scholarly journals Selective Retention of Bone Marrow Stromal Cells with Gelatin Sponge for Repair of Intervertebral Disc Defects after Microendoscopic Discectomy: A Prospective Controlled Study and 2-Year Follow-Up

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Baoshan Xu ◽  
Hao Zhang ◽  
Lilong Du ◽  
Qiuming Yuan ◽  
Kaihui Zhang ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Stromal Cells ◽  
Bone Marrow Stromal Cells ◽  
Gelatin Sponge ◽  
Improvement Rate ◽  
Sf 36 ◽  
Selective Retention ◽  
Microendoscopic Discectomy ◽  
Pfirrmann Grade

Objective. Discectomy remains the classic procedure for treating lumbar intervertebral disc (IVD) herniation, but the occurrence of defects after discectomy is thought to be an important cause generating recurrent and accelerated IVD degeneration. Previous studies attempted suture of the annulus fissure, but the validity of this technique on restraining the degenerative process is controversial. On the other hand, cell therapies have been shown in multiple clinical and basic studies. Our purpose was to investigate the effectiveness of selective retention of autologous Bone Marrow Stromal Cells (BMSCs) with gelatin sponge in combination with annulus fibrosus suture (AFS) for the repair of IVD defects following mobile microendoscopic discectomy (MMED). Methods. This prospective, two-armed, and controlled clinical study was conducted from December 2016 to December 2018. Written informed consent was obtained from each patient. Forty-five patients with typical symptoms, positive signs of radiculopathy, and obvious lumbar disc herniation observed by MRI were enrolled. Patients were divided into 3 groups with different treating methods: MMED ( n = 15 ), MMED+AFS ( n = 15 ), and MMED+AFS+BMSCs ( n = 15 ). A postoperative 2-year follow-up was performed to evaluate the patient-reported outcomes of VAS, ODI, and SF-36. The improvement rate of VAS and ODI was calculated as latest ‐ preoperative / preoperative to evaluate the therapeutic effect of the three groups. Assessment parameters included Pfirrmann grade, intervertebral disc height (IDH), and disc protrusion size (DPS), as measured by MRI to evaluate the morphological changes. Results. All patients enrolled had a postoperative follow-up at 3, 6, 12, and 24 months. VAS and ODI scores were significantly improved compared to the preoperative status in all three groups with a mean DPS reduction rate over 50%. At the final follow-up, the improvement rate of the VAS score in the MMED+AFS+BMSCs group was significantly higher than the MMED+AFS and MMED groups ( 80.1 % ± 7.6 % vs. 71.3 % ± 7.0 % vs. 70.1 % ± 7.8 % ), while ODI improvement showed a significant change ( 65.6 % ± 8.8 % vs. 59.9 % ± 5.5 % vs. 57.8 % ± 8.1 % ). All participants showed significant improvement in SF-36 PCS and MCS; the differences between each group were not significant. The mean IDH loss rate of the MMED+AFS+BMSCs group was also significantly lower than other groups ( − 17.2 % ± 1.3 % vs. − 27.6 % ± 0.7 % vs. − 29.3 % ± 2.2 % ). The Pfirrmann grade was aggravated in the MMED and MMED+AFS groups while maintained at the preoperative grade in the MMED+AFS+BMSCs group. No adverse events of cell transplantation or recurrence were found in all patients during the postoperative follow-up period. Conclusions. It is feasible and effective to repair lumbar IVD defects using SCR-enriched BMSCs with gelatin sponges, which warrants further study and development as a cell-based therapy for IVD repair.

Long-Term Outcome of Microendoscopic Diskectomy for Lumbar Disk Herniation. A Clinical Study of Consecutive 112 Cases with More than 5-Year Follow-Up

2017 ◽  
Vol 78 (05) ◽  
pp. 446-452 ◽  
Author(s):  
Noriyuki Iesato ◽  
Yoshinori Terashima ◽  
Katsumasa Tanimoto ◽  
Tsuneo Takebayashi ◽  
Toshihiko Yamashita ◽  
...  
Keyword(s):  
Blood Loss ◽  
Recurrence Rate ◽  
Operative Time ◽  
Clinical Results ◽  
Improvement Rate ◽  
Long Term Outcome ◽  
Sf 36 ◽  
The Mean

Background Clinical results and recurrence rate after microendoscopic diskectomy (MED) with long-term follow-up is still unclear, in spite of its relatively long history. Materials and Methods A total of 112 who underwent MED participated in this study. Operative time, blood loss, serum C-reactive protein (CRP), creatine kinase (CK), and visual analog scale (VAS) were evaluated as indexes of surgical invasiveness. The 36-Item Short Form Survey Instrument (SF-36), Japanese Orthopaedic Association (JOA) score, patient satisfaction, and recurrence were also evaluated with a follow-up of at least 5 years. Results The mean operative time was 86.7 minutes, and the mean blood loss was 35.7 mL. The mean CRP on postoperative day 3 and CK on the first postoperative day was 0.72 mg/dL and 224.6 IU/L, respectively, and VAS to assess surgical site pain on the first postoperative day was 24.9 mm on average. The improvement rate in the JOA score was 68.7%. The physical component summary of SF-36 in norm-based scoring was improved from 23.4 to 48.6. Overall, 90.8% of patients evaluated their response to the surgery as extremely satisfied or satisfied. The recurrence rate was 10.5%, and reoperation was performed in 7.9% of patients. Conclusions MED is a technique that offers both reduced invasiveness and good long-term clinical results.

scholarly journals Percutaneous Endoscopic Lumbar Interbody Fusion: Technical Note and Preliminary Clinical Experience with 2-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Junlong Wu ◽  
Huan Liu ◽  
Shengxiang Ao ◽  
Wenjie Zheng ◽  
Changqing Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Interbody Fusion ◽  
Short Form ◽  
Minimal Invasive ◽  
Leg Pain ◽  
Large Sample Size ◽  
Lumbar Interbody Fusion ◽  
Improvement Rate ◽  
Sf 36

Objective. Endoscopic surgeries have been attempted in the field of lumbar decompression and fusion surgery in the past decade. Percutaneous endoscopic lumbar interbody fusion (PELIF) is a new-emerging technique taking advantages of an anatomical (Kambin’s triangle) to achieve simultaneous decompression and fusion under endoscopic visualization. The purpose of this study is to evaluate the feasibility and safety of PELIF technique with general anesthesia and neuromonitoring.Methods. The authors present the details of PELIF technique with general anesthesia and neuromonitoring. The first 7 consecutive patients treated with minimum of 2 year’s follow-up were included. Clinical outcomes were assessed by visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI) scores, and the Short Form-36 health survey questionnaire (SF-36) in the immediate preoperative period and during the follow-up period.Results. All patients underwent single-level PELIF surgery successfully and without conversion to open surgery. The average age was 56.0±13.0 years. All patients had Grade I degenerative/isthmic spondylolisthesis and 4 patients coexisted with disc herniation. The mean operative time was 167.5±30.9 minutes, and intraoperative blood loss was 70.0±24.5 ml. Postoperative drainage volume was 24.5±18.3 ml. The differences in the VAS scores for low back pain and leg pain between preoperative and follow-up were significant (P<0.05). The SF-36 Physical Component Summary (PCS) improved from 38.83±4.17 to 55.67±2.58 (P<0.001). The SF-36 Mental Component Summary (MCS) improved from 43.83±3.13 to 57.50±5.36 (P=0.001). The ODI score improvement rate was 33.7±3.7 %. All cases demonstrated radiopaque graft in the intervertebral disc space consistent with solid arthrodesis.Conclusions. PELIF technique seems to be a promising surgical technique for selected appropriate patients, with the minimal invasive advantages in decreased blood, shortage of ambulation time, and hospital stay, compared with MIS-TLIF. Because of limited Kambin’s triangle space and the exiting nerve root nearby, PELIF is still a challenging technique. Future advancement and development in instrument and cage design are vital for application and popularization of this technique. Prospective, randomized, controlled studies with large sample size on PELIF technique are still needed to prove its safety, efficacy, and minimal invasive advantages.

scholarly journals Bleomycin induces fibrotic transformation of bone marrow stromal cells to treat height loss of intervertebral disc through the TGFβR1/Smad2/3 pathway

2020 ◽  
Author(s):  
Xiao Yang ◽  
zhiqian chen ◽  
Chen Chen ◽  
Chen Han ◽  
Yifan Zhou ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Intervertebral Disc ◽  
Signaling Pathway ◽  
Histological Examination ◽  
Stromal Cells ◽  
Bone Marrow Stromal Cells ◽  
Transforming Growth Factor ◽  
Marrow Stromal Cells ◽  
Cell Counting ◽  
Height Loss

Abstract Background: Lower back pain is often accredited to loss of intervertebral disc (IVD) height and compromised spine stability as a result of intervertebral disc degeneration (IVDD). We aim to locally use Bleomycin to induce the fibrotic transformation of bone marrow stromal cells (BMSCs) as a means to induce reparative fibrosis to slow down the height loss. Methods: IVD from patients were gathered for histological examination. The expression of transforming growth factor beta 1 (TGF-β) signaling pathway was determined by qPCR and western blotting. Nucleus pulposus (NP) cells, annulus fibrosus (AF) cells and the Rats’ bone marrow stromal cells (BMSC)were cultured and their responsiveness to Bleomycin was evaluated by Cell Counting Kit-8, comet assay, transwell migration and wound healing assays. Rat IVDD models were created by puncture, rescued by Bleomycin injection and the effectiveness was evaluated by images (X-ray and MRI) and atomic force microscope. Results: Histological examination showed increased levels of pro-fibrotic markers in IVDD tissues from patients. AF cells and BMSC cells was induced to adopt to a pro-fibrotic phenotype with increased expression fibrotic markers Col1a1, Col3a1, FSP1. The pro-fibrotic effect of Bleomycin on AF cells and BMSCs was in part due to the activation of the TGFβ-TGFβR1-SMAD2/3 signaling pathway. Pharmacological inhibition or gene knock-down of TGFβR1 could mitigate the pro-fibrotic effects. Conclusion: Locally injection of Bleomycin in rats’ IVD induced rapid fibrosis and maintained its height through TGFβ-TGFβR1-SMAD2/3 signaling pathway.

scholarly journals Bleomycin induces fibrotic transformation of bone marrow stromal cells to treat height loss of intervertebral disc through the TGFβR1/Smad2/3 pathway

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Xiao Yang ◽  
Zhiqian Chen ◽  
Chen Chen ◽  
Chen Han ◽  
Yifan Zhou ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Intervertebral Disc ◽  
Signaling Pathway ◽  
Histological Examination ◽  
Stromal Cells ◽  
Bone Marrow Stromal Cells ◽  
Transforming Growth Factor ◽  
Marrow Stromal Cells ◽  
Cell Counting ◽  
Height Loss

Abstract Background Lower back pain is often accredited to loss of intervertebral disc (IVD) height and compromised spine stability as a result of intervertebral disc degeneration (IVDD). We aim to locally use bleomycin to induce the fibrotic transformation of bone marrow stromal cells (BMSCs) as a means to induce reparative fibrosis to slow down the height loss. Methods IVDs from patients were gathered for histological examination. The expression of the transforming growth factor beta 1 (TGF-β) signaling pathway was determined by qPCR and western blotting. Nucleus pulposus (NP) cells, annulus fibrosus (AF) cells, and the rats’ bone marrow stromal cells (BMSC) were cultured and their responsiveness to bleomycin was evaluated by Cell Counting Kit-8, comet assay, transwell migration, and wound healing assays. Rat IVDD models were created by puncture and rescued by bleomycin injection, and the effectiveness was evaluated by images (X-ray and MRI) and atomic force microscope. Results Histological examination showed increased levels of pro-fibrotic markers in IVDD tissues from patients. AF cells and BMSC cells were induced to adopt a pro-fibrotic phenotype with increased expression fibrotic markers Col1a1, Col3a1, and FSP1. The pro-fibrotic effect of bleomycin on AF cells and BMSCs was in part due to the activation of the TGFβ-TGFβR1-SMAD2/3 signaling pathway. Pharmacological inhibition or gene knock-down of TGFβR1 could mitigate the pro-fibrotic effects. Conclusion Locally, injection of bleomycin in rats’ IVD induced rapid fibrosis and maintained its height through the TGFβ-TGFβR1-SMAD2/3 signaling pathway.

scholarly journals Bleomycin Induces Fibrotic Transformation of Bone Marrow Stromal Cells to Treat Height Loss of Intervertebral Disc Through the TGFβR1/Smad2/3 Pathway

2020 ◽  
Author(s):  
Xiao Yang ◽  
zhiqian chen ◽  
Chen Chen ◽  
Chen Han ◽  
Yifan Zhou ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Intervertebral Disc ◽  
Signaling Pathway ◽  
Histological Examination ◽  
Stromal Cells ◽  
Bone Marrow Stromal Cells ◽  
Transforming Growth Factor ◽  
Marrow Stromal Cells ◽  
Cell Counting ◽  
Height Loss

Abstract Background: Lower back pain is often accredited to loss of intervertebral disc (IVD) height and compromised spine stability as a result of intervertebral disc degeneration (IVDD). We aim to locally use Bleomycin to induce the fibrotic transformation of bone marrow stromal cells (BMSCs) as a means to induce reparative fibrosis to slow down the height loss.Methods: IVD from patients were gathered for histological examination. The expression of transforming growth factor beta 1 (TGF-β) signaling pathway was determined by qPCR and western blotting. Nucleus pulposus (NP) cells, annulus fibrosus (AF) cells and the Rats’ bone marrow stromal cells (BMSC)were cultured and their responsiveness to Bleomycin was evaluated by Cell Counting Kit-8, comet assay, transwell migration and wound healing assays. Rat IVDD models were created by puncture, rescued by Bleomycin injection and the effectiveness was evaluated by images (X-ray and MRI) and atomic force microscope.Results: Histological examination showed increased levels of pro-fibrotic markers in IVDD tissues from patients. AF cells and BMSC cells was induced to adopt to a pro-fibrotic phenotype with increased expression fibrotic markers Col1a1, Col3a1, FSP1. The pro-fibrotic effect of Bleomycin on AF cells and BMSCs was in part due to the activation of the TGFβ-TGFβR1-SMAD2/3 signaling pathway. Pharmacological inhibition or gene knock-down of TGFβR1 could mitigate the pro-fibrotic effects. Conclusion: Locally injection of Bleomycin in rats’ IVD induced rapid fibrosis and maintained its height through TGFβ-TGFβR1-SMAD2/3 signaling pathway.

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