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Treatment for spinal cord injuries (SCIs) is often ineffective because SCIs result in a loss of nerve tissue, glial scar formation, local ischemia and secondary inflammation. The current promising strategy for SCI is the combination of bioactive materials and cytokines. Bioactive materials support the injured spinal cord, stabilize the morphology, and avoid excessive inflammatory responses. Fat extract (FE) is a cell-free liquid component containing a variety of cytokines extracted from human fat tissue using mechanical methods. In this research, a biocompatible HAMC (hyaluronan and methylcellulose) loaded with FE is used to treat a model of spinal cord contusion in mice. The composite not only inhibits death of neuro- and vascular cells and leads to the preservation of neural and vascular structure, but also modulates the inflammatory phenotype of macrophages in the locally injured region. Specifically, FE promotes the polarization of macrophages from an inflammatory M1 phenotype to an anti-inflammatory M2 phenotype. During the screening of the involved pathways, it is corroborated that activation of the STAT6/Arg-1 signaling pathway is involved in macrophage M2 polarization. In summary, FE is a promising treatment for SCI, as it is easy to obtain, nonimmunogenic, and effective.

PURPOSE A novel H-reflex method using the biceps femoris-long head (BF-LH) was investigated to collect the normative data for this reflex arc and assess its clinical utility for S1 radiculopathy evaluation. Comparability with conventional tibial and Sol H-reflex findings was also determined. METHODS BF-LH H-reflexes were recorded using surface electrodes to S1-root stimulation in 43 unilateral S1 radiculopathy patients (radiculopathy group) and 34 normal subjects (control group) from March 2009 to December 2011. H-M interval and peak-to-peak amplitudes were measured. The BF-LH H-reflex and the H-reflex from the soleus muscle (Sol H-reflex) to both tibial nerve stimulation (tibial H-reflex) and S1-root stimulation were used and compared for application in S1 radiculopathy evaluation. RESULTS BF-LH H-reflexes were reliably recorded for all control group subjects. Abnormal BF-LH H-reflexes were recorded for 40 (93.0%) radiculopathy group patients in the involved extremity, and abnormal involved side tibial H-reflexes and Sol H-reflexes were recorded in 31 (72.1%) and 41 (95.3%) radiculopathy group patients, respectively. The BF-LH H-reflex exhibited significantly higher sensitivity for evaluation of S1 radiculopathy, accurate in 40 (93.0%) radiculopathy group patients, than that provided by the conventional tibial H-reflex of only 31 (72.1%) (P < 0.05). CONCLUSIONS The BF-LH H-reflex is a highly sensitive and reliable clinical tool for evaluation of the S1 spinal reflex pathway in radiculopathy that is distinct from the Sol H-reflex and conventional tibial H-reflex arcs.

In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors, postoperative back muscle function, and 24-month postoperative follow-up results.From September 2006 to June 2008, patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study. Patients were randomized to undergo either minimally invasive surgery (MIS, transforaminal lumbar interbody fusion via MAST Quadrant retractor, 41 cases) or open surgery (improved transforaminal lumbar interbody fusion, 38 cases).The MIS group had longer intraoperative fluoroscopy time than the open surgery group, and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group (P0.05 for all). MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery (P0.01). Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group (P0.01). The Oswestry disability index and visual analog scale scores were better at 3, 6, 12 and 24 months postoperatively than preoperatively in both groups. Both groups of patients met the imaging convergence criteria at the last follow-up.MIS can effectively reduce sacrospinalis muscle injury compared with open surgery, which is conducive to early functional recovery. In the short term, MIS is superior to open surgery, but in the long term there is no significant difference between the two procedures.