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Objective: Turnover of cartilage endplate extracellular matrix (ECM) may play an important role in disc degeneration and low back pain (LBP). However, the expression pattern of pro‐inflammatory factors, matrix metalloproteinases (MMP), and tissue inhibitors of metalloproteinases (TIMP) in the cartilage endplates (CEP) of intervertebral discs (IVD) is not understood. We aimed to examine the transcriptional levels of MMP, TIMP, and interleukins (IL), and the correlations between them. Methods: Thirty degenerated cartilage endplate samples from patients with LBP who underwent lumbar fusion surgery were included in the degenerated group. Ten patients without LBP history who underwent lumbar surgery because of vertebral burst fractures were included in the control group. The degenerative severity of the samples was evaluated by MRI, and hematoxylin–eosin and safranin O‐fast green (SO‐FG) staining. Real‐time polymerase chain reaction (RT‐PCR) was used to detect the mRNA levels of MMP‐1, MMP‐3, MMP‐9, MMP‐13, TIMP‐1, TIMP‐2, TIMP‐3, IL‐1α, IL‐1β, and IL‐6. The correlations between the levels of these genes were tested using Spearman's rho test. Results: Hematoxylin–eosin and SO‐FG staining confirmed a decrease in cell number and proteoglycans in the degenerated cartilage endplate. MRI showed significant signal changes in degenerated cartilage endplates. Patients in the degenerated group showed a higher rate of endplate Modic changes when compared with the control group. MMP‐3, MMP‐9, TIMP‐3, IL‐1α, and IL‐1β were elevated with statistical significance, while MMP‐1, MMP‐13, TIMP‐1, TIMP‐2, and IL‐6 were changed without statistical significance or remained unchanged. Expression of MMP‐3 was positively correlated with IL‐1α (Spearman coefficient, 0.486; P < 0.05); expression of TIMP‐3 was positively correlated with MMP‐9, IL‐1α, and IL‐1β (Spearman coefficient, 0.577, 0.407, and 0.571, respectively; P < 0.05). Conclusion: MMP‐3, MMP‐9, TIMP‐3, IL‐1α, and IL‐1β may play a role in the process of cartilage endplate degeneration. MMP‐3 may be regulated by IL‐1α, and TIMP‐3 might be associated with MMP‐9 and regulated by IL‐1α and IL‐1β. [ABSTRACT FROM AUTHOR]

Objective: To compare postoperative imaging results, clinical outcomes and complications between the multifidus muscle bundle (MMB) approach and the conventional open (CO) approach in one‐level posterior lumbar interbody fusion (PLIF). Methods: Based on the inclusion and exclusion criteria, 201 of 351 patients in our hospital were enrolled in this prospective study and underwent MMB‐PLIF or CO‐PLIF randomly: 111 patients in the MMB‐PLIF group and 90 patients in the CO‐PLIF group. A total of 100 patients failed to be followed up in the following 7–9 years. Therefore, in this study, 52 patients of the MMB group and 49 patients of the CO group were included. We evaluated the differences in terms of multifidus atrophy rate, intervertebral disc height and segmental lordosis restoration of the operation segment, lumbar lordosis restoration, fusion rate, visual analogue scale (VAS) for back and leg pain, Oswestry disability index (ODI), complication rates, and patient satisfaction rates between the two groups. Correlation between multifidus muscle degeneration and the incidence of complications was investigated, and we compared the multifidus muscle degeneration rate between patients with or without intractable back pain or adjacent segment degeneration. Results: There were no significant differences in age, sex, body mass index (BMI), diagnosis, segments distribution, and mean follow‐up time between the MMB‐PLIF group and the CO‐PLIF group. In addition, no differences regarding sex, age, or BMI were found between the lost follow‐up group and the successful follow‐up group. In regard to imaging and clinical evaluation, at the final follow‐up, there were significant differences in multifidus atrophy rates (27.0% ± 6.8% vs 38.7% ± 10.9%), lumbar lordosis restoration (4.6° ± 2.5° vs 3.0° ± 1.9°), postoperative VAS for back pain (1.1 ± 0.9 vs 1.8 ± 1.2), ODI (7.7 ± 5.0 vs 12.4 ± 6.7), and patient satisfaction rates (86.5% vs 61.2%) between MMB‐PLIF and CO‐PLIF groups. However, there were no significant differences in segmental lordosis, intervertebral height restoration, postoperative VAS for leg pain or fusion rate between the two groups. In regards to complications, there were significant differences in the incidence of adjacent segment degeneration (3.8% vs 14.3%), intractable back pain (3.8% vs 22.4%), and residual neurological symptoms (5.8% vs 20.4%) between the two groups (P < 0.05) at the final follow‐up. In addition, patients with adjacent segment degeneration and intractable back pain were observed with more significant multifidus muscle atrophy than those without these two complications (31.9% ± 1.1% vs 39.6% ± 2.1% and 30.9% ± 1.1% vs 42.8% ± 2.1%). Conclusion: Compared with CO‐PLIF, MMB‐PLIF had advantages in relation to protection of the multifidus muscle, better maintenance of lumbar lordosis, reduced lower back pain and ODI score, fewer complications, and a higher patient satisfaction rate. Protection of the multifidus muscle in lumbar surgery is an important aspect of minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Objective: To analyze the early complications and causes of oblique lateral interbody fusion, and put forward preventive measures. Methods: There were 235 patients (79 males and 156 females) analyzed in our study from October 2014 to May 2017. The average age was 61.9 ± 0.21 years (from 32 to 83 years). Ninety‐one cases were treated with oblique lateral interbody fusion (OLIF) alone (OLIF alone group) and 144 with OLIF combined with posterior pedicle screw fixation through the intermuscular space approach (OLIF combined group). In addition, 137/144 cases in the combined group were primarily treated by posterior pedicle screw fixation, while the treatments were postponed in 7 cases. There were 190 cases of single fusion segments, 11 of 2 segments, 21 of 3 segments, and 13 of 4 segments. Intraoperative and postoperative complications were observed. Results: Average follow‐up time was 15.6 ± 7.5 months (ranged from 6 to 36 months). Five cases were lost to follow‐up (2 cases from the OLIF alone group and 3 cases from the OLIF combined group). There were 7 cases of vascular injury, 22 cases of endplate damage, 2 cases of vertebral body fracture, 11 cases of nerve injury, 18 cases of cage sedimentation or cage transverse shifting, 3 cases of iliac crest pain, 1 case of right psoas major hematoma, 2 cases of incomplete ileus, 1 case of acute heart failure, 1 case of cerebral infarction, 3 case of left lower abdominal pain, 9 cases of transient psoas weakness, 3 cases of transient quadriceps weakness, and 8 cases of reoperation. The complication incidence was 32.34%. Thirty‐three cases occurred in the OLIF alone group, with a rate of 36.26%, and 43 cases in the group of OLIF combined posterior pedicle screw fixation, with a rate of 29.86%. Fifty‐seven cases occurred in single‐segment fusion, with a rate of 30.0% (57/190), 4 cases occurred in two‐segment fusion, with a rate of 36.36% (4/11), 9 cases occurred in three‐segment fusion, with a rate of 42.86% (9/21), and 6 cases occurred in four‐segment fusion, with a rate of 46.15% (6/13). Conclusion: In summary, OLIF is a relatively safe and very effective technique for minimally invasive lumbar fusion. Nonetheless, it should be noted that OLIF carries the risk of complications, especially in the early stage of development. [ABSTRACT FROM AUTHOR]