Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

Treatment of extremely-lateral lumbar disc herniation with METRx through intertransversal route

Objective: To study the feasibility and effects of disc resection in patients with extremely-lateral disc herrniation (ELDH) with microendoscopic tubular retractor (METRx) through intertransversal route. Methods: In the period from March 2000 to December 2002, 9 patients with ELDH underwent disc resection with METRx system through intratransversal route and the clinical outcome was evaluated with Nakai standard. Results: The operation time ranged from 60 to 120 min with an average of 75 min; the blood loss ranged from 50 to 120 ml with an average of 60 ml; and the hospitalization time ranged from 5 to 19 d with an average of 13 d. No wound infection, neurological damages, pseudomeningocele or other complications occurred. The rate of excellent and good outcome was 88.9%. Conclusion: Disc removal in patients with ELDH can be done with METRx system and satisfactory results are obtained.

Research advancements of axonal remyelination in spinal cord injury

Spinal cord injuries(SCI)usually result in impairment of axonal conduction and sensorimotor function.There are no effective therapy to completely repair SCI.Axonal demyelination is very common as a pathologic change in SCI,and demyelination partly contributes to neural function impairment.So,it may be reasonable that remyelination of demyelinated axons become one of effective therapeutic targets for SCI treatment. Demyelination involves myelin breakdown and loss of myelin-forming cells(oligodendrocytes).The death of oligodendrocytes plays a key role in axonal demyelination in SCI.Recently a number of studies demonstrate that cell replacements could facilitate axonal remyelination and restore axonal conductive func- tion.Thus,it is expected that myelinogenetic cell transplantation(oligodendroglial lineage)will have good prospect as an effective therapy to improve axonal remyelination and restore neural function for SCI treat- ment in the near future.

Comparison of phenotype characteristics of rat annulus fibrosus cells cultured on flexible silicone membrane and in plastic plate

Objective：To compare the phenotype characteristics of rat annulus fibrosus （AF） cells cultured on flexible silicone membranes and those in plastic plates. Methods：The morphology of AF cells cultured in different suhstrates was examined. Proteoglycan was stained by toluidine blue. Contents of collagen type Ⅰ, collagen type Ⅰ and aggrecan mRNAs were determined by reverse transcription-polymerase chain reaction （RT-PCR）. The expression of integrin β1 was monitored by flow cytometry. By using propidium iodide （PI）, the cell cycle in AF cells was analyzed. Cell adhesion to silicone membrane was also measured. Results：The AF cells cultured on different suhstrates were morphologically undistinguishable. Toluidine blue staining showed that there was also no difference between AF cells cultured on these 2 substrates. They still had the same expression levels of collagen type Ⅰ , collagen type Ⅰ, aggrecan mRNAs, and integrin β1. No significant difference was observed in the distribution of the cell cycle. AF cells grew well on silicone membrane. Conclusion：AF cells cultured on flexible silicone membrane maintain the stability of phenotype and may he appropriate for further studying the metabolic responses to mechanical stimuli at the cellular level.

Role of calcium signaling in down-regulation of aggrecan induced by cyclic tensile strain in annulus fibrosus cells

Objective:To study the role of intracellular calcium signal pathway in the down-regulation of aggrecan induced by cyclic tensile strain in the annulus fibrosus cells. Methods:The expression of aggrecan mRNA and core protein were respectively detected with RT-PCR and western blot after the channels transmitting calcium ions were blocked with EGTA, gadolinium and verapamil. Results :EGTA. gadolinium and verapamil partially prevented the effects of cyclic tensile strain on the expression of aggrecan in annulus fibrosus cells. Conclusion:The calcium signaling is involved in the down-regulation of proteoglycan resulting from cyclic tensile strain in the annulus fibrosus cells.

Clinical application of anterior cervical decompression and fusion under METRx system

Objective: To explore the feasibility and effect of anterior cervical decompression and fusion under METRx system. Methods: Between Nov. 2001 and Nov. 2003, totally 23 consecutive patients were performed anterior cervical decompression and fusion under METRx system. The clinical outcome was evaluated by Odom standard. Results: Decompression and fusion along with internal fixation was obtained in all the 23 patients with minimal tissue damage and operation-caused scar. There were no wound infection, neurological injuries, throat discomfort and other complications. The total rate of excellent and good outcome in patients with degenerative cervical diseases was 94%. Conclusion: Cervical decompression and fusion can be performed under METRx system with its own advantages, such as minimal tissue damage and operation-caused scar, less throat discomfort.

Differentiation of rat oligodendrocyte precursor cells in chemical conditional medium in vitro

Objective: To investigate in vitro differentiation of oligodendrocyte precursor cells (OPCs) into mature oligodendrocytes in chemical conditional medium. Methods: The mixed glial cells from cerebral cortices of 48-hour-old Sprague-Dawley (SD) rats were cultured in vitro. The OPCs were separated by shaking procedure around 9–10 d in the primary culture. Then the isolated OPCs were further transferred into the chemical conditional medium for cell differentiation. The pattern of OPCs maturation in vitro was continuously observed with contrast phase microscopy and mature oligodendrocytes were further identified by immunocytochemical assays. Results: OPCs grew well when co-cultured with glial cells and distinct cellular stratification formed about 9–10 d in the primary culture, which indicated the appropriate opportunity for the separation of OPCs. Following cultured in the chemical conditional medium, the OPCs progressively differentiated into the mature oligodendrocytes. These mature oligodendrocytes were also immunostained with the oligodendrocyte lineage-specific antibody, Oligo2. Conclusion: The OPCs isolated from the cerebral cortices of neonatal SD rats can progressively differentiate into mature oligodendrocytes in the chemical conditional medium in vitro.

Modified Glucose-insulin-potassium Therapy for Hemorrhage-induced Traumatic Cardiac Arrest in Rabbits

Objective Resuscitation with whole blood is known to be better than that with saline in attaining the return of spontaneous circulation(ROSC)and improving the short-term survival rate for hemorrhage-induced traumatic cardiac arrest(HiTCA).However,the resuscitation with whole blood alone fails to address the pathophysiological abnormalities,including hyperglycemia,hyperkalemia and coagulopathy,after HiTCA.The present study aimed to determine whether the modified glucose-insulin-potassium(GIK)therapy can ameliorate the above-mentioned pathophysiological abnormalities,enhance the ROSC,improve the function of key organs,and reduce the mortality after HiTCA.Methods HiTCA was induced in rabbits(n=36)by controlled hemorrhage.Following arrest,the rabbits were randomly divided into three groups(n=12 each):group A(no resuscitation),group B(resuscitation with whole blood),and group C(resuscitation with whole blood plus GIK).The GIK therapy was administered based on the actual concentration of glucose and potassium.The ROSC rate and survival rate were obtained.Hemodynamical and biochemical changes were detected.Thromboelastography(TEG)was used to measure coagulation parameters,and enzyme-linked immunosorbent assay to detect parameters related to inflammation,coagulation and the function of brain.Results All animals in groups B and C attained ROSC.Two rabbits died 24–48 h after HiTCA in group B,while no rabbits died in group C.The GIK therapy significantly reduced the levels of blood glucose,potassium,and biological markers for inflammatory reaction,and improved the heart,kidney,liver and brain function in group C when compared to group B.Furthermore,the R values of TEG were significantly lower in group C than in group B,and the maximum amplitude of TEG was slightly lower in group B than in group C,with no significant difference found.Conclusion Resuscitation with whole blood and modified GIK therapy combined can ameliorate the pathophysiological disorders,including hyperglycemia,hyperkalemia and coagulopathy,and may improve the function of key organs after HiTCA.

Exosomes derived from stem cells as an emerging therapeutic strategy for intervertebral disc degeneration

Intervertebral disc(IVD)degenerative diseases are a common problem in the world,and they cause substantial social and economic burdens for people.The current methods for treating IVD degenerative diseases mainly include surgery and conservative treatment,which cannot fundamentally restore the normal structure of the disc.With continuous research on the mechanism of degeneration and the development of regenerative medicine,rapid progress has been made in the field of regenerative medicine regarding the use of stem cell-derived exosomes,which are active biological substances used in intercellular communication,because they show a strong effect in promoting tissue regeneration.The study of exosomes in the field of IVD degeneration has just begun,and many surprising achievements have been made.This paper mainly reviews the biological characteristics of exosomes and highlights the current status of exosomes in the field of IVD degeneration,as well as future developments regarding exosomes.

Endoscopic transforaminal lumbar decompression, interbody fusion and pedicle screw fixation a report of 42 cases

Objective： To evaluate the surgical procedure of endo- scopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis. Methods： From June 2004 to May 2006, 42 patients with classic features of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis underwent endoscopic transforminal lumbar interbody fu- sion （TLIF）. Under the guidance of fluoroscopy, a 2.8 to 3.0 cm incision with 4.5 to 5.0 cm apart from the posterior middle line was made on the symptomatic side and the working portal （X-Tube） was docked unilaterally on the facet joint. A total facetectomy was then performed to expose neural fo- ramina and nerve root. Discectomy and endplate prepara- tion were completed through the tube. A Telamon cage was placed obliquely into the intervertebral space after interbody grafting, and then the Dynalok pedicle screw fixation system was performed. This procedure was accomplished on the lateral side when it is necessary. Results： Clinical outcomes were determined using the Oswestry Disability Index （ODI） which revealed that 62.2% of patients got excellent results, 29.2% good and 8.6% fair. The average hospital stay was 12.5 days （5-25 days）. Op- eration time averaged 240 min （110-320 min）, blood loss averaged 140 ml （80-420 ml） and incision length averaged 3 cm （2.8-3.2 cm）. Five patients had complications including wound infection in 1 case, incision dehiscence and focal skin necrosis in 1, progressive radicular pain of contralat- eral leg in 1 and residual radicular numbness after transient radicular pain in 2. Conclusions： This surgical procedure of endoscopic transforminal diskectomy, bone grafting, cage placement and pedicle screw fixation can be effectively accomplished under X-Tube operation system with predominant benefits such as small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery.

Optimized clinical practice for superaged patients with hip fracture:significance of damage control and enhanced recovery program

With the advent of global aging,the incidence,mortality,and medical costs of hip fracture among aged patients are increasing annually.The number of controlled clinical studies and health economics analyses that conform to evidence-based medicine principles is growing day by day.However,unfortunately,no specific recommendations regarding the procedures for the treatment of hip fracture are available.Meanwhile,the existence of both traditional treatment systems and new treatment theories means that most doctors confront difficult choices in their daily practice.These factors make the therapeutic approach for aged patients,especially among superaged patients with hip fracture,extremely challenging.This study focuses on superaged patients(>80 years as defined by the World Health Organization)with hip fracture and includes their preoperative pathological condition;therapeutic decision-making in terms of the benefit and risk ratio,damage control theory,and enhanced recovery after surgery were also investigated.These patients were discussed specifically by combining the current treatment strategies from several experts and the results of a meta-analysis published recently.The study presents some new ideas and approaches currently recognized in the field,such as preoperative assessment,surgical planning,safety consideration,complication intervention,and enhanced recovery implementation,and further presents some clear interpretations regarding misunderstandings in clinical practice.Finally,optimized treatment according to damage control principles and enhanced recovery after surgery during the perioperative period among superaged hip fracture patients is defined.

Biomechanical comparison of interspinous distraction device and facet screw fixation system on the motion of lumbar spine： a finite element analysis

Background A large amount of biomechanical and clinical evidence from previous studies suggest the efficiency of the two different posterior lumber non-fusion methods,interspinous distraction device （ISDD） and facet screw fixation system （FSS）,but the biomechanical comparison of ISDD and FSS has not been thoroughly clarified.Methods In the current study,finite element methods were used to investigate the biomechanical comparison of ISDD and FSS.The range of motion （ROM）,intradiscal pressure （IDP） and the protective effects gained by maintaining disc heights were evaluated.Results The ROM was similar between the two non-fusion methods under static standing,flexion and lateral bending.The FSS appeared to be more effective in resisting extension.At the implanted level L3/4,FSS displayed better results for maintaining and increasing posterior disc heights.At the L4/5 level in extension and lateral bending,FSS was better than ISDD,with comparable results observed in other motions.Comparing the posterior and lateral disc heights,FSS appeared to be more effective than ISDD.FSS also had a minor effect on the inferior adjacent segment than ISDD.FSS was more effective in reducing IDP than ISDD in extension.Conclusion Through the finite element analysis study,it can be seen that FSS demonstrates more beneficial biomechanical outcomes than does ISDD,such as being more effective in resisting extension,maintaining and increasing lumbar disc heights and reducing the inferior adjacent IDP in extension.

Vascular endothelial growth factor and its receptor expression during the process of fracture healing

Objective： To study the expression regularity of vascular endothelial growth factor （VEGF） during the process of fracture healing, and the type of VEGF receptor expressed in the vascular endothelial cells of the fracture site. Methods： The fracture model was made in the middle part of left radius in 35 rabbits. The specimens from the fracture site were harvested at 8, 24, 72 hours and 1, 3, 5, 8 weeks, and then fixed, decalcified, and sectioned frozenly to detect the expression of VEGF and its receptor at the fracture site by in situ hybridization and immunochemical assays. Results： VEGF mRNA and VEGF expression was detected in many kinds of cells at the fracture site during 8 hours to 8 weeks after fracture. Fltl receptor of VEGF was found in the vascular endothelial cells at the fracture site during 8 hours to 8 weeks after fracture, and strong expression of flkl receptor was detected from 3 days to 3 weeks after fracture. Conclusions： The expression of VEGF and fltl receptor appears during the whole course of fracture healing, especially from 1 to 3 weeks. Flkl receptor is highly expressed in a definite period after fracture. VEGF is proved to be involved in the vascular reconstruction and fracture healing.

Control of demyelination for recovery of spinal cord injury

Since loss of oligodendrocytes and consequent demyelination of spared axons severely impair the functional recovery of injured spinal cord, it is reasonably expected that the reduction of oligodendroglial death and enhanced remyelination of demyelinated axons will have a therapeutic potential to treat spinal cord injury. Amelioration of axonal myelination in the injured spinal cord is valuable for recovery of the neural function of incompletely injured patients. Here, this article presents an overview about the patho-physiology and mechanism of axonal demyelination in spinal cord injury and discusses its therapeutic significance in the treatment of spinal cord injury. Moreover, it further introduces the recent strategies to improve the axonal myeliantion to facilitate functional recovery of spinal cord injury.

Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries

Purpose:It is challenging to prepare military surgeons with the skills of combat damage control surgery(CDCS).The current study aimed to establish a damage control surgery(DCS)training platform for explosive combined thoraco-abdominal injuries.Methods:The training platform established in this study consisted of 3 main components:(1)A 50 m×50 m square yard was constructed as the explosion site.Safety was assessed through cameras.(2)Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group(accepted DCS)and the control group(have not accepted DCS).The mortality rate was observed.(3)The literature was reviewed to identify the key factors for assessing CDCS,and testing standards for CDCS were then established.Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Then,a 5-day training course with incorporated tests was used to test the efficacy of the established platform.In total,30 teams attended the first training course.The scores that the trainees received before and after the training were compared.SPSS 11.0 was employed to analyze the results.Results:The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall.No pig died within 24 h when DCS was performed,while 7 pigs died in the control group.After a literature review,assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts:leadership and team cooperation,resuscitation,surgical procedure,and final outcome.Expert questionnaire results showed that the scientific score was 8.6±1.25,and the feasibility score was 8.74±1.19.When compared with the basic level,the trainees’score improved significantly after training.

Antagonizing exosomal miR-18a-5p derived from prostate cancer cells ameliorates metastasis-induced osteoblastic lesions by targeting Hist1h2bc and activating Wnt/β-catenin pathway

More than 50%of prostate cancer(PCa)patients have bone metastasis with osteo-blastic lesions.MiR-18a-5p is associated with the development and metastasis of PCa,but it remains unclear whether it is involved in osteoblastic lesions.We first found that miR-18a-5p was highly expressed in the bone microenvironment of patients with PCa bone metastases.To address how miR-18a-5p affects PCa osteoblastic lesions,antagonizing miR-18a-5p in PCa cells or pre-osteoblasts inhibited osteoblast differentiation in vitro.Moreover,injection of PCa cells with miR-18a-5p inhibition improved bone biomechanical properties and bone mineral mass in vivo.Furthermore,miR-18a-5p was transferred to osteoblasts by exosomes derived from PCa cells and targeted the Hist1h2bc gene,resulting in Ctnnb1 up-regulation in the Wnt/β-catenin signaling pathway.Translationally,antagomir-18a-5p significantly improved bone biomechanical properties and alleviated sclerotic lesions from osteoblastic me-tastases in BALB/c nude mice.These data suggest that inhibition of exosome-delivered miR-18a-5p ameliorates PCa-induced osteoblastic lesions.

Minimally invasive strategies and options for far-lateral lumbar disc herniation

Objective： To investigate the surgical procedures, options and surgical indications for far-lateral lumbar disc herniation between three different minimally invasive procedures. Methods： From January 2000 to October 2006, 52 patients with far-lateral lumbar disc herniation （29 males and 23 females, with the average age of 41.5 years） were treated with minimally invasive procedures. All the patients were assessed by X-ray and CT. Some were given additional myeography, discography, Computerized tomography myelography （CTM） and MRI examination. Yeung Endoscopy Spine System （YESS）, METRx and X-tube procedures were performed in 25, 13 and 14 cases, respectively. All patients were followed up for a mean period of 13.5 months. Clinical outcomes were assessed by visual analog score （VAS） and Nakai criteria. Results： The results indicated that the three procedures could significantly improve the radiating leg symptoms （P〈0.05）. The postoperative overall excellent and goodrates of YESS, METRx and X-tube procedures were 84.0%, 84.6% and 92.8% respectively, with no statistical difference among three groups （P〉0.05）. The YESS procedure had several advantages including shortest operation time, simplest anesthesia and least trauma as compared with the other two procedures, especially for simple type I far-lateral lum- bar disc herniation. METRx procedure was specially suitable for simple type II. And the procedure of posterior endoscopic facetectomy, posterior lumbar interbody fusion and unilateral pedicle screw instrumentation with X-tube was designed for far-lateral disc herniation combined with degenerative lumbar instability. Conclusion： Minimally invasive strategies and options should be determined by different types of far-lateral lumbar disc herniation.

Operative treatment for cervical fracture and dislocation with blunt unilateral vertebral artery injury

Objective： To investigate risks and clinical effects of operative treatment for cervical vertebral fracture and dislocation associated with unilateral vertebral artery injury. Methods： This group consisted of 76 cases of closed cervical spine trauma combined with unilateral vertebral artery injury （23 cases of bilateral facet dislocation, 28 unilateral facet dislocation and 25 fracture）. All patients underwent prospective examination of cervical spine MRI and vertebral artery two-dimensional time-of-flight （2D TOF） magnetic resonance angiography （MRA）, and anterior cervical decompression. The healthy vertebral artery paths were evaluated before the surgery, and were protected during the surgery according to the anatomical signs. Results： There were no acute or chronic clinical dam- age symptoms in 76 cases after surgery. No neural damage symptoms were observed in patients with normal neural functions. The neural functions of incomplete paralyzed patients were improved in different grades. Conclusions： Reliable anterior operation can produce good results for cervical fracture and dislocation with unilateral vertebral artery injury. Detecting the course of uninjured vertebral artery before operation and locating the anatomical site during operation are effective to avoid damaging vertebral artery of uninjured side.

Robot-assisted surgery in total knee arthroplasty:trauma maker or trauma savior?A prospective,randomized cohort study

Background:Robotic assistance has been increasingly employed to improve the operative precision in modern knee surgery.The purpose of the study was to evaluate the trauma effect of one of the first domestically developed orthopedic surgical robots in China in a clinical trial of robot-assisted total knee arthroplasty(RA-TKA).Methods:A total of 33 patients who underwent unilateral TKA for end-stage osteoarthritis were randomized to receive RA-TKA(17 cases)or conventional manual TKA(CM-TKA)in our institution in 2020.The trauma effects of the 4 main indicators with 48 sub-indicators in terms of subsectional operative time,inflammation and coagulation markers,physical and radiographical analyses of osteotomy deviation,and postoperative comfort were analyzed.Results:Subsectional operative time analysis showed that the times for bone cutting and gap balancing with RA-TKA were 5.3 and 2.2 min shorter than those with CM-TKA(p=0.010,p=0.02),respectively.Arterial blood gas indicators(partial pressure of carbon dioxide,partial pressure of oxygen and SO2)24 h after RA-TKA,as well as the white blood cell count and neutrophil ratio,were significantly lower than those after CM-TKA(p<0.05).Inflammatory markers at 72 h after surgery showed the increments of C-reactive protein,erythrocyte sedimentation rate and D-dimer of RA-TKA declined by 180.7,22.0 and 1050.0%(p<0.05),respectively,referenced to the preoperative baseline values,as compared to CM-TKA.Mechanical deviation distribution exhibited percentages of region I errors for RA-TKA and CM-TKA of 76.5%and 27.1%(p=0.000),respectively,and the success rates of one-time osteotomy were 94.1%and 62.5%(p=0.039),respectively.Radiographi-cal verification showed RA-TKA was more conducive to achieving mechanical alignment and ideal tibial component azimuths.Postoperative efficacy showed that patients were more comfortable after RA-TKA in terms of reduced administration of tranexamic acid,hydrocortisone and the utilization rate of temporary intensive opioid analgesics.No statistical difference in patient-reported outcome measures and complications were recorded between the two groups during continuous observation.Conclusions:Compared with CM-TKA,RA-TKA decreases rather than increases trauma.It might shorten the time required for bone cutting and gap balancing,reduce mechanical errors related to the osteotomy and prosthesis position,and improve the accuracy of the mechanical alignment reconstruction.RA-TKA is also favorable in promoting postoperative comfort and minimizing inflammatory response and drug consumption.

Microendoscopic discectomy,a less traumatic procedure for lumbar disk herniation

Objective: To investigate the change of serum levels of interleukin-6 (IL-6), C-reactive protein (CRP) and creatine kinase ( CK ) in patients undergoing microendoscopic discectomy (MED) and open discectomy.Methods: Forty-four patients with single level lumbar disk herniation were treated, either by MED ( Group A, n = 22) or open discectomy ( Group B, n = 22). Peripheral venous blood samples were taken before surgery and at 24 and 48 hours postoperatively. The operating time,intraoperative blood loss, postoperative hospital stay were recorded. The pain severity of incision was evaluated by visual analog scale after operation and the clinical outcome was evaluated by Oswestry disability index. Statistical comparison was performed by the analysis of variance and Student's t test.Results: The data showed that patients in Group A had a less intraoperative blood loss ( P ＜ 0.05 ), shorter operating length ( P ＜ 0.05), shorter postoperative hospital stay (P ＜ 0.05) and less postoperative pain of incision than those in Group B. Serum levels of IL-6 ( mean, 31.60 ng/L ± 9.88 ng/L vs 39.16 ng/L ±11. 14 ng/L, P＜0.05) and CK ( mean, 167.91 U/L ±51.85 U/L vs 401.55 U/L ± 108.86 U/L, P ＜ 0. 05 ) all get to the peak at 24 hours after operation and Group A with the response statistically less than Group B. Serum level of CRP peaked at 24 hours in Group A ( mean, 12.68 mg/L ± 7.10 mg/L vs 20.82 mg/L± 8. 79 mg/L, P ＜ 0. 05 ) and peaked at 48 hours after surgery in Group B ( mean, 10.77 mg/L ± 5.25 mg/L vs 29.95 mg/L ± 14. 85 mg/L, P ＜0. 05). The clinical outcomes of both groups were the same at 6 months after surgery.Conclusions: Both MED and open discectomy have made good clinical outcomes, however, the less change of IL-6, CRP and CK after operation proves that MED procedure is less traumatic to patients than open discectomy.