To evaluate the biomechanical influence after percutaneous endoscopic lumbar facetectomy in different diameters on segmental range of motion (ROM) and intradiscal pressure (IDP) of the relevant segments by establishing three dimensional finite element (FE) model.An intact L3-5 model was successfully constructed from the CT of a healthy volunteer as Model A (MA). The Model B (MB), Model C (MC) and Model D (MD) were obtained through facetectomy on L4 inferior facet in diameters 7.5 mm, 10 mm and 15 mm on MA for simulation. The ROM and IDP of L3/4 and L4/5 of four models were all compared in forward flexion, backward extension, left and right bending, left and right rotation.Compared with MA, the ROM of L4/5 of MB, MC and MD all increased. MD changed more significantly than MB and MC in backward extension, right bending and right rotation. But that of MB and MC on L3/4 had no prominent change, while MD had a slight increase in backward extension. The IDP of MB and MC on L4/5 in six states was similar to MA, yet MD increased obviously in backward extension, right bending, left and right rotation. The IDP on L3/4 of MB and MC was resemble to MA in six conditions, nevertheless MD increased slightly only in backward extension.Compared with the facetectomy in diameters 7.5 mm and 10 mm, the mechanical effect brought by facetectomy in diameter 15 mm on the operating segment changed more significantly, and had a corresponding effect on the adjacent segments.
Abstract Objective To explore the safety and the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and 3D microscope-assisted transforaminal lumbar interbody fusion (MMIS-TLIF) for treating single-segment lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS). Methods The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital were retrospectively analyzed, including 26 patients who underwent the UBE-TLIF and 23 patients who underwent the MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes of patients before surgery and at 1, 3, 6, 12 and 24 months after surgery. The lumbar lordosis angle (LL), disc height (DH) and lumbar intervertebral fusion rate were assessed before surgery and at the last follow-up. Results The VAS and ODI scores of the two groups were improved compared with those before surgery. The ODI of UBE-TLIF group was lower than that of MMIS-TLIF group at 1, 3, 6, and 12 months after surgery, and there were no significant differences between the two groups at other time points ( P > 0.05). There were no significant differences in VAS between the two groups at each time point ( P > 0.05). However, the UBE-TLIF group had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF group (11.54%) and the MMIS-TLIF group (17.39%) were comparable ( P > 0.05). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before surgery, and the difference before and after surgery was not significant ( P > 0.05). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups ( P > 0.05). Conclusions Both UBE-TLIF and MMIS-TLIF have favorable outcomes for treating single-segment DLS-LSS. Both groups have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.
To retrospectively review the clinical features and treatment strategy of lumbar disc herniation in adolescents initially misdiagnosed as idiopathic scoliosis.From 1998 to 2007, nineteen adolescents with lumbar disc herniation were admitted to our hospital. All of them presented a scoliotic curve as their first complaint. There were 10 males and 9 females with the age ranged from 14 to 20 years. The disc herniation located at L(4,5) in 10 patients, at L(5)S(1) in 7, and at L(4)-S(1) in 2. The Cobb angle ranged from 23 degrees to 38 degrees . The distance from the C(7) plumb line to the central sacral line averaged 4.7 cm. All the patients underwent conventional open discectomy, followed by a pelvic traction for 3 weeks. A cast fixation for one month was recommended for further correction of scoliosis if the curve improvement was not obvious.Fourteen (73.7%) patients had a disc herniation at the convex side of lumbar curve, and 5 (26.3%) patients had a disc herniation at the concave side, which showed a marginal statistical correlation between the side of the disc herniation and the direction of lumbar curve (P = 0.07). Leg pain and numbness disappeared in the 19 patients after surgical decompression. After the pelvic traction for 3 weeks postoperatively, the Cobb angle reduced to 14 degrees, with the mean distance from the C(7) plumb line to the central sacral line of 2.2 cm. At a mean follow-up of 21 months, neither the recurrence of back pain and leg pain nor the loss of spontaneous scoliosis correction was found.Care should be taken to the diagnosis of lumbar disc herniation in adolescents with spine deformity as their chief complaint. Satisfactory clinical results can be achieved by early diagnosis and proper treatment.
Abstract Introduction: It is well known that the main segments of spinal fracture is thoracolumbar (T11-L11). Therefore, in addition to the lumbar, the lower thoracic vertebra (T9-T12) often has the clinical needs of implantation of cortical bone trajectory (CBT) screws. However, the anatomic parameters of the lower thoracic vertebrae are quite different from those of the lumbar vertebrae, which means that if CBT screws are to be implanted in the lower thoracic vertebrae, the selection of the screw entry point, the length, diameter, angle and path of the screws in each segment need to be redefined. Methods In this part, 3-dimensional finite element model was established to analyze the stress and fixation efficiency of CBT screws in thoracic vertebrae after 5000 times of fatigue loading of normal model and osteoporosis model. Discussion If the outcomes indicate the trial is feasible and there is evidence to provide some basic anatomical parameters for CBT screw implantation in the lower thoracic spine, so that the ideal insertion point, length, diameter, and angle of CBT screw in different segments of the lower thoracic spine were determined. Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026915.Registered on September 26, 2019.
Objective
Dynamic MRI with rectum injectionis employed to assess female spastic pelvic floor syndrome of anorectal morphology and function in relation to various pelvic compartment abnormalitiesin female outlet obstruction constipation.
Methods
Dynamic MRI was performed in 53 female patients (14-78 years of age, with a mean age of 52.7±15.8 years) with clinical diagnosis of spastic pelvic floor syndrome.The homemade highly conformable sacculus was inserted into the rectum to simulate stool. The relevant measurements were then obtained during straining before and after rectum injection.
Results
Among the 53 female patients with spastic pelvic floor syndrome, 24 patients (45.3%) have multifocal disorders involving more than one compartment.The difference in the anorectal angles before and after rectum injection was not significant (χ2=0.603, P>0.05) . Differences in the cystocele, vaginal or cervical prolapse, rectocele, and descending perineum before and after rectum injection were significant.
Conclusion
Using dynamic MRI with rectum injection allows for the accurate evaluation of the anorectal morphology and function related to various pelvic compartment abnormalitiesin female spastic pelvic floor syndrome; thus, this method is proved valuable in the diagnosis and treatment of female spastic pelvic floor syndrome.
Key words:
Pelvic floor; Magnetic resonance imaging; Spastic pelvic floor syndrome
Objective To observe the clinical effects of Setus-M in conservative treatment of the lumbar intervertebral disc protrusion for out-patients.Method To observe the clinical effects of Setus-M which are taken orally to treat the lumbar intervertebral disc protrusion in 90 cases.The control group were given mannitol and dexamethasone intravenously guttae.Results After a course of treatment,the total effectiveness is 88.89%(80/90),and the obvious effectivenss 52.22%(47/90).No adverse reaction was found during the treatment.And there was no obvious difference between Setus-M and control group in treatment effectiveness.Conclusion The clinical application of Setus-M shows that the medicine has obvious effect on the lumbar intervertebral disc protrusion.Hence,it is worthy to be generalized in the conservative treatment of the lumbar intervertebral disc protrusion for out-patients.
Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality worldwide. Preeclampsia is linked to mitochondrial dysfunction as a contributing factor in its progression. This study aimed to develop a novel diagnostic model based on mitochondria-related genes(MRGs) for preeclampsia using machine learning and further investigate the association of the MRGs and immune infiltration landscape in preeclampsia. In this research, we analyzed GSE75010 database and screened 552 DE-MRGs between preeclampsia samples and normal samples. Enrichment assays indicated that 552 DE-MRGs were mainly related to energy metabolism pathway and several different diseases. Then, we performed LASSO and SVM-RFE and identified three critical diagnostic genes for preeclampsia, including CPOX, DEGS1 and SH3BP5. In addition, we developed a novel diagnostic model using the above three genes and its diagnostic value was confirmed in GSE44711, GSE75010 datasets and our cohorts. Importantly, the results of RT-PCR confirmed the expressions of CPOX, DEGS1 and SH3BP5 were distinctly increased in preeclampsia samples compared with normal samples. The results of the CIBERSORT algorithm revealed a striking dissimilarity between the immune cells found in preeclampsia samples and those found in normal samples. In addition, we found that the levels of SH3BP5 were closely associated with several immune cells, highlighting its potential involved in immune microenvironment of preeclampsia. Overall, this study has provided a novel diagnostic model and diagnostic genes for preeclampsia while also revealing the association between MRGs and immune infiltration. These findings offer valuable insights for further research and treatment of preeclampsia.
Abstract Objectives The study is aimed to evaluate clinical outcomes of debridement, decompression and interbody fusion by using biportal spine endoscopy for treating treat patients diagnosed with lumbar spinal tuberculosis (LST). Methods Forty patients with LST who underwent debridement, decompression, and interbody fusion using biportal spine endoscopy between January 2020 to March 2022 were included in the study. The operation time, blood loss, complication rate, fusion rate, visual analogue scale (VAS) score, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and kyphotic Cobb’s angle were measured to explore the effects on patients with LST. Results The patients were followed up for 12–16 months, and the mean follow-up period was 14.6 months. The mean operation time was 223.4 ± 94.4 min (range, 140–410 min), with a mean blood loss of 235.0 ± 190.5 cc (range, 120–700 cc). The VAS (1.57 ± 0.65) and ODI (8.29 ± 3.05) scores at the last phase of follow-up were significantly lesser than the preoperative scores (5.86 ± 0.86 and 74.29 ± 6.26, respectively). Additionally, the mean JOA score increased from 10.29 ± 2.58 (preoperatively) to 24.93 ± 1.86 (postoperatively). Meanwhile, the mean preoperative ESR and CRP (74.36 ± 8.18 and 71.28 ± 8.58, respectively) decreased to average values. The preoperative kyphotic Cobb’s angle of 21.40 ± 2.22° decreased to 9.86 ± 0.76° postoperatively. However, the kyphotic correction remained unchanged at the last phase of the follow-up. Furthermore, the fusion rate was 100%. The complication rate was 7.5% (three case of cerebrospinal fluid leakage). Conclusion Debridement, decompression, and interbody fusion using biportal spine endoscopy might be ideal for treating patients with LST.
Abstract Background: Percutaneous endoscopic interlaminar discectomy (PEID) has been widely used in the treatment of lumbar disc herniation and spinal stenosis, epidural steroids following PEID in an effort to reduce the incidence and duration of postoperative pain. Although steroids are widely thought to reduce the effect of surgical trauma, the observation index is not uniform, so the issue is still controversial. Therefore, the purpose of this paper is to systematically evaluate the efficacy and safety of local epidural steroids application following PEID. Methods: We will search the following databases from their inception to August 2020, PubMed, Embase, Medline, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Web of Science, Wan Fang Database, Cochrane Library. The search strategy includes the MeSH terms. Meta-analysis will be performed using Rev Man V.5.3.5 statistical software. Results: This study will provide a high-quality synthesis to evaluate the efficacy and safety of local epidural steroids following PEID. Conclusion: This systematic review will provide evidence to judge whether local epidural steroids application following PEID is an effective and safe intervention for patients. It will provide reliable evidence for its extensive application. Registration number: INPLASY2020100085
Objective To evaluate the clinical efficacy of an allogeneic bone cage (Biocage; Beijing Datsing Bio-Tech Co., Ltd., Beijing, China) for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion. Methods From January 2013 to December 2016, 67 patients who underwent lumbar fusion were divided into the Biocage group (n = 33) and polyether ether ketone (PEEK) group (n = 34). The patients were followed up for 24 to 48 months. The mean intervertebral height of the fusion level, fusion rate, height of the intervertebral foramen, visual analog scale score, and Oswestry disability index were compared. Results The PEEK group had a lower fusion rate than the Biocage group (88.24% vs. 90.91%), although the difference was not statistically significant. During follow-up, the height of the intervertebral space was similar between the Biocage and PEEK groups (12.88 ± 0.45 and 12.84 ± 1.01 mm, respectively). The height of the intervertebral foramen was larger in the Biocage than PEEK group (20.67 ± 1.34 vs. 20.00 ± 2.05 mm). Good clinical efficacy was achieved in both groups. Conclusion The Biocage is efficient and safe for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.
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