Adjacent segment degeneration after intervertebral fusion surgery by means of cervical block vertebrae

Tuina Promotes Repair of Chronic Cervical Muscle Injury by Regulating Satellite Cell Proliferation and Differentiation and Inhibiting Myocyte Apoptosis

Purpose

Chronic cervical muscle injury is the first common cause of the development of cervical spondylosis, and Tuina can effectively promote the repair of chronic cervical muscle injury and alleviate neck pain, but the mechanism behind its efficacy is still unknown. The proliferation and differentiation of muscle satellite cells and the apoptosis of cervical myocytes play important roles in the repair of chronic cervical muscle injuries; therefore, this study aimed to explore the potential mechanisms of Tuina to promote the repair of cervical muscle injuries in terms of the proliferation and differentiation of satellite cells and the apoptosis of myocytes.

Patients and Methods

Twenty-eight Wistar rats were randomly divided into control group, model group, Tuina group, and meloxicam group, with 7 rats in each group. Except for the control group, each group were establish a chronic cervical muscle injury model (CCMI). Meloxicam (0.79 mg/kg) was administered by gavage, and in the Tuina group, pressure was applied to the Fengchi acupoint on the affected side once a day. Morphological changes of cervical muscle tissues were detected by ultrasonic diagnostic instrument and HE staining, electrophysiological recordings of electromyographic changes, apoptosis rate was detected by TUNEL staining, and positive expression of Bax, Bcl-2, IGF-1, MyoD, and Pax-7 were detected by Immunohistochemistry and Western blot.

Results

In CCMI model rats, we observed that the cervical muscle fibers were disorganized, with irregular morphology, and the amplitude of electromyography was significantly weakened, while Tuina could significantly improve these symptoms and effectively promote the repair of chronic cervical muscle injury. Meanwhile, compared with the model group, Tuina could significantly increase the expression levels of IGF-1 (P<0.01) and MyoD (P<0.05) and decrease the expression level of Pax7 (P<0.05). In addition, we found that the number of apoptotic cells in cervical myocytes was reduced after Tuina intervention (P<0.05), and Tuina inhibited the expression of pro-apoptotic factor Bax (P<0.01) and promoted the expression of anti-apoptotic factor Bcl-2 (P<0.05).

Conclusion

Tuina can promote the proliferation and differentiation of satellite cells to repair chronic cervical muscle injury by regulating the expression of Pax7, MyoD, and IGF-1, as well as inhibiting the expression of Bax and promoting the expression of Bcl-2 to ameliorate the apoptosis of cervical myocytes in CCMI model rats.

Factors Associated With Compliance With Self-Management Home Therapies for Spine Pain: A Survey of Participants Attending a Chiropractic Teaching Clinic in South Africa

Objective

The purpose of this study was to determine factors that affect compliance with various prescribed home therapies based on reported feedback from participants with spine pain.

Methods

This was a descriptive, quantitative, cross-sectional survey. A purposive sampling method was used to recruit 121 participants with neck and back pain attending the Durban University of Technology Chiropractic Day Clinic located in KwaZulu-Natal, South Africa. Data were collected using a self-administered questionnaire. Descriptive statistics, including frequencies and percentages, were used to summarize the data, and odds ratios (ORs) were calculated.

Results

Most participants presented with chronic pain, reporting an average severity of 6 out of 10 and little disability from the pain. Home therapy included stretches (92.2%), heat therapy (49.1%), and ice therapy (38.8%). Almost two-thirds (62.1%) of participants reported being fully compliant with the prescribed home therapy, while 32.8% reported partial compliance. The main factors that potentially affected compliance were laziness and forgetfulness. Participants who reported having depression were less compliant (OR, 0.181), while those with chronic pain were more compliant (OR, 3.74). Those who believed that home therapy would alleviate their pain were also more compliant (OR, 3.83).

Conclusion

The study found that a majority of participants with spine pain were compliant with prescribed chiropractic home treatment. Key factors that potentially influenced compliance were identified.

Biomechanical evaluation of the hybrid pedicle screw-cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration-finite element analysis

BACKGROUND

Transforaminal lumbar interbody fusion is an effective surgical treatment of intervertebral disk herniation. However, its clinical efficacy for adjacent segment disk degeneration (ASDD) after hybrid bilateral pedicle screw - bilateral cortical screw (pedicle screw at L4 and cortical bone trajectory screw at L5) and hybrid bilateral cortical screw - bilateral pedicle screw (bilateral cortical screw at L4 and bilateral pedicle screw at L5) remains undiscovered. Therefore, the aim of this study is to evaluate the effect of the hybrid bilateral pedicle screw - bilateral cortical screw and hybrid bilateral cortical screw - bilateral pedicle screw on the adjacent segment via a 3-dimensional (3D) finite element (FE) analysis.

METHODS

Four human cadaveric lumbar spine specimens were provided by the anatomy teaching and research department of Xinjiang Medical University. Four finite element models of L1-S1 lumbar spine segment were generated. For each of these, four lumbar transforaminal lumbar interbody fusion models at L4-L5 segment with the following instruments were created: hybrid bilateral pedicle screw - bilateral cortical screw, bilateral cortical screw - bilateral cortical screw (bilateral cortical screw at both L4 and L5 segments), bilateral pedicle screw - bilateral pedicle screw (bilateral pedicle screw at both L4 and L5 segments), and hybrid bilateral cortical screw - bilateral pedicle screw. A 400-N compressive load with 7.5 Nm moments was applied for the simulation of flexion, extension, lateral bending, and rotation. The range of motion of L3-L4 and L5-S1 segments and von Mises stress of the intervertebral disc at the adjacent segment were compared.

RESULTS

Hybrid bilateral pedicle screw - bilateral cortical screw has the lowest range of motion at L3-L4 segment in flexion, extension, and lateral bending, and the highest disc stress in all motions, while the range of motion at L5-S1 segment and disc stress was lower than bilateral pedicle screw - bilateral pedicle screw in flexion, extension, and lateral bending, and higher than bilateral cortical screw - bilateral cortical screw in all motions. The range of motion of hybrid bilateral cortical screw - bilateral pedicle screw at L3-L4 segment was lower than bilateral pedicle screw - bilateral pedicle screw and higher than bilateral cortical screw - bilateral cortical screw in flexion, extension, and lateral bending, and the range of motion at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in flexion, lateral bending, and axial rotation. The disc stress at L3-L4 segment was lowest and more dispersed in all motions, and the disc stress at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in lateral bending and axial rotation, but more dispersed.

CONCLUSION

Hybrid bilateral cortical screw - bilateral pedicle screw decreases the impact on adjacent segments after spinal fusion, reduces the iatrogenic injury to the paravertebral tissues, and provides throughout decompression of the lateral recess.

Unexpected positive cultures in presumed aseptic revision spine surgery using sonication

AIMS

During revision procedures for aseptic reasons, there remains a suspicion that failure may have been the result of an undetected subclinical infection. However, there is little evidence available in the literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and to evaluate clinical characteristics of these patients.

PATIENTS AND METHODS

All patients who underwent a revision surgery after instrumented spinal surgery at our institution between July 2014 and August 2016 with spinal implants submitted for sonication were retrospectively analyzed. Only revisions presumed as aseptic are included in the study. During the study period, 204 spinal revisions were performed for diagnoses other than infection. In 38 cases, sonication cultures were not obtained, leaving a study cohort of 166 cases. The mean age of the cohort was 61.5 years (sd 20.4) and there were 104 female patients.

RESULTS

Sonication cultures were positive in 75 cases (45.2%). Hardware failure was the most common indication for revision surgery and revealed a positive sonication culture in 26/75 cases (35%) followed by adjacent segment disease (ASD) in 23/75 cases (30%). Cutibacterium acnes and Staphylococcus epidermidis were the most commonly isolated microorganisms, observed in 45% and 31% of cases, respectively. C. acnes was isolated in 65.2% of cases when the indication for revision surgery was ASD.

CONCLUSION

Infection must always be considered as a possibility in the setting of spinal revision surgery, especially in the case of hardware failure, regardless of the lack of clinical signs. Sonication should be routinely used to isolate microorganisms adherent to implants. Cite this article: Bone Joint J 2019;101-B:621-624.