Erratum: 17ß-Estradiol Inhibites Tumor Necrosis Factor-α Induced Apoptosis of Human Nucleus Pulposus Cells via the PI3K/Akt Pathway.

The authors asked for the change of the figure 1. They wanted to send the figure that was 200 times bigger under the microscope as described in Figure 1 caption, however, they mistakenly uploaded the wrong picture. Reference: 1. Tao Wang, Si-Dong Yang, Sen Liu, Hui Wang, Huan Liu, Wen Yuan Ding: 17ß-Estradiol Inhibites Tumor Necrosis Factor-alpha Induced Apoptosis of Human Nucleus Pulposus Cells via the PI3K/Akt Pathway. Med Sci Monit, 2016; 22: 4312-4322. DOI: 10.12659/MSM.900310.

The Beneficial Role of Exercise Training for Myocardial Infarction Treatment in Elderly.

Worldwide, elderly people have a higher prevalence of myocardial infarction (MI), which is associated with body function aging and a sedentary lifestyle. In addition to medication, exercise training is a well-established supplementary method to prevent and treat cardiovascular diseases (CVDs). Substantial evidence has shown the value of different intensity exercise programs in the prevention and treatment of MI, and exercise rehabilitation programs are also applicable to elderly patients with MI. Although exercise rehabilitation programs could significantly improve function, quality of life (QoL), and lower mortality and morbidity for people with MI, such programs are underused because their mechanisms are not accurately elucidated. To promote the application of exercise therapy for MI, this review summarizes the benefits and mechanisms of exercise rehabilitation for post-MI patients and provides rationalized proposals for outpatient cardiac rehabilitation.

The benefits and mechanisms of exercise training for Parkinson's disease.

Parkinson's disease (PD) is a significantly progressive neurodegenerative disease characterised by both motor and nonmotor disorders. The main pathological characteristics of PD consist of the loss of dopaminergic neurons and the formation of alpha-synuclein-containing Lewy bodies in the substantia nigra. Currently, the main therapeutic method for PD is anti-Parkinson medications, including levodopa, madopar, sirelin, and so on. However, the effect of pharmacological treatment has its own limitations, the most significant of which is that the therapeutic effect of dopaminergic treatments gradually diminishes with time. Exercise training, as an adjunctive treatment and complementary therapy, can improve the plasticity of cortical striatum and increase the release of dopamine. Exercise training has been proven to effectively improve motor disorders (including balance, gait, risk of falls and physical function) and nonmotor disorders (such as sleep impairments, cognitive function and quality of life) in PD patients. In recent years, various types of exercise training have been used to treat PD. In this review, we summarise the exercise therapy mechanisms and the protective effects of different types of exercise training on PD patients.

17ß­Estradiol protects against interleukin­1ß­induced apoptosis in rat nucleus pulposus cells via the mTOR/caspase­3 pathway.

Intervertebral disc degeneration (IVDD) is the main pathological basis of spinal degenerative diseases, and aberrant apoptosis of nucleus pulposus cells (NPCs) is the main cellular process that causes IVDD. In our previous studies, 17ß­estradiol (E2) was demonstrated to protect rat NPCs from interleukin­1ß (IL­1ß)­induced apoptosis via the PI3K/Akt signaling pathway. However, the downstream signaling pathway of PI3K/Akt is currently unclear. The present study aimed to explore the signaling pathways that are downstream of the PI3K/Akt pathway, including mTOR, NF­κB and glycogen synthase kinase­3ß (GSK­3ß). Annexin V/propidium iodide double staining was used to determine the incidence of apoptosis. Cell Counting kit­8 and MTS assays were used to determine the proliferation and viability of NPCs, respectively. Cellular binding was evaluated using a cell­collagen binding assay. Western blotting was used to determine the protein expression levels of mTOR, NF­κB and GSK­3ß, and their phosphorylation levels, as well as the expression levels of active caspase­3. The results revealed that IL­1ß induced NPC apoptosis and increased the early apoptotic rate of NPCs. However, E2 reduced the early apoptosis of NPCs induced by IL­1ß. In addition, E2 suppressed the decrease in cell viability and binding ability caused by IL­1ß cytotoxicity. Western blotting revealed that E2 also reduced the expression of activated caspase­3, and increased the expression of activated mTOR. As a specific inhibitor of mTOR, rapamycin effectively attenuated the effects of E2. These findings indicated that E2 protected NPCs against apoptosis via activation of the mTOR/caspase­3 pathway.

The Relationship Between Autophagy and Brain Plasticity in Neurological Diseases.

Autophagy, a catabolic degradation system, is utilized for destroying and recycling the damaged or unnecessary cellular components. Brain plasticity refers to the remarkable characteristics of brain neurons that change their structure and function according to previous experience. This review was performed by searching the relevant articles in databases of SCIENCEDIRECT, PUBMED, and Web of Science, from respective inception to January 2019. Here, we review the neuroprotective effect of autophagy in neurological diseases and the mechanism of autophagy in brain plasticity. Moreover, the mechanism of autophagy in the process of brain plasticity can provide the possibility for the development of new treatment methods in the future, thus benefiting patients with neurological diseases. In summary, autophagy and brain plasticity play important roles in neurological diseases.

Analyses of effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL: a retrospective cohort study.

OBJECTIVES: This study aimed to investigate the effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL. METHODS: In this study, 194 patients, who underwent open-door laminoplasty for cervical OPLL from January 2009 to January 2016, were retrospectively reviewed. The Patient Satisfaction Index (PSI) was collected at discharge, 6 months, 1 year, and the last follow-up. According to the PSI, patients were divided into satisfied group and dissatisfied group. The possible effect factors included demographic variables and surgery-related variables. RESULTS: At discharge, 42 (21.6%) patients were in the dissatisfied group, as compared to the satisfied group, the hospitalization cost, hospital stay, postoperative depression, the axial neck pain, delayed wound healing, and VAS-neck had significant statistical differences. At 6-month follow-up, 25 (12.9%) patients were in the dissatisfied group. The axial neck pain and JOA score had significant statistical differences between the two groups, and no significant differences were found between the two groups in other items. At 1 year with 18 (9.3%) dissatisfied patients and last follow-up with 14 (7.2%) dissatisfied patients, the JOA score and symptom recurrence had significant statistical differences. For further analysis, the dissatisfied patients with axial neck pain at 6 months were significantly higher than that at other terms and the JOA score of the two groups increased gradually with prolonging of restoration years but compared with the dissatisfied group, the JOA scores were obviously better in the satisfied group at the last follow-up. CONCLUSIONS: Overall, to patients undergoing open-door laminoplasty for cervical OPLL, hospitalization cost and neck pain might be mainly associated with patient dissatisfaction at the early and middle recovery. Patient dissatisfaction at the long-term treatment outcome might be mainly associated with the low improvement rate of JOA score and symptom recurrence.

Prevalence and risk factors of axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery.

OBJECTIVES: The aim of this study was to explore the prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery. METHODS: In this study, 88 patients, who underwent multilevel anterior cervical decompression with fusion surgery from January 2012 to January 2017, were retrospectively reviewed. Based on the postoperative axial neck pain, the patients were classified into two groups: axial pain group and no axial pain group. The patients were followed up 3 weeks, 3 months, and 1 year after cervical anterior surgery for the early- and long-term clinical evaluation. The possible effect factors included demographic variables (age, sex, BMI, smoking, drinking, heart disease, hypertension, diabetes, preoperative kyphosis, preoperative axial neck pain, preoperative JOA scores, and ODI) and surgery-related variables (surgical option, vertebral lesions, spinal canal stenosis rate, superior fusion segment, presence of intramedullary high signal intensity). RESULTS: The prevalence of axial neck pain was 27.3% (24 cases of 88). Our results showed that preoperative axial neck pain (62% vs 23%, P < 0.001) and preoperative kyphosis (42% vs 21.9%, P < 0.001) were risk factors for axial pain after multilevel anterior cervical surgery. Additionally, for patients with preoperative cervical kyphosis, compared to no axial pain group, the axial neck group was significantly more likely to exist a higher preoperative angle of C2-7 (13.31 ± 2.33 vs 7.33 ± 2.56, P < 0.001) and a higher correction range for kyphosis (20.24 ± 4.12 vs 12.34 ± 3.12, P < 0.001). However, for all the patients with postoperative axial symptoms, the improvement rate of axial pain was significantly higher for patients without cervical kyphosis at the early-term follow-up (3 weeks) (P = 0.032), no significant differences were found at the medium-term (P = 0.554) and long-term follow-up (P = 0.902), and improvements of clinical symptom have no obvious difference at the last follow-up. CONCLUSIONS: Overall, preoperative axial neck pain and kyphosis could predict axial neck pain for patients undergoing multilevel anterior cervical decompression with fusion surgery, and recovery of cervical kyphosis may contribute to the long-term recovery of neural function, but may also suffer from risk of short-term axial pain, which could be reduced through moderate cervical curvature recovery.

The beneficial roles of exercise training via autophagy in neurological diseases and possible mechanisms.

Autophagy is a conservative catabolism process, participating in delivering the cytosol and cytosolic components to the lysosome. Abnormal autophagy is related to human pathologies, for instance diabetes, neurodegeneration, cardiovascular, macular degeneration, pulmonary, and cancer. Enormous evidences indicate that autophagy may mediate the cellular pathological condition in the process of neurological diseases. Exercise as a form of physiological stress may cause an adaptation, and autophagy is a necessary process for adaptational response to exercise. Autophagy during exercise may improve neurological function, control tissue maintain tissue integrity, and activate different signals pathway for adaptation. In this review, we summarize the possible mechanisms of exercise training via autophagy in neurological diseases.

Risk Factors for Lower Limb Deep Vein Thrombosis in Patients With Single-Level Lumbar Fusion: A Prospective Study of 710 Cases.

Lower limb deep vein thrombosis (DVT) is not an uncommon postoperative complication of spinal fusion surgery. However, the related risk factors identified in previous studies remain controversial. This study aimed to investigate risk factors for lower limb DVT in patients with single-level lumbar fusion surgery. Between January 2010 and December 2016, a total of 710 patients undergoing lumbar fusion were recruited for this study, including 172 males and 538 females (aged 18-75 years). Deep vein thrombosis was detected by ultrasonography. Accordingly, patients were divided into the DVT group and the non-DVT group and compared in terms of operative data, underlying diseases, and biochemical data. Additionally, logistic regression analysis was performed to identify risk factors for lower limb DVT. The incidence of lower limb DVT was 11.8% (84 of 710 cases). Five patients were symptomatic, with lower limb pain and swelling. Two patients developed pulmonary embolism and 1 died. Binary logistic regression indicated that advanced age (P = .001, odds ratio [OR] = 2.86, 95% CI: 1.85-5.12), hypertension (P = .006, OR = 4.10, 95% CI: 1.09-2.30), and increased d-dimer (P < .001, OR = 3.49, 95% CI: 2.05-6.36) were risk factors for postoperative DVT. In conclusion, for patients with single-level lumbar fusion, advanced age, increased d-dimer, and hypertension may contribute to DVT development after spinal fusion surgery. Therefore, patients with these risk factors should be protected during the perioperative period.

Electroacupuncture Alleviated Neuronal Apoptosis Following Ischemic Stroke in Rats via Midkine and ERK/JNK/p38 Signaling Pathway.

This study aimed to evaluate the effects of electroacupuncture (EA) intervention administered at rats of middle cerebral artery occlusion (MCAO)/reperfusion. Fifty-four male Sprague-Dawley rats were divided into three groups, consisting of sham group, MCAO/R group, and EA group. EA treatment at Quchi and Zusanli acupoints was applied in rats of EA group at 24 h after MCAO once per day for 3 days. Our results indicated that EA treatment reduced infarct volumes and neurological deficits, as well alleviated the apoptotic cells in peri-infarct cortex, indicating that EA exerted neuroprotective effect in cerebral ischemic rats. Moreover, EA treatment may effectively reverse the upregulation of caspase-3 and Bim and alleviate the inhibition of Bcl-2 following 72-h ischemic stroke. EA may significantly reverse the promoted relative density level of p-ERK1/2, p-JNK, and p-p38 in the EA group compared with the MCAO/R group. In addition, the growth factor midkine (MK) was upregulated at 72 h after MCAO/R, and EA treatment may significantly prompt expression of MK. Our study demonstrated that EA exerted neuroprotective effect against neuronal apoptosis and the mechanism might involve in upregulation of MK and mediation of ERK/JNK/p38 signal pathway.

17ß-Estradiol inhibits intervertebral disc degeneration by down-regulating MMP-3 and MMP-13 and up-regulating type II collagen in a rat model.

OBJECTIVES: This study was aimed to further explore whether estradiol (E2) had protective effects on intervertebral disc degeneration (IVDD) in a rat model. MATERIAL/METHODS: Forty, three-month-old female Sprague Dawley (SD) rats were randomly divided into four groups: Sham, Ovariectomy (OVX), E2 and ICI182780 (ICI). Sham group only underwent the resection of a bit fat; OVX group underwent bilateral ovariectomy; E2 group was treated with E2 based on OVX; ICI group was treated with E2 and pretreated ICI182780 (inhibitor of the estrogen receptor) based on OVX. Radiography, hematoxylin and eosin (HE) staining, immunohistochemistry (IHC), western blot and quantitative real-time PCR (qRT-PCR) were applied to detect the apoptosis characteristics of intervertebral disc cells. RESULTS: Radiographs showed marked intervertebral disc narrowing and HE staining showed typical apoptosis characteristics of intervertebral disc cells in OVX, which were reversed by E2. Furthermore, the results of IHC, Western blot and qRT-PCR revealed that OVX-induced IVDD was protected by E2 through decreasing the expression of caspase-3 and intracellular matrix metalloproteinases (MMPs), including MMP-3 and MMP-13, while increasing the expression of collagen Type II. All of the detected effects of E2 were abolished after treatment with ICI182780. CONCLUSION: 17ß-E2 inhibits IVDD by down-regulating MMP-3 and MMP-13 and up-regulating collagen Type II in a rat model.

The beneficial role of early exercise training following stroke and possible mechanisms.

Exercise training is a regular therapy for stroke patients in clinic. However, whether the early exercise is beneficial for stroke patients is still controversial. The review was performed in databases of OVID, PUBMED, and ISI Web of Science, from respective inception to December 2017. In this review, we summarize the effect of different exercise intensity, initiation time, and style on ischemic stroke. Moreover, the possible mechanism is also discussed. The conclusion is that the voluntary exercise is better in promoting the functional recovery following stroke compared to forced exercise; too early initiated exercise might play a harmful role following stroke, while early initiated exercise might exert benefits after stroke; mild and moderate intensity exercise training could generate better neuroprotection in comparison with high intensity exercise training; early excise training could regulate the process of brain edema, cell apoptosis, oxidative damage, stem cells and other mechanisms in order to exert neuroprotection for brain.

Cauda Equina Syndrome Due to Vigorous Back Massage With Spinal Manipulation in a Patient With Pre-Existing Lumbar Disc Herniation: A Case Report and Literature Review.

Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4-5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.

Analysis of clinical and neurological outcomes in patients with cauda equina syndrome caused by acute lumbar disc herniation: a retrospective-prospective study.

OBJECTIVES: In this research we analyzed the results of surgical treatment of cauda equina syndrome (CES) caused by acute lumbar disc herniation. We emphasize the early treatment for good neurological recovery. METHODS: A retrospective-prospective, non randomized, clinical study was performed between Jan 2010 and Dec 2014. We retrospectively collected medical records of 18 patients who suffered from CES due to acute lumbar disc herniation and followed up them regularly. Visual analogue scale (VAS) score, lumbar JOA score (29 points), RR (recovery rate) and Oswestry disability index (ODI) questionnaire were used to evaluate clinical outcomes. RESULTS: All patients were followed up for at least two years. Lumbar disc herniation is located at L2-3 level in 2 cases, L3-4 level in 2 cases, L4-5 level in 9 cases, L5-S1 level in 5 cases. VAS score is 6±2.5 preoperatively and 1.5±1.0 postoperatively at last follow-up (P<0.001). JOA score is 5±3.5 preoperatively, while it is 20±7 postoperatively at last follow-up (P<0.001). RR ≥ 50% was found in 12 cases. ODI is 75%±25% preoperatively, while it becomes 28%±16% postoperatively at last follow-up (P<0.001). It also shows that advanced age (≥45 years) may act as a risk factor for poor RR(<50%), while early operation (duration before surgery, <48 h) proves to be a protective factor. CONCLUSIONS: Early operations are mandatory and closely relevant to final outcomes for CES patients. However, elder patients are more likely to have poor clinical effect after surgery.

Anterior cervical discectomy and fusion surgery versus total disc replacement: A comparative study with minimum of 10-year follow-up.

Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58-4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05-3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26-0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.

Risk Factors Associated with Adjacent Vertebral Compression Fracture Following Percutaneous Vertebroplasty After Menopause: A Retrospective Study.

BACKGROUND Clinically, percutaneous vertebroplasty (PVP) is frequently applied to treat osteoporotic vertebral compression fracture (OVCF). It is believed that new compression fractures are more likely to occur adjacent to the PVP-treated segment, typically within 1 month after PVP. The purpose of this study was to investigate risk factors for adjacent vertebral compression fractures (AVCF) after PVP in patients with OVCF after menopause. MATERIAL AND METHODS Between Jun 2012 and Dec 2016, 412 patients were initially identified. We enrolled 390 patients in this study, and 22 were lost to follow-up. The medical records of the patients were retrospectively collected. Patients were followed up for at least 6 months, with an average follow-up period of 18 months. The potential risk factors investigated in this study included age, duration of menopause (DoM), preoperative vertebral compression, number of preoperative vertebral fractures (NPVF), bone mineral density (BMD), surgical approach (unilateral or bilateral), anesthesia methods, bone cement dose, complications (including COPD), and anti-osteoporosis treatment. Logistic regression analysis was used to determine the risk factors. RESULTS Sixty-eight patients were observed to have suffered from AVCF after PVP at the last follow-up. Univariate analysis showed that age, DoM, NPVF, BMD, COPD, and anti-osteoporosis treatment were the potential variables associated with the onset of AVCF (all P<0.05). Binary logistic regression analysis showed that the logistic regression equation was as follows: logit P=-3.10-1.07×X2+0.99×X3+2.15×X4 (where X2=BMD; X3=DoM; X4=NPVF), and "logit P" stands for the likelihood of developing an AVCF following PVP. CONCLUSIONS A long duration of menopause and preoperative multi-level vertebral fractures were the risk factors for AVCF in patients following PVP after menopause, while a high-level BMD acted in a protective role for AVCF development.

Protective role of 17ß-estradiol on tumor necrosis factor-α-induced apoptosis in human nucleus pulposus cells.

The molecular mechanisms underlying protection and pathogenesis in spinal degenerative diseases remain unclear. Tumor necrosis factor-α (TNF-α) has been demonstrated to induce apoptosis of inte rvertebral disc (IVD) cells during IVD degeneration, and 17ß­estradiol (17ß­E2) has a protective effect against IVD cell apoptosis. However, the underlying molecular mechanism by which 17ß­E2 protects nucleus pulposus (NP) cells remains to be investigated. The aim of the present study was to evaluate whether 17ß­E2 modulates apoptosis of human NP cells induced by TNF­α. In addition, the concentration­response effect of 17ß­E2 on human NP cells was investigated. Human NP cells were cultured in complete medium, which was replaced every three days until the culture was ~80% confluent. Cells were treated with 100 ng/ml TNF­α for 48 h, with or without pretreatment with various concentrations of 17ß­E2, and ICI 182,780, for 30 min. Morphologic alterations characteristic of apoptosis were observed by inverted phase­contrast microscopy and Hoechst 33258 staining; the apoptosis rate was analyzed by flow cytometry. A Cell Counting kit­8 assay was used to assess cell proliferation. Furthermore, caspase­3 activity was determined and proteins associated with apoptosis were analyzed by western blotting. The level of apoptosis and caspase­3 activity in human NP cells increased, whereas proliferation and the expression of poly ADP­ribose polymerase decreased following TNF­α treatment. These effects of TNF­α were abolished by pretreatment with 17ß­E2 in a concentration­dependent manner. The results of the present study indicated that 17ß­E2 serves a critical role in the survival of degenerative human NP cells.

Unilateral versus bilateral pedicle screw fixation with posterior lumbar interbody fusion for lumbar degenerative diseases: A meta-analysis.

BACKGROUND: Both unilateral pedicle screw fixation with posterior lumbar interbody fusion (PLIF) and bilateral pedicle screw fixation with PLIF are used to treat lumbar degenerative diseases (LDD). However, which one is a better treatment for LDD remains considerable controversy. Therefore, the focus of this meta-analysis was to assess the merits and shortcomings of efficacy of these 2 surgical procedures for LDD. METHODS: An extensive search of literature was performed in Pubmed/MEDLINE, Embase, CNKI, and WANFANG databases on unilateral versus bilateral pedicle screw fixation with PLIF fusion for LDD, from January 2007 to January 2017 and language was restricted to Chinese or English. The following variables were extracted: blood loss, operation time, length of hospital stay, Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) and Oswestry disability index (ODI) scores, fusion rate, total complications, infection, dural injury, and nerve injury. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS: A total of 11 studies containing 844 patients were included in our study. The results showed that unilateral is better than bilateral pedicle screw fixation with PLIF in blood loss (P < .00001), operation time (P < .00001), the length of hospital stay (P = .003), and the final follow-up ODI scores (P = .04). However, there are no significant differences in JOA, VAS, and preoperative ODI scores. There are also no significant differences in fusion rate and complications (all P > .05). CONCLUSION: Based on our meta-analysis, our results suggest that both unilateral pedicle screw fixation with PLIF and bilateral pedicle screw fixation with PLIF for LDD have effective results in clinical outcomes. Both 2 methods may result in clinical improvement and similar outcomes of fusion rate and complications; However, compared with bilateral fixation, unilateral fixation produces more satisfactory efficacy in the blood loss and the operation time.

Risk factors for dysphagia after anterior cervical spine surgery: A meta-analysis.

BACKGROUND: Dysphagia is a well-known complication following anterior cervical spine surgery. Although risk factors for dysphagia have been reported in the literature, they still remain controversial. This study aims to investigate the risk factors associated with dysphagia following anterior cervical spinal surgery. METHODS: PubMed, EMBASE, and The Cochrane Library were searched up to June 2016 for studies examining dysphagia following anterior cervical spinal surgery. Risk factors associated with dysphagia were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for outcomes. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS: The final analysis includes a total of 18 distinct studies. The pooled analysis reveals that there are significant differences in female gender (OR = 2.30, 95% CI: 1.76-2.99, P < 0.001), the use of anterior cervical plate (OR = 1.66, 95% CI: 1.05-2.62, P = 0.03), more than 1 surgical level (OR = 2.07, 95% CI: 1.62-2.66, P < 0.001), the upper surgical level at C3/4 (OR = 3.08, 95% CI: 1.44-6.55, P = 0.004), and the use of bone morphogenetic protein-2 (rhBMP-2) (OR = 5.52, 95% CI: 2.16-14.10, P < 0.001). However, no significant difference is found in revision surgery (OR = 1.67, 95% CI: 0.60-4.68, P = 0.33), the type of fusion (OR = 1.02, 95% CI: 0.62-1.67, P = 0.95), and cervical disc arthroplasty (OR = 1.37, 95% CI: 0.75-2.51, P = 0.30). CONCLUSION: Female gender, the use of anterior cervical plate, more than 1 surgical level, the upper surgical level at C3/4, and the use of rhBMP-2 are the risk factors for dysphagia following anterior cervical spinal surgery. However, revision surgery, the type of fusion, and cervical disc arthroplasty are unassociated with dysphagia. Considering the limited number of studies, this conclusion should be interpreted cautiously, and larger scale studies are required.

The Treatment Evaluation for Osteoporotic Kummell Disease by Modified Posterior Vertebral Column Resection: Minimum of One-Year Follow-Up.

BACKGROUND The aim of this study was to evaluate the clinical efficacy of modified posterior vertebral column resection (MPVCR) in treating osteoporotic Kummell disease. MATERIAL AND METHODS Between January 2013 and January 2015, 10 patients who were diagnosed with Kummell disease underwent MPVCR treatment, and their medical records were retrospectively collected. Every patient had follow-up for at least one year, with an average of 15 months. Clinical efficacy of MPVCR treatment was evaluated by kyphotic Cobb's angle, Oswestry disability index (ODI) and visual analogue scale (VAS) score. RESULTS Data analyses showed that operation time was 188.39±30.8 minutes, and blood loss was 860±130 mL with 600±200 mL of blood transfusions. VAS score decreased significantly after MPVCR surgery (p<0.001, Mann-Whitney U test). In addition, data analyses showed that postoperative ODI was less than preoperative ODI, which was a statistically significant difference (p<0.001, Mann-Whitney U test). X-ray radiograph showed that kyphotic Cobb's angle was 45°±12° preoperatively, 10°±4° two weeks after surgery, and 15°±6° at last follow-up, indicating that Cobb's angle after MPVCR surgery was significantly improved, compared to the preoperative scores (p<0.05, SNK-q test). CONCLUSIONS MPVCR surgery was an effective and safe surgical method to treat Kummell disease, especially for patients with kyphotic deformity and obvious nerve-oppressed symptoms. However, the long-term clinical effect still needs further studies.