Objective To assess the effectiveness and safety of collagenase for intervertebral disk hernia, to facilitate the rational selection of the most appropriate therapy. Methods We searched the following electronic databases: Medline (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 to 2006), and VIP (1989 to 2006). RCTs or quasi-RCTs were included. RevMan 4.2 was used for statistical analysis. Results Six RCTs and one quasi-RCT involving 829 participants were included. One study showed that the short-term effective rate was similar between chemonucleolysis (CNL) and percutaneous laser dise decompression (PLDD), but the long-term effective rate of PLDD was superior to that of CNL (RR 0.35, 95%CI 0.13 to 0.96). One study revealed that the short- and long-term effective rate of CNL were higher than those of placebo (Plt;0.05). Two studies comparing collagenase vs chymopaain were heterogeneous: one indicated that chymopapain was superior to collagenase according to ITT analysis (Plt;0.05); but the other revealed no significant difference among the high- and low-dose collagenase groups and chymopapain group (Pgt;0.05). One trial showed that the effective rate between collagenase and automated percutaneous lumbar discectomy (APLD) was not significantly different (Pgt;0.05). The overall results of CNL vs Triamcinolone Acetonide showed no significant difference, but significant difference was found among patients with different types of intervertebral disk hernia. One study showed that CNL was superior to Prednisolone. Three studies reported adverse effects, mainly involving pain, neurologic deficit, cauda equina syndrome and allergic reaction amongst others. Conclusions No adequate evidence shows which therapy is more effective for intervertebral disk hernia. More high-quality trials are required.
Objective To investigate the effects of human insulin-like growth factor 1 (hIGF-1) gene transfected by recombinant adenovirus vector (Ad-hIGF-1) on the apoptosis of rabbit nucleus pulposus cells induced by tumor necrosis factor α (TNF-α). Methods The intervertebral disc nucleus pulposus were harvested from 8 healthy adult domestic rabbits (male or female, weighing 2.0-2.5 kg). The nucleus pulposus cells were isolated with collagenase II digestion and the passage 2 cells were cultured to logarithm growing period, and then they were divided into 3 groups according to culture condition: DMEM/F12 medium containing 10% PBS, DMEM/F12 medium containing 10% PBS and 100 ng/mL TNF-α, and DMEM/ F12 medium containing 10% PBS, 100 ng/ mL TNF-α, and Ad-hIGF-1 (multiplicity of infection of 50) were used in control group, TNF-α group, and Ad-hIGF-1 group, respectively. The results of transfection by adenovirus vector carrying hIGF-1 gene were observed by fluorescent microscopy; the expression of hIGF-1 protein was detected by Western blot, hIGF-1 mRNA expression by RT-PCR, and the cell apoptosis rate by TUNEL and flow cytometry. Results Green fluorescence was observed by fluorescent microscopy in Ad-hIGF-1 group, indicating that successful cell transfection. The expressions of hIGF-1 protein and mRNA were detected in Ad-hIGF-1 group by Western blot and RT-PCR, while the control group and TNF-α group had no expression. The cell apoptosis rates of TNF-α group, Ad-hIGF-1 group, and control group were 34.24% ± 4.60%, 6.59% ± 1.03%, and 0.40% ± 0.15%, respectively. The early apoptosis rates of TNF-α group, Ad-hIGF-1 group, and control group were 22.16% ± 2.69%, 5.03% ± 0.96%, and 0.49% ± 0.05%, respectively; the late cell apoptosis rates were 13.96% ± 4.86%, 10.68% ± 3.42%, and 0.29% ± 0.06%, respectively. Compared with TNF-α group, the cell apoptosis rates of Ad-hIGF-1 group and control group were significantly reduced (P lt; 0.05); the cell apoptosis rate of Ad-hIGF-1 group was significantly higher than that of control group (P lt; 0.05). Conclusion Ad-hIGF-1 could inhibit the apoptosis of nucleus pulposus cells induced by TNF-α.
Objective To review the progress of the mechanisms of Wnt/β-catenin and nuclear factor-kappa B (NF-кB) pathways in the process of the intervertebral disc degeneration. Methods The related literature about the mechanisms of Wnt/β-catenin and NF-кB pathways in the process of the intervertebral disc degeneration was reviewed, analyzed, and summarized. Results Wnt/β-catenin and NF-кB pathways are both activated in the process of the intervertebral disc degeneration, and exist interaction. However, the specific mechanisms and interactive mediums of Wnt/β-catenin and NF-кB pathways in the process of the intervertebral disc degeneration are still unclear. Conclusion The mechanisms of Wnt/β-catenin and NF-кB pathways in the process of the intervertebral disc degeneration have to be studied deeply.
Objective To explore the occurrence condition of the neck axial symptom (AS) after cervical Bryan artificial disc replacement combined with anterior cervical discectomy and fusion (Hybrid surgery) and traditional anterior cervical discectomy and fusion (ACDF surgery) to treat the two-level cervical disease, and to do contrastive analysis. Methods Between August 2006 and March 2010, 18 patients underwent Hybrid surgery (group A) and 30 patients underwent two-level ACDF surgery (group B). There was no significant difference in age, gender, disease duration, type, and operated segment between 2 groups (P gt; 0.05). The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, cervical curvature of the operated segment, total range of motion (ROM) of C2-7, ROM of the adjacent segment, and incidence of neck AS were recorded and compared between before operation and at last follow-up. Results All the patients were followed up 18-34 months (24.1 months on average). In both groups, the JOA and NDI scores at last follow-up had significantly improvement when compared with preoperative scores (P lt; 0.01), but there was no significant difference between 2 groups at preoperation and last follow-up (P gt; 0.05). The kyphosis incidence of the operated segment in group B was significantly higher than that in group A (χ2=5.333, P=0.021). There was no significant difference in the total ROM of C2-7 between at preoperation and last follow-up in group A (t=0.410, P=0.685); the total ROM of C2-7 at last follow-up was significantly lower than that at preoperation in group B (t=3.007, P=0.006); and significant difference was found between 2 groups at last follow-up (t=2.664, P=0.013). At last follow-up, ROM of the superior and inferior adjacent segments in group B increased obviously (P lt; 0.05) and was significantly higher than that in group A (t=2.252, P=0.033; t=2.203, P=0.037). The incidence of neck AS were 16.7% in group A and 46.7% in group B, showing significant difference at last follow-up (χ2=4.427, P=0.035). Conclusion Compared with two-level ACDF surgery, Hybrid surgery has good outcomes. At the same time, it can maintain the curvature of operated segments and total ROM, avoid excessive increased ROM of the adjacent segments, and reduce the incidence of neck AS.
Objective To evaluate the influence of PKH26 labeling on the biological function of the goat nucleus pulposus cells and the biological function of seeded cells in nude mice by in vivo imaging techonology. Methods Primary nucleus pulposus cells were isolated by enzymatic digestion from the nucleus pulposus tissue of the 1-year-old goat disc. The nucleus pulposus cells at passage 1 were labeled with PKH26 and the fluorescent intensity was observed under the fluorescence microscopy. The labeled cells were stained with toluidine blue and collagen type II immunocytochemistry. The cells viability and proliferation characteristics were assessed by trypan blue staining and MTT assay, respectively. Real-time fluorescent quantitative PCR was used to detect the gene expressions of collagen types I and II, and aggrecan. The fluorescent intensity and scope of the nucleus pulposus cells-scaffold composite in vivo for 6 weeks after implanting into 5 6-week-old male nude mice were measured by in vivo imaging technology. Results Primary nucleus pulposus cells were ovoid in cell shape, showing cluster growth, and the cells at passage 1 showed chondrocyte-like morphology under the inverted phase contrast microscope. The results of toluidine blue and collagen type II immunocytochemistry staining for nucleus pulposus cells at passage 1 were positive. The fluorescent intensity was even after labeling, and the cell viability was more than 95% before and after PKH26 labeling. There was no significant difference in cell growth curve between before and after labeling (P gt; 0.05). The real-time fluorescent quantitative PCR showed that there was no significant difference in gene expressions of collagen types I and II, and aggrecan between before and after labeling (P gt; 0.05). Strong fluorescence in nucleus pulposus cells-scaffold composite was detected and by in vivo imaging technology. Conclusion The PKH26 labeling has no effect on the activity, proliferation, and cell phenotype gene expression of the nucleus pulposus cells. A combination of PKH26 labeling and in vivo imaging technology can track the biological behavior of the cells in vivo.
Objective To review the research progress of the seed cells, scaffolds, growth factors, and the prospects for clinical application of the intervertebral disc regeneration. Methods The recent literature concerning the regeneration strategies and tissue engineering for treatment of degenerative intervertebral disc disease was extensively reviewed and summarized. Results Seed cells based on mesenchymal stem cells (MSCs) and multiple-designed biomimetic scaffolds are the hot topic in the field of intervertebral disc regeneration. It needs to be further investigated how to effectively combine the interactions of seed cells, scaffolds, and growth factors and to play their regulation function. Conclusion The biological regeneration of intervertebral disc would have a very broad prospects for clinical application in future.
Objective To investigate the relationship between the volume of bone-graft and fusion efficacy in posterior lumbar interbody fusion and internal fixation of spondylolisthesis. Methods Between May 2004 and June 2007, 79 patients with spondylolisthesis were treated with posterior lumbar interbody fusion and internal fixation. The patients were randomly divided into 3 groups according to the volume of bone-graft for interbody fusion: group A (n=27), 5 bone granules/ cm3 on average; group B (n=26), 11 bone granules/cm3 on average; and group C (n=26), 25 bone granules/cm3 on average. There was no significant difference in gender, age, disease duration, affected segment, and the degree of vertebral slip among 3 groups (P gt; 0.05). The volume of bone-graft, the fusion rate, the loss of intervertebral height, and the incidence of internal fixation failure were compared among 3 groups. Results All cases were followed up 24-43 months (mean, 35 months). There were significant differences in volume of bone-graft among 3 groups (P lt; 0.05). There was no significant difference in total volume of bone-graft and Cage height among 3 groups (P gt; 0.05). The Oswestry disability index (ODI) and visual analogue scale (VAS) scores of low back pain and leg pain at last follow-up were significantly decreased when compared with preoperative scores in 3 groups (P lt; 0.05); but no significant difference was found among 3 groups (P gt; 0.05). The fusion rate was significantly higher in group B than in groups A and C, and in group A than in group C at 1 and 2 years after operation (P lt; 0.05). The change values of the intervertebral height were (2.2 ± 1.4), (0.8 ± 1.3), and (2.3 ± 1.6) mm respectively in groups A, B, and C; it was significantly lower in group B than in groups A and C (P lt; 0.05). The degree of vertebral slip at immediately after operation and last follow-up was significantly improved when compared with preoperative one in 3 groups (P lt; 0.05); the loss of vertebral slip in group B was significantly lower than that in groups A and C at last follow-up (P lt; 0.05). After operation, nail breaking occurred in 1 case (3.7%) of group C at 1 year, depinning in 1 case (3.8%) of group A at 2 years, and no nail breaking or depinning in group B. There was no significant difference in the incidence of internal fixation failure among 3 groups (χ2=3.950, P=0.604). Conclusion The application of bone-graft with middle volume (11 bone granules/cm3 on average) in internal fixation and posterior lumbar interbody fusion has a good imageology outcome, which can increase the fusion rate and decrease the loss of intervertebral height.
Objective To summarize the research situation of stem cells transplantation for intervertebral disc (IVD) degeneration. Methods The original articles about stem cells transplantation for repair of IVD degeneration were extensively reviewed; the clinical applications, the mechanisms, and related factors to influence repair effect were analyzed; and obstacles in stem cells transplantation for repair of IVD degeneration. Results Autogenic stem cells transplantation can repair IVD degeneration and effectively relieve the symptoms of low back and leg pain. Stem cells can differentiate into disc chondrocytes in the disc microenvironment, increase the production of various growth factors, and exert a trophic effect on disc cells. It is also evident that the transplanted stem cells can potentially protect disc cells from apoptosis and maintain an immune-privileged state in the IVD. Multiple factors such as tissue origin of stem cells, methods to pre-modulate the seeds, choice of injectable scaffolds, and even the severity of degeneration are closely related to the repair effects. To get a more efficient stem cell therapy, future researches are challenged to modulate the migration and distribution of stem cells in the IVD, avoid flow back, and better understand their ability to restore stemness properties within the degenerative disc niche. Conclusion Stem cells transplantation is proven to be a promising biological approach for repair of IVD degeneration.
【Abstract】 Objective To explore the effectiveness of bone grafting by intervertebral disc endoscope for postoperativenonunion of fracture of lower limb. Methods Between August 2004 and August 2008, 40 patients (23 males and 17 females) with postoperative nonunion of femoral and tibial fracture, aged 20-63 years (mean, 41.5 years) were treated. Nonunion of fracture occurred at 10-16 months after internal fixation. During the first operation, the internal fixation included interlocking intramedullary nail ing of femoral fracture in 12 cases and plate in 16 cases, and interlocking intramedullary nail ing of tibial fractures in 9 cases and plate in 3 cases. The X-ray films showed hypertrophic nonunion in 24 cases, common nonunion in 3 cases, and atrophic nonunion in 13 cases. Results The average operation time was 61 minutes (range, 40-80 minutes), and the blood loss was 80-130 mL (mean, 100 mL). The hospital ization time were 6-11 days (mean, 8.1 days). Incisions healed by first intention in all patients with no complication of infection or neurovascular injury. Forty patients were followed up 10-16 months (mean, 12.3 months). The X-ray films showed that all patients achieved healing of fracture after 4-10 months (mean, 6.8 months). No pain, disfunction, or internal fixation failure occurred. Conclusion Bone grafting by intervertebral disc endoscope is an effective method for treating postoperative nonunion of femoral and tibial fracture.
Objective To investigate the expression and significance of growth-associated protein 43 (GAP-43) in the dorsal root ganglion (DRG) and intervertebral disc in the rat model of intervertebral disc inflammation. Methods A total of 103 adult male Sprague Dawley rats (weighing, 200-250 g) were randomly divided into the experimental group (n=48), the control group (n=48), and the blank control group (n=7). Fluoro-gold (F-G) as tracer was injected into the L5, 6 intervertebral disc of 3 groups; after 7 days of F-G injection, complete Freund’s adjuvant (50 µL) and the same volume of saline were injected in the experimental group (to prepare the model of intervertebral disc inflammation) and the control group, respectively, and the blank control group had no further treatment. After 1, 3, 7, and 14 days, T13-L6 DRG and L5, 6 intervertebral disc of experimental group and control group were harvested to detect the GAP-43 by using fluorescent immunohistochemistry, in situ hybridization, and RT-PCR. The DRG and intervertebral disc of blank control group were also harvested after 8 days of F-G injection. Results Fluorescent immunohistochemistry results showed that the number of F-G-labeled GAP-43 immunoreaction (GAP-43-IR) cells of the DRGs in the experimental group was significantly higher than that in the control group (P lt; 0.05) at 3 days, and no significant difference was found at the other time points (P gt; 0.05). There was no significant difference in the cross-sectional area of F-G-labeled GAP-43-IR cells between the experimental group and the control group at each time point (P gt; 0.05). The co-expression of GAP-43 with calcitonin gene-related peptide (CGRP) and isolectin B4 (IB4)-binding glycoprotein exhibited that the expression of CGRP was 91.4% ± 7.4% in the control group and was 87.6% ± 7.8% in the experimental group, showing no significant difference between 2 groups (P gt; 0.05). There was no IB4-binding glycoprotein expression in GAP-43-IR cells of the DRGs in 2 groups. The expressions of GAP-43, CGRP, and IB4-positive nerve fibers in the intervertebral disc exhibited that the GAP-43-IR nerve fibers in the experimental group were significantly more than that in the control group (P lt; 0.05), but no significant difference was found in the expression of CGRP between 2 groups (P gt; 0.05); and there was no IB4-binding glycoprotein expression in GAP-43-IR nerve fibers of the intervertebral disc in 2 group. In situ hybridization and RT-PCR detection showed that the positive expression cells ratio of GAP-43 mRNA and the level of GAP- 43 mRNA were significantly higher in the experimental group than in the control group at 1 day (P lt; 0.05), and no significant difference was found at the other time points (P gt; 0.05). Conclusion Intradiscal inflammatory environment may induce the expression of GAP-43, and potentially promote the nerve fiber ingrowth of rat.