Analysis Of Etiology, Progression Factors And Choice Of Operation Strategy In Degenerative Lumbar Scoliosis

1.Correlation between the gene single-nucleotide polymorphism and serum concentration of tumor necrosis factor-alpha and degenerative lumbar scoliosisObjective:This study aims to investigate the correlation between tumor necrosis factor-alpha(TNF-α) gene single-nucleotide polymorphism and serum concentrations levels in degenerative lumbar scoliosis, which explore etiology of degenerative lumbar scoliosis from genetic and molecular level and provide the basis for analyzing the etiology and prevention of degenerative lumbar scoliosis.Methods:40patients with degenerative lumbar scoliosis were selected as patient group, they were out-patient or in the wards of the Third Hospital of He Bei Medical University from December2009to December2011, the DLS group were all undertaken lumbar spine X-ray and MRI.40cases of healthy persons were selected as normal control. The two groups matched with gender, age, body mass index. Fresh peripheral blood of the two groups were collected. DNA was extracted by the small amount of whole blood Genomic DNA extraction reagent kit, specific fragments in TNF-a gene promoter region were amplified by polymerase chain reaction (PCR) technology, and then the amplified specific fragments were digested using Ncol by restriction fragment length polymorphism (RFLP) technology, finally the products were detected with a2%agarose gel electrophoresis and cases’genotype and allele frequency distribution were analyzed. Serum TNF-a levels were determined by Enzyme-linked immunosorbent assay technique (ELISA). Using Adobe Photoshop6.0software, in DLS group the relative signal intensity of apical vertebra and the upper and lower vertebral disc’s nucleus pulposus and cerebrospinal fluid in T2-weighted MRI images were measured. Cobb angles were measured on the antero-posterior lumbar spine X-ray films. All the data were analyzed by Statistic Package for Social Science (SPSS)17.0. Gender, body mass index and serum TNF-a levels were compared using the t-test or analysis of variance. The count data, such as age, genotype and allele frequency were compared using the χ2or Fisher exact test. Correlation between serum TNF-αa levels and vertebral disc’degeneration and correlation between serum TNF-α levels and Cobb angles were made by Linear Correlation Analysis.Results:The comparison of the two groups’age, gender distribution and body mass index did not show statistical difference, The amplification TNF-a-308fragments was107bp by polymerase chain reaction and there were three genotypes after digested by incision enzyme, including G/G genotype, G/A genotype, A/A genotype. On the electropherogram G/G genotype had two bright bars(87bp,20bp), G/A genotype had three bright bars(107bp,87bp,20bp), and A/A genotype had one bright bars(107bp). Three genotypes frequencies of the two groups are in accordance with Hardy-Weinberg equilibrium. In DLS group, the frequencies of GIG genotype, G/A genotype and A/A genotype were70.0%、22.5%and7.5%, in the control group the frequencies of the three genotypes were77.5%、17.5%and5.0%. The three genotypes frequencies of the two groups are of no significant differences. In DLS group the frequencies of G/G genotype and non-G/G (G/A、A/A) genotype and the frequencies of allele G and A were70.0%、30.0%and81.3%、18.7%, in the control group were77.5%,22.5%and86.2%、13.8%. The comparison of two groups are of no significant difference. Cytokine TNF-a serum concentration in DLS group was172.15±33.51ng/L and in control group was53.75±3.84ng/L, The concentration of DLS group was significantly higher than that of control group, and there was significant difference, and the patient group was significantly higher. Serum TNF-a concentration has a negative correlation with the RSI and a positive correlation with the Cobb angle. According to the disc degeneration grade, DLS group was divided, there were significant differences between different groups.Conclusion:Serum TNF-α concentration in degenerative lumbar scoliosis patients were significantly increased. Serum TNF-a concentration has a negative correlation with the RSI and a positive correlation with the Cobb angle. The higher serum TNF-a concentration is, the more severe disc degeneration occur. TNF-a may play an important role in the degeneration of degenerative lumbar scoliosis.TNF-a-308polymorphism was of no significant correlation with degenerative lumbar scoliosis.2.Vertebral endplate signal changes on MRI T1and T2in degenerative lumbar scoliosis and its associated factors analysisObjective:Vertebral endplate signal changes (vESC) is common in degenerative lumbar disease, it is the characteristic of injury of endplate and degeneration of lumbar endplate, we do the work to investigate the vertebral endplate signal changes on MRI and explore its associated factors in degenerative lumbar scoliosis(DLS).Methods:The image data of120patients who were diagnosed primary DLS in our hospital from march2005to march2011were retrospectively reviewed as the case group. The image data of89patients who were diagnosed degenerative lumbar diseases(DLD) without scoliosis were selected as the control group. The prevalence, type and distribution of vESC in two groups was observed and compared. Intervertebral disc degeneration, lumbar scoliosis Cobb’s angle, body mass index(BMI) and status of smoking et al were recorded in DLS, and the relationship of vESC with these influential factors was analyzed.Results:Of1440endplate from120patients in case group,247(17.2%) from71(59.2%) patients were found to have vESC. Contrasting to the control group, of1068endplate from89patients,49(4.5%) from21(23.6%) patients were found to have vESC. The prevalence of vESC in two groups had a significantly statistical difference (P<0.01). Modic type II was more common in case group but Modic type I was more common in control group. The prevalence of vESC on concave side(12.1%) was significantly different with on convex(1.5%) and both sides(3.6%) in case group(P<0.01), While in control group, the prevalence of vESC on both sides(2.9%) was significantly significantly different with on right(1.0%) or left sides(0.7%, P<0.01). vESC were more common at L4/5and L5/S1in control group, but in case group, vESC mainly occured at L2/3, L4/5and L5/S1which were accordance with the common levels of apex vertebrae. Intervertebral disc degeneration, lumbar scoliosis, overweight and heavy smoking were considered as risk factors to vESC. By Multinomial Logistic Regression analysis with these factors, the regression function was obtained:log Y=-0.82+1.27D+0.55S+1.77D*S (Y for endplate degeneration, D for intervertebral disc degeneration, S for scoliosis Cobb’s angle and D*S for interaction of disc degeneration and scoliosis Cobb’s angle).Conclusion:vESC positively correlate with intervertebral disc degeneration, scoliosis Cobb’s angle and their interaction in DLS. its prevalence is relatively higher, most of them are type II and mostly locate on the concave side of L2/3, L4/5and L5/S1. Overweight and heavy smoking are probably its risk factors.3.Limited decompression, fixation,and fusion for degenerative scoliosis with vertebral stenosisObjective:Patients with degenerative lumbar scoliosis always suffered from vertebral stenosis, this may be induced by the lumbar disc herniation,atrophy of articular process or calcification of yellow ligaments. Patients always complained of leg pain, which is caused by the compression of the nerve root or spinal cord. We do the work to evaluated the efficiency of limited decompression, fixation, and fusion for degenerative scoliosis with vertebral stenosis.Method:From January,2001to January2008,36patients with degenerative scoliosis with vertebral stenosis were treated in our hospital. There were2males and34females. The age was from51to76years with an average of62.3years. X-ray, CT, MR examination were performed preoperatively for all the cases,5cases underwent myelography. Preoperative Cobb angle, focal lordosis, the distance between C7plumb line (C7PL) and upper edge of S1vertebral body(SVA), and the distance between C7PL and center sacral vertical line (CSVL) were24.0°±10.2°,22.6°±11.2°,(7.8±6.6)cm and (6.9±5.8)cm respectively. Limited decompression, pedicle screw internal fixation and fusion were carried out for patients, VAS and SF-36scored system were used to evaluate surgery effects.Result:The mean follow-up period was2.4years (range,1.2-4years) and no patients were lost during follow-up. The mean surgery time was130min (range,115-164min) with an average bleeding amount of625ml (range,450-870ml). compared to pre-operation, Cobb angle (10.6°±8.5°,8.9°±5.3°), focal lordosis (25.6°±14.3°,31.8°±13.4°), SVA [(0.5±3.4) m,-1.2±2.7) cm] and CSVL [(2.9±1.4)cm,(1.7±1.2)cm] were significantly improved at post-operation and final follow-up through statistics of SPSS13.0software. Loss of correction happened in one case. No collapse of the disc height occurred, neither did never root injures nor fracture of the fixation system.Conclusion:Limited decompression, pedicle screw fixation are testified efficient for degenerative scoliosis with vertebral stenosis, individualized surgery design should be made according to clinical symptoms, signs and imaging features to expect a satisfactory result.4.1ntervertebral disc degeneration and bone density in degenerative lumbar scoliosis:a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosisObjective:Degenerative lumbar scoliosis is common in old patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients and explore the relationship among disc degeneration and scoliotic angle.Methods:From January2001to August2010,96patients with degenerative lumbar scoliosis were retrospectively enrolled and96patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5discs and the height of L2/L4vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.Results:In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P<0.001). The vertebral body height on the convex side was greater than the height on the concave side (P=0.016). There was a significant difference between the scoliosis group and the control group (P=0.003), and between T-value and the rate of osteoporosis between the two groups (both P<0.001). Results were verified using multiple linear regression analysis.Conclusion:Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces.There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.