The capacity of embryonic spinal cord tissue in the repair of injured structure of spinal cord has been noted for years. In order to investigate the embryonic spinal cord graft in the repair of motor function of injured spinal cord, the embryonic spinal cord tissue was transplanted to the hemisection cavity in spinal cord in adult rat. One hundred adult Wistar Rats were used to simulate the hemisectional injury of spinal cord by drilling 2-3 mm cavity in lumbar enlargement. Sixty rats were treated with rat embryonic spinal cord tissue grafting while the other forty were chosen as control. The outcome was evaluated according the combined behavioural score (CBS) and motor evoked potential (MEP) in the 1, 2, 4 and 12 weeks. The grafting group was superior to the control as assessed by CBS (P lt; 0.05), especially within 4 weeks. (P lt; 0.01). The restoration of the latent peak of early wave(P1, N1) was better in the grafting group, too. This suggested that embryonic spinal cord graft could improve the recovery of motor function of injured spinal cord in adult rat. The effect of the embryonic spinal cord tissue graft might be concerned with its secretion of several kinds of neurotrophic factors, nerve growth factor, nerve transmitted factor, or adjustment of hormone.
Objective To investigate the latest research and the therapeutic development in the injuries to the spine and spinal cord. Methods Literature concerned was reviewed, combined with our own research and clinical experience, to summarize the trend of the researches and their clinical application in the treatment of the injured spine and spinal cord.Results Theposterior approach atlantoaxial stabilization technique changed the conventional wiring technique into the transarticular screw fixation to the plate and pedicle or the lateral mass screw fixation technique. Theclinical application of the transoralpharyngeal atlantoaxial reduction plate fixation technique showed a good effect on the reduction of atlantoaxial dislocation. However, there were no unified criteria for selection of the surgical approach, fixation level, and fusion mode in the treatment of thoracolumbar spinalfractures. Under optimal conditions, both the anterior and the posterior approaches could achieve good clinical effects on decompression and spinal reconstruction. The single level fixation technique showed some advantages in treating certaintypes of thoracolumbar spinal fractures when compared with the traditional cross-sectional fixation. The endoscopy-assistant and image-guiding spinal intervention techniques were evolved in China during these years. In the treatment of the obstinate painful osteoporotic vertebral compressive fracture, percutaneous vertebroplasty and kyphoplasty achieved good results in the pain relief and spinal reconstruction. Numerous basic and clinical researches have given us a further understanding of the medical protection of acute spinal cord injury, and biological treatments have given us new ideas on neural reparation and regeneration. Cell transplantation and gene therapy have become the most promising treatment strategies in this field.Conclusion With the rapid development of spine surgery, the repair and reconstruction ofthe injured spine and spinal cord made a great stride in the recent years.
目的 探讨躯体感觉诱发电位（SEP）在颈脊髓损伤术前、术中监测的意义。 方法 纳入2010年1月－2012年4月治疗的241例颈脊髓损伤患者，术前按美国脊柱脊髓损伤协会（ASIA）评分并分级，确定损伤平面。术前与术中SEP监测，分析不同损伤分级以及不同损伤平面术前的波幅及潜伏期的差异，术中SEP监测以波幅下降＞50%和或潜伏期延长＞10%为预警标准。 结果 各损伤分级组术前SEP监测：A级组SEP波消失，呈一直线，而B、C、D、E级组均测出SEP波形，根据是否可测出SEP波形，可将A级与B、C、D、E及组区别。B、C、D级组之间波幅和潜伏期均无统计学意义（P＞0.05）。E级组较B、C、D级组波幅增高、潜伏期缩短，差异有统计学意义（P＜0.05）；不完全性颈脊髓损伤组内不同损伤平面组之间波幅和潜伏期差异均无统计学意义（P＞0.05）。术中SEP对脊髓功能损伤监测的灵敏度83.3%、特异度98.7%。其中术中：SEP阳性8例，真阳性5例，4例术者处理后波幅及潜伏期回复至正常范围，术后无新的神经功能损伤，另1例术者采取各种处理后波幅及潜伏期无恢复，术后神经功能损伤较术前加重；假阳性3例，1例麻醉师给予升高血压后波形恢复至正常，另2例经麻醉师调整麻醉深度后波形恢复正常，此3例术后无新的神经功能损伤。SEP阴性233例，真阴性232例，术后无新的神经功能损伤；假阴性1例，患者术中、术后波形未见异常，术后运动功能损伤程度较术前加重。 结论 ① SEP能准确评估完全性和不完性颈脊髓损伤，但对不完全性颈脊髓损伤的损伤程度不能作出准确评估、也不能区分颈脊髓损伤的损伤平面；② 术中SEP监测能较好地反映颈脊髓功能完整性，对减少颈脊髓损伤术中发生医源性颈脊髓损伤风险具有重要意义。
Objective To compare the surgical efficacy of different operating methods for treating old thoracolumbarfracture with spinal cord injury. Methods From September 2000 to March 2006, 34 cases of old thoracolumbar fractures with spinal cord injury were treated. Patients were divided into 2 groups randomly. Group A (n=18): anterior approach osteotomy, il iac bone graft and internal fixation were used. There were 10 males and 8 females with the age of 17-54 years. The apex level of kyphosis was T11 in 2 cases, T12 in 5 cases, L1 in 8 cases and L2 in 3 cases. The average preoperative Cobb angle of kyphosis was (36.33 ± 3.13)°, and the average preoperative difference in height between anterior and posterior of involved vertebra was (22.34 ± 11.61) mm. Neurological dysfunction JOA score was 10.44 ± 1.12. Group B (n=16): transpedicular posterior decompression and internal fixation were used. There were 8 males and 8 females with the age of 18-56 years. The apex level of kyphosis was T11 in 2 cases, T12 in 6 cases, L1 in 7 cases and L2 in 1 case. The preoperative Cobb angle of kyphosis was (38.55 ± 4.22)°, and the preoperative difference in height between anterior and posterior of involved vertebra was (20.61 ± 10.22) mm. Neurological dysfunction JOA score was 10.23 ± 2.23. Results All the patients were followed up for 9-46 months with an average of 13.5 months. Cobb angle was (12.78 ± 3.76)° in group A, which was improved by (24.23 ± 1.64)° campared to that of preoperation; and was (10.56 ± 4.23)° in group B, which was improved by (26.66 ± 1.66)°. JOA score was 14.21 ± 1.08 in group A, which wasimproved by 3.92 ± 1.33; and it was 13.14 ± 2.32 in group B, which was improved by 3.12 ± 1.95. The average postoperative difference between anterior height and posterior height of vertebral body in group A was (3.11 ± 1.06) mm, which was improved by (18.03 ± 2.14) mm; and it was (2.56 ± 1.33) mm in group B, which was corrected by (20.36 ± 3.78) mm. There were statistically significant differences in the above indexes between preoperation and postoperation in 2 groups (P lt; 0.01), but no significant differences between 2 groups (P gt; 0.05). In group A, pleural effusion occurred in 2 cases and local pulmonary collapse in 4 cases and intercostals neuralgia in 1 case. In group B, leakage of cerebrospinal fluid occurred in 3 cases. Conclusion Both anterior and posterior approach are capable of treating of the old thoracolumbar fracture with incomplete spinal cord injury and providing the satisfying result of deformation correction, neurological decompression and neurological functional recovery to a certain extent.
Objective Adenosine tri phosphate (ATP) can promote the repair of spinal cord injury (SCI). To investigate the effect of ATP combined with bone marrow mesenchymal stem cells (BMSCs) transplantation on SCI, and to evaluate the synergistic action of ATP and BMSCs in the repair of SCI and the feasibil ity of the combined transplantation in the treatment of SCI. Methods BMSCs were isolated from the marrow of the tibia and the femur of a male SD rat (weighing 120 g), the 3rd generation BMSCs were labeled with BrdU, then BMSCs suspension of 5.0 × 107 cell/mL were prepared. Fortyeightadult female SD rats (weighing 240-260 g) were made SCI models at T12 levels according to the improved Allen’s method, and were randomly divided into 4 groups (groups A, B, C, and D, n=12). In group A, ATP (40 mg/kg) and BMSCs (6 μL) were injected to the central point and the other 2 points which were 1 mm from the each side of head and tail of the injured spinal cord; after blending the BMSCs suspension, the cells amount was about 3.0 × 105. In groups B, C, and D, the BMSCs suspension (6 μL), ATP (40 mg/kg), and PBS (40 mg/kg) were injected to the points by the same method as group A, respectively. The general conditions of the rats were observed after operation. The nerve function of low extremities was evaluated using the improved Tarlov scale and the Rivil in incl ined plane test at 1, 3, 7, 14, 21, and 28 days after operation. At 28 days after operation, the reparative effect of SCI was observed using histological and immunohistochemical staining. Results One rat of group A, 2 of group B, 2 of group C, and 3 of group D died of infection and anorexic, the others survived to the end of the experiment. Paralysis symptom in low extremities occurred in all rats after operation and was improved at 2-3 weeks postoperatively, the improvement of group A was the best, groups B and C were better, group D was the worst. There was no significant difference in the Tarlov scale and the Rivil in incl ined plane test among 4 groups at 1 and 3 days after operation and between groups B and C at 7, 14, 21, and 28 days after operation (P gt; 0.05), but there were significant differences among other groups at 7, 14, 21, and 28 days after operation (P lt; 0.05). At 28 days after operation, HE staining demonstrated that the injured region in group A was finely restored, without obvious scar tissue and cavity, and there existed clear stem cell differentiation characters; there was small amount of scar tissue and cavity in the injury site of groups B and C; and there was great deal of scar tissue in the injury site of group D, in which there were numerous inflammatory cells and fibroblasts infiltration and bigger cavity. Immunohistochemical staining showed that BrdU-positive BMSCs were seen in groups A and B, and positive cells of group A was significantly more than that of group B (P lt; 0.05). The expressions of neruofilament protein 200 and gl ial fibrillary acidic protein in group A were significantly higher than those in groups B, C, and D, and groups B and C were significantly higher than group D (P lt; 0.05). Conclusion ATP has protective effects on injured spinal cord, a combination of ATP and BMSCs can synergistically promote the reparation of SCI.
ObjectiveTo explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.MethodsFrom July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].ConclusionThe evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.
This article investigates the role of AMP-activated protein kinase (AMPK) and its downstream signaling targets in mediating cellular processes such as autophagy, apoptosis, and inflammation, offering insights into how acupuncture may treat common central nervous system (CNS) diseases, including ischemic stroke, spinal cord injury, Parkinson disease, and Alzheimer disease. AMPK and its downstream effectors are pivotal in the signaling pathways that underlie the pathophysiology of CNS diseases. These pathways are implicated in a variety of cellular responses that contribute to the progression of neurological disorders. During CNS injury, AMPK can be activated through phosphorylation, triggering the regulation of downstream molecules and exerting protective effects on neuronal function. Acupuncture has been shown to promote neuroprotection and enhance recovery in CNS diseases through multiple mechanisms, one of which involves the activation of AMPK-related signaling pathways. Nevertheless, numerous unresolved challenges remain in this research field.
Objective To investigate the effect of olfactory ensheathing cell culture medium (OECCM) on the growth of spinal cord neurons and its protective effect on the injured neurons by H2O2, and to disscuss the probable protective mechanisms of olfactory ensheathing cells (OECs). Methods The primary olfactory ensheathing cells (OECs) were isolated from olfactory bulb of adult SD rat, and OECCM were prepared. The morphology of OECs was observed by inverted phase contrast microscope, identified by rabbit-antiratlow-affinity nerve growth factor p75 (NGFRp75), and its purity were calculated.Primary spinal cord neurons were cultured from 15 to 17 days pregnant SD rats, and injury model of neurons were prepared by H2O2. OECCM and control culture medium were added into the normal spinal neurons (groups A, B). OECCM and control culture medium were added into the injured spinal neurons by H2O2 (groups C, D). In groups A and C, 200 μL of control culture medium was used; in groups B and D, 100 μL of control culture medium and 100 μL of OECCM were used. Then the growth index such as average diameter of neuron body, the number and length of neuron axons were measured. The viabil ities of normal and injured neurons were assessed by MTT. Results OECs showed bipolar or tripolar after 6-9 days of culture. Primary spinal cord neurons were round and bigger, and neuron axons grew significantly and showed bipolar after 5-7 days of culture. The immunocytochemisty of OECs by NGFRp75 showed that membrane were stained. The degree of purity was more than 90%. Primary spinal cord neurons grew well after 6-9 days of culture, and compared with group A, neurons of group B grew b, whose cell density and diameter were bigger. The average diameter of neuron body, the number and length of neuron axons were (33.38 ± 6.80) D/μm, (1.67 ± 0.80), and (91.19 ± 62.64) L/μm in group A, and (37.39 ± 7.28) D/μm, (1.76 ± 0.82), and (121.33 ± 81.13) L/μm in group B; showing statistically significant differences (P lt; 0.05). The absorbency (A) value of neurons was 0.402 0 ± 0.586 9 in group A and 0.466 0 ± 0.479 0 in group B; showing statistically significant difference (P lt; 0.01). After 2 hours of injury by H2O2, the cell density of spinal cord neurons decreased, and neuron axons shortened. The A value of injured neurons was 0.149 0 ± 0.030 0 in group C and 0.184 0 ± 0.052 0 in group D, showing statistically significant difference (P lt; 0.01). Conclusion The results above suggest that OECCM could improve the growth of spinal cord neurons and protectthe injured neurons. The neurotrophic factors that OECs secrete play an important role in the treatment of spinal cord injury.
Electric field stimulation (EFS) can effectively inhibit local Ca2+ influx and secondary injury after spinal cord injury (SCI). However, after the EFS, the Ca2+ in the injured spinal cord restarts and subsequent biochemical reactions are stimulated, which affect the long-term effect of EFS. Polyethylene glycol (PEG) is a hydrophilic polymer material that can promote cell membrane fusion and repair damaged cell membranes. This article aims to study the combined effects of EFS and PEG on the treatment of SCI. Sprague-Dawley (SD) rats were subjected to SCI and then divided into control group (no treatment, n = 10), EFS group (EFS for 30 min, n = 10), PEG group (covered with 50% PEG gelatin sponge for 5 min, n = 10) and combination group (combined treatment of EFS and PEG, n = 10). The measurement of motor evoked potential (MEP), the motor behavior score and spinal cord section fast blue staining were performed at different times after SCI. Eight weeks after the operation, the results showed that the latency difference of MEP, the amplitude difference of MEP and the ratio of cavity area of spinal cords in the combination group were significantly lower than those of the control group, EFS group and PEG group. The motor function score and the ratio of residual nerve tissue area in the spinal cords of the combination group were significantly higher than those in the control group, EFS group and PEG group. The results suggest that the combined treatment can reduce the pathological damage and promote the recovery of motor function in rats after SCI, and the therapeutic effects are significantly better than those of EFS and PEG alone.