Objective The best method for femoral fixation in anterior cruciate ligament reconstruction (ACLR) remains controversial. The study assesses the bone tunnel enlargement and clinical outcome in hamstring ACLR using cortical suspension or hybrid (cortical suspension and compression) femoral fixation. Methods From January 2010 to December 2021, 102 patients who underwent quadruple hamstring ACLR using cortical suspension (39 patients) or hybrid (63 patients) fixation on the femoral side were retrospectively analyzed. Clinical evaluation was conducted using the international knee documentation committee score, the Lysholm score, the Tegner activity level scale, the knee injury and osteoarthritis outcome score (quality of life score), the Lachman test, and the side‐to‐side difference by the KT‐1000 arthrometer. The complications after the surgery were also evaluated. These data were compared at baseline and last follow‐up. The diameters of the femoral tunnel were calculated at three sites: the width of the entrance of the femoral tunnel, 1 cm proximal to the entrance of the femoral tunnel and the largest diameter of the femoral tunnel on magnetic resonance imaging (MRI) coronal images. Bone tunnel widening data were contrasted between MRI images conducted at least 2 years and within 2 weeks after surgery. The morphology of bone tunnel enlargement was also observed and recorded. The categorical parameters were analyzed using the χ 2 ‐test and Fisher's exact test. The continuous variables conforming to a normal distribution were analyzed using Student's t ‐test, and the Mann–Whitney U ‐test was undertaken between the two groups without normal distribution. Results Both cortical suspension and hybrid femoral fixation in quadruple hamstring ACLR achieved significantly improved patient‐reported outcome scores and knee stability compared to preoperative data. However, no significant differences were found between these two methods in clinical evaluations, postoperative complications, and patient‐reported outcome scores. Although the mean diameter of the enlarged bone tunnel was lowered by an additional bioabsorbable interference screw fixation near the joint line, a statistically insignificant difference was found between the hybrid and cortical suspension fixation on the femoral side. There was no statistical difference in the distribution of enlarged bone tunnel morphology between groups. Conclusions No significant difference was found in the bone tunnel enlargement and clinical outcome between cortical suspension and hybrid femoral fixation in ACLR using hamstring autograft.
Abstract Cellular loss induced by tumor necrosis factor alpha (TNF‐α) contributes to the pathogenesis of intervertebral disc (IVD) degeneration. Cellular stress induced by TNF‐α activates several processes to restore cell homeostasis. These processes include autophagy, endoplasmic reticulum stress, and related unfolded protein response (UPR). However, the effect and mechanism of UPR and autophagy regulated by TNF‐α in IVD degeneration (IDD) remain unclear. The effect of autophagy on biological changes in nucleus pulposus cells (NPCs) also remains elusive. In this study, rat NPCs were cultured with TNF‐α in the presence or absence of the UPR or autophagy pathway small‐interfering RNAs. The associated genes and proteins were evaluated through immunofluorescence staining, quantitative real‐time polymerase chain reaction (qRT‐PCR) and western blot analyses to monitor UPR and autophagy signaling and identify the regulatory mechanism of autophagy by the UPR pathway. Trypan blue exclusion assay, cell flow cytometry, terminal deoxynucleotidyl transferase dUTP nick end labeling staining, qRT‐PCR, and western blot analyses were performed to examine the apoptosis of NPCs. The results showed that the acute exposure of TNF‐α induced the apoptosis of rat NPCs and activated the protein kinase RNA‐like ER kinase/eukaryotic translation initiation factor 2α (PERK/eIF2α) pathway of UPR and initiated autophagy. Silencing the PERK/eIF2α pathway or inhibiting autophagy enhanced the apoptosis of NPCs. Interference of the PERK/eIF2α pathway suppressed the autophagy of rat NPCs under TNF‐α stimulation. Taken together, the PERK/eIF2α pathway reinforces the survival of NPCs under TNF‐α stimulation by activating autophagy. Therefore, PERK/eIF2α‐dependent autophagy could be a novel biological therapeutic target for IDD.
To summarize the research progress on the nerve root sedimentation sign of lumbar spinal stenosis.The recent domestic and foreign literature in recent years was reviewed. The definition, classification, and mechanism of nerve root sedimentation sign and the relation of nerve root sedimentation sign to diagnosis and treatment of lumbar spinal stenosis were summarized.Nerve root sedimentation sign is a phenomena which is found in MRI images of lumbar spine. Its mechanism is mainly increased intraoperative epidural pressure. There are two types of classification and the classification in which nerve root sedimentation sign is classified into "positive" and "negative" is widely applied. It has high sensitivity and specificity in differential diagnosis patients with severe lumbar spinal stenosis and patients with nonspecific low back pain. As for treatment, the nerve root sedimentation sign is related to the surgical disc levels. However, it's not sure if the nerve root sedimentation sign is related to surgical outcome. In addition, a positive sedimentation sign turns negative after sufficient surgical decompression and a new positive sedimentation sign after sufficient decompression surgery could be used as an indicator of new stenosis in previously operated patients.For lumbar spinal stenosis, the nerve root sedimentation sign can be applied as an auxiliary diagnostic indicator, as a guidance for deciding the operated disc levels, and as a postoperative indicator for evaluating the effectiveness.总结近年神经根沉降征在腰椎管狭窄症中的研究进展。.查阅近年来国内外相关文献，对神经根沉降征的定义、分型及发生机制，及其在腰椎管狭窄症诊疗中的意义进行归纳总结。.神经根沉降征是近年来提出的一种腰椎 MRI 图像中的现象，其发生机制主要为硬膜囊外压力增高。目前对该征象有两种分型方法，研究常用分型方法为二分法，即分为阳性和阴性。鉴别诊断重度腰椎管狭窄症患者和轻度的非特异性下腰痛患者时，神经根沉降征具有较高的敏感性和特异性。研究表明神经根沉降征与手术节段有一定相关性，与手术疗效的相关性存在较大争议。另外，神经根沉降征可用于术后疗效评价，腰椎管狭窄症患者手术后相应节段神经根沉降征由阳性转为阴性，如新出现阳性神经根沉降征则提示出现新的狭窄。.神经根沉降征临床可以用作腰椎管狭窄症的辅助诊断指标，对治疗方案的选择具有一定指导意义，并能用于腰椎管狭窄症术后疗效的评价。.
Thoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF).OVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF.A total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was - 2.99 ± 1.11, - 3.24 ± 1.14, - 3.05 ± 1.40 in < 70, 70-80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior-posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1-2, and 2-4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1-2, 2-4, and > 4 weeks.Thoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.
Intervertebral disc (IVD) degeneration results in segmental instability and irritates neural compressive symptoms, such as low back pain and motor deficiency. The transplanting of stem cell into degenerative discs has attracted increasing clinical attention, as a new and proven approach to alleviating disc degeneration and to relieving discogenic pains. Aside from supplementation with stem cells, the IVD itself already contains a pool of stem and progenitor cells. Since the resident disc stem cells are incapable of reversing the pathologic changes that occur during aging and disc degeneration, it has been debated as to whether transplanted stem cells are capable of providing an efficient and durable therapeutic effect, even though there have been positive outcomes in both animal models and in clinical trials. This review aims to decipher the interactions between the stem cell and the disc microenvironment. Within their new niches in the IVD, the exogenous stem cell shows metabolic adaptation to the low-glucose supply, hypoxia, and compressive loadings, but demonstrates little tolerance to the disc-like acidity and hypertonicity. Similarly, the survival of endogenous stem cells is threatened as well by the harsh disc microenvironment, which may exhaust the stem cell resources and restrict the self-repair capacity of a degenerating IVD. To eliminate the intrinsic obstacles within the stressful disc niches, stem cells should be delivered with an injectable scaffold that provides both survival and mechanical support. Quick healing or concretion of the injection injuries, which minimizes stem cell leakage and disturbance to disc homeostasis, is of equal importance toward achieving efficient stem cell-based disc regeneration.
The reported date in the repeat surgical intervention for adolescent lumbar disc herniation (ALDH) after percutaneous endoscopic lumbar discectomy (PELD) was quite scarce. This study aims to introduce cases of repeat surgeries after PELD for ALDH and assess the incidence, chief causes, repeat surgery methods, and surgical outcomes of repeat surgeries after PELD for ALDH.
Background. Increasing evidence has shown that noncoding RNAs perform a remarkable function in neuropathic pain (NP); nonetheless, the mechanisms underlying the modulation of competitive endogenous RNA in NP remain uncertain. The goal of this research was to investigate the molecular processes underlying NP. Methods. We utilized the Gene Expression Omnibus (GEO) to obtain NP-related microarray datasets that included the expression patterns of circular RNAs (circRNAs) and messenger RNAs (mRNAs). Following that, bioinformatics analyses and a molecular biology experiment were carried out. Results. According to the findings, carrying out enrichment studies of the targeted genes had an impact on a variety of NP-related pathways. Notably, we isolated a ceRNA subnetwork incorporating two upregulated circRNAs (Esrrg and Map3k3) which primarily participate in the focal adhesion pathway by regulating Integrin Subunit Beta 4 (ITGB4) and two downregulated circRNAs (Dgkb and Atp2a2), which potentially regulate metabolism-related molecule Lipase A (LIPA). Conclusions. According to our findings, the focal adhesion and metabolic signaling pathways could be critical in the advancement of NP, and some circRNA might regulate this biological process through the ceRNA network, which might offer pertinent insights into the underlying mechanisms.
Objectives: To investigate the loss of correction and defects repairment in Denis type B thoracolumbar fractures treated by short-segment pedicle screw instrumentation and transpedicular interbody bone graft.Methods: X-ray and CT images of forty patients suffering from Denis type B thoracolumbar fractures from May 2005 to December 2011 were collected.The assessments included sagital Cobb angle,compression rate of anterior vertebral body height,and the height of disk space of preoperation and postoperation,the vertebra defect degrees and sites in sagittal view and cross-section view of latest CT imaging.Results: 20 cases underwent short-segment pedicle screw instrumentation with transpedicular interbody bone graft.The time of follow-up was 15-30 months with an average of 22.3 months.20 cases underwent only short-segment pedicle screw instrumentation.The time of follow-up was 12-30 months with an average of 19.6 months.Two groups showed good recovery of Cobb angle and anterior vertebral body height,with no significant differences(P0.05).In bone graft group,the loss of correction was 4.1°±4.0°,the loss of anterior vertebral body height was(5.0±3.7)%,the loss of height at cranial adjacent disc was(1.29 ±1.9)mm.In none-bone graft group,the loss of correction was 5.6°±3.2°,the loss ofanterior vertebral body height was(5.7 ±4.5)%,the loss of height at cranial adjacent disc was(1.87±1.1)mm.There was no significant difference in the degree of loss of correction(P0.05).The defects in sagittal and cross section CT scan in bone graft group mainly existed in onethird of the vertebral superior border.Compared with none-bone graft group,bone graft group had less degree of bone defects(P0.05).Conclusions: Short-segment pedicle screw instrumentation with allograft graft is effective for Denis type B thoracolumbar fractures,which can effectively correct kyphosis,recover anterior vertebral body height and decrease the degree of bone defect.
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