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We sought to provide clinical evidence of the potential influence of ovariectomy (OVX) on intervertebral disk degeneration.We retrospectively reviewed patients with a history of OVX who visited our hospital for lower back pain. In addition, 60 age-matched patients without OVX were randomly selected as control subjects. Next, the following demographic data were recorded and compared among groups: age, body mass index, duration of OVX, history of smoking, alcohol use, hypertension, diabetes, cardiocerebrovascular disease, hyperlipemia, osteoporosis, and degenerative spondylolisthesis. Next, the severity of lumbar disk degeneration, evaluated by the modified Pfirrmann grading system, was compared between groups. Data analyses were performed with SPSS 20.0. software.A total of 15 OVX (unilateral, n = 10; bilateral, n = 5) patients were included with a mean age of 62.40 ± 10.64. The average durations of OVX were 21.33 ± 9.24 years. There existed no remarkable intergroup differences in the demographic data (P0.05). Overall, the average Pfirrmann grading scores from L1/2 to L5/S1 presented as L1/2L2/3L3/4 ≤ L5/S1 ≤ L4/5, with no marked differences between groups (P0.05). Nevertheless, OVX groups displayed a relatively higher score at each level than non-OVX group. Moreover, the scores from L3/4 to L5/S1 were higher in the bilateral OVX group relative to the unilateral OVX group while they were equal at L1/2 and L2/3.Our findings demonstrated that OVX contributed to the progression of lumbar disk degeneration to some extent, but it appeared to be a long-term event.

Intervertebral disk (IVD) degeneration (IVDD) can cause various spinal degenerative diseases. Cumulative evidence has indicated that IVDD can result from inflammation, apoptosis, autophagy, biomechanical changes and other factors. Currently, lack of conservative treatment for degenerative spinal diseases leads to an urgent demand for clinically applicable medication to ameliorate the progression of IVDD. Resveratrol (3,5,4'-trihydroxy-trans-stilbene), a polyphenol compound extracted from red wine or grapes, has shown protective effects on IVD, alleviating the progression of IVDD. Resveratrol has been demonstrated as a scavenger of free radicals both in vivo and in vitro. The antioxidant effects of resveratrol are likely attributed to its regulation on mitochondrial dysfunction or the elimination of reactive oxygen species. This review will summarize the mechanisms of the reactive oxygen species production and elaborate the mechanisms of resveratrol in retarding IVDD progression, providing a comprehensive understanding of the antioxidant effects of resveratrol in IVD.

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

To evaluate the efficacy of locking stand-alone cage (LSC) compared with anterior plate construct (APC) in anterior cervical discectomy and fusion (ACDF). A comprehensive literature search was carried out in PubMed, Embase, Web of Science, and Cochrane Library to screen randomized controlled trials (RCTs) that directly compared LSC with APC in ACDF. The Cochrane Collaboration’s tool was used for assessment of study quality. Data were analyzed with the Review Manager 5.3 software. A total of seven RCTs were included. The results revealed no significant differences between LSC and APC in ACDF regarding the fusion rate, Japanese Orthopaedic Association score, visual analogue scale score, neck disability index score, hospital stay, subsidence rate, cervical lordosis, segmental Cobb angle, and disc height. However, LSC was associated with a significantly shorter operation time, less blood loss, lower overall incidence of dysphagia, and lower adjacent-level ossification (ALO) rate compared with APC. In summary, LSC is not only a safe and effective device for ACDF but also has the advantages of significantly reduced operation time, blood loss, overall incidence of dysphagia, and ALO rate over APC. Therefore, LSC is a better alternative than APC for the patients undergoing ACDF procedures.

Patients with degenerative lumbar spondylolisthesis (DLS) often suffer from years of low back pain (LBP) due to instability of the lumbar spine and the reduction of disc height. Since January 2016, we have performed oblique lateral interbody fusion (OLIF) on 154 patients. Among these, 56 patients who suffered from DLS underwent OLIF with stand-alone cages. Forty-two patients with a follow-up time that exceeded 1-year were enrolled for this study. The forty-two patients were followed up for at least one year. Operation segments ranged from L3-4 to L4-5. All the patients were with 1-level fusion. The mean postoperative ventral-disc height and dorsal-disc height increased significantly compared with preoperative (P<0.05). A significant postoperative increase was also observed in the mean operative segmental lordotic angle and the whole lumbar lordotic angle (P<0.05). Compared with preoperative, the postoperative VAS significantly decreased with no significant increase in the VAS in the last follow-up. The LBP was significantly relieved. The mean postoperative VAS of LBP decreased significantly compared with the preoperative ((1.6 ± 0.8) vs. (7.8 ± 0.8)). Postoperative complications included psoas major abscess and intervertebral space infection (1/56). Except for one patient whose cage subsided during the last follow-up, the other patients had good cage position. The one whose cage collapsed complained no symptoms including LBP. OLIF with stand-alone cages should be considered as a safe and effective option which can effectively alleviate LBP for the treatment of DLS.

After spine surgery, venous thromboembolism (VTE) is not uncommon in aged patients. This study investigates time-to-event risk factors of postoperative VTE based on medical records of aged patients (age≥60 yr) between January 2013 and December 2018. All participants had undergone lower extremity ultrasonography pre- and postoperatively at the first, second, fourth, eighth, and twelfth weeks. Mann-Whitney U tests and chi-square tests were used for univariate analyses, and Cox regression was utilized for multivariate analyses. A total of 1620 cases were recruited, VTE group (N=382, 23.6%) and non-VTE group (N=1238, 76.4%), aged 67 (IQR 11) years and 65 (IQR 6) years, respectively. The univariate analyses indicated significant differences between the VTE and non-VTE groups regarding advanced age, VTE history, hypertension, fusion, hospital stay, FIB, HDL, D-dimer, and TC (all P

Aim To investigate the effect of 17β-Estradiol (E2) on intervertebral disc degeneration (IVDD) and the related mechanism. Materials and methods Immunohistochemistry was used to detect the expression of estrogen receptor β (ERβ) within intervertebral discs of humans and rats. After that, rat IVDD model was established by needle puncture and bilateral ovariectomy. Then, the serum E2 level was detected by enzyme linked immunosorbent assay, and the degree of IVDD was evaluated by X-ray, magnetic resonance imaging, hematoxylin and eosin staining, and Safranin O-Fast Green staining. Finally, we used immunohistochemistry and immunofluorescence staining to determine the effect of E2 on nuclear factor kappa-B (NF-κB) signal pathway both in vivo and in vitro. Key findings We identified that IVDD was associated with lower levels of ERβ and ERβ levels were inversely correlated with IVDD. The histological staining and radiological results showed that E2 supplement could alleviate IVDD progression. Additionally, immunohistochemistry staining demonstrated that E2 could inhibit nucleus pulposus cell (NPC) apoptosis, matrix metalloproteinases (MMPs) synthesis, and degradation of extracellular matrix (ECM) by inhibiting the activation of NF-κB signal pathway. Furthermore, immunofluorescence staining showed that the above effects of E2 on the NF-κB signal pathway could be blocked by the estrogen receptor antagonist ICI182780 in vitro. Finally, inhibition of NF-κB signal pathway by BAY11-7082 could reduce MMPs synthesis and ECM degradation of NPCs. Significance Collectively, these findings indicated that E2 could effectively ameliorate IVDD by inhibiting NPC apoptosis via inhibition of NF-κB signal pathway.

Background This study investigated the clinical effect of laminectomy plus pedicle screw fixation in treating thoracolumbar intradural extramedullary schwannomas. Material/Methods Between October 2011 and May 2017, 57 patients undergoing resection of thoracolumbar schwannomas were retrospectively identified and included in the study. Based on the surgical procedures used, all participants were assigned to either the laminectomy-only group (n=33) or the combination group (laminectomy plus pedicle screw fixation, n=24). All participants were followed up for over 2 years. In the laminectomy, the spinal process, vertebral laminae, and bilateral upper articular processes of the surgical segments were completely resected and the lower articular processes were reserved. For further analysis, we evaluated the pain levels using visual analogue scale (VAS) score. The assessment of neurological function was performed with Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI). The comparisons of Cobb angle changes were carried out pre-surgery and post-surgery. Results The demographic data were well matched between the laminectomy-only group and combination group, without significant differences (P>0.05). After surgery, both surgical procedures achieved significant improvement in VAS score, ODI, and JOA score (P0.05). The postoperative change in Cobb angle indicated a significant difference in the laminectomy-only group, but not in the combination group (P

Background. In this study, it was aimed to investigate the clinical rehabilitation effect of lower-limb training on the patients that undergo oblique lumbar interbody fusion (OLIF) procedures. Methods. The eligible participants undergoing OLIF procedures between 01/2017 and 07/2019 were identified. All the patients underwent one-segment fusion operation (L3-4 or L4-5). Based on whether the participants received postoperative rehabilitation training, they were divided into two groups: intervention group and control group. Postoperatively, the participants in the intervention group were trained with lower-extremity rehabilitation exercise and maintained for three months. All participants got reexamined at the first postoperative week, the second postoperative week, the first postoperative month, and the third postoperative month (last follow-up). Comparisons were made in terms of the lower-extremity muscle force, visual analogue scale (VAS) score, lumbar JOA score, Oswestry disability index (ODI), the incidence of deep venous thrombosis (DVT), and patient satisfaction. Results. Seventy-seven participants in the intervention group (32 males and 45 females) and 82 in the control group (39 males and 43 females) were incorporated in this study. The median age of the participants was 57 years (39∼73) in the intervention group and 54 years (35∼71) in the control group. No statistical significance between the two groups was found (P>0.05). ODI score was less in the intervention group as compared to the control group in the first week after surgery (P=0.029). VAS and JOA scores were better in the intervention group in the first two weeks after surgery (P<0.05). DVT incidence in the intervention group was lower than the control group at final follow-up (P=0.037). Both group participants have achieved good grading in muscle force rehabilitation but no significant differences between the two groups. Additionally, satisfaction was higher in the intervention group than the control group. Conclusions. In summary, postoperative lower-extremity rehabilitation exercise can effectively accelerate patients’ health recovery from the OLIF surgery and increase their satisfaction.