Zhengxue Quan

A hollow cylindrical nano-hydroxyapatite/polyamide composite strut for cervical reconstruction after cervical corpectomy☆

This retrospective study included 35 patients who had a nano-hydroxyapatite/polyamide (n-HA/PA) composite strut implanted for cervical reconstruction and fusion after corpectomy from 2006 to 2008. The average follow-up period was 38.5 months (range: 24-48 months). The Japanese Orthopedic Association score and visual analog pain scale score were significantly improved and maintained to the last follow-up. The cervical curvature and the height of fused segments were also corrected significantly and retained to the last follow-up. A total of 94.3% of patients had achieved radiographic bony fusion at the postoperative 24-month follow-up. One patient presented with subsidence of the n-HA/PA composite strut and dislodgement of the screws, but the patient had no discomfort and no additional surgery was needed. We conclude that the n-HA/PA composite strut is scientifically and technically sound for cervical reconstruction and interbody fusion after corpectomy with anterior plate fixation.

Evaluation of Anterior Cervical Reconstruction with Titanium Mesh Cages versus Nano-Hydroxyapatite/Polyamide66 Cages after 1- or 2-Level Corpectomy for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 117 Patients

Objective To retrospectively compare the efficacy of the titanium mesh cage (TMC) and the nano-hydroxyapatite/polyamide66 cage (n-HA/PA66 cage) for 1- or 2-level anterior cervical corpectomy and fusion (ACCF) to treat multilevel cervical spondylotic myelopathy (MCSM). Methods A total of 117 consecutive patients with MCSM who underwent 1- or 2-level ACCF using a TMC or an n-HA/PA66 cage were studied retrospectively at a mean follow-up of 45.28±12.83 months. The patients were divided into four groups according to the level of corpectomy (1- or 2-level corpectomy) and cage type used (TMC or n-HA/PA66 cage). Clinical and radiological parameters were used to evaluate outcomes. Results At the one-year follow-up, the fusion rate in the n-HA/PA66 group was higher, albeit non-significantly, than that in the TMC group for both 1- and 2-level ACCF, but the fusion rates of the procedures were almost equal at the final follow-up. The incidence of cage subsidence at the final follow-up was significantly higher in the TMC group than in the n-HA/PA66 group for the 1-level ACCF (24% vs. 4%, p = 0.01), and the difference was greater for the 2-level ACCF between the TMC group and the n-HA/PA66 group (38% vs. 5%, p = 0.01). Meanwhile, a much greater loss of fused height was observed in the TMC group compared with the n-HA/PA66 group for both the 1- and 2-level ACCF. All four groups demonstrated increases in C2-C7 Cobb angle and JOA scores and decreases in VAS at the final follow-up compared with preoperative values. Conclusion The lower incidence of cage subsidence, better maintenance of the height of the fused segment and similar excellent bony fusion indicate that the n-HA/PA66 cage may be a superior alternative to the TMC for cervical reconstruction after cervical corpectomy, in particular for 2-level ACCF.

Clinical outcomes of discectomy in octogenarian patients with lumbar disc herniation.

Study Design: A retrospective clinical study. Objective: To investigate the efficacy and safety of surgery for lumbar disc herniation in octogenarian patients. Summary of Background Data: Lumbar disc protrusion in the very elderly becomes more common with the aging of the general population, but few patients undergo surgical treatment because the chronological age of 80 years or more has long been considered a contraindication to elective spine surgery. Thus, there is little information about acute and long-term outcomes of lumbar discectomy in octogenarians, and the influence of age on outcome after surgery still remains controversial. Methods: Sixty-four octogenarian patients with lumbar disc herniation underwent unilateral laminectomy and discectomy between January 2004 and June 2010. Operative time (OT), intraoperative estimated blood loss (EBL), length of hospital stay (LOS), and complication rate (CR) were used to assess the safety of surgery. The visual analog scale (VAS), the Oswestry disability index (ODI), and the North American Spine Society Outcome Questionnaire were used to evaluate clinical effectiveness. Results: Significant differences were found between the very elderly and the middle-aged group in LOS (P<0.001) but not in OT, EBL, and CR (all P>0.05). The preoperative, postoperative, and final follow-up VAS and ODI scores were not significantly different between the 2 groups (each P>0.05). However, the VAS and ODI scores significantly improved after surgery and at final follow-up compared with those before surgery (all P<0.001). Satisfaction with outcome was expressed by 57 (89.1%) of 64 very elderly patients. Conclusions: Discectomy through hemilaminectomy is a feasible, safe, and effective treatment procedure in octogenarian patients with lumbar disc herniation. Disc resection in octogenarian patients usually gives good or excellent results. Careful examination of the surgical indications and attentive perioperative management should be considered for this patient population.

Selective COX-2 inhibitor ameliorates osteoarthritis by repressing apoptosis of chondrocyte

Summary Background Celecoxib has a positive effect on human osteoarthritic cartilage, but the mechanisms remain unclear. The aim of this study was to test whether celecoxib could inhibit the apoptosis of chondrocyte and ameliorate type II collagen synthesis to relieve symptoms of OA (osteoarthritis). Material/Methods 130 Wistar rats were randomly divided into 4 groups as celecoxib (CE), ibuprofen (IBP), indomethacin (IN) and normal saline group (NS). The osteoarthritis was induced by the excision of the left Achilles tendon. At the 3th, 6th, 9th month of treatment, the histological structure of articular cartilage was observed using HE staining. Type II collagen was examined using immunohistochemistry. Chondrocyte apoptosis was detected by TUNEL staining, and the change of ultra-microstructure of chondrocyte was examined through a transmission electron microscope. Results CE reduced the OA-like histological changes and suppressed chondrocyte apoptosis. However, IN or IBP had deleterious effects on articular cartilage and enhanced the chondrocyte apoptosis. IBP promoted the expression of type II collagen, and IN inhibited its expression, but had no effect in the CE group. Conclusions CE had favorable action on OA progression, and may be the ideal choice in the treatment of chronic destructive joint disease where anti-inflammatory drugs need to be used for a prolonged period.

Insulin with Chondroitinase ABC Treats the Rat Model of Acute Spinal Cord Injury

Traumatic brain injury is often associated with acute spinal cord injury (ASCI). Insulin and chondroitinase ABC (ChABC) are both therapeutically effective, but the combined therapeutic effect of insulin and ChABC is still not clear. A combination of insulin and ChABC were used to treat a rat model of ASCI. This combination therapy prevented neuronal cell death by improving motor function, increasing cell growth and inhibiting cell apoptosis in ASCI rats. Expression of growth-associated protein 43, a marker of axonal re-growth, increased after combined treatment with insulin and ChABC. These results may provide a basis for a future method of treating ASCI.

Tranexamic acid reduces perioperative blood loss of posterior lumbar surgery for stenosis or spondylolisthesis: A randomized trial

Background: A prospective, randomized, double-blind, placebo-controlled study was performed. The routine usage of TA in spinal surgery is controversial. Only a few studies have focused on patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis, although a large clinical cohort exists in the population. This study aimed to evaluate the effect and safety of TA in reducing perioperative blood loss in posterior lumbar surgery for stenosis or spondylolisthesis. Methods: 100 eligible patients out of 126 were randomized to receive either a bolus dose of 30 mg/kg TA i.v, a maintenance dosage of 2 mg/kg/h TA, or an equivalent volume of normal saline. The pedicle screw system was used for fixing in all the patients, followed by decompression and posterior lumbar interbody fusion. The primary outcomes were intraoperative estimated blood loss and total blood loss. The secondary outcomes were receiving packed red blood cells and postoperative hemoglobin and hematocrit levels. Results: In total, 4 patients were excluded from the analyses, 50 patients were in the TA group, and 46 in the placebo group. The demographic and baseline data between the groups were not statistically different. The intraoperative estimated blood loss and the total blood loss were 33% and 41% lower in the TA group than the placebo group, respectively. The blood transfusion rate did not vary significantly (P = 0.191). Except a patient with a dural tear in the placebo group, no other complications were observed. Conclusion: TA significantly reduced the perioperative blood loss in patients undergoing posterior lumbar surgery for stenosis or spondylolisthesis.

Capsaicin inhibits proliferation and induces apoptosis in osteosarcoma cell lines via the mitogen‑activated protein kinase pathway

Capsaicin, a pungent molecular compound present in many hot peppers, exerts anticancer activities against various human cancer cell lines by inducing apoptosis. However, the effects of capsaicin on human osteosarcoma (OS) as well as the related mechanisms remain to be fully elucidated. In the present study, the anticancer effects of capsaicin on 3 human OS cell lines (MG63, 143B and HOS) were investigated. Various concentrations of capsaicin (50–300 µM) effectively decreased cell viability in all 3 OS cell lines in a dose-dependent manner. Notably, capsaicin-induced apoptosis was observed when OS cells were treated with relatively high concentrations of capsaicin (starting at 250 µM). In addition, the mitochondrial apoptotic pathway was involved in the capsaicin-induced apoptosis in the OS cells. Meanwhile, our results also indicated that at relatively low concentrations (e.g., 100 µM), capsaicin could inhibit the proliferation, decrease the colony forming ability and induce G0/G1 phase cell cycle arrest of OS cells in a dose-dependent manner. Moreover, our results revealed that the anticancer effects induced by capsaicin on OS cell lines involved multiple MAPK signaling pathways as indicated by inactivation of the ERK1/2 and p38 pathways and activation of the JNK pathway. Furthermore, the results of animal experiments showed that capsaicin inhibited tumor growth in a xenograft model of human OS. In conclusion, these results indicate that capsaicin may exert therapeutic benefits as an adjunct to current cancer therapies but not as an independent anticancer agent.

Long-term results of anterior cervical corpectomy and fusion with nano-hydroxyapatite/polyamide 66 strut for cervical spondylotic myelopathy

To assess the long-term clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) with a neotype nano-hydroxyapatite/polyamide 66 (n-HA/PA66) strut in the treatment of cervical spondylotic myelopathy (CSM). Fifty patients with CSM who underwent 1- or 2-level ACCF with n-HA/PA66 struts were retrospectively investigated. With a mean follow-up of 79.6 months, the overall mean JOA score, VAS and cervical alignment were improved significantly. At last follow-up, the fusion rate was 98%, and the subsidence rate of the n-HA/PA66 strut was 8%. The “radiolucent gap” at the interface between the n-HA/PA66 strut and the vertebra was further noted to evaluate the osteoconductivity and osseointegration of the strut, and the incidence of it was 62% at the last follow-up. Three patients suffered symptomatic adjacent segment degeneration (ASD). No significant difference was detected in the outcomes between 1- and 2-level corpectomy at follow-ups. In conclusion, the satisfactory outcomes in this study indicated that the n-HA/PA66 strut was an effective graft for cervical reconstruction. Moreover, the osteoconductivity and osseointegration of the strut is still need to be optimized for future clinical application owing to the notably presence of “radiolucent gap” in present study.

In vitro evaluation of antibacterial activity and cytotoxicity of novel nanocomposite material for bone filling

Abstract In this study, silver ion substituted nanohydroxyapatite, titania nanoparticles and polyamide 66 composite bone filling materials were prepared, which were expected to be a suitable bone repair material with good antibacterial activity, biocompatibility and osteoconductivity, for use in osteomyelitis surgery. The antibacterial activity and release of Ag ions in vitro were evaluated. Two types of bacteria strains, Staphylococcus aureus and Escherichia coli were used in this test. The results showed that the composite materials exhibited significant antibacterial effects on the two bacteria. Time course release testing of Ag ions from the composite materials on immersion in simulated body fluid showed pronounced Ag release in the first several days after immersion, and then the release speed slowed down after 14 days. International standard ISO 10993‐12:2007 was adopted for cytotoxicity evaluation using fibroblast cell line L929, and it was found that the cytotoxicities for the composite materials ranked are all within 1, which showed no cytotoxicity for the composite materials.

Comparison of osteotomy versus non-osteotomy approach for congenital scoliosis: a retrospective study of three surgical techniques

Currently, there are many reports about congenital scoliosis (CS) treatment, but there are still controversies existing with respect to selecting its surgical methods.