Acupuncture at the “Huatuojiaji” point affects nerve root regional interleukin-1 level in a rat model of lumbar nerve root compression

BACKGROUND：It has been shown that interleukin-1 （IL-1） may cause inflammatory reactions, which stimulate the nerve root of patients with lumbar intervertebral disc protrusion and leads to pain. Whether the clinical curative effects of acupuncture in the treatment of lumbar and leg pain are linked to an inhibition of local IL-1 secretion is unknown. OBJECTIVE： To assess the influence of acupuncture on IL-1, this study was designed to verify the effects of acupuncture at the ＂Huatuojiaji （Extra）＂ point on the nerve root in a rat model of lumbar nerve root compression, compared with administration of meloxicam, a non-steroidal anti-inflammatory drug. DESIGN, TIME AND SETTING： Randomized, controlled, molecular biology experiment, performed at the Experimental Center, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between September 2005 and April 2006. MATERIALS： Forty healthy adult Sprague Dawley rats of either gender were included in this study. The rats were randomly and evenly divided into the following four groups： normal control, model, acupuncture and meloxicam groups. Lumbar nerve root compression was induced in rats in the model, acupuncture, and meloxicam groups by inserting a specially made silicon rubber slice at the juncture of the L5 nerve root and the dural sac. The acupuncture needle （pattern number N3030, 30#, 1.5 inch） was purchased from Suzhou Medical Appliance Factory, China. IL-1 enzyme linked immunosorbent assay （ELISA） kit was purchased from Santa Cruz Biotechnology, Inc., USA. METHODS： The acupuncture group was acupunctured at the ＂Huatuojiaji＂ point, which is lateral to the compressed L5-6 nerve root, with an acupuncture depth of 0.5 cm. There were two treatment courses, each of involved seven 20-minute acupuncture sessions, one session a day. The meloxicam group was administered intragastrically 3.75 mg/kg meloxicam （5 mg meloxicam /10 mL physiological saline）. Rats in the normal control group and model group received an intragastric administration of 10 mL/kg physiological saline. All administrations were performed once a day. MAIN OUTCOME MEASURES： At day 14 post-surgery, the IL-1 level in the compressed nerve root was determined by a streptavidin-peroxidase （S-P） immunohistochemical method, and IL-1β mRNA expression in the compressed nerve root was simultaneously detected by real-time reverse transcription-polymerase chain reaction. RESULTS： The expression levels of IL-1 and IL-1β mRNA in the L5 nerve root were significantly higher in the model group than in the control group （P 〈 0.01）. However, the expression levels of IL-1 and IL-1β mRNA were significantly lower in the acupuncture and meloxicam groups than in the model group （P 〈 0.05–0.01）. Expression levels of IL-1 and IL-1β mRNA were significantly higher in the acupuncture group than in the meloxicam group （P 〈 0.01）. CONCLUSION： Acupuncture at the ＂Huatuojiaji＂ point decreases the IL-1 level by inhibiting IL-1β mRNA expression to a greater extent than meloxicam administration.

Primary extraskeletal Ewing’s sarcoma of the lumbar nerve root:A case report

BACKGROUND Ewing’s sarcoma(ES)is a highly aggressive bone malignancy.Extraskeletal ES(EES)originating in the spinal canal is extremely rare.Herein,we report on a rare case of EES with a primary lumbar spinal nerve root including the complete diagnosis and treatment.CASE SUMMARY A young female patient presented with a complaint of right lower limb pain for 1 mo.Magnetic resonance imaging(MRI)revealed an 11 mm×14 mm×31 mm mass in the lumbar epidural region extending at the fifth lumbar spine(L5)level toward the right L5 neural foramen.Our initial diagnosis was an epidural schwannoma.The patient underwent total laminectomy,tumor resection and pedicle screw internal fixation and the L5 root tumor was found to have been completely removed intraoperatively.Histopathological examination of the lesion showed a typical ES with a large number of small,round cells.Immunohistochemistry analysis indicated positive CD99 and S100.After surgery,the patient received chemotherapy and radiotherapy with a 1 year of follow-up and no recurrent tumors or new lesions were found upon spine MRI and positron emission tomography/computed tomography reexamination.CONCLUSION Clinically,ES outside the bone should be considered when nerve root tumors are encountered inside and outside the spinal canal and the diagnosis should be determined by pathological biopsy.After surgical resection,chemotherapy and radiotherapy should be performed.After treatment,active follow-up and regular review should be completed.

Optimal technique of three-dimensional MRI of the lumbar nerve root and its radicular vein in normal and lumbar disc herniation patients

Background Although three-dimensional MRI （3D-MRI） of short T1 inversion recovery turbo spin-echo （STIR TSE） has showed superior to two-dimensional MRI （2D-MRI） in showing the spinal cord and lumbar nerve roots, it remains difficult in demonstrating radicular vein at present. We have found that short T1 inversion recovery long time echo （STIR LONG TE） was better in showing radicular vein. To further study the methods and character of the 3D-MRI of lumbar nerve root, ganglions and radicular vein in normal and lumbar disc herniation （LDH） adults, in the present study, we evaluated two 3D-MRI techniques, STIR TSE and STIR LONG TE for demonstrating lumbar nerve roots and especial radicular vein in normal and LDH adults. Methods Twelve normal adult persons and 19 LDH patients were included in this study; special oblique coronal location was adopted. STIR TSE and STIR LONG TE were performed in all participants, and the detection rates of radicular vein and nerve root of L3, L4, L5,S1 were calculated. The grading system was used in grading compromise of the intraspinal extradural lumbar nerve root, ganglion and radicular vein in LDH patients, and all the grading injury of nerve root, ganglion and radicular vein had been evaluated. Results The definite rate of radicular vein （DRRV） of 3D-MRI of STIR LONG TE was significantly different from that of STIR TSE. DRRV of STIR LONG TE was L3, 91.7%, L4, 100%, L5, 100%, $1, 100% and that of STIR TSE was L3, 33.3%, L4, 37.5%, L5, 58.3%, $1,45.8% in normal adults. It showed no difference between STIR LONG TE and STIR TSE in the detection rate of nerve root. The different patho-injuries of nerve root, ganglion and radicular vein could be seen in all LDH patients by the 3D-MRI of STIR LONG TE. The mean score of Japanese Orthopaedic Association （JOA） was 16.16, and 29 nerve roots were calculated in all the study. The mean grading injury of nerve root was 2.17, that of nerve root ganglion was 1.28, that of radicular vein was 1.83, and the mean co-grading injury of nerve root, ganglion and radicular vein was 5.31. The correlation coefficient was 0.478 （P=0.010） between the score of JOA and that of radicular vein. Conclusion The 3D-MRI of STIR LONG TE is superior to STIR TSE for not only detecting the lumbar nerve root, ganglion and especial radicular vein in normal adults, but also displaying their patho-injuries degree in LDH patients.