Paraspinal abscess communicated with epidural abscess after extra-articular facet joint injection

Facet joint injection is considered to be a safe procedure. There have been some reported cases of facet joint pyogenic infection and also 3 cases of facet joint infection spreading to paraspinal muscle and epidural space due to intra-articular injections. To the author's knowledge, paraspinal and epidural abscesses after facet joint injection without facet joint pyogenic infection have not been reported. Here we report a case in which extra-articular facet joint injection resulted in paraspinal and epidural abscesses without facet joint infection. A 50-year-old man presenting with acute back pain and fever was admitted to the hospital. He had the history of diabetes mellitus and had undergone the extra-articular facet joint injection due to a facet joint syndrome diagnosis at a private clinic 5 days earlier. Physical examination showed tenderness over the paraspinal region. Magnetic resonance image (MRI) demonstrated the paraspinal abscess around the fourth and fifth spinous processes with an additional epidural abscess compressing the thecal sac. The facet joints were preserved. The laboratory results showed a white blood cell count of 14.9 x 10(9) per liter, an erythrocyte sedimentation rate of 52 mm/hour, and 10.88 mg/dL of C-reactive protein. Laminectomy and drainage were performed. The pus was found in the paraspinal muscles, which was communicated with the epidural space through a hole in the ligamentum flavum. Cultures grew Staphylococcus aureus. Paraspinal abscess communicated with epidural abscess is a rare complication of extra-articular facet joint injection demonstrating an abscess formation after an invasive procedure near the spine is highly possible.     

Effects of a carrageenan-induced inflammation in rabbit lumbar facet joint capsule and adjacent tissues

The effects of experimentally induced inflammation of the lumbar facet joint capsule and adjacent tissues were investigated electrophysiologically and histologically. Type II carrageenan was injected into the receptive fields innervated by identified mechanosensitive afferent units. The multi-unit spontaneous background discharge rate showed increases that consisted of two phases over a time period of 150 min: the first phase (0–30 min) and the second phase (45–150 min). The time course of single units, identified as groups II, III and IV, and silent units, was also investigated. The silent unit discharge rates displayed a gradual increase in the first 15 min and persisted beyond 75 min. Histological examination revealed inflammatory changes in carrageenan injected tissues. In contrast, in isotonic saline injected control experiments there were no changes observed in the electrophysiological or histological studies. This study shows the effects of inflammation in rabbit lumbar facet joint capsule and adjacent tissues. The electrophysiological results show that inflammation of the facet joint and deep back muscles causes (1) increases in multi-unit discharge rate, (2) sensitization to mechanical stimuli and (3) recruitment of previously silent units. Inflammatory changes were also demonstrated histologically.     

Endoscopic Facet Debridement for the treatment of facet arthritic pain - a novel new technique

Study design: Retrospective, observational, open label.Objective: We investigated the efficacy of facet debridement for the treatment of facet joint pain.Summary of background data: Facet joint disease, often due to degenerative arthritis, is common cause of chronic back pain. In patients that don''t respond to conservative measures, nerve ablation may provide significant improvement. Due to the ability of peripheral nerves to regenerate, ablative techniques of the dorsal nerve roots often provide only temporary relief. In theory, ablation of the nerve end plates in the facet joint capsule should prevent reinnervation.Methods: All patients treated with endoscopic facet debridement at our clinic from 2003-2007 with at least 3 years follow-up were included in the analysis. Primary outcome measure was percent change in facet-related pain as measured by Visual Analog Scale (VAS) score at final follow-up visit.Results: A total of 174 people (77 women, 97 men; mean age 64, range 22-89) were included. Location of facet pain was cervical in 45, thoracic in 15, and lumbar in 114 patients. At final follow-up, 77%, 73%, and 68% of patients with cervical, thoracic, or lumbar disease, respectively, showed at least 50% improvement in pain. Mean operating time per joint was 17 minutes (range, 10-42). Mean blood loss was 40 ml (range, 10-100). Complications included suture failure in two patients, requiring reclosure of the incision. No infection or nerve damage beyond what was intended occurred.Conclusions: Our results demonstrate a comparable efficacy of endoscopic facet debridement compared to radiofrequency ablation of the dorsal nerve branch, with durable results. Large scale, randomized trials are warranted to further evaluate the relative efficacy of this surgical treatment in patients with facet joint disease.     

颈椎关节突关节矢状位角的不对称性和关节突关节退变关系的影像学研究

目的 探讨颈椎关节突关节矢状位角的不对称性和关节突关节退变的关系。 方法 利用4度评估法,3位测评者对20具新鲜尸体颈椎标本的轴向位CT图像上C3/4 ~ C6/7节段共160个关节突关节矢状位角和退变程度进行单盲随机测评,并统计分析。 结果 20具颈椎标本在不同节段间的关节突关节矢状位不对称角度无显著性差异（F＝0.55,P＝0.65）,关节突关节退变程度也无显著性差异（左侧：Z＝3,P＝0.646;右侧：Z＝3,P＝0.376）,但C3/4和C4/5的关节突关节矢状位角的不对称程度与同节段关节突关节退变的程度之间有显著的差异性（C3/4：Z＝8.567,P＝0.014;C4/5：Z＝2.000,P＝0.025）。 结论 关节突关节矢状位角的不对称性可能和关节突关节的退变有关。     

Analysis of Efficacy Differences between Caudal and Lumbar Interlaminar Epidural Injections in Chronic Lumbar Axial Discogenic Pain: Local Anesthetic Alone vs. Local Combined with Steroids

Study Design: Comparative assessment of randomized controlled trials of caudal and lumbar interlaminar epidural injections in chronic lumbar discogenic pain.Objective: To assess the comparative efficacy of caudal and lumbar interlaminar approaches of epidural injections in managing axial or discogenic low back pain.Summary of Background Data: Epidural injections are commonly performed utilizing either a caudal or lumbar interlaminar approach to treat chronic lumbar axial or discogenic pain, which is pain exclusive of that associated with a herniated intervertebral disc, or that is due to degeneration of the zygapophyseal joints, or due to dysfunction of the sacroiliac joints, respectively. The literature on the efficacy of epidural injections in managing chronic axial lumbar pain of presumed discogenic origin is limited.Methods: The present analysis is based on 2 randomized controlled trials of chronic axial low back pain not caused by disc herniation, radiculitis, or facet joint pain, utilizing either a caudal or lumbar interlaminar approach, with a total of 240 patients studied, and a 24-month follow-up. Patients were assigned to receive either local anesthetic only or local anesthetic with a steroid in each 60 patient group.Results: The primary outcome measure was significant improvement, defined as pain relief and functional status improvement of at least 50% from baseline, which was reported at 24-month follow-ups in 72% who received local anesthetic only with a lumbar interlaminar approach and 54% who received local anesthetic only with a caudal approach. In patients receiving local anesthetic with a steroid, the response rate was 67% for those who had a lumbar interlaminar approach and 68% for those who had a caudal approach at 12 months. The response was significantly better in the lumbar interlaminar group who received local anesthetic only, 77% versus 56% at 12 months and 72% versus 54% at 24 months.Conclusion: This assessment shows that in patients with axial or discogenic pain in the lumbar spine after excluding facet joint and SI Joint pain, epidural injections of local anesthetic by the caudal or lumbar interlaminar approach may be effective in managing chronic low back pain with a potential superiority for a lumbar interlaminar approach over a caudal approach.     

Prediction of the human thoracic and lumbar articular facet joint morphometry from radiographic images

The articular facet joints (AFJ) play an important role in the biomechanics of the spine. Although it is well known that some AFJ dimensions (e.g. facet height/width or facet angles) play a major role in spinal deformities such as scoliosis, little is known about statistical correlations between these dimensions and the size of the vertebral bodies. Such relations could allow patient-specific prediction of AFJ morphometry from a few dimensions measurable by X-ray. This would be of clinical interest and could also provide parameters for mathematical modeling of the spine. Our purpose in this study was to generate prediction equations for 20 parameters of the human thoracic and lumbar AFJ from T1 to L4 as a function of only one given parameter, the vertebral body height posterior (VBHP). Linear and nonlinear regression analyses were performed with published anatomical data, including linear and angular dimensions of the AFJ and vertebral body heights, to find the best functions to describe the correlations between these parameters. Third-order polynomial regressions, in contrast to the linear, exponential and logarithmic regressions, provided moderate to high correlations between the AFJ parameters and vertebral body heights; e.g. facet height superior and interfacet width (R2, 0.605-0.880); facet height inferior, interfacet height and sagittal/transverse angle superior (R2, 0.875-0.973). Different correlations were found for facet width and transverse angle inferior in the thoracic (R2, 0.703-0.930) and lumbar (R2, 0.457-0.892) regions. A set of 20 prediction equations for AFJ parameters was generated (P-values < 0.005, anova). Comparison of the AFJ predictions with experimental data indicated mean percent errors <13%, with the exception of the thoracolumbar junction (T12-L1). It was possible to establish useful predictions for human thoracic and lumbar AFJ dimensions based on the size of the vertebral bodies. The generated set of equations allows the prediction of 20 AFJ parameters per vertebral level from the measurement of the parameter VBHP, which is easily performed on lateral X-rays. As the vertebral body height is unique for each person and vertebral level, the predicted AFJ parameters are also specific to an individual. This approach could be used for parameterized patient-specific modeling of the spine to explore the clinically important mechanical roles of the articular facets in pathological conditions, such as scoliosis.     

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized,Double-Blind,Active-Control Trial

Study Design: A randomized, active control, double-blind trial. Objective: To evaluate the effectiveness of fluoroscopically directed caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to post lumbar surgery syndrome. Summary of Background Data: There is a paucity of evidence concerning caudal epidural injections for managing chronic persistent low back pain with or without lower extremity pain caused by post lumbar surgery syndrome.Methods: This active control randomized study included 140 patients with 70 patients in each group. Group I received 0.5% lidocaine, 10 mL; Group II received 9 mL of 0.5% lidocaine mixed with 1 mL of 6 mg of nonparticulate betamethasone. The multiple outcome measures included the numeric rating scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as at least 50% improvement in pain and Oswestry Disability Index scores. Patients with a positive response to the first 2 procedures with at least 3 weeks of relief were considered to be successful. All others were considered as failures.Results: Overall in Group I, 53% and 47% of the patients and in Group II, 59% and 58% of the patients, showed significant improvement with reduction in pain scores and disability index at 12 months and 24 months. In contrast, in the successful groups, significant pain relief and improvement in function were observed in 70% and 62% of Group I at one and 2 years; in 75% and 69% of Group II at one and 2 years. The results in the successful group showed that at the end of the first year patients experienced approximately 38 weeks of relief and at the end of 2 years Group I had 62 weeks and Group II had 68 weeks of relief. Overall total relief for 2 years was 48 weeks in Group I and 54 weeks in Group II. The average procedures in the successful groups were at 4 in one year and 6 at the end of 2 years.Conclusion: Caudal epidural injections of local anesthetic with or without steroid might be effective in patients with chronic persistent low back and/or lower extremity pain in patients with post lumbar surgery syndrome.     

Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized,Double-Blind,Controlled Trial with a 2-Year Follow-Up

Study Design: A randomized, double-blind, controlled trial.Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin.Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin.Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks.Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months.Results: Significant improvement with significant pain relief of ≥ 50% and functional improvement of ≥ 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up.The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment.Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin.     

人和大鼠腰椎关节突关节的SP能神经纤维的分布

目的：证实支配腰椎关节突关节的神经支配和化学性质，方法：用逆行荧光素标记结合免疫组化法，研究７只大鼠腰部脊神经节细胞的周围突分支投射到腰椎关节突关节及其递质性质以及３例人腰椎关节突关节囊上神经末梢的化学性质，结果：发现大鼠一侧Ｌ５和Ｌ６之间的关节突关节受同侧Ｌ２－５节段的脊神经节的部分细胞周围突分支支配，其中有３３．３９９％的中型和小型细胞为中ＳＰ能免疫反应阳性，人的关节突关节囊含有ＳＰ阳性的神经     

含降钙素基因相关肽的脊神经节细胞分支分布至股神经和腰背肌的研究

目的 探讨腰背痛伴下肢痛和下肢肌痉挛的化学神经机制。方法 应用荧光双标记法结合免疫组化及ＰＡＰ法对１７只豚鼠进行了研究,将碘化丙啶注入股神经干,双苯甲亚胺注入腰背肌,结果：发现在Ｌ３～５节段脊神经节中存在着荧光双标记细胞,荧光双标记细胞的出现率为３．４％,约４３．７％的荧光双标记细胞含降钙素基因相关肽,含降钙基基因相关肽的荧光双标记细胞均中,中小和小型细胞,结论：在腰背肌与股神经之间存在着脊神经节     

非手术脊柱减压系统DRX9000治疗椎间盘源性腰痛的临床初步报告

目的观察非手术脊柱减压系统DRX9000治疗椎间盘源性腰痛的疗效。方法对50例椎间盘源性腰痛患者进行非手术脊柱减压系统DRX9000治疗,在治疗开始时、治疗1周后、治疗2周后、治疗4周后、整个疗程结束时都对患者进行腰椎活动度、压痛点、双下肢运动感觉、肌力、神经反射的检查并记录,填写《汉化Oswestry功能障碍评分表》,根据分值的变化对疗效进行评估。50例患者均完成了20次治疗。结果 50例患者汉化Oswestry功能障碍评分平均分从治疗前的24.64分,变为治疗1周后13.12分,治疗2周后11.74分,治疗4周后9.70分,治疗结束后9.22分。治疗有效率为86%。将汉化Oswestry功能障碍评分的分值换算为功能障碍指数（CODI）后,发现随着治疗时间的增加,CODI降低的人数逐渐增多。随访50例患者,得到其中36人完整资料,平均随访时间6.2个月,汉化Oswestry功能障碍评分平均分为5.75分。结论非手术脊柱减压系统DRX9000治疗椎间盘源性腰痛,患者恢复良好,效果优。     

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized,controlled, clinical trial

Intracutaneous sterile water injection (ISWI) is used for relief of low back painduring labor, acute attacks of urolithiasis, chronic neck and shoulder pain followingwhiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized,double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief ofacute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an11-point visual analogue scale [VAS]) were recruited and randomly assigned to receiveeither ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment;n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45,and 90 min and 1 day after treatment. The secondary outcome was functionalimprovement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1day after treatment. The mean VAS score was significantly lower in the ISWI groupthan in the control group at 10, 45, and 90 min, and 1 day after injection(P<0.05, t-test). The mean increment in PSFS score of the ISWIgroup was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2.Our study showed that ISWI was effective for relieving pain and improving function inaLBP patients at short-term follow-up. ISWI might be an alternative treatment foraLBP patients, especially in areas where medications are not available, as well as inspecific patients (e.g., those who are pregnant or have asthma), who are unable toreceive medications or other forms of analgesia because of side effects.     

Mechanism of change in the orientation of the articular process of the zygapophyseal joint at the thoracolumbar junction

The orientation of the superior articular processes in thoracic and lumbar vertebrae differs. The present study was undertaken to investigate the possible mechanism for the change from a posterolaterally facing superior articular surface in the thoracic region to a posteromedially facing curved articular surface in the lumbar region. The material of the study consisted of dry macerated bones of 44 adult human vertebral columns. The orientation of the superior articular process and its relation to the mamillary tubercle (process) was examined between T9 and L5 vertebrae in each column. An abrupt change from the thoracic to lumbar type of articular process was observed in 3 columns (7%). Forty-one (93%) columns showed a gradual change extending over either 2 or 3 successive vertebrae. The present study suggests that the change in the orientation of the superior articular process, from the coronal to the sagittal plane (sagittalisation), occurs due to the change in the direction of weight transmission through zygapophyseal joints at the thoracolumbar junction. It was observed that the gradual sagittalisation of the superior articular process in the transitional zone brought it close to the mamillary tubercle which eventually fused with it. Thus the study suggests that the characteristic posteromedially facing concave superior articular process of lumbar vertebrae may have formed because of the fusion of the articular process and the mamillary tubercle.     

Possible nociceptive structures in the sacroiliac joint cartilage: An immunohistochemical study

The sacroiliac joint (SI joint) is a known source of low back pain. In the absence of validated physical signs and imaging studies, the diagnosis of SI joint pain can be secured by positive response to SI joint intra‐articular infiltration with local anesthetics. The current anatomical and histological knowledge concerning intra‐articular structures of the sacroiliac joint is insufficient to explain the efficacy of this infiltration. Consequently, this study was undertaken to detect the intra‐articular presence of substance P and calcitonin gene‐related peptide (CGRP) positive nerve fibers, providing indirect evidence of nociceptive innervation of the SI joint. Free‐floating sections, obtained from iliac and sacral cartilage and subchondral bone of the SI joint and adjacent ligamentous tissue, of 10 human cadavers were studied immunohistochemically. Tissue of nine human cadavers showed the presence of substance P and CGRP immunoreactivity in the superficial layer of sacral and iliac cartilage, and the surrounding ligamentous structures. Subchondral bone reacted weakly to the antisera used. These findings support the view that the SI joint may be capable of intra‐articular nociception and may explain the positive response to the intra‐articular deposition of local anesthetic. Clin. Anat. 23:192–198, 2010. © 2009 Wiley‐Liss, Inc.     

椎小关节注射与经皮椎体后凸成形治疗椎体轻度脆性骨折：快速镇痛与恢复脊柱稳定性

文题释义：椎小关节：是真正的滑膜关节,具有关节面、关节软骨、关节腔和关节囊,当骨质疏松压缩性骨折患者变动体位时损伤的小关节进一步受力卡压神经,疼痛通过上关节突与横突交界处绕行的脊神经后内侧支传递引起爆发痛。 经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)：1994年Reiley等在经皮椎体成形术(percutaneous vertebroplasty,PVP)的基础上,设计了通过球囊扩张来纠正脊柱后凸畸形的技术,即经皮球囊扩张椎体后凸成形术。经皮椎体后凸成形做为一种脊柱微创手术,具有创伤小、操作简便、手术安全性高等诸多优点,在治疗骨质疏松压缩性骨折方面,可以更快地恢复身体动能及缓解疼痛,尽可能恢复椎体高度和矫正后凸畸形。 背景：经皮椎体后凸成形治疗骨质疏松压缩性骨折受到临床上广泛的认可,但因存在骨水泥渗漏、邻近椎体再骨折等并发症促使临床医生寻求新的治疗方案。 目的：对比研究椎小关节注射与经皮椎体后凸成形对轻度椎体脆性骨折的疗效。 方法：纳入轻度椎体脆性骨折(骨质疏松性骨折)患者46例,根据治疗方案分为小关节注射组和经皮椎体后凸成形组。2组患者在给予规范的抗骨质疏松治疗基础上,分别行小关节注射和经皮椎体后凸成形治疗,记录2组患者治疗前,治疗后1周及第1,3,6,12个月时的数据,采用目测类比评分、功能障碍指数问卷表(Oswestry disability index,ODI)评估镇痛效果;采用椎体前缘高度、后凸角度、腰椎骨密度评估脊柱稳定性;比较再骨折发生率。研究方案的实施符合山西医学科学院山西大医院的相关伦理要求,所有患者均签署了“知情同意书”。 结果与结论：①组内比较：与治疗前相比,2组患者治疗后各时间段的目测类比评分和ODI评分均显著降低(P < 0.01),在12个月时椎体骨密度显著升高(P < 0.05);经皮椎体后凸成形组的椎体前缘高度、后凸角度均优于治疗前(P < 0.01);②组间比较：治疗后1周和1个月时,小关节注射组的目测类比评分和ODI评分显著高于经皮椎体后凸成形组(P < 0.05),而在第3,6,12个月时2组的评分无明显差异(P > 0.05);经皮椎体后凸成形组治疗后各时间点的椎体前缘高度、后凸角度均优于小关节注射组(P < 0.01);③再骨折发生率2组差异无显著性(P > 0.05);④结果说明,经过规范的抗骨质疏松治疗后,小关节注射和经皮椎体后凸成形都能为轻度椎体脆性骨折患者提供有效的镇痛,后者在快速镇痛和恢复脊柱稳定性方面有一定优势。 ORCID: 0000-0001-6535-7359(罗伟) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

针刺激痛点治疗腰背肌筋膜疼痛综合征的Meta分析

目的 系统评价针刺激痛点治疗腰背肌筋膜疼痛综合征（MPS）的有效性及安全性。方法 通过检索中文数据库,包括中国知网（CNKI）、万方（Wanfang）,英文数据库PubMed库,时间设定为2010年1月-2022年10月,检索针刺激痛点治疗MPS患者的随机对照试验（RCTs）,由3位研究员根据纳排标准独立进行文献筛选、提取数据及评估文献质量风险,通过Review Manager 5.4软件分析腰背MPS患者针刺激痛点后的VAS疼痛、腰部功能、总有效率指标,并按照不同疗程（2周、3周、4周）及是否合并其他治疗进行亚组分析。结果 最终纳入8篇RCTs,共计639名受试者。Meta分析结果显示,试验组（针刺激痛点）在VAS疼痛指标（MD=-1.84,95%CI:-2.39~-1.30,P＜0.000 01）、腰部功能评分（SMD=-1.34,95%CI:-2.40~-0.28,P=0.01）总有效率（RR=1.27,95%CI:1.16~1.39,P＜0.000 01）均优于对照组;亚组分析显示针刺激痛远期（4周）镇痛效果优于短期（2周、3周）治疗[MD（4周）2.71＞MD（3周）2.09＞MD（2周）0.97,P＜0.000 01],无论是否合并其他治疗,针刺激痛点在缓解疼痛（MD=-1.84,95%CI:-2.39~-1.30,P=0.001）方面的效果优于对照组。结论 从目前发表的文献汇总分析,针刺激痛点治疗腰背肌筋膜疼痛综合征患者可有效缓解疼痛症状、改善腰部功能,无论配合其他治疗或单独干预,均可明显改善症状,效果优于传统的口服药物、推拿、电疗等,而皮下出血是针刺常见的不良反应。但本研究纳入的研究质量偏低,此结论还需要更多高质量的随机对照试验进一步验证。     

Projection field of primary afferent fibers innervating the ventral portion of the lumbar intervertebral disc in the spinal cord dorsal horn

In the present study, we investigated the central projection of afferent fibers innervating the lumbar intervertebral disc using the fluorescent neurotracer 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (Dil). The tracer Dil was applied to the ventrolateral portion of the L5-L6 intervertebral disc in 11 adult rats. Fluorescent sites were observed microscopically on spinal cord transverse sections. Fluorescent spots in laminae I-III were plotted on the central projection map of cutaneous afferents. In six of 11 rats, Dil was restricted to the application site. Of these six rats, three showed no evident fluorescent sites. In the remaining three rats, small fluorescent spots were scattered in the dorsal horn. Fluorescent spots in dorsal horn lamina I were located in the central projection fields of the low back and groin skin. Fluorescent spots were observed, also sporadically, in Clarke's column in T12-L1 segments. The central projection of afferent fibers innervating the rat lumbar intervertebral disc was indistinct with Dil labeling. We presumed this was due to the scarcity of central terminal arbors of disc afferent fibers. Spotty projections in laminae I-IllIIere present near the central projection fields of the loin and groin, indicating that pain would be perceived in the groin.     

Danger of damaging the medial branches of the posterior rami of spinal nerves during a dorsomedian approach to the spine

Postoperative atrophy of the deep back muscles may be caused by denervation during a dorsomedian approach to the thoracolumbar spine; ensuing instability of the spine with poor clinical results, perhaps due to such muscle loss, has been observed in 11.7% of cases (Sihvonen et al., 1993, Spine 18:575--581). More specifically, this complication may be caused by damaging the medial branches of the posterior rami of the spinal nerves during lateral retraction of the muscles. To investigate the anatomic topography of the medial branches of the posterior rami of the spinal nerves, 18 carbol-formol-fixed specimens were dissected using an operation microscope; also, 3 fresh cadavers were cut in horizontal and vertical planes with a rotary cryotome to confirm the anatomic topography observed in the fixed specimens. In the thoracolumbar spine the medial branch of the posterior ramus of the spinal nerve is subject to ligamentous fixation by the strong fibers of the mammillo-accessory ligament, which extends between the mammillary process and accessory process infero lateral to the superior articular process. When the dorsomedian approach to the thoracolumbar spine is enlarged laterally to the articular processes by retracting the paraspinous muscles, the medial branches of the posterior rami of the spinal nerves are endangered. This may cause postoperative pain as well as dynamic instability beyond the corresponding segments. The results of our anatomic study suggest that the posterior surgical midline approach to the thoracolumbar spine should not be enlarged laterally to the articular processes to prevent injury to the medial branches of the posterior rami of the spinal nerves.     

穴位注射改善膝骨关节炎患者疼痛及关节功能的Meta分析

文题释义： 穴位注射法：将药液注入穴位使药物直接应用于穴位,既发挥药物作用又能发挥经络传导的作用,通过药物刺激调节人体经络系统,达到舒筋通络的作用。 膝骨关节炎：又称为膝关节增生性关节炎、退行性膝关节炎,是中老年人常见的一种慢性骨关节病,主要病理特点为关节软骨退变、破坏、软骨下骨硬化、关节边缘软骨下骨增生,进而引起滑膜炎症、半月板损伤、游离体形成及关节外组织炎症等一系列病变,临床症状以膝关节的疼痛、肿胀、变形及活动受限为主。背景：大量临床研究显示,穴位注射治疗膝骨关节炎具有治疗效果好、不良反应少等优点,但当前穴位注射治疗该病缺乏多中心大样本的临床研究试验。 目的：应用Meta分析法系统评价穴位注射疗法对膝骨关节炎患者疼痛改善及关节功能的影响。 方法：检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Embase及Cochrane Library等数据库中自建库以来至2019年5月有关穴位注射治疗膝骨关节炎的临床随机对照试验,观察组为穴位注射或穴位注射联合其他疗法,对照组为不同于穴位注射疗法的其他治疗方法,检索语言中、英文不限,筛选后使用Review Manager 5.3软件提取文献数据进行Meta分析。 结果与结论：①共纳入16篇随机对照试验,涉及患者1 287例,其中观察组648例,对照组639例;②Meta分析显示,观察组的总体有效率、治愈率、Lysholm评分、日本膝关节功能评分均高于对照组[OR=3.23,95%CI(2.19,4.76),Z=5.91,P < 0.000 01;OR=1.86,95%CI(1.35,2.58),Z=3.74,P=0.000 2;MD=7.87,95%CI(2.66,13.08),Z=2.96,P=0.003;MD=9.16,95%CI(4.18,14.13),Z=3.61,P=0.000 3],两组目测类比评分、WOMAC评分、Lequesne指数及不良反应发生率比较差异均无显著性意义[MD=-1.11,95%CI(-2.29,0.07),Z=1.84,P=0.07;MD=-7.56,95%CI(-17.26,2.14),Z=1.53,P=0.13;MD=-0.46,95%CI(-1.62,0.71),Z=0.77,P=0.44;OR=1.31,95%CI(0.31,5.57),Z=0.37,P=0.71];③结果表明穴位注射治疗膝骨关节炎的疗效确切,但由于纳入研究的文献质量普遍不高及可能存在偏倚等因素,仍需更多更高质量的随机对照试验来验证结论。ORCID: 0000-0002-7859-7850(邓凯烽) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

腰椎小关节退变的相关因素及生物力学特点

文题释义：腰椎小关节：为相近节段腰椎上位椎体的下关节突与下位椎体的上关节突组成的腰椎后外侧关节,将一个腰椎的椎弓与相邻腰椎的椎弓相连,在腰椎运动中占据着重要的地位。生物力学：是应用力学原理和方法对生物体中的力学问题定量研究的生物物理学分支,研究范围从生物整体到系统组织,其研究重点是与生理学、医学有关的力学问题。背景：腰椎小关节退变近年来成为学者们研究的重点,认识腰椎小关节退变的危险因素对于预防以及减少脊柱损害具有关键性作用,并且了解其解剖结构对于治疗脊柱相关疾病及手术实施有着重要的指导意义。目的：简述腰椎小关节解剖学、组织学特性,总结能够引起腰椎小关节退变的相关危险因素。方法：利用计算机检索CNKI、万方、维普、PubMed、Elsevier和Web of Science数据库2018年3月至2019年9月有关腰椎小关节退变的文章,检索词为“腰椎小关节,关节囊,关节面方向,神经支配,骨性关节炎,生物力学,下腰痛,椎间盘退变,腰椎滑脱,腰椎退行性脊柱侧弯,lumbarfacet joint,jointcapsule,articulardirection,eneurosis,osteoarthritis,biomechanics,low back pain,intervertebral disc degeneration,umbar spondylolisthesis,lumbar degenerative scoliosis”。查阅相关文章,包括综述、基础研究及临床研究,通过阅读标题及摘要进行初步筛选,排除与主题相关度低的文献,最终共纳入60篇文献进行结果分析。结果与结论：①腰椎小关节退变的主要危险因素包括年龄、性别、异常应力、关节面方向、关节不对称性、腰椎节段和椎间盘退变;②关节退变后会导致下腰痛、椎间盘退变、腰椎滑脱、退行性脊柱侧弯等临床疾病的发生和发展,严重影响患者的日常生活和工作,降低生活质量。因此,腰椎小关节在脊柱相关疾病的治疗中不应该被忽视。ORCID: 0000-0002-5700-8674(文王强)中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程