Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took res...Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients’ function recovery.展开更多
Chronic compressive spinal cord injury in compressive cervical myelopathy conditions can lead to rapid neurological deterioration in the early phase,followed by partial self-recovery,and ultimately an equilibrium stat...Chronic compressive spinal cord injury in compressive cervical myelopathy conditions can lead to rapid neurological deterioration in the early phase,followed by partial self-recovery,and ultimately an equilibrium state of neurological dysfunction.Ferroptosis is a crucial pathological process in many neurodegenerative diseases;however,its role in chro nic compressive spinal cord injury remains unclear.In this study,we established a chronic compressive spinal cord injury rat model,which displayed its most severe behavioral and electrophysiological dysfunction at 4 wee ks and partial recovery at 8 weeks after compression.Bulk RNA sequencing data identified enriched functional pathways,including ferroptosis,presynapse,and postsynaptic membrane activity at both 4 and 8 wee ks following chro nic compressive spinal co rd injury.Tra nsmission electron microscopy and malondialdehyde quantification assay confirmed that ferroptosis activity peaked at 4 weeks and was attenuated at 8 weeks after chronic compression.Ferro ptosis activity was negatively correlated with behavioral score.Immunofluorescence,quantitative polymerase chain reaction,and western blotting showed that expression of the anti-ferroptosis molecules,glutathione peroxidase 4(GPX4) and MAF BZIP transcription factor G(MafG),in neuro ns was suppressed at 4 weeks and upregulated at 8 weeks following spinal co rd compression.There was a positive correlation between the expression of these two molecules,suggesting that they may work together to contribute to functional recovery following chronic compressive spinal cord injury.In conclusion,our study determined the genome-wide expression profile and fe rroptosis activity of a consistently compressed spinal cord at different time points.The results showed that anti-fe rroptosis genes,specifically GPX4 and MafG,may be involved in spontaneous neurological recovery at 8 weeks of chronic compressive spinal cord injury.These findings contribute to a better understanding of the mechanisms underlying chronic compressive spinal cord injury and may help identify new therapeutic targets for compressive cervical myelopathy.展开更多
The spinal cord is composed of gray matter and white matter.It is well known that the properties of these two tissues differ considerably.Spinal diseases often present with symptoms that are caused by spinal cord comp...The spinal cord is composed of gray matter and white matter.It is well known that the properties of these two tissues differ considerably.Spinal diseases often present with symptoms that are caused by spinal cord compression.Understanding the mechanical properties of gray and white matter would allow us to gain a deep understanding of the injuries caused to the spinal cord and provide information on the pathological changes to these distinct tissues in several disorders.Previous studies have reported on the physical properties of gray and white matter,however,these were focused on longitudinal tension tests.Little is known about the differences between gray and white matter in terms of their response to compression.We therefore performed mechanical compression test of the gray and white matter of spinal cords harvested from cows and analyzed the differences between them in response to compression.We conducted compression testing of gray matter and white matter to detect possible differences in the collapse rate.We found that increased compression(especially more than 50%compression)resulted in more severe injuries to both the gray and white matter.The present results on the mechanical differences between gray and white matter in response to compression will be useful when interpreting findings from medical imaging in patients with spinal conditions.展开更多
Background Cervical spondylotic myelopathy （CSM） is a common cause of disability in elderly patients.Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role...Background Cervical spondylotic myelopathy （CSM） is a common cause of disability in elderly patients.Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy.Although changes in magnetic resonance imaging （MRI） T2 signal intensity ratio （SIR） are considered to be an indicator of CSM,little information is published supporting the correlation between changes in MRI signal and pathological changes.This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.Methods Forty-eight rabbits were randomly assigned to four groups：one control group and three experimental chronic compression groups,with each group containing 12 animals.Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra.The control group underwent sham surgery.Experimental groups were observed for 3,6,or 9 months after surgery.MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials （CSEPs） were periodically monitored.At each time point,rabbits from one group were sacrificed to determine the level of apoptosis by histology （n=6） and Western blotting （n=6）.Results Tarlov motor scores in the compression groups were lower at all time points than the control group scores,with the lowest score at 9 months （P ＜0.001）.Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group.All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls,and higher SIR was also found at 9 months compared with 3 or 6 months.Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups,but not in the control group.There were significant differences in apoptosis degree over time （P ＜0.001）,with the 9-month group displaying the most severe spinal cord apoptosis.Spearman＇s rank correlation test showed that there was close relation between MRI SIR and degree of caspase-3 expression in Western blotting （r=0.824.P ＜0.001）.Conclusions Clear apoptosis of spinal cord tissue was observed during chronic focal spinal compression.Changes in MRI T2 SIR mav be related to the severity of the apoptosis in cervical spinal cord.展开更多
目的:观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效.方法:回顾性分析2008年3月~2019年9月,采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定...目的:观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效.方法:回顾性分析2008年3月~2019年9月,采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗的18例多节段脊髓受压的慢性颈脊髓病合并退变性颈椎后凸患者,其中男11例,女7例,年龄52.3±8.1岁;颈椎后纵韧带骨化症(ossification of posterior longi-tudinal ligament,OPLL)合并慢性颈脊髓病5例,脊髓型颈椎病13例.减压节段:17例为C3~C7,1例为C3~T1,术中固定融合3.8±1.0个椎体.12例患者出院时(术后2周左右)复查颈椎MRI,11例患者获得随访,随访时间2.1~13.5年(10.5±2.8年).在术前、出院时颈椎侧位X线片上测量后凸节段Cobb角,在颈椎MRI上测量脊髓前缘角及改良K线,末次随访时在X线片上评估手术固定节段骨性融合及后凸矫形角度丢失情况.术前及末次随访时进行JOA评分及颈痛VAS评分.结果:18例患者术前后凸节段的局部Cobb角为6.6°±6.5°后凸,术后2周为3.8°±8.0°前凸,有显著性差异(P<0.01);术前C2~C7颈椎Cobb角为1.3°±9.4°前凸,术后2周为5.8°±7.0°前凸,无显著性差异(P>0.05).12例患者颈椎MRI上测量脊髓前缘角术前为11.1°±4.2°后凸,术后2周为1.3°±5.2°后凸,有显著性差异(P<0.01);C2~C7节段脊髓前缘角术前为6.5°±4.4°后凸,术后2周为1.1°±6.3°前凸,有显著性差异(P<0.01).7例(39%)患者术后出现C5神经根麻痹,均在术后1~4个月内完全恢复.术后末次随访11例患者颈椎侧位X线片显示手术固定节段均获骨性融合,后凸矫形角度无丢失;颈椎MRI显示脊髓无受压,正中矢状位片显示脊髓前缘角无丢失.11例患者JOA评分术前8.0±2.8分,末次随访时15.6±0.9分,有显著性差异(P<0.01),JOA评分改善率(83±14)%;颈痛VAS评分术前为2.2±3.0分,末次随访时为1.11.2分,术前与末次随访时相比无显著性差异(P>0.05).结论:对于合并有退变性颈椎后凸的多节段受压的慢性压迫性颈脊髓病,采用椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术可以获得长期稳定、良好的脊髓功能改善的效果.展开更多
文摘Objective To investigate diagnosis and treatment characters of cervical spondylotic myelopathy combined with thoracic spinal stenosis, and to analysis effective pathway of spinal function recovery. Methods We took respective analysis on diagnosis, treatment and recovery results of 12 cases, whose symptoms, signs and MR were explicit. Results Follow ups times were from 9 months to 5 years and 8 months. Nerve function of 8 cases recovered completely or nearly completely; that of 2 cases improved apparently and that of 2 cases improved slightly. Conclusion Detailed disease history collection, particular body examination and MR reading are very important to early diagnosis of cervical spondylotic myelopathy combined with thoracic spinal stenosis. Early operation combined with cervical and thoracic spinal canal decompression at same time or at different stages is the single effective method to patients’ function recovery.
文摘Chronic compressive spinal cord injury in compressive cervical myelopathy conditions can lead to rapid neurological deterioration in the early phase,followed by partial self-recovery,and ultimately an equilibrium state of neurological dysfunction.Ferroptosis is a crucial pathological process in many neurodegenerative diseases;however,its role in chro nic compressive spinal cord injury remains unclear.In this study,we established a chronic compressive spinal cord injury rat model,which displayed its most severe behavioral and electrophysiological dysfunction at 4 wee ks and partial recovery at 8 weeks after compression.Bulk RNA sequencing data identified enriched functional pathways,including ferroptosis,presynapse,and postsynaptic membrane activity at both 4 and 8 wee ks following chro nic compressive spinal co rd injury.Tra nsmission electron microscopy and malondialdehyde quantification assay confirmed that ferroptosis activity peaked at 4 weeks and was attenuated at 8 weeks after chronic compression.Ferro ptosis activity was negatively correlated with behavioral score.Immunofluorescence,quantitative polymerase chain reaction,and western blotting showed that expression of the anti-ferroptosis molecules,glutathione peroxidase 4(GPX4) and MAF BZIP transcription factor G(MafG),in neuro ns was suppressed at 4 weeks and upregulated at 8 weeks following spinal co rd compression.There was a positive correlation between the expression of these two molecules,suggesting that they may work together to contribute to functional recovery following chronic compressive spinal cord injury.In conclusion,our study determined the genome-wide expression profile and fe rroptosis activity of a consistently compressed spinal cord at different time points.The results showed that anti-fe rroptosis genes,specifically GPX4 and MafG,may be involved in spontaneous neurological recovery at 8 weeks of chronic compressive spinal cord injury.These findings contribute to a better understanding of the mechanisms underlying chronic compressive spinal cord injury and may help identify new therapeutic targets for compressive cervical myelopathy.
基金supported by JSPS KAKENHI(No.JP 15K20002)Yamaguchi University School of Medicine Affiliated Hospital:Translational Promotion Grant and President of Yamaguchi University Strategic Expenses:Young Researcher Support Project(all to NN)
文摘The spinal cord is composed of gray matter and white matter.It is well known that the properties of these two tissues differ considerably.Spinal diseases often present with symptoms that are caused by spinal cord compression.Understanding the mechanical properties of gray and white matter would allow us to gain a deep understanding of the injuries caused to the spinal cord and provide information on the pathological changes to these distinct tissues in several disorders.Previous studies have reported on the physical properties of gray and white matter,however,these were focused on longitudinal tension tests.Little is known about the differences between gray and white matter in terms of their response to compression.We therefore performed mechanical compression test of the gray and white matter of spinal cords harvested from cows and analyzed the differences between them in response to compression.We conducted compression testing of gray matter and white matter to detect possible differences in the collapse rate.We found that increased compression(especially more than 50%compression)resulted in more severe injuries to both the gray and white matter.The present results on the mechanical differences between gray and white matter in response to compression will be useful when interpreting findings from medical imaging in patients with spinal conditions.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 81071510）.
文摘Background Cervical spondylotic myelopathy （CSM） is a common cause of disability in elderly patients.Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy.Although changes in magnetic resonance imaging （MRI） T2 signal intensity ratio （SIR） are considered to be an indicator of CSM,little information is published supporting the correlation between changes in MRI signal and pathological changes.This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.Methods Forty-eight rabbits were randomly assigned to four groups：one control group and three experimental chronic compression groups,with each group containing 12 animals.Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra.The control group underwent sham surgery.Experimental groups were observed for 3,6,or 9 months after surgery.MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials （CSEPs） were periodically monitored.At each time point,rabbits from one group were sacrificed to determine the level of apoptosis by histology （n=6） and Western blotting （n=6）.Results Tarlov motor scores in the compression groups were lower at all time points than the control group scores,with the lowest score at 9 months （P ＜0.001）.Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group.All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls,and higher SIR was also found at 9 months compared with 3 or 6 months.Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups,but not in the control group.There were significant differences in apoptosis degree over time （P ＜0.001）,with the 9-month group displaying the most severe spinal cord apoptosis.Spearman＇s rank correlation test showed that there was close relation between MRI SIR and degree of caspase-3 expression in Western blotting （r=0.824.P ＜0.001）.Conclusions Clear apoptosis of spinal cord tissue was observed during chronic focal spinal compression.Changes in MRI T2 SIR mav be related to the severity of the apoptosis in cervical spinal cord.
文摘目的:观察颈后路椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗多节段压迫性颈脊髓病合并退变性颈椎后凸患者的中长期疗效.方法:回顾性分析2008年3月~2019年9月,采用颈后路单开门椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术治疗的18例多节段脊髓受压的慢性颈脊髓病合并退变性颈椎后凸患者,其中男11例,女7例,年龄52.3±8.1岁;颈椎后纵韧带骨化症(ossification of posterior longi-tudinal ligament,OPLL)合并慢性颈脊髓病5例,脊髓型颈椎病13例.减压节段:17例为C3~C7,1例为C3~T1,术中固定融合3.8±1.0个椎体.12例患者出院时(术后2周左右)复查颈椎MRI,11例患者获得随访,随访时间2.1~13.5年(10.5±2.8年).在术前、出院时颈椎侧位X线片上测量后凸节段Cobb角,在颈椎MRI上测量脊髓前缘角及改良K线,末次随访时在X线片上评估手术固定节段骨性融合及后凸矫形角度丢失情况.术前及末次随访时进行JOA评分及颈痛VAS评分.结果:18例患者术前后凸节段的局部Cobb角为6.6°±6.5°后凸,术后2周为3.8°±8.0°前凸,有显著性差异(P<0.01);术前C2~C7颈椎Cobb角为1.3°±9.4°前凸,术后2周为5.8°±7.0°前凸,无显著性差异(P>0.05).12例患者颈椎MRI上测量脊髓前缘角术前为11.1°±4.2°后凸,术后2周为1.3°±5.2°后凸,有显著性差异(P<0.01);C2~C7节段脊髓前缘角术前为6.5°±4.4°后凸,术后2周为1.1°±6.3°前凸,有显著性差异(P<0.01).7例(39%)患者术后出现C5神经根麻痹,均在术后1~4个月内完全恢复.术后末次随访11例患者颈椎侧位X线片显示手术固定节段均获骨性融合,后凸矫形角度无丢失;颈椎MRI显示脊髓无受压,正中矢状位片显示脊髓前缘角无丢失.11例患者JOA评分术前8.0±2.8分,末次随访时15.6±0.9分,有显著性差异(P<0.01),JOA评分改善率(83±14)%;颈痛VAS评分术前为2.2±3.0分,末次随访时为1.11.2分,术前与末次随访时相比无显著性差异(P>0.05).结论:对于合并有退变性颈椎后凸的多节段受压的慢性压迫性颈脊髓病,采用椎板成形椎管扩大术结合椎弓根螺钉矫形内固定融合术可以获得长期稳定、良好的脊髓功能改善的效果.
