q-Space diffusion of myelin-deficient spinal cords.

The apparent water diffusion anisotropy in white matter (WM) of excised spinal cords of myelin-deficient (md) rats and their age-matched controls was studied by high-b-value q-space diffusion MRS and MRI at different diffusion times. Non-monoexponential signal decay was observed at long diffusion times. The mean displacements in the md spinal cords were found to be higher than those of the controls. The apparent anisotropy (AA) of the fast-diffusing component was found to decrease more dramatically with the increase in diffusion time for the md spinal cords as compared with controls, whereas the AA of the slow-diffusing component in the controls was found to increase with the increase in diffusion time while that of the md cords decreased with the increase in diffusion time. When diffusion MRI was performed, similar diffusion anisotropy was extracted for the md and control spinal cords at diffusion times of 22 and 50 ms. Only at a diffusion time of about 200 ms was a significant difference obtained in the AA of the two groups. This originates from the much smaller increase in the mean displacement perpendicular to the fiber direction in the control group vs. the md group when the diffusion time was increased.     

The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis

Abstract The aim of this study was to evaluate the short- to medium-term results (up to 2 years) of conservative and surgical treatments of patients with symptomatic lumbar stenosis. To our knowledge, no previous study has provided strict indications for conservative or surgical treatment. We retrospectively studied 184 patients, who were divided into 3 groups according to JOA (Japanese Orthopaedic Association) score. A cutoff JOA score was arbitrarily fixed at 7. Patients with a score ≤7 (n=12; group A) underwent surgery, while patients with a score >7 (n=172) were conservatively treated. Group A included patients surgically treated within two months from diagnosis. Group B consisted of 144 patients who received conservative treatment, while group C (28 patients) represented patients who underwent surgery after a period of failed conservative treatment. The outcomes of surgical and conservative treatments were evaluated after 12 and 24 months, and were rated as satisfactory, not totally satisfactory, not satisfactory or totally unsatisfactory. Conservative treatment consisted of physical, orthotic and drug therapy, whereas surgical treatment included spinal decompression and instrumentation (if indicated), either rigidly or dynamically performed. Surgery was indicated in 22% of all patients and we obtained excellent results in 85% of them. Operative treatment provides excellent results for patients with severe clinical presentation (JOA score ≤7), while individuals with mild to moderate spinal stenosis (JOA score >7) should receive conservative treatment.     

Spinal Cord Stimulation in a Mouse Chronic Neuropathic Pain Model

Objective. Development of a spinal cord stimulation (SCS) system in a mouse model of chronic neuropathic pain. Materials and Methods. Male C57BL/6 mice (N = 6) underwent a partial ligation of the sciatic nerve. Development of mechanical hyperalgesia was tested using the withdrawal response to tactile stimuli with the von Frey test. An SCS system was implanted on day 14. On day 16, the mice were stimulated for 30 min (f = 50 Hz; pulse width 0.2 msec and stimulation at 2/3 of motor threshold). Repeated measure analysis of variance (anova ) and paired Student's t‐test with Bonferroni correction were used to evaluate the development of mechanical hyperalgesia and the therapeutic effect of SCS. Results. Five out of six mice developed marked mechanical hyperalgesia in the nerve‐lesioned paw that persisted for the duration of the study (16 days). No changes contralateral to the injury were observed. In four out of five mice, a successful implantation of the electrodes followed by stimulation was achieved. Then, SCS resulted in a fast and robust increase of withdrawal threshold back to pre‐injury levels. After termination of the SCS, the withdrawal threshold of the ipsilateral paw slowly decreased. No effect of SCS on the contralateral paw was noted. Conclusion. The development of a mouse SCS system is described that is practical in use, is reproducible, and shows a comparative therapeutic effect in treatment of chronic neuropathic pain as reported in rat.     

角蛋白人工腱膜预防全椎板切除术后硬脊膜黏连

[目的]探讨角蛋白（keratinsubstance，KS）人工腱膜材料用于预防全椎板切除术后硬脊膜黏连的效果。[方法]Wistar大白鼠60只，随机分3组，每组20只，咬除T。：全椎板，造成2rnrnX8rnlffl大小的椎板缺损，加入不同处理因素，A组：空白对照组；B组：人工腱膜组；C组：白体腱膜组。术后2、4、8，12周处死动物，各时间点大体观察采用Rydell瘢痕黏连程度评级标准评分。完整取出T。：节段，包括椎旁肌。经HE染色后，镜下组织学观察采用改良Nussbaum标准行评分。同时切取2，4、8、12周人工腱膜组硬膜外瘢痕组织进行透射电镜观察。所测数据行Kruskal—Wallis秩和检验，取a〈0．05作为统计显著差异的标准。[结果]KS人工腱膜材料无毒性和排异反应：A组的Rydell评分，改良Nussbaum评分高于B、C组（P〈0．05），B组C组比较无差别（P〉0．05）。B、C组与对照组比较，均能够明显减少椎板切除术后的硬膜外瘢痕形成。[结论]硬膜外瘢痕黏连主要来自硬膜后方的血肿和成纤维细胞（fibroblast，FB）的增殖。KS人工腱膜具有良好的组织相容性，无局部及全身的不良反应，具有良好物理屏障作用。将l（S人工腱膜放置在椎板缺损处，能够有效的防止纤维组织侵入椎管，预防硬膜外瘢痕黏连。在动物实验中，KS人工腱膜能够安全有效的预防椎板切除术后硬膜外瘢痕黏连。     

核素全身骨显像在脊柱结核诊治中的临床价值

[目的]评价核素全身骨显像在脊柱结核诊治中的价值。[方法]对175例脊柱结核采用99Tcm—MDP（亚锡亚甲基二膦酸盐）核素全身骨显像，了解脊柱病灶的显影情况和全身其他骨关节是否并存病灶的情况。[结果]175例患者全部显像为阳性，其中伴有多节段椎体结核者146例，其中2个椎体者78例，3个椎体者26例，4个椎体以上者42例。伴有四肢骨关节结核者22例，伴骶髂关节结核者29例。[结论]核素全身骨显像在脊柱结核诊治中有重要价值，可以发现全身骨与关节多个结核病灶，对制定脊柱结核的治疗方案有指导作用。     

阿司匹林对大鼠脊髓损伤细胞凋亡的保护作用

目的 观察阿司匹林对大鼠慢性压迫性脊髓损伤后神经细胞凋亡及神经功能恢复的影响。方法选择65只体重为220～250g的Wistar大鼠（雌雄不限），于T10部位置入后路渐进式压迫装置，制作成慢性压迫性脊髓损伤模型。随机分为阿司匹林治疗组（A组，30只）、生理盐水对照组（B组，30只）和假手术组（C组，5只）。应用原位末端脱氧核糖核苷酸转移酶介导dUTP标记技术，分别于慢性压迫性脊髓损伤后1、3、7、14、28d做行为学评价，并取材对脊髓损伤区进行细胞凋亡检测。结果A、B组均发现细胞凋亡，A组与B组细胞凋亡率相比差异有显著性（P〈0．05），A组与B组行为学评价相比差异有显著性（P〈0．05），神经细胞凋亡情况与运动功能改变具有相关性。结论 阿司匹林对慢性脊髓压迫损伤后所导致的神经细胞凋亡产生抑制作用。     

大鼠脊髓压迫损伤减压后钙离子和兴奋性氨基酸的变化

目的 :SS研究大鼠脊髓压迫损伤减压后钙离子和兴奋性氨基酸变化及其与神经功能恢复的关系 .方法 :将动物随机分为 :慢性渐进性脊髓损伤组 ,慢性渐进性脊髓损伤减压 1,7,14 ,2 8d组 .取伤段脊髓 ,用高效液相色谱法检测谷氨酸和天门冬氨酸的含量的变化 ,用原子吸收光谱法测定其离子改变及水含量 .结果 :慢性渐进性脊髓损伤减压后钙离子和兴奋性氨基酸有明显的降低 ,减压后 1,7,14 ,2 8dGlu(μmol·g-1)分别为 :6 .16± 0 .16 ,5 .4 3± 0 .2 2 ,5 .4 3± 0 .17,5 .33± 0 .2 0 ;Asp(μmol·g-1)分别为 :3.39± 0 .12 ,2 .96±0 .11,2 .92± 0 .16 ,2 .89± 0 .15 ;Ca2 + 离子 (μmol·kg-1)分别为 :5 .84± 0 .11,5 .33± 0 .10 ,5 .2 8± 0 .17,5 .2 4± 0 .0 2 .它们均较减压前 (Glu为 6 .32± 0 .10 μmol·g-1,Asp为 3.5 6±0 .13μmol·g-1,Ca2 + 为 6 .5 3± 0 .6 4 μmol·kg-1)有显著降低 (P <0 0 5 ) ,其中前 7d降低较快 ,以后有降低不明显 .减压后 1,7,,14 ,2 8d改良的Tralov评分分别为 3.5 3± 0 .11,3.74± 0 .12 ,3.86± 0 .12 ,3.88± 0 .10 ;斜板试验分别为 4 3.3± 2 .3,4 6 .2± 1.1,4 8.8± 2 .8,4 9.7± 2 .6 ,均较减压前Tralov评分 (3.4 0± 0 .13)斜板试验 (40 .9± 1.8)有显著升高     

腰椎间盘突出症患者腰腿痛的血循环障碍因素与推拿手法的促循环作用机制

推拿手法长期以来被广泛用于腰椎间盘突出症的治疗．但其疗效机制却不甚明了。腰椎间盘突出症最具特征性的临床症状是不同程度的腰腿痛，其发病机制主要是机械压迫、无菌性炎症刺激以及循环与营养障碍等因素导致受累神经根传导功能的障碍，其中血循环与营养障碍是腰腿痛发病的重要环节。手法治疗对患者腰腿痛的缓解与消除作用应与改善患者的血循环和营养障碍有直接或间接的关系。