| Part one Establishment of a rat model of cervical spondylotic myelopathy and the correlation study of disc degeneration and inflammatory factorsObjective:To establishment of a rat model of cervical spondylotic myelopathy and to explore the relationship between the degree of cervical disc degeneration and the level of inflammatory factors.Methods:Forty 3-month old male SD rats were numbered and randomly divided into model group and control group by random number method.Each group had 20 rats.In the experimental group the C4-5 and C5-6 discs were punctured and placed into a composite preparation of a composite preparation of Bone morphogenetic protein(BMP)and polyvinylpyrrolidone(PVP).Five rats were randomly selected from the 4th,8th,and 12 th week after surgery to evaluate the motor function of the experimental animals.Then the rats were sacrificed to obtain C4-5 and C5-6 intervertebral discs.Morphological changes of C4-5 intervertebral disc tissue and changes of IL-1? positive cells were observed by HE staining and immunohistochemical staining.Changes of mRNA and protein levels of TNF-a,IL-1?,IL-33 and IL-6 in C5-6 intervertebral discs were detected by RT-PCR and Western Blot.The difference of TNF-?,IL-1?,IL-33 and IL-6 between the two groups of C6-7 intervertebral discs was determined by ELISA.Results:The results of the sloping plate test showed that compared with the control group,there was no significant change in motor function of the model group at the 4th week after modeling(P>0.05),but the motor function was obvious decreased at the 8th and 12 th week after modeling and the differences were statistically significant(P<0.05).The motor function of the control group at different time after operation was not significantly different from that before surgery(P>0.05).According to the Thompson intervertebral disc degeneration score,there was no significant difference between the model group and the control group at 4th week after operation(P>0.05).However,at 8th and 12 th weeks after operation,the difference between the two groups was statistically significant(P<0.05).At 4th week after operation,the HE staining showed that the nucleus pulposus of the experimental group became smaller,and the number of cells in the nucleus pulposus decreased,and the annulus fibrosus was disordered.The morphology of the discs in the control group was basically regular,and the fibers were basically regular.At 8 weeks after operation,the posterior margin of the vertebral body was mildly hyperosteogeny and osteophyte formation.By the 12 th week after surgery,the posterior margin of the vertebral body was hyperplasia and osteophytes were formed.The control group did not form significant bone hyperplasia and callus at these times.The number of IL-1? positive cells in the intervertebral disc of the experimental group and the control group were(9.71±1.94)and(4.33±1.15)at 8th week after operation respectively,and(12.23±2.49)and(4.66±1.38)at 12 th week after operation respectively.The differences between the groups were statistically significant(P<0.05).The levels of inflammatory factors such as TNF-?,IL-1?,IL-33 and IL-6 in the experimental group and the control group were determined by RT-PCR and Western Blot at 8th week and 12 th after operation,and differences between the groups were statistically significant(P<0.05).ELISA showed similar trends in TNF-?,IL-1?,IL-33 and IL-6 in the intervertebral discs of each group.Conclusion:The experimental results showed that the biological characteristics of BMP were utilized to implant it in the posterior margin of intervertebral disc tissue,which not only started the degeneration process,but also promoted the proliferation and ossification of intervertebral disc and ligament tissue.The inflammatory factors IL-1?,TNF-?,IL-33 and IL-6 are highly expressed in degenerated intervertebral disc tissue,and the expression level is significantly increased with the degree of degeneration.Part two Analysis about therapeutic effects of anterior or posterior approach in severe cervical spondylotic myelopathy with ossification of posterior longitudinal ligamentObjective:Cervical spondylitis myelopathy(CSM)and ossification of posterior longitudinal ligament(OPLL)are common cervical degenerative diseases.Severe cervical spondylotic myelopathy with spinal stenosis rate of more than 50% is often accompanied by ossification of the posterior longitudinal ligament,which is difficult to be completely separated due to the intersection of the site,natural course and clinical symptoms.At the same time,both of them have sustained compression on the spinal cord,which can cause quadriplegia,so the disability rate is high and needs surgical treatment.At present,there is no unified conclusion on the surgical treatment of severe cervical spondylotic myelopathy with ossification of posterior longitudinal ligament.The purpose of Our research is to discuss the clinical efficacy of anterior cervical cortectomy and fusion(ACCF)and posterior cervical laminoplasty in the treatment of cervical spondylotic myelopathy.Methods:A retrospective analysis was made on clinical data from 40 patients with cervical spondylotic myelopathy with ossification of posterior longitudinal ligament admitted to the Department of Spine Surgery of The Third Hospital of Hebei Medical University from March 2015 to April 2017.Eighteen patients underwent anterior cervical cortectomy and fusion and 22 patients underwent posterior cervical laminoplasty.The blood volume,cervical lordosis and postoperative complications of the two groups were analyzed.The neurological function of the two groups was evaluated according to the Japanese Orthopaedic Association(JOA)score,and the recovery rate was calculated and compared.Results:All patients were followed up from 12 to 24 months with an average of 18 months.There was no significant difference in the basic data(age,sex)between the two groups.Intraoperative blood loss in anterior cervical group was 350 ml less than 675 ml in posterior cervical group.The preoperative JOA score of the two groups was 6.83 ±1.62 in the anterior group and 6.77±1.41 in the posterior group.The JOA score was significantly improved one week after operation,and the JOA score was further improved in the last follow-up.There was statistical significance compared with before treatment.The recovery rates were 31.9%±6.2% and 32.2%±5.8% in the two groups for Postoperative.At the last follow-up recovery rates were 62.1%±6.7% and 64.1%±7.6%.All of them improved significantly compared with preoperative.There was no statistical difference in the recovery rate between the two groups.Postoperative changes of cervical lordosis in both groups were 14.4 ±4.3 and 14.2 ±3.5 respectively,which were larger than those before operation.The incidence of C5 nerve root paralysis was 11.1% in anterior group and 13.6% in posterior group.There was no significant difference in the results.The incidence of cerebrospinal fluid leakage was 22.2% in anterior group and 9.1% in posterior group.Conclusion:For ossification within 3 vertebral bodies' patient who have severe cervical spondylotic myelopathy with ossification of posterior longitudinal ligament,both anterior cervical cortectomy and fusion and posterior cervical laminoplasty are safe and effective methods.Anterior surgery can effectively relieve nerve compression and restore the physiological curvature of cervical spine.Posterior surgery can enlarge the spinal canal and maintain the stability of physiological curvature.Part three Risk factors for C5 palsy after anterior cervical decompressionObjective:Cervical spondylitis myelopathy(CSM)is a common degenerative disease which severely affects patients' physical,mental health and quality of life.Anterior cervical decompression surgery procedures have been confirmed to yield generally good outcomes,but C5 palsy is a potential complication after anterior decompression surgery.The related studies of C5 palsy after posterior procedure has been studied intensively,whereas the number of studies about C5 palsy after anterior cervical decompression surgery is relatively small.Thus,the risk factors of C5 palsy after ACD have not yet been fully substantiated.The purpose of this study was investigated risk factors for C5 palsy following anterior cervical decompression.Methods:A retrospective analysis was made on clinical data from 100 patients with cervical spondylitis myelopathy admitted to the Department of Spine Surgery of The Third Hospital of Hebei Medical University from January2015 to June 2017.All the patients underwent ACD.In terms of the criteria for diagnosing postoperative C5 palsy,the patients were divided into the palsy group and the non-palsy group.The patients in the two groups were compared in the basic data,the Japanese Orthopedic Association(JOA)scores and changes in the values of cervical lordosis,the sagittal diameters of C4/C5 intervertebral foramina,and the incidence of preoperative hyper-intense signal changes within the spinal cord at C4-C5.Multivariate logistic regression analysis was employed for exploring the risk factors for C5 palsy.Results:The patients in the two groups differed insignificantly in basic data(age,sex,operative time,intraoperative blood loss,and course of disease).The postoperative JOA scores in the palsy group were significantly lower than those in the non-palsy group(P < 0.001).The changes in the values of cervical lordosis before and after surgery in the paralyzed group were greater than those in the non-palsy group,but sagittal diameters of C4/C5 intervertebral foramina were remarkably larger in the non-palsy group than in the palsy group(all P < 0.001).The incidence of preoperative hyper-intense signal changes within the spinal cord at C4/C5 varied insignificantly between the two groups.Multivariate logistic regression analysis demonstrated that changes in the values(greater than 6.5°)of cervical lordosis before and after surgery,and sagittal diameter(less than 2.2 mm)of C4/C5 intervertebral foramina were risk factors for the presence of postoperative C5 palsy.Conclusion:For patients with CSM who had undergone ACD,changes in the values of cervical lordosis before and after surgery,changes in the values of cervical lordosis,and the sagittal diameter of C4/C5 intervertebral foramina are risk factors for presence of postoperative C5 palsy. |
PDF Full Text Request