Novel minimal invasive surgical techniques for the treatment of segmental-lateral pathologic lesions of the spine, preserving the dorsal stabilizing structures

Objective: Laminectomy, the commonly used dorsal approach for the surgical removal of most of the pathologic lesions, situated in the spinal canal and the neuroforamen destroying the dorsal stabilizing structures of the spinal column. Retraction and detachment of the longitudinal muscles, removal of the vertebral arches (laminectomy), and injury of the joint capsules and ligaments are responsible most of short and late-time complications.  Among of these complications spinal deformities, segmental instability and permanent spinal pain are most often mentioned in the literature. The main objective of the authors was to develop and evaluate the novel minimally invasive techniques suitable for exploring and treating different segmental-lateral pathologies, expanding to the neuroforamen or even paravertebraly, with preservation of the stability of the spine. One of the key issues of this article was to summarize these procedures, with evaluating the safety and efficacy in the routine spine surgery. Methods: 153 patients were operated and followed up during 2000 to 2010 in our Institute with segmental lateral spinal pathologies. For the surgical treatment we used “Over-the-top” decompression, hemi-semi laminectomy, supraforaminal burr-hole, open-tunnel and paravertebral approaches alone or combined with each-other. The above mentioned surgical techniques are mostly our developments, or modifications of previously used surgical techniques.Results: The new surgical procedures developed or modified by our team, are effective techniques for treating the spinal pathologies located in the spinal canal, neuroforamen or even the paravertebral space. The posterior stabilizing structures of the spine, as the vertebral laminae and the longitudinal musculature are mostly preserved. Leaving the longitudinal paraspinal musculature innervations intact, and with the preservation of the bone-muscle attachments and ligaments, the dynamic stability of the spine remains unchanged. Retaining the bony structures (vertebral arches) and the vertebral joints the static stability of the spinal column remain intact, the chance of developing the long-term spinal deformation is minimal.During the follow up we performed static and dynamic X-ray, MR and CT scans, completed with neurological examinations to evaluate the progression of the illness, the neurological deficit and the actual state of the spinal column. With clinical use and evaluation of the various surgical approaches we determined the main indications and contraindications of the surgical procedures, highlighting the pit-falls and limitations.Conclusion: The above mentioned minimally invasive surgical approaches are suitable for treating segmental – lateral spinal pathologies. . For the routine clinical use we organized the surgical techniques into a complete framework based on the location of the pathologic lesions.  DOI: 10.17489/biohun/2013/1/2

Minimal invasive surgical techniques for the treatment of pathologic lesions, situated in the midline of the spinal canal

Objective: Multilevel laminectomy for exposing the spinal canal to remove spinal cord lesions has been widely used in spine surgery. Destruction of the dorsal structures of the spinal column, detachment of the longitudinal musculature, resection of the vertebral arches, and injury of the joint capsules and ligaments are responsible most of short and late-time complications. Spinal deformities, instability, subluxation, invasion of haematoma and scar tissue into the spinal canal are the most often mentioned complications in the literature. The author main objective was to develop and summarize the novel minimally invasive techniques suitable for exploring and treating different pathologies, located in the midline of the spinal canal with preservation of the stability of the spine.Methods: 38 patients were operated on with intramedullary laesions located from CIII to LI level of the spine with the newly developed multilevel spinous process splitting and distracting laminotomy technique. The dorsal, paraspinal musculature was not detached from the vertebras. With splitting and distracting the spinous processes and the vertebral arches, the vertebral joints, the joint capsules and the ligaments were not injured, these structures remained mostly intact. To achieve a moderate enlargement and decompression of the spinal canal, complementary intervertebral spacer insertion was performed in some cases. The patients were followed with regular MRI, CT scans and neurological examinations.Results: Adequate surgery of the lesions located intramedullary was achieved in all patients using our new procedures. Moderate enlargement and permanent decompression of the spinal canal was achieved with the insertion of homologues tricortical iliac crest bone graft or heterologous PEEK spacer. The numbers of split laminae were 3 to 6. The split spinous processes were closed directly to each other in 24 patients. In 9 cases a tricortical bone graft and in 5 cases a heterologous PEEK spacer was inserted between the facing bony parts.The incidence of postoperative local pain was lower, within acceptable limits, and early mobilization was allowed. The average length of hospital stay was shorter too. The postoperative followup CT scans demonstrated bony healing, with the inserted graft or cage between the osteotomized faces. No compression or dislocation of the spacer was seen. Instability was not detected in any of the patients by fl exion or extension lateral radiographs. DOI: 10.17489/biohun/2010/1/2

Új mechanizmusok azonosítása az oxidatív stressz indukálta mitokondrium-függő nekrotikus sejthalálban = Identification of novel mechanisms in the oxidative stress induced mitochondria-related necrotic cell death

Oxidatív stress körülményei között kimutattuk, hogy a PARP enzim gátlása növeli az MKP-1 expresszióját (ez a foszfatáz felelős elsődlegesen a JNK és p38 MAPK inaktivációjáért), ezért szerepet játszhat a PARP gátlás mediálta mitokondriális védelem folyamatában. LPS indukálta szeptikus shock modell rendszeren vizsgáltuk az Akt kináz mitokondriális targetjeit. Normál állatokban nem, míg a szeptikus shockban az MPT (mitochondrial permeability transition) előfordul, így azonosítani tudtuk a folyamatban részt vevő fehérjéket. Először írtuk le, hogy az Akt foszforilálni tudja a ciklofillin D-t, ezzel csökkentve az MPT folyamatát. Különböző technikákkal igazoltuk, hogy a PARP-1 direkt módon (ADP-ribozilálva) képes befolyásolni transzkripciós faktorokat, melyek az MKP-1, 2 illetve 3 expresszió szabályozásában vesznek részt. | In oxidative stress, we provided evidence that PARP inhibition increase the oxidative stress dependent expression of MKP-1 which is the main phosphatase responsible for the inactivation of JNK and p38 MAP kinase, and so it can play a role in the PARP inhibition mediated mitochondrial protection. Using control mouse liver and liver from LPS induced secptic shock models we isolated mitochondria, and isolated proteins by anti-Akt substrate antibodies. That way we could isolate mitochondrial targets of Akt kinase, and comparing the data we could detect which proteins are phosphorylated in septic shock. Since septic shock model animals mitochondrial permeability transition is taking place while in normal liver it is not, therefore these data may show which protein phosphorylation can contribute to mitochondrial permeability transition. Our data firstly indicated that Akt can phosphorylate cyclophilin D and thereby can prevent cyclophilin D dependent mitochondrial permeability transition. We identified the mechanism by which PARP-1 directly modulated (poly-ADP-ribosylates) nuclear transcription factors involved in the regulation of MKP-1, 2 & 3 expression

Önszerveződő hibrid filmek előállítása nanoszerkezetű anyagokból = Preparation of self-assembled hybrid films from nanostructured materials

Önszerveződő hibrid nanofilmek előállítását, szerkezeti és optikai tulajdonságait vizsgáltuk különböző kolloidokból felépíthető ultravékony rétegekben. Funkcionált felületű nanorészecskékből szabályozott szerkezetű nanohibrid ultravékony filmeket készítettünk. A félvezető-oxidok közül a cink-oxid részecskéket alkalmaztuk önszerveződő filmek építéséhez és szenzorok előállításához. Réteges szerkezetű nanolamellás rendszerek kiváló önszerveződő tulajdonságokkal rendelkeznek a lamellák anizometrikus dimenziói miatt. A hibrid rétegek további komponensei lehetnek polimerek, peptidek és fehérjék is. Az önrendeződés folyamatát kétdimenziós kísérletekben Langmuir-mérleggel is követtük és jellemeztük a filmek kompresszibilitását. Az ezüst plazmonikus tulajdonságait kihasználva a látható fényben gerjeszthető fotokatalizátorokat készítettünk és azok hatékonyságát fotooxidációs reakciókkal minősítettük. Kvázi-kétdimenziós optikai reflexiós spektroszkópiával tanulmányoztuk a hidrofil és hidrofób nanohibrid filmeket. Funkcionalizált arany részecskékkel gőzök adszorpciójára szenzitív interdigitális szenzorokat fejlesztettünk ki. Aminosavak funkcionalizáló hatását tanulmányoztuk, és a plazmonikus anyagok felületén bekövetkező szorpciós folyamatok alkalmasak az ezüst valamint az arany nanorészecskék felületén megkötött biokolloidok tulajdonságainak optikai jelzésére. Ez a módszer kifejleszthető gyógyszer hatóanyagok megkötésének kvantitatív detektálására protein szupramolekulákra. | Structural and optical properties of self-assembled hybrid nanofilms prepared from different colloids were investigated. The nanohybrid ultrathin films with tailored structure were prepared from functionalized nanoparticles. Semiconductor metal oxide (zinc oxide) nanoparticles were applied for the construction of self assembled films for sensor application. The layered structured nanolamellar systems exhibit excellent self assembled properties because of the anisometric dimensions of the lamellae. Further components of the hybrid layers may also involve polymers, peptides and proteins as well. The self-assembly process was controlled by two dimensional Langmuir-balance measuring the compressibility of the films. The plasmonic properties of silver were exploited for photocatalysis. The catalysts can be excited in visible light and their efficiency in photooxidation reactions was determined. Quasi-two dimensional optical reflection spectroscopy on hydrophilic and hydrophobic nanohybrid films were studied using setup developed in our laboratory. Gold nanoparticles were deposited on interdigital sensor surfaces measuring the vapours adsorption. The effect of surface functionalization by amino acids were also studied. The sorption processes are able to modify the optical signal on the surface of plasmonic materials for biocolloids on plasmonic surfaces. This method can be developed for quantitative characterization of pharmaceutical drug materials binding on supramolecules