ObjectiveTo investigate the effectiveness of pedicle screw internal fixation for the atlantoaxial instability of children. MethodsBetween July 2005 and January 2012, 19 cases of atlantoaxial instability were treated, included 10 boys and 9 girls with an average age of 7.5 years (range, 4-15 years). The X-ray films, CT, and MRI examinations of the cervical spine showed craniocervical malformation in 9 cases, congenital os odontoideum in 3 cases, odontoid fracture (type Ⅱ) in 1 case, disruption of transverse ligament in 2 cases, atlantoaxial fracture and dislocation in 4 cases; and spinal cord injury in 8 cases, according to the American Spinal Cord Injury Association (ASIA) impairment scale, 1 case was rated as grade B, 2 as grade C, and 5 as grade D. Preoperative skull traction was performed routinely on all cases, and complete reduction was achieved in 17 cases, no reduction in 2 cases. In 17 patients who achieved complete reduction, pedicle screw internal fixation was used through posterior approach, including occipitocervical fusion and fixation in 5 cases, and atlantoaxial fusion and fixation in 12 cases; in 2 patients with no reduction, pedicle screw internal fixation was used through posterior approach (atlantoaxial fusion and fixation) after release by transoral approach. ResultsThe operation was successfully performed in all patients. The mean operation time was 89 minutes; the mean intraoperative blood loss was 95 mL; the mean postoperative drainage volume was 73 mL; and the mean hospitalization days were 14 days. The patients were followed up 6-27 months (mean, 18.3 months). Satisfactory atlantoaxial fusion was obtained, and bone fusion was obtained at 3-7 months after operation (mean, 4.5 months). No breakage of screw or rods and re-dislocation occurred during follow-up. At last follow-up, the cervical range of motion (CROM) of the left and right rotation were (62.0±5.9)°and (63.9±3.8)°respectively in 5 patients receiving occipitocervical fusion and fixation, showing significant difference when compared with the values of normal children[(72.3±7.0)°and (74.1±7.6)°, respectively] at the same age (t=-3.915, P=0.018; t=-5.954, P=0.004). The CROM of the left and right rotation were (70.5±5.8)°and (72.7±4.9)°respectively in 14 patients receiving atlantoaxial fusion and fixation, showing no significant difference when compared with normal children at the same age (t=-1.417, P=0.180; t=-1.021, P=0.323). The visual analogue scale (VAS) score was significantly decreased from 7.8±1.1 at pre-operation to 3.5±0.8 at last follow-up (t=17.267, P=0.000). In 8 cases having spinal cord injury, 2 cases were rated as grade C, 1 case as grade D, and 5 cases as grade E according to ASIA impairment scale. ConclusionTechnique of pedicle screw internal fixation has been proven to be an effective treatment for the atlantoaxial instability of children. It plays an important part in relieving pain and limitation of the cervical region.
ObjectiveTo observe the effect of transplantation of neural stem cells (NSCs) induced by all-trans-retinoic acid (ATRA) combined with glial cell line derived neurotrophic factor (GDNF) and chondroitinase ABC (ChABC) on the neurological functional recovery of injured spinal cord in Sprague Dawley (SD) rats. MethodsSixty adult SD female rats, weighing 200-250 g, were randomly divided into 5 groups (n=12): sham operation group (group A), SCI model group (group B), NSCs+GDNF treatment group (group C), NSCs+ChABC treatment group (group D), and NSCs+GDNF+ChABC treatment group (group E). T10 segmental transversal injury model of the spinal cord was established except group A. NSCs induced by ATRA and marked with BrdU were injected into the site of injury at 8 days after operation in groups C-E. Groups C-E were treated with GDNF, ChABC, and GDNF+ChABC respectively at 8-14 days after operation;and group A and B were treated with the same amount of saline solution. Basso Beattie Bresnahan (BBB) score and somatosensory evoked potentials (SEP) test were used to study the functional improvement at 1 day before remodeling, 7 days after remodeling, and at 1, 2, 5, and 8 weeks after transplantation. Immunofluorescence staining and HE staining were performed to observe the cells survival and differentiation in the spinal cord. ResultsFive mouse died but another rats were added. At each time point after modeling, BBB score of groups B, C, D, and E was significantly lower than that of group A, and SEP latent period was significantly longer than that of group A (P<0.05), but no difference was found among groups B, C, D, and E at 7 days after remodeling and 1 week after transplantation (P>0.05). BBB score of groups C, D, and E was significantly higher than that of group B, and SEP latent period was significantly shorter than that of group B at 2, 5, and 8 weeks after transplantation (P<0.05);group E had higher BBB score and shorter SEP latent period than groups C and D at 5 and 8 weeks, showing significant difference (P<0.05). HE staining showed that there was a clear boundary between gray and white matter of spinal cord and regular arrangement of cells in group A;there were incomplete vascular morphology, irregular arrangement of cells, scar, and cysts in group B;there were obvious cell hyperplasia and smaller cysts in groups C, D, and E. BrdU positive cells were not observed in groups A and B, but could be found in groups C, D and E. Group E had more positive cells than groups C and D, and difference was significant (P<0.05). The number of glial fibrillary acidic protein positive cells of groups C, D, and E was significantly less than that of groups A and B, and it was significantly less in group E than groups C and D (P<0.05). The number of microtubule-associated protein 2 positive cells of groups C, D, and E was significantly more than that of groups A and B, and it was significantly more in group E than groups C and D (P<0.05). ConclusionThe NSCs transplantation combined with GDNF and ChABC could significantly promote the functional recovery of spinal cord injury, suggesting that GDNF and ChABC have a synergistic effect in the treatment of spinal cord injury.