Incidence and risk factors of lateral cage migration occurred after the first-stage lateral lumbar interbody fusion surgery.

BACKGROUND: Lateral lumbar interbody fusion (LLIF) is a novel, minimally invasive technique for the surgical treatment of lumbar diseases. The aim of this study was to identify the incidence and risk factors of lateral cage migration (LCM) occurred after the first-stage LLIF. HYPOTHESIS: The hypothesis was that LCM occurred after the first-stage LLIF was associated with some demographic characteristics, surgical variables and radiographic parameters. PATIENTS AND METHODS: Between June 2016 and August 2020, 335 patients (901 levels) underwent staged LLIF were retrospectively reviewed. Patients were classified into LCM and non-LCM group based on the experience of LCM before the second-stage posterior instrumentation. 100 patients in non-LCM were randomly sampled as a control group. Incidence of LCM was determined; demographic characteristics, surgical variables and radiographic parameters associated with LCM were compared between the LCM and control group. Univariate analyses and multivariable logistic regression analysis were used to identify the risk factors. RESULTS: LCM occurred after the first-stage LLIF was found in 19 (5.7%) patients. Bony endplate injury (OR, 106.255; 95% CI, 1.265-8924.765; p=0.039) and greater preoperative range of motion (ROM) (OR, 2.083, 95% CI, 1.068-4.066, p=0.031) were high risk factors for LCM. LCM occurred mainly 3 days later after the first-stage LLIF, while 4 cases experienced severe neural symptoms, intolerable low back pain and finally underwent reoperation. DISCUSSION: LCM occurred after the first-stage LLIF was significantly associated with bony endplate injury and greater preoperative ROM. Second-stage posterior fixation should be performed as soon as possible or a supplement lateral fixation/self-locking cage should be used in high-risk patients. LEVEL OF EVIDENCE: IV.

DUSP19 mediates spinal cord injury-induced apoptosis and inflammation in mouse primary microglia cells via the NF-kB signaling pathway.

Objective: Spinal cord injury (SCI) is a common injury that seriously threatens human health. NF-κB may be involved in the secondary injury of SCI that is mediated by inflammation and aggravates damage. Our study was aimed to investigate the role of NF-κB signaling in DUSP19-mediated cleaved Caspase-3 expression and the release of inflammatory factors in vivo and in vitro.Materials and Methods: DUSP19 mRNA expression and the content of IL-6 and IL-8 in patients with traumatic SCI (TSCI) were measured by real-time PCR and ELISA, respectively. The levels of p-NF-κBp65, NF-κBp65 and cleaved Caspase-3 expression and the concentrations of IL-6 and IL-8 were measured by western blotting and ELISA, respectively.Results: Patients with TSCI showed lower DUSP19 expression and higher concentration of IL-6 and IL-8 compared with healthy controls. DUSP19 overexpression inhibited p-NF-κBp65 level, cleaved Caspase-3 expression, and production of IL-8 and IL-6 in the mice induced by TSCI. DUSP19 silencing increased p-NF-κBp65 level, cleaved Caspase-3 expression, and concentration of IL-6 and IL-8 in mouse primary microglia cells. DUSP19 overexpression had an inverse effect. Importantly, DUSP19 silencing and overexpression mediated p-NF-κBp65 level, cleaved Caspase-3 expression, and concentration of IL-6 and IL-8 in mouse primary microglia cells were reversed by NF-κB inhibitor pyrrolidine dithiocarbamate (PDTC) and NF-κB activator 12-myristate 13-acetate (PMA), respectively.Conclusion: These results suggested that DUSP19-mediated SCI-induced apoptosis and inflammation via NF-κB signaling and might therefore serve as a potential therapeutic target for SCI.

Computer Simulation of Two-level Pedicle Subtraction Osteotomy for Severe Thoracolumbar Kyphosis in Ankylosing Spondylitis.

BACKGROUND: Advanced ankylosing spondylitis is often associated with thoracolumbar kyphosis, resulting in an abnormal spinopelvic balance and pelvic morphology. Different osteotomy techniques have been used to correct AS deformities, unfortunnaly, not all AS patients can gain spinal sagittal balance and good horizontal vision after osteotomy. MATERIALS AND METHODS: Fourteen consecutive AS patients with severe thoracolumbar kyphosis who were treated with two-level PSO were studied retrospectively. All were male with a mean age of 34.9 ± 9.6 years. The followup ranged from 1-5 years. Preoperative computer simulations using the Surgimap Spinal software were performed for all patients, and the osteotomy level and angle determined from the computer simulation were used surgically. Spinal sagittal parameters were measured preoperatively, after the computer simulation, and postoperatively and included thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence, pelvic tilt (PT), and sacral slope (SS). The level of correlation between the computer simulation and postoperative parameters was evaluated, and the differences between preoperative and postoperative parameters were compared. The visual analog scale (VAS) for back pain and clinical outcome was also assessed. RESULTS: Six cases underwent PSO at L1 and L3, five cases at L2 and T12, and three cases at L3 and T12. TK was corrected from 57.8 ± 15.2° preoperatively to 45.3 ± 7.7° postoperatively (P < 0.05), LL from 9.3 ± 17.5° to -52.3 ± 3.9° (P < 0.001), SVA from 154.5 ± 36.7 to 37.8 ± 8.4 mm (P < 0.001), PT from 43.3 ± 6.1° to 18.0 ± 0.9° (P < 0.001), and SS from 0.8 ± 7.0° to 26.5 ± 10.6° (P < 0.001). The LL, VAS, and PT of the simulated two-level PSO were highly consistent with, or almost the same as, the postoperative parameters. The correlations between the computer simulations and postoperative parameters were significant. The VAS decreased significantly from 6.1 ± 1.9 to 2.0 ± 1.1 (P < 0.001). In terms of clinical outcome, 10 cases were graded "excellent" and 4 cases were graded "good." CONCLUSION: Two-level PSO using a preoperative computer simulation is a feasible, safe, and effective technique for the treatment of severe thoracolumbar kyphosis in AS patients with normal cervical motion.