean age 59.56 years) with painful pathologic compression vertebral fractures caused by metastatic cancers of the spine (5 thoracic levels, 8 lumbar levels) were admitted to our hospital between July 17, 2016 and September 25, 2018. All patients were treated with PVP via bilateral pedicle approach combined with postoperative RT to treat metastatic lesions of the centrum. The clinical records of the patients were retrospectively analyzed. Patients’ demographic features and medical conditions including the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Imageology data were observed. Patients’ mean VAS scores decreased from 8.67 ± 0.50 preoperatively to 1.78 ± 0.83 at 6 months after PVP. Moreover, the mean ODI score decreased from 74.07 ± 13.15 preoperatively to 31.87 ± 10.00 at 6 months after PVP. Significant improvement in the degree of pain and dysfunction among the enrolled patients were observed. Furthermore, the metastatic carcinoma lesion within the vertebral body was well controlled according to imaging. PVP in conjunction with postoperative RT is a good treatment strategy for vertebral compression fractures caused by metastases.

Objective To compare the von Mises stresses of the pedicle screw system and the displacement of injured vertebrae using 3-D finite element analysis, and to evaluate the curative effect of the pedicle screw system. Methods Finite element methods were used for biomechanical comparison of four posterior short segment pedicle screw fixation techniques. The different pedicle screw models are traditional trajectory (TT), Universal Spine System (USS), cortical bone trajectory (CBT), and CBT at the cranial level and pedicle screw (PS) at the caudal level (UP-CBT). The stress distribution of the screws and connecting rods under different working conditions and the displacement of the injured vertebrae were compared and analyzed. Results After the pedicle screw system was fixed, the stress under vertical compression was mainly concentrated at the proximal end of the screw, while the stress was mainly concentrated on the connecting rod during flexion, extension, lateral flexion, and rotation. The TT group had the greatest stress during the flexion, extension, and left and right rotation. The UP-CBT group was most stressed when the left and right sides were flexed; the stress of the USS screw system was less than that of the other three models during flexion, lateral flexion, and rotation. The maximum von Mises stress values of pedicle screws in all exercise states were 556.2, 340.7, 458.1, and 533.4 MPa, respectively. In the USS group, the displacement of the injured vertebra was small in the flexion, and the left and right lateral flexion and the right rotation were higher than in the TT group and the CBT group. The maximum displacements of the injured vertebrae in all motion states were 1.679, 1.604, 1.752, and 1.777 mm, respectively. Conclusion Universal Spine System pedicle screws are relatively less stressed under different working conditions, the risk of breakage is small, and the model is relatively stable; CBT screws do not exhibit better mechanical properties than conventional pedicle screws and USS pedicle screws.

As RNA interference (RNAi) received solicitous attention by many for its promising performance in gene therapy recently, and how to obtain a choice small interfering RNA (siRNA) vector has become a moot point at this moment. Exosomes (Exo) show advantages of long survival time in vivo, high transmission efficiency and easy penetration across the blood-brain/spinal cord barrier, renowned as excellent carriers of bioactive substances. Previous studies have confirmed the detrimental effect of connective tissue growth factor (CTGF) on axonal regeneration after spinal cord injury (SCI) via stimulating the unrestricted growth of glial scars. In this study, we applied mesenchymal stem cells (MSCs)-derived Exo as the delivery of synthesized siRNA, which were extracted from rat bone marrow. We constructed exosome-siRNA (Exo-siRNA) that could specifically silence Ctgf gene in the injury sites by electroporation.During the administration, we injected Exo-siRNAs into the tail vein of SCI rats, and their distribution and accumulation in the spinal cord were visualized by in vivo fluorescence imaging. Relevant in vivo and in vitro experiments in this study showed that Exo-siRNA not only effectively inhibited the expressions of Ctgf gene and glial scar formation related proteins, such as GFAP, vimentin fibronectin and laminin, in the injured spinal cord segments, but quenched inflammation, and thwarted neuronal apoptosis and reactive astrocytes and glial scar formation. Besides, it significantly up-regulated several neurotrophic factors and anti-inflammatory factors (e.g., TGF-β1), acting as a facilitator of axon regeneration of nerve-injured motor neurons. Thus, the motor function of SCI rats were remarkably promoted.In conclusion, this study has combined the thoroughness of gene therapy and the excellent drug-loading characteristics of Exo for the precise treatment of SCI, which will shed new light on the drug-loading field of Exo.

Rationale: Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra. Patient concerns: A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months. Diagnoses: Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra. Interventions: The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time. Outcomes: The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later. Conclusion: This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.

Low molecular weight poly-lactic acid (PLLA) is a polymer matrix of orthopaedic implants. The PLLA matrix incorporating bioactive magnesium ion (Mg2+) enhances bone regeneration. But the optimal ratio of Mg2+ to PLLA matrix has not been well reported and is worthy of study. We synthesized silane-coated Mg/PLLA composites containing 1%, 2%, 3%, 4% and 5% Mg micro-particles. The mechanical properties, in vitro cytocompatibility, cell viability and osteogenesis differentiation and in vivo performance of silane-coated Mg/PLLA composites were evaluated. These results showed that the bending and tensile strength of PLLA matrix was reduced by incorporation of Mg micro-particles. Mg/PLLA composites with higher Mg micro-particles ratio showed higher Mg2+ leaching rate and pH value in immersion solutions. MC3T3-E1 pre-osteoblasts incubated with Mg/PLLA composites containing higher ratio of Mg micro-particles showed higher cytocompatibility, cell viability, osteogenesis differentiation and migration. In vitro cellular responses showed that MC3T3-E1 pre-osteoblasts had the highest cell viability at 50 ppm Mg2+. In vivo animal studies showed there was no change in serum Mg2+ concentration after implanting Mg/PLLA composites comparing with control and the implants of silane-coated Mg/PLLA composites accelerated bone formation. In summary, our study revealed the feasibility of silane-coated Mg/PLLA composites as orthopaedic implants. Silane-coated Mg/PLLA composites with Mg micro-particles ratio of 3% ∼ 5% were optimal substitutes for bone regeneration.

Background Spinal cord injury (SCI) is a lesion of neural elements of spinal cord. Frequently, there is motor incomplete injury and locomotor disability. Robot assisted locomotor training, functional electrical stimulation (FES) devices, and repetitive transcranial magnetic stimulation (rTMS) devices are commonly used to improve motor control and gait of patients with SCI. The efficacies of different interventions for SCI have not been reported comprehensively, and a full comparison of these strategies may benefit clinicians who apply these techniques in the rehabilitation of patients with SCI. This study aimed to comprehensively evaluate the efficacies of different interventions for SCI. Methods We did a systematic review and meta-analysis by searching for publications using PubMed, Embase, the Cochrane Database, the database of the US National Institutes of Health, and the WHO International Clinical Trials Registry Platform on Dec 30, 2018. Randomised controlled trials and controlled trials that compared interventions with usual care or a no exercise control, and that were published in English, were selected for our meta-analysis. The primary outcomes included functional independence (assessed using the functional independence measure, SCI independence measure, American Spinal Injury Association [ASIA] upper extremity motor score [UEMS] or lower extremity motor score [LEMS], and other hand function tests), walking speed (10 m walking test [10MWT]) and walking distance (6 min walking test [6MWT]), walking capacity (walking index for spinal cord injuries version II [WISCI II]), spasticity (modified Ashworth scale [MAS]), and quality of life of patients with SCI. The secondary outcomes included patient dropout and adverse events during intervention. Weighted mean differences and 95% CIs were used to measure intervention efficacy, and the OR was used for analysis of adverse events. Physiotherapy Evidence Database (PEDro) scale scores were used for quality assessment of the included studies. Meta-analysis was performed using Revman 5.0 software. Findings Our initial search yielded 1410, 1643, and 452 English articles reporting the effectiveness of rTMS or FES, exercise or training, and robot assisted locomotor treadmill training on functional recovery after SCI. Of these articles, 27 randomised controlled trials and three controlled trials, including 1020 patients with SCI, were included for meta-analysis. Four articles were available for evaluating rTMS versus control (81 participants), six for FES (174 participants), nine for massed practice or treadmill training (218 participants), and 11 for robot assisted treadmill training (547 participants). rTMS improved walking speed (mean absolute difference [MD] 0·09, 95% CI 0·01–0·16, p=0·03, 10MWT) and lower extremity motor function (4·41, 1·55–7·27, p=0·003, ASIA LEMS) compared with control (sham rTMS plus gait training), but not spasticity and walking index. FES significantly increased upper extremity independence (2·92, 0·37–5·48, p=0·03) compared with control (conventional occupational therapy [COT] or resistance and aerobic training), but not upper extremity or lower extremity function and quality of life. Activity-based therapy (massed practice and treadmill training) showed no benefit to nerve injury and functional rehabilitation compared with control (no intervention, overground mobility therapy, self-regulated exercises, or conventional rehabilitation program), whereas robot assisted treadmill training significantly improved ASIA LEMS scores (5·00, 3·44–6·56, p Interpretation rTMS, FES, and robot assisted treadmill training are effective in rehabilitating patients with SCI. The efficacies of rTMS and robot assisted treadmill training were relatively consistent among articles. The combination of rTMS and robot assisted treadmill training was effective in the rehabilitation of patients with SCI. Funding None.