| Objective To explore three factor(IL-1β、IL-6、COX-2)expression correlation and difference of cervical intervertebral disc in patients with spinal cord compression which had different clinical symptoms. Preliminary to clarify the onset of patients with cervical spinal cord compression in the process of relationship with the clinical symptoms in patients with inflammatory neurotransmitter stimulation. Research expansive open-door laminoplasty surgery(EOLP) therapy postoperatively in patients with cervical spinal cord compression "spring back" phenomenon with miniature titanium plate or anxhor screw, Study the safety and efficacy on two methods of treatment cervical spondylosis myelopathic. Analysis the cause of "spring back" phenomenon and the effect of surgery on the patients. Discussed the mechanism of C5 palsy,investigated clinical curative effect of preventing C5 palsy after EOLP by C4,5 partial foraminotomy.Methods The basic research:Using the herniation Intervertebral disc or the responsibility Intervertebral disc with anterior approach disc removed and fixed surgery in spinal surgery department of tianjin people’s hospital. Three groups were divided on the basis of clinical symptoms.Group with myelopathic symptoms(Group A); Group with nerve root symptoms(Group B); Group with cervical spine trauma(Group C). The Intervertebral disc HE staining and immunohistochemical staining were used for morphological observation.Then positive cell counted to the result of immunohistochemical staining.The clinical research: All cases were derived from the spinal surgery department of tianjin people’s hospital. The first part: 55 patients with cervical Myelopathic disease were treated with EOLP using miniature titanium plate or anxhor screw, Clinical curative effect and radiographic evaluation were used after surgery. Clinical curative effect evaluation included Japanese Orthopaedic Association Scores(JOA),JOA improvement, Postoperative axial symptoms. radiographic evaluation included measured the spinal cord diameter and spinal vertebral spacing with cervical spine MRI, Cervical vertebral laminar openning angle with cervical spine CT. The second part: 155 patients with ossification of posterior longitudinal ligament(OPLL) were treated with EOLP,including 75 males and 80 females.65 with EOLP and C4,5 partial foraminotomy(Group A),90 cases with EOLP(Group B). Clinical curative effect and imaging evaluation were used after operation. Clinical curative effect evaluation included JOA scores,JOA scores improvement rate, C5 palsy occurrence rate,evaluated nerve function and the status of the prognosis in patients with C5 palsy.Imaging evaluation included CI,changing of laminar open angle, shift of anterior margin of the spinal cord(SAMSC), shift of posterior margin of the spinal cord(SPMSC),Then statistical analyses of the parameters above were performed.ResultsThe basic research: There were visible inflammatory cells infiltration and new blood vessels formed in HE staining of group A and group B. Positive cells were mainly concentrated in the prominent inflammatory granulation tissue around the cervical intervertebral disc.there were no obvious inflammatory cells infiltration and new blood vessels formmed in group C. positive cells were seen in Immunohistochemical staining results of group A. Cytoplasm staining mainly for tan. COX-2 results rare expressed positive cells. IL-1β、IL-6、COX-2 results showed more positive cells in group B than group A.There were rare positive cells in IL-1β、IL-6、COX-2 results of group C.In group A and group B IL-1β positive expression rate and IOD values were significantly higher than that of group C. IL-1β in group A and group B there was no statistically significant difference of positive expression rate,which IOD value difference was statistically significant. IL-6 in group A and group B positive expression rate and IOD values were significantly higher than that of group C. IL-6 in group A and group B there was no statistically significant difference of positive expression rate and IOD value. COX-2 positive expression rate in group B and IOD values were significantly higher than that of group A and group C. In group A and group C there was no statistically significant difference COX-2 positive expression rate. IOD value difference was statistically significant.The clinic research: The first part: In clinical curative effect aspect,JOA score after operation had no statistically significance, JOA score improvement after operation had statistically significance in 1 year after operation. Two groups showed different degrees of axial symptoms after surgery.Axial symptoms had eased significantly in 1 year than 1 week after surgery. Two groups of postoperative follow-up in a week,axial symptoms score difference was statistically significant.The spinal cord diameter and spinal vertebral spacing with cervical spine MRI was no statistically significant in Preoperation and 1 week and 1 year after surgery, Measured cervical vertebral laminar opening angle with cervical spine CT, The difference was statistically significant.After 1 week and 1 year in achor screw group. openning angle difference between the two groups had statistical significance in 1 year after surgery. The second part: In clinical curative effect aspect,JOA score after operation had no statistically significance, JOA score improvement after operation had no statistically significance.The C5 palsy occurrence rate after operation in 2 groups had statistically significance,11 cases showed C5 palsy after operation,3 cases in team A including 1case showed Triangle strength decreased obviously and 2 cases showed the feeling of numbness, pain associated with C5 section;8 cases in team B including all cases showed Triangle strength decreased obviously and 6 cases showed the feeling of numbness, pain associated with C5 section;To comparision of imaging parameters between 2 groups,CI preoperation after operation had no statistically significance,laminar openning angle mean status after operation had no statistically significance. The laminar openning angle is smaller in 1 years than 8 weeks after operation. SAMSC after operation had no statistically significance.SPMSC in 8 weeks after operation(P=0.001)and 1 years after operation(P=0.000)had statistically significance. Conclusion The basic research: The herniated the cervical intervertebral disc can produced IL-1, IL-6,Cox-2 positive cells, These cytokines played a role in the early of the cervical intervertebral disc degeneration, The inflammation in patients with different clinical symptoms of cervical cord compression factor had obvious differences expression. The clinic research: The first part: Open Angle changes of Patients may be related to neural functional recovery after operation, postoperative axial symptoms, C5 nerve root palsy etc. The spring back phenomenon may caused adverse effects in the operation curative effect.EOLP with miniature titanium plate was a safe and effective treatment,which can effectively maintained vertebral plate expanded effect and avoided the spring back phenomenon.The second part: To therapy OPLL patient by EOLP,there was no significant difference in JOA score improvement whether with C4,5 partial forminotomy, C4,5 partial forminotomy can not totally avoid C5 palsy,but it can decrease the incidence rate of C5 palsy after EOLP and may get better outcome. |
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