Objective To retrospectively analyze the clinical and imaging features of multi-segmental lumbar intervertebral disc protrusion and its treatment with the limited recessive decompression operation. Methods Twenty two patients (14 males and 8 females, aged 49-68 years) were admitted to hospital from March 1999 to March 2004. They suffered from multisegmental lumbar intervertebral disc protrusion that involved L1S1 and were treated with the limited recessive decompression operation. Results The follow-up for 4-21 months showed that 16 of the patients had an excellent outcome, 5 had a good outcome, and 1 had fair outcome. There were nosuch operative complications as nerve root lesions and putamen lesions. Conclusion The limited recessive decompression operation is one of the available good treatments for multi-segmental lumbar intervertebral disc protrusion. It solves problems of herniation and stenosis and maintains stability ofthe spine.
Objective To investigate the feasibility oftissue engineered intervertebral disc for regeneration of discs. Methods A three-dimensional porous poly(L-lactic-co-glycolic acid) (PLGA) scaffold was fabricated by temperature induced phase separation method. Human fetal disc cells were isolated and cultured in vitro. The disc cells labeledwith a PKH-26 fluorescent dye were seeded into a threedimensional porous scaffold. The proliferation of disc cells with PKH-26 fluorescent labels was assessed by using MTT uptake, laser fluorescence microscopy and SEM. Results Human fetal disc cells displayed a polygonal shape in primary monolayer culture. A regular arrangement and microtubules orientationstructure scaffold with 50-300 μm in diameter was fabricated by thermal-induced phase separation technique. MTT uptake and fluorescent microscopy examination indicated that the seeded disc cells were viable and showed proliferation activity within a porous scaffold. Conclusion The above findings support potential applications of tissue engineered disc in treatment of disc degenerative diseases.
Objective To evaluate the effectiveness and safety of different injection sites for collagenase chemonucleolysis for lumbar intervertebral disc protrusion (LIDP). Methods We searched for randomized controlled trials (RCTs) and quasi-RCTs in the following electronic databases: Pubmed (1966 to May 2006), EMBASE(1966 to May 2006), The Cochrane library (Issue 2, 2006), CRD(Center for Reviews and Dissemination),York University, CBM (1978 to May 2006 ), CNKI(1994-2006)and VIP(1989-2006). Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. Results Eight studies involving a total of 1035 participants met the inclusion criteria. Meta-analysis was not carried out because of apparent heterogeneity. Four studies made comparisons among intradisc, extradisc, and combined intra- and extra-disc injection. One study (62 participants) showed that intradisc injection was superior to extradisc injection (RR 3.71, 95% CI 1.19 to 11.58, Plt;0.05). Another study (240 participants) showed that intradisc injection was superior to combined intra- and extra-disc injection after 3 months and 6 months of follow-up (RR 0.88, 95% CI 0.80 to 0.98, Plt;0.05). The other two studies showed no significant difference among intradisc, extradisc, and combined intra- and extra-disc injection. Four studies (436 participants in total) showed that amongst three extradisc injections, both anterior epidural space injection and lateral epidural space injection were superior to posterior epidural space injection (Plt;0.05). Although one study indicated that anterior epidural space injection was superior to lateral epidural space injection (RR 1.24, 95% CI 1.03 to 1.51, Plt;0.05), no statistical significance was found between anterior epidural space injection and lateral epidural space injection in two other studies (Pgt;0.05). Conclusions There is insufficient evidence to identify which injection site for collagenase is the most effective for lumbar intervertebral disc protrusion. The included studies showed that both anterior and lateral epidural space injection were superior to posterior epidural space injection. However, these studies are too small and poor quality, and have different diagnostic criteria, follow-up time points, outcome measures and efficacy parameters. Thus, more high quality and large-scale RCTs are needed.
Objective To explore the osteogenic potential of cervical intervertebral disc fibroblasts in vitro, to investigate the regulatory factors of recombinant human bone morphogenetic protein 2(rhBMP-2) and tumor necrosis factor α(TNF-α) on osteogenic phenotype of fibroblasts and to discuss the condition that facilitates osteogenesis of fibroblasts. Methods Theannulus fibroblasts cell lines of experiment goats were established in vitro and the biologicspecificity was found. According to different medias, 4 groups were included in this experiment: control group, TNF-α group ( 50 U/ml TNF-α), rhBMP-2 group (0.1 μg/ml rhBMP-2) and TNF-α+rhBMP-2 group (50 U/ml TNF-α+0.1 μg/ml rhBMP-2). Thefibroblasts were incubated in the media for about 3 weeks,and then the markers for osteogenic features were investigated by biochemistry, histochemistry observations. Results rhBMP-2 and TNF-α had no effect on the proliferation of fibroblasts from the experiment goats. rhBMP-2 or TNF-α could stimulate fibroblasts to secrete alkaline phosphatase and collagen type Ⅰ. The combined use of rhBMP-2 and TNF-α or the single use of rhBMP-2 could make fibroblasts to secrete osteocalin and the morphological changes of the fibroblasts were very obvious. Histochemical study of the nodules with specific new bone labeler(Alizarin red S) revealed positive reaction, denoting that the nodules produced by the fibroblasts werebone tissues. There was statistically significant difference(Plt;0.05) inALP activity between 3 experimental groups and control group and in secretion of osteocalcin between rhBMP-2 group, TNF-α+rhBMP-2 group and control group. Conclusion The results point out clearly that rhBMP-2 can induce theosteogenic potential of annulus fibroblasts in vitro.
ObjectiveTo investigate the role of transforming growth factor β1(TGF-β1) and connective tissue growth factor (CTGF) in pathogenesis and progression of human intervertebral disc degeneration by detecting the expressions of these two factors in different degrees of degenerative discs.
MethodsThe lumbar intervertebral discs were collected from 33 patients with lumbar disc herniation and 12 patients with lumbar vertebral fracture between November 2012 and April 2013.All samples were observed under the microscope after HE staining,and then were divided into different subgroups according to the degenerative degree.The expressions of TGF-β1 and CTGF were detected by Western blot.
ResultsAccording to the pathological features,10 discs were defined as normal discs,10 as mild degenerative discs,9 as moderate degenerative discs,and 16 as severe degenerative discs.The histological observation showed that rounded nucleus pulposus cells with similar size evenly distributed in the cartilage-like matrix,and no hyperplastic collagenous fiber was seen in normal discs;mild degenerative discs characterized by slightly larger nucleus pulposus cells in the matrix,but cells did not decrease,a small quantity of inflammatory cells infiltrated in the matrix,hyperplasia of collagenous fiber was not seen;most of the nucleus pulposus cells became bigger,some showed a bulb form,the number of nucleus pulposus cells was significantly reduced,low grade hyperplasia of collagenous fiber emerged in the matrix,new vessels and inflammatory cells were both found in some specific areas of discs in moderate degenerative discs;there was no nucleus pulposus cells in the matrix of severe degenerative discs,the hyperplasia of collagenous fiber was obvious.The relative expression of TGF-β1 in 3 degeneration discs was significantly higher than that in normal discs (P<0.05),and the expression of TGF-β1 was significantly higher in severe degenerative discs than in moderate and mild degenerative discs (P<0.05),but no significant difference between moderate and mild degenerative discs (P>0.05).The relative expression of CTGF in moderate and severe degeneration discs was significantly higher than that in normal discs (P<0.05);and the expression of CTGF in mild degenerative discs was higher than that in normal discs,but there was no significant difference (P>0.05);and significant difference in CTGF expression was found among 3 degeneration discs (P<0.05).
ConclusionThe expressions of TGF-β1 and CTGF are closely related to the degree of human lumbar disc degeneration,these two factors may play an important role in promoting lumbar intervertebral disc degeneration.
ObjectiveTo discuss the safety and effectiveness of combined dynamic cervical implant (DCI) and Cage fusion in the treatment of two-level cervical disc protrusion.
MethodsBetween September 2009 and June 2011, 16 cases of two-level cervical disc protrusion were treated with combined DCI and Cage fusion. Of 16 cases, 10 were male and 6 were female, with a mean age of 44.1 years (range, 37-64 years) and with a mean disease duration of 5.1 years (range, 2-8 years), including 8 cases of cervical myelopathy, 5 cases of nerve root cervical myelopathy, and 3 cases of mixed cervical myelopathy. Radiological results indicated degenerative intervertebral discs and compressed never root or spinal cord. Involved discs included C3,4 and C4,5 (1 case), C3,4 and C5,6(5 cases), C4,5 and C5,6 (3 cases), C4,5 and C6,7 (5 cases), and C5,6 and C6,7 (2 cases). The neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analogue scale (VAS) were used to evaluate the neurological function and pain relief. The stabilities and activities of involved segments, intervertebral fusion, and displacement of Cages were observed during follow-up.
ResultsPrimary healing of incisions was obtained in all cases; no complication of hematoma, infection, cerebrospinal fluid leakage, or neural function damage occurred. All 16 patients were followed up 18 months on average (range, 6-36 months). The cervical X-ray results indicated that the activities of involved segments was (7.8±3.1)°, showing no significant difference (t=0.655, P=0.132) when compared with preoperative value [(7.3±2.6)°]. No implant loosening was observed; slight heterotopic ossification occurred in 1 patient at the posterior rim of intervertebral space. No cage loosening or sinking was seen, and good fusion was achieved. The mean time of fusion was 4.5 months (range, 3-8 months). NDI, JOA, and VAS scores at last follow-up (18.3±5.1, 15.7±1.5, and 3.4±1.8 respectively) were significantly improved (t=2.131, P=0.016; t=3.126, P=0.024; t=6.102, P=0.038) when compared with preoperative scores (49.6±11.3, 12.8±2.0, and 6.7±1.2 respectively).
ConclusionA combination of DCI and intervertebral Cage fusion has satisfactory early effectiveness in treatment of two-level cervical intervertebral protrusion for maintaining the stability and activity of cervical vertebrae.
Objective To summarize the research progress of platelet-rich plasma (PRP) for the treatment of discogenic low back pain (DLBP). Methods The literature on the treatment of DLBP with PRP was extensively reviewed, and the classification, treatment mechanism, in vitro and in vivo experiments and clinical trial progress of PRP were summarized. Results According to the PRP composition, preparation methods, and physicochemical properties, there are five commonly used PRP classification systems at present. PRP is involved in delaying or reversing the progress of disc degeneration and pain control by promoting the regeneration of nucleus pulposus cells, increasing the synthesis of extracellular matrix, and regulating the internal microenvironment of degenerative intervertebral disc. Although several in vitro and in vivo studies have confirmed that PRP can promote disc regeneration and repair, significantly relieve pain, and even improve the mobility of DLBP patients. But the contrary conclusion has been reached in a few studies, and there are limitations to the application of PRP. ConclusionCurrent studies have confirmed the effectiveness and safety of PRP in the treatment of DLBP and intervertebral disc degeneration, as well as the advantages of PRP in terms of ease of extraction and preparation, low immunological rejection, high regenerative and repair capacity, and the ability to compensate for the shortcomings of traditional treatment modalities. However, relevant studies are still needed to further optimize PRP preparation methods, unify systematic classification guidelines, and clarify its long-term effectiveness.
Objective To evaluate the effect and safety of the conservative treatment for the protrusion of cervical vertebra intervertebral disc. Methods We searched CBM disk (1978~2007), CNKI (1979~2007), VIP (1989~2007). Telephone interviewed the original authors of claimed randomized controlled trials(RCTs) to identify whether they are truly RCTs. Only true RCTs and quasi-randomized controlled trials were included and the quality of them was critically assessed. Results Five RCTs and eleven quasi-randomized controlled trials were identified and included. It showed that lifting-massage, massage combining with traction or acupuncture, articulus mobilization combining with traction and electrotherapy, traction combining with computer intermediate frequency therapeusis and injectio ad acumen combining with massage have marked improvement. But it could hardly draw a conclusion that all the combining therapies had better curative effect. Conclusions Weak evidence shows that combining conservative treatment can improve the curative effect of the protrusion of cervical vertebra intervertebral disc. The results need to be supported by well designed and high quality trials.
Objective To review the mechanism of extracellular vesicles (EVs) in treating intervertebral disc degeneration (IVDD). Methods The literature about EVs was reviewed and the biological characteristics and mechanism of EVs in the treatment of IVDD were summarized. Results EVs are a kind of nano-sized vesicles with a double-layered lipid membrane structure secreted by many types of cells. EVs contain many bioactive molecules and participate in the exchange of information between cells, thus they play important roles in inflammation, oxidative stress, senescence, apoptosis, and autophagy. Moreover, EVs are found to slow down the process of IVDD by delaying the pathological progression of the nucleus pulposus, cartilage endplates, and annulus fibrosus. Conclusion EVs is expected to become a new strategy for the treatment of IVDD, but the specific mechanism remains to be further studied.
ObjectiveTo review the research progress of endogenous repair strategy (ERS) in intervertebral disc (IVD).MethodsThe domestic and foreign literature related to ERS in IVD in recent years was reviewed, and its characteristics, status, and prospect in the future were summarized.ResultsThe key of ERS in IVD is to improve the vitality of stem/progenitor cells in IVD or promote its migration from stem cell Niche to the tissue that need to repair. These stem/progenitor cells in IVD are derived from nucleus pulposus, annulus fibrosus, and cartilaginous endplate, showing similar biological characteristics to mesenchymal stem cells including the expression of the specific stem/progenitor cell surface markers and gene, and also the capacity of multiple differentiations potential. However, the development, senescence, and degeneration of IVD have consumed these stem/progenitor cells, and the harsh internal microenvironment further impair their biological characteristics, which leads to the failure of endogenous repair in IVD. At present, relevant research mainly focuses on improving the biological characteristics of endogenous stem/progenitor cells, directly supplementing endogenous stem/progenitor cells, biomaterials and small molecule compounds to stimulate the endogenous repair in IVD, so as to improve the effect of endogenous repair.ConclusionAt present, ERS has gotten some achievements in the treatment of IVD degeneration, but its related studies are still in the pre-clinical stage. So further studies regarding ERS should be carried out in the future, especially in vivo experiments and clinical transformation.
