Background: To assess the efficacy of the superior notch of inferior vertebral pedicle approach of transforaminal percutaneous endoscopic lumbar discectomy for very high-grade inferiorly migrated disc herniation.Methods: Data on 32 consecutive patients operated with percutaneous endoscopic surgery via the superior notch of inferior vertebral pedicle approach were reviewed. Age, gender, clinical diagnoses, operation time, hospitalization time, a self-administered questionnaire composed of the leg pain visual analogue scale (VAS leg pain) and the Oswestry Disability Index (ODI) had been recorded before operation and 1, 3, 6 and 12 months after operation, respectively. The clinical results were assessed at the final follow-up by using modified Macnab criteria. Complications were recorded during follow-up, and postoperative X-ray, CT and MRI examinations were performed.Results: There were 21 males and 11 females. The mean age of patients was 51.8±10.6 years. MRI findings of patients with disc herniation were L2-3 level in 4 case, L3-4 level in 9 cases and L4-5 level in 19 cases, which were correlated with clinical symptoms. All patients completed a 12-month follow-up assessment after surgery. The mean operative duration was 68.2±12.8 min, and hospitalization time was 3.6±0.8 days. At 12 months follow up the VAS leg pain had improved by 6.3 (P< 0.05) and the ODI by 43.6 points (P< 0.05). Twenty-three cases (71.9%) were rated as excellent, 7 (21.9%) as good, 2 (6.2%) as fair at the final follow-up. On the basis of the modified MacNab criteria, the overall excellent and good rate was 93.8%. Two patients (6.2%) had transient dysesthesia after surgery. Postoperative radiological evaluations showed no signs of instability or recurrence of pathology.Conclusion: Transforaminal percutaneous endoscopic lumbar discectomy via the superior notch of inferior vertebral pedicle approach could be a safe and effective minimally invasive technique for very high-grade inferiorly migrated disc herniation. This technique warrants further study and clinical application.
386 Background: Xenograft tumours are validated models using either patient samples (primary xenografts) or cell lines (secondary xenografts) grown in a murine host. Repeated culturing of cancer cell lines results in epigenetic changes and subsequent behaviour changes distinct from primary human cancers. The aim of this study is to form both models and compare their responses to chemotherapy agents. Methods: Fresh primary colorectal adenocarcinoma tissue or colorectal cell lines (SW480 non metastatic line / SW620 metastatic line) were inoculated subcutaneously into immunodeficient mice to form primary and secondary xenografts respectively. Both models were subjected to either a 5-fluorouracil (5-FU) or irinotecan trial. The clinical response and biological features were evaluated. Results: Secondary xenografts were more aggressive with a shorter time to tumour formation, higher uptake rate and more aggressive histological features. The mice were randomised to either the control group (saline) or to the treatment group [60mg/kg of 5FU (SW620 / primary xenografts) or 60 mg/kg of Irinotecan (SW480 / primary xenografts)] via intraperitoneal injection. In the 5FU group, the primary xenografts began regressing after Day 2 but the secondary xenografts continued to grow until Day 8. The decrease from the maximal tumor volume to the study end point (Day 12 in primary xenograft group and Day 10 in secondary xenograft group) was evaluated with primary xenografts showing a greater decrease compared to secondary xenografts (56.6% vs. 10.4%; p =0.002). Conclusions: We demonstrated the ability to grow tumours in mice from fresh human colonic adenocarcinomas. Tumours formed in mice from patient derived adenocarcinomas produce more clinically accurate testing than tumours formed from cell line and may allow for drug screening in order to personalise an individual’s chemotherapy regime.
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