Unilateral biportal endoscopic transforaminal lumbar interbody fusion versus conventional interbody fusion for the treatment of degenerative lumbar spine disease: a systematic review and meta-analysis.

BACKGROUND: This meta-analysis compares the efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) to conventional interbody fusion in lumbar degenerative diseases (LDD). METHODS: An extensive literature search was conducted in PubMed, Web of Science, and the Cochrane Library. Research related to UBE-TLIF published up to November 2022 was reviewed. The relevant articles were selected based on inclusion and exclusion criteria, as well as an evaluation of the quality of the data extraction literature. Meta-analysis was performed using Review Manager 5.3 software. RESULTS: This meta-analysis included six high-quality case-control trials (CCTs) involving 621 subjects. The clinical outcomes assessment showed no statistical differences in complication rates, fusion rates, leg pain VAS scores, or ODI scores. After UBE-TLIF, low back pain VAS scores were significantly improved with less intraoperative blood loss and a shorter hospital stay. A longer time was required for UBE-TLIF, however. CONCLUSION: Despite the lack of sufficient high quality randomized controlled trials (RCTs) in this study, the results of this meta-analysis suggest that UBE-TLIF is more effective than open surgery in terms of length of stay, blood loss reduction during surgery, and improved low back pain after surgery. Nevertheless, the evidence will be supplemented in the future by more and better quality multicenter randomized controlled trials.

Small molecule natural compound targets the NF-κB signaling and ameliorates the development of osteoarthritis.

Osteoarthritis (OA) is a multifactorial and chronic disease describing the destruction of cartilage that can lead to defects in the elderly. There is currently no practical strategy that can reverse the OA process. Here, we describe nepetin, a small natural compound with extracellular matrix (ECM) and inflammation regulating functions. In this study, we investigated the therapeutic effects of nepetin on interleukin-1ß (IL-1ß)-induced inflammation in mice chondrocyte and OA model. In chondrocytes, treatment with nepetin inhibited the overexpression of pro-inflammatory cytokines and mediators induced by IL-1ß. Moreover, pretreatment or posttreatment with nepetin also reduced the ECM catabolism and enhanced the ECM anabolism. Mechanistically, nepetin suppressed NF-κB signaling pathway in IL-1ß stimulated chondrocyte. Meanwhile, our molecular docking studies indicated nepetin had a powerful binding capacity to p65. Furthermore, nepetin showed a protective and therapeutic effect on the mouse OA model. To sum up, this study indicated nepetin had a new potential therapeutic option in OA.

Maslinic acid prevents IL-1ß-induced inflammatory response in osteoarthritis via PI3K/AKT/NF-κB pathways.

Osteoarthritis (OA) is a degenerative joint disease characterized by destruction of articular cartilage. The inflammatory response is the most important factor affecting the disease process. As interleukin-1ß (IL-1ß) stimulates several key mediators in the inflammatory response, it plays a major role in the pathogenesis of OA. Maslinic acid (MA) is a natural compound distributed in olive fruit. Previous studies have found that maslinic acid has an inhibitory effect on inflammation, but its specific role in the progression of OA disease has not been studied so far. In this study, we aim to assess the protective effect of MA on OA progression by in vitro and in vivo experiments. Our results indicate that, in IL-1ß-induced inflammatory response, MA is effective in attenuating some major inflammatory mediators such as nitric oxide (NO) and prostaglandin E2, and inhibits the expression of IL-6, inducible nitric oxide synthase, cyclooxygenase-2, and tumor necrosis factor-α (TNF-α) in a concentration-dependent manner. Also, MA downregulated the expression levels of thrombospondin motif 5 (ADAMTS5) and matrix metalloproteinase 13 in chondrocytes, resulting in reduced degradation of its extracellular matrix. Mechanistically, MA exhibits an anti-inflammatory effect by inactivating the PI3K/AKT/NF-κB pathway. In vivo, the protective effect of MA on OA development can be detected in a surgically induced mouse OA model. In summary, these findings suggest that MA can be used as a safe and effective potential OA therapeutic strategy.

Computed tomography morphometric analysis of C2 translaminar screw fixation of Wright's technique and a modified technique in the pediatric cervical spine.

PURPOSE: To establish reference data on the dimensions of C2 lamina to guide the use of translaminar screws with Wright's technique and a modified technique for pediatric patients in different age groups. METHODS: 113 pediatric patients were divided into six age groups, and their cervical vertebrae were studied on CT scans. Laminar height, width, length and screw angle were measured. Statistical analysis was performed using Student t tests, Pearson's correlation and linear regression analysis. RESULTS: Mean laminar height was 10.95 ± 2.81 mm, and mean width was 6.01 ± 0.90 mm. For Wright's technique, mean laminar length was 30.65 ± 3 mm, and the screw angle was 56.02° ± 3.62°. For the modified technique, mean laminar length was 22.07 ± 2.38 mm, and the screw angle was 67.40° ± 3.39°. 95.6% (108/113) of the children could insert a screw into the lamina (laminar width ≥ 4.5 mm), 72.6% (82/113) could accept bilateral translaminar screws (laminar width ≥ 4.5 mm and laminar height ≥ 9 mm). CONCLUSION: Our investigation provides insight into the anatomy of C2 lamina in six pediatric age groups. Compared to adults, the benefits of C2 translaminar screws fixation are more obvious in the pediatric spine which has a large C2 lamina. Compared to Wright's technique, the modified technique should insert a screw with bigger insert angle and shorter screw length.

Comparing Augmentative Plating and Exchange Nailing for the Treatment of Nonunion of Femoral Shaft Fracture after Intramedullary Nailing: A Meta-analysis.

OBJECTIVE: The aim of this meta-analysis was to systematically evaluate the efficacy of augmentative plating (AP) and exchange nailing (EN) in the treatment of nonunion of femoral shaft fracture. METHODS: For the present meta-analysis, PubMed, EMBASE, and the Cochrane Library were searched to identify relevant articles up to April 2019. Two investigators independently evaluated the quality of original publications following the guidelines proposed by the Cochrane Handbook. Data were extracted from the studies and analyzed using Review Manager 5.3. RESULTS: Five studies were included in this meta-analysis, with a total of 506 patients. There were 232 patients in the AP group and 276 patients in the EN group. The AP group was associated with higher union rate (OR, 11.66; 95% CI, 4.31-31.50; P < 0.01), shorter union time (SMD, -1.10; 95% CI, -2.09 to -0.11; P = 0.03), shorter operation time (SMD, -0.55; 95% CI, -0.88 to -0.21; P < 0.01), less blood loss (SMD, -1.72; 95% CI, -3.33 to -0.11; P < 0.01), and fewer complications (OR, -0.11; 95% CI, -0.16 to -0.07; P < 0.01) than the EN group. CONCLUSION: The results of the meta-analysis showed that AP is found to be superior for nonunion of femoral shaft fractures in both intraoperatively (ie, shorter operation time and less blood loss) and postoperatively (ie, higher union rate, shorter union time, and lower complication rate). Overall, AP was superior to EN in the treatment of nonunion of femoral shaft fractures after intramedullary nailing (IMN).

Activation of AKT signaling via small molecule natural compound prevents against osteoblast apoptosis and osteonecrosis of the femoral head.

Vinpocetine (Vinp), a natural compound extracted from the leaves of Phyllostachys pubescens with apoptosis modulatory properties in variety of disorders. In the present study, we investigated the possible mechanism of Vinp in alleviating of the progress of osteonecrosis of the femoral head (ONFH) both in vitro and in vivo experiments. The results showed that treatment with Vinp suppressed the dexamethasone (Dex) induced over-regulation of ROS level and apoptotic factors. Mechanistically, the Vinp activated Akt signaling pathway in osteoblast. Moreover, Vinp exerted a protective role in animal ONFH model. To summarize, this work illustrated Vinp possessed a new potential therapeutic drug in ONFH.

Hederacoside-C protects against AGEs-induced ECM degradation in mice chondrocytes.

Hederacoside-C (HDC), a natural compound extracted from the leaves of Hedera helix with inflammation modulatory properties in variety of disorders. In this study, we investigated the latent mechanism of HDC in alleviating of the progress of OA in vitro experiment. The results showed that HDC pretreatment suppressed the advanced glycation end-products (AGEs) induced over-regulation of ROS level and inflammatory factors. Moreover, HDC also downregulate the degradation of ECM induced by AGEs. Mechanistically, the HDC suppressed NF-κB signaling pathway in chondrocyte. To sum up, this study indicated HDC possessed a new potential therapeutic option in osteoarthritis.

A Computed Tomographic Morphometric Study of the Pediatric Occipital Bone Thickness: Implications for Pediatric Occipitocervical Fusion.

STUDY DESIGN: This study is a computed tomographic-based morphometric analysis of the pediatric occipital bones as related to pediatric occipitocervical fusion. OBJECTIVE: To quantify reference data concerning the thicknesses of the immature occipital bones to guide the pediatric occipitocervical fusion. SUMMARY OF BACKGROUND DATA: To the best of our knowledge, no published study has provided insight into the thicknesses of pediatric occiputs with different age groups. METHODS: 80 pediatric patients were divided into 4 age groups, and their occiputs were studied on Philips Brilliance 256 iCT scan. RESULTS: The mean thickness ± standard deviations of the pediatric occipital bones with different age groups is shown. The median and the paramedian regions are always thicker than the more lateral regions at each age group and the thickest point in the occiputs is mostly at the external occipital protuberance. The mean thickness of occiputs showed an obvious significant difference between each 2 age groups and no significant difference between male and female in different age groups except the group 4. CONCLUSION: Our investigation provides insight into the anatomy of occiputs in pediatric population and preoperative CT evaluation must be required to further decrease the risk of occipitocervical fusion.

Computed tomographic morphometric analysis of the pediatric occipital condyle for occipital condyle screw placement.

STUDY DESIGN: This study is a computed tomographic (CT)-based morphometric analysis of the pediatric occipital condyles as related to occipital condyle screw placement. OBJECTIVE: To quantify reference data concerning the dimensions of the immature occipital condyles to guide the placement of occipital condyle screw. SUMMARY OF BACKGROUND DATA: To the best of our knowledge, no published study has provided insight into the anatomy of occipital condyle of the pediatric population with different age groups. METHODS: Sixty-nine pediatric patients were divided into 4 age groups, and their occipital condyles were studied on CT scans. Condylar length, width, height, sagittal angle, and sagittal angle lengths were measured on Philips Brilliance 16 CT. RESULTS: The mean pediatric coronal height, sagittal length, and axial width noted statistically significant age-related differences were 9.0 mm, 21.3 mm, and 9.8 mm, respectively. The mean sagittal angle for all patients was 27.2 ± 5.1° (range, 15.1-41.0°). In 82.6% (114/138) of the occipital condyles, the anatomy could accept the occipital condyle screw (width ≥8 mm and height ≥6.5 mm). CONCLUSION: Our investigation provides insight into the anatomy of occipital condyle of the pediatric population with different age groups. As the pediatric occipital condyles have sufficient occipital bone for appropriate fixation or fusion, the occipital condyle screws fixation is a feasible technique for children. Even so, given the evolution of this technique being still in its infancy and the complexity inherent to the craniovertebral junction, a careful radiological analysis of occipital condyle must be required in preoperative planning and feasibility determination. LEVEL OF EVIDENCE: N/A.