Normal spinopelvic parameters and correlation analysis in 217 asymptomatic children.

BACKGROUND: Understanding spinal sagittal balance is crucial for assessing and treating spinal deformities in pediatric populations. OBJECTIVE: The aim of the present observational study is to examine the parameters of sagittal alignment of the regional spine and spinopelvic region in asymptomatic pediatric populations and the characteristics of these parameters with age and sex. METHODS: We enrolled 217 participants, consisting of 112 males (51.6%) and 105 females (48.4%), aged between 4 and 15 years, with an average age of 12.19 years. Pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, T1 slope, C7 slope, cervical sagittal vertical axis, and C2-7 Cobb angle were measured. Three spine surgeons conducted radiographic measurements utilizing the PACS software. The measurement reliability was assessed through ICCs. RESULTS: Our results show significant age-related changes in pelvic tilt and cervical sagittal vertical axis, with notable gender differences in pelvic tilt, lumbar lordosis, and thoracic kyphosis. Girls have larger PT, boys have larger cSVA. PI, PT, and cSVA also differ among different age groups. Correlation analysis shows that a series of relationships that align with adult population patterns between pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, and thoracic kyphosis. CONCLUSION: Significant variations in PT and cSVA across diverse age cohorts highlights notable disparities in the distribution of PT and cSVA values within the pediatric population. Gender-based differences in PT, LL, and TK and correlation in spinopelvic parameter could enhances our understanding of compensatory mechanisms.

Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation.

PURPOSE: This study aimed to evaluate the clinical outcomes of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) in the treatment of symptomatic lumbar disc herniation (LDH). METHODS: From January 2020 and May 2021, 128 patients with single-level LDH at L4-5 or L5-S1 received FEFLD, UBE discectomy or MD. Patients were divided into three groups according to surgical method: the FEFLD group (n = 43), the UBE group (n = 42), and the MD group (n = 43). Operative time, fluoroscopy frequency, in-bed time, length of hospital stays, total expenses, complications, visual analogue scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among three groups. RESULTS: There were no significant differences in VAS or ODI scores at 12 months after surgery among three groups. In comparison with the MD group, the FEFLD and UBE group yield better VAS scores for back pain on the first day following surgery (P < 0.05). The FEFLD group was superior to the UBE group or MD group with less time in bed and shorter hospital stay (P < 0.05). The operation time and total expenses in the UBE group were significantly longer and higher than those in the FEFLD group or MD group (P < 0.05). CONCLUSIONS: FEFLD and UBE discectomy yield comparable results to conventional MD concerning pain relief and functional outcomes. In addition, FEFLD and UBE discectomy enable less back pain in the immediate postoperative period. FEFLD offers advantages in rapid recovery. Conventional MD is still an efficient and cost-effective surgical procedure.

Asymmetric distribution of Modic changes in patients with lumbar disc herniation.

PURPOSE: This study aims to report a new distribution pattern of Modic changes (MCs) in patients with lumbar disc herniation (LDH) and investigate the prevalence, correlative factors and clinical outcomes of asymmetric Modic changes (AMCs). METHODS: The study population consisted of 289 Chinese Han patients who were diagnosed with LDH and single-segment MCs from January 2017 to December 2019. Demographic, clinical and imagological information was collected. Lumbar MRI was performed to assess MCs and intervertebral discs. The visual analogue score (VAS) and Oswestry disability index (ODI) were evaluated in patients undergoing surgery preoperatively and at the final follow-up. Correlative factors contributing to AMCs were analysed by multivariate logistic regression. RESULTS: The study population included 197 patients with AMCs and 92 patients with symmetric Modic changes (SMCs). The incidence of leg pain (P < 0.001) and surgical treatment (P = 0.027) in the AMC group was higher than that in the SMC group. The VAS of low back pain was lower (P = 0.048), and the VAS of leg pain was higher (P = 0.036) in the AMC group than in the SMC group preoperatively. Multivariate logistic regression analysis revealed that leg pain (OR = 2.169, 95% CI = 1.218 ~ 3.864) and asymmetric LDH (OR = 7.342, 95% CI = 4.170 ~ 12.926) were independently associated with AMCs. The receiver operating characteristic curve showed an AUC of 0.765 (P < 0.001). CONCLUSION: AMCs were a more common phenomenon than SMCs in this study. The asymmetric and symmetric distribution of MCs was closely related to LDH position. AMCs were related to leg pain and higher pain levels. Surgery can achieve satisfactory clinical improvement for asymmetric and symmetric MCs.

Anemia was associated with multilevel lumbar disc degeneration in patients with low back pain: a single-center retrospective study.

PURPOSE: It has not been determined which factors were related to multilevel lumbar disc degeneration (MLDD). The objective of this study was to determine the prevalence of MLDD among symptomatic patients using the magnetic resonance imaging method. The study also aimed to clarify the associations between MLDD and suspected risk factors through a multivariate model. METHODS: A total of 530 young and middle-aged patients, suffered from low back pain were retrospectively assessed by 2 independent observers, who used sagittal T2-weighted MR imaging. Subjects were divided into two groups, MLDD group and non-MLDD group, according to the number of degenerated discs. Demographic and radiological data included age, gender, weight, height, body mass index, smoking status, alcohol drinking, lumbar lordosis, presence of hypertension (HT), diabetes mellitus and anemia. RESULTS: There were 309 men and 221 women with an average age of 37.5 ± 8.5 years. In general, 37.7% of patients were diagnosed with disc degeneration (DD) at more than two levels. Triple level DD was the most common pattern and was more prevalent in women (p <0.05). Using multivariate analyses, age (odds ratio [OR]: 1.14; 95% confidence interval [CI] 1.11-1.18; p <0.001), hypertension (OR: 2.67; 95% CI 1.38-5.16; p = 0.03) and anemia (OR: 3.84; 95% CI 2.03-7.28; p <0.001) were significantly associated with MLDD. CONCLUSION: Despite the young age of this cohort, MLDD is common among patients with low back pain. A significant independent association exists between age, HT, anemia and multilevel disc degeneration in the lumbar region.

Exosomes Derived from Bone Marrow Mesenchymal Stem Cells Prevent Acidic pH-Induced Damage in Human Nucleus Pulposus Cells.

BACKGROUND The exosomes (Exo) derived from mesenchymal stem cells (MSCs) are capable of attenuating the apoptosis of nucleus pulposus cells (NPCs) elicited by proinflammatory cytokines. However, it remains unknown whether MSC-derived Exo also exert a protective effect on NPCs in the pathological acid environment. MATERIAL AND METHODS NPCs were divided into 3 groups: Group A, pH 7.1-7.3; Group B, pH 6.5-6.7 and Group C, pH 5.9-6.1. The NPCs were cultured in the above-defined acidic medium, and 3 different amounts of Exo were added into the media. Finally, the expression of the caspase-3, aggrecan, collagen II, and MMP-13 was analyzed and compared among the different groups. RESULTS Compared with cells cultured at pH 7.1-7.3 (Group A), proliferation activity of NPCs cultured at pH 5.9-6.7 (Group B and C) decreased significantly. Collagen II and aggrecan expression was also obviously reduced with the decrease of cell proliferation. Conversely, the expression of caspase-3 and MMP-13 significantly increased. Further experiments showed that proliferation activity was significantly attenuated in NPCs cultured at pH 5.9-6.1 without Exo treatment (Group E) compared with those cultured at pH 7.1-7.3 without Exo treatment (Group D). CONCLUSIONS In the pathological acid environment, MSC-derived Exo promotes the expression of chondrocyte extracellular matrix, collagen II, and aggrecan, and reduces matrix degradation by downregulating matrix-degrading enzymes, protecting NPCs from acidic pH-induced apoptosis. This study reveals a promising strategy for treatment of IVD degeneration.

Predictors of Deterioration in Sagittal Balance Following Long Fusion Arthrodesis to L5 in Patients with Adult Scoliosis.

BACKGROUND The aim of this study was to identify the predictors of deterioration in sagittal balance in patients with adult scoliosis following long fusion arthrodesis to L5. MATERIAL AND METHODS A retrospective clinical study included 63 patients with adult scoliosis who underwent long fusion arthrodesis to L5, between February 2005 and May 2015. Radiological imaging values included the angle of lumbar lordosis (LL), and the angle of pelvic incidence (PI). The patients were divided into two cohorts, according to the threshold of average loss of sagittal vertical axis (SVA): a cohort with stable sagittal balance (SSB) and a cohort with deteriorated sagittal balance (DSB). Multivariate logistic regression analysis and the receiver operating characteristic (ROC) curve were used to identify the predictors of clinical outcome. RESULTS There were significant differences between the SSB and DSB cohorts in age (p<0.001), preoperative SVA (p<0.001), last follow-up SVA (p<0.001), preoperative LL (p=0.001), last follow-up LL (p<0.001), subsequent L5-S1 disc degeneration (p<0.001) and PI (p=0.028). Patient age >61.5 years (OR=1.251, 95% CI, 1.055-1.484) (P=0.010), preoperative SVA >3.54 cm (OR=1.844, 95% CI, 1.249-2.732) (P=0.002) and preoperative LL <19.0 degrees (OR=0.922, 95% CI, 0.869-0.979) (P=0.008) were identified as predictors of deterioration in sagittal balance. CONCLUSIONS Deterioration in sagittal balance following long fusion arthrodesis to L5 in patients with adult scoliosis was associated with subsequent L5-S1 disc degeneration and loss of LL, age >61.5 years, preoperative SVA >3.54 cm, and preoperative LL <19.0 degrees.

Predictors for Postoperative Loss of Lumbar Lordosis After Long Fusions Arthrodesis in Patients with Adult Scoliosis.

BACKGROUND Loss of lumbar lordosis (LL) is closely related to clinical symptoms and operative complications, however, few studies have identified its predictors. The purpose of our study was to identify the predictors for loss of LL in patients with adult scoliosis and provided evidence for surgical decision-making. MATERIAL AND METHODS There were 69 patients with adult scoliosis who underwent long fusions arthrodesis from January 2006 to March 2015 included in this retrospectively study. The patients were divided into two cohorts according the average loss of LL: cohort LL (loss of LL below the average) and cohort GL (loss of LL above the average). Multivariate logistic regression analysis and the receiver operating characteristic curve were used to identify the predictors. RESULTS There were statistically significant differences between the two cohorts in preoperative LL (p=0.002), postoperative LL (p=0.036), last follow-up LL (p<0.001), postoperative loss LL (p<0.001), preoperative SVA (p=0.007), last follow-up SVA (p=0.018), and pelvic incidence (p=0.016). Preoperative LL <23.5 (OR=0.920, 95% CI=0.870-0.973, p=0.003) and preoperative sagittal vertical axis >4.28 (OR=1.199, 95% CI=1.007-1.429, p=0.041) had good accuracy to predict postoperative loss of LL. CONCLUSIONS Loss of LL commonly occurred after long fusions arthrodesis in patients with adult scoliosis. Postoperative deteriorated sagittal balance was more frequently than deteriorated coronal balance. Preoperative LL <23.5 and preoperative SVA >4.28 were the predictors for postoperative greater loss of LL in patients after long fusions arthrodesis. More attention should be paid to how to maintain the LL in patients with preoperative predictors, especially if both the identified predictors are present.

Safe placement of pedicle screw in lumbar spine with minimum three year follow-up: a case series and technical note.

PURPOSE: This study aims to find a safe and easy-to-perform strategy for lumbar pedicle screw insertion based on anatomical landmarks. METHODS: From March 2011 to January 2012, 74 patients underwent posterior lumbar interbody fusion or transforaminal lumbar interbody fusion using the new-designed screw insertion technique. During the operation, the entry site for screw insertion was on the outer edge of the superior facet joint, 4 mm downward from upper border of processus transversus. A connecting line between superior and inferior facet joints was used to determine the direction of screw insertion. Postoperative radiograph and computed tomography (CT) were taken routinely to show the position of the screws. Functional outcomes were evaluated using Oswestry Disability Index score, Japanese Orthopedic Association score, and Visual Analogue Scale, respectively. RESULTS: Sixty-two patients (27 males and 35 females, average age 58.95 ± 8.45) finished the follow-up visit with an average of 46.03 months (36-60). The mean operation time and the blood loss were 169.60 ± 41.21 min and 489.52 ± 189.38 ml, respectively. A total of 274 pedicle screws were inserted following the new technique. According to Lothar Wiesner's classification, 11 screws (4.01%) caused minor violation into wall, two screws (0.73%) caused moderate violation, and other screws were in proper position. CONCLUSION: A new-designed surgical strategy for pedicle screw insertion of lumbar spine was introduced and performed, which featured a series of original and easily distinguished landmarks. Clinical application demonstrated the safety and effectiveness of this novel technique for pedicle screw insertion.

Clinical Predictors of Surgical Outcomes and Imaging Features in Single Segmental Cervical Spondylotic Myelopathy with Lower Cervical Instability.

BACKGROUND Cervical degenerative changes are the most common cause of cervical spondylotic myelopathy (CSM) and lower cervical instability (LCI). The purpose of this study was to investigate the associated factors of MRI signal changes and prognosis in single segmental CSM accompanied by LCI. MATERIAL AND METHODS A total of 122 patients met the inclusion criteria and were enrolled in this study with a minimum follow-up period of 2 years. According to the absence/presence of LCI, patients were divided into the unstable group (n=43 [35.2%]) and the stable group (n=79 [64.8%]). Clinical data and radiological parameters were compared between groups. RESULTS The occurrence rate of increased signal intensity (ISI) of the spinal cord was 72.1% in the unstable group and 44.3% in the stable group, and the difference was significant. There were significant differences in preoperative JOA score, duration of symptoms, and number of physical signs between the 2 groups (p<0.001, =0.001 and <0.001, respectively). The recovery rate of the JOA score in the unstable group was significantly lower than in the stable group (p<0.001). Long duration of symptoms, low preoperative JOA score, and more preoperative physical signs were significantly correlated with low JOA recovery rate. CONCLUSIONS Patients suffering from CSM with LCI have higher incidence of ISI of the spinal cord. Longer duration of symptoms, lower preoperative JOA score, and more preoperative physical signs were highly predictive of poor surgical outcomes for patients with single segmental CSM with LCI.

Do Modic changes affect cervical sagittal alignment and motion in symptomatic patients?

PURPOSE: The cervical segmental instability often occurs simultaneously with Modic changes (MCs). However, it is unknown whether there is a relation between the two diseases. The aim of this study was to evaluate the relationship between MCs and cervical segmental instability, cervical curvature and range of motion (ROM) in the cervical spine. METHODS: A total of 464 patients with neck pain or cervical neurologic symptoms who underwent imaging examination were analyzed retrospectively. Based on MRI imaging cervical MCs were diagnosed, and patients were divided into with or without MCs groups. The cervical curvature and range of motion were measured. We compared the incidence of cervical instability, cervical curvature and ROM between the two group patients and their relationships with MCs were studied. Logistic regression was used to study the risk factors associated with MCs. RESULTS: MCs were observed in 94 of 464 patients and 122 of total 2320 cervical segments and were most frequent at C5-6 segment. The incidence of the cervical instability was significantly higher in patients with MCs than those without MCs at cervical level C3-7. In addition, cervical curvature and ROM in patients with MCs were less than those without MCs. Logistic regression analysis showed that the occurrence of cervical spine instability, less cervical curvature and ROM were risk factors for MCs. CONCLUSIONS: Patients with MCs were prone to have cervical instability at the same cervical level and may have a higher possibility of less cervical curvature and ROM.

Safe placement of lateral mass screw in the subaxial cervical spine: a case series.

PURPOSE: Laminectomy with lateral mass screw fixation has been proven to be an effective method to treat the multilevel cervical degenerative myelopathy and severe cervical spondylosis. However, accurate and safe insertion of the lateral mass screw is technically demanding due to the individual variations of the anatomy of the lateral mass of the subaxial cervical spine. Misplaced lateral mass screw is not uncommon, and operation-related complications still beset the surgeons, which may impair the clinical outcomes. This study aimed to introduce a novel strategy for safe and accurate insertion of lateral mass screw in the subaxial cervical spine. METHODS: From July 2014 to March 2015, 24 patients with multilevel cervical degenerative myelopathy at C3-C6 levels received laminectomy. Before the operation, the screw insertion technique depended on the pre-operative imaging and operative exploration. Following this strategy, the lateral mass screws were inserted into the subaxial cervical spines. Post-operative radiograph was performed to observe the locations of the lateral mass screws and the cervical curvature. Patients were followed up, and the functional neurological recovery was evaluated by the modified Japanese Orthopedic Association (JOA) disability scale, the Neck Disability Index (NDI) and NDI ranking system. RESULTS: All screws were inserted into the lateral mass of C3-C6 cervical vertebrae following the current technique. Post-operative CT scans confirmed all screws inserted into the safe zone and relative safe zone of the lateral mass without any screw placed into the transverse foramen. The angle between the lateral mass screw and the vertical line was 40.49 ± 5.44 degrees on the axial CT images. Twenty-four patients were followed up for an average of 25.79 months (range, 20-30 months), and 22 cases evaluated as no or mild disability. According to the JOA score, NDI score and NDI ranking system, the postoperative function of the patients was significantly better when compared with their preoperative corresponding data (all p < 0.001) CONCLUSION: Inserting lateral mass screw following this new strategy is safe and easy to perform without any screw-related neurovascular complications, which contribute to the rigid fixation of the subaxial cervical spine and the satisfactory functional recovery.

Prospective Randomized Comparison of Knee Stability and Proprioception for Posterior Cruciate Ligament Reconstruction With Autograft, Hybrid Graft, and γ-Irradiated Allograft.

PURPOSE: To evaluate posterior stability and proprioception after arthroscopic posterior cruciate ligament reconstruction with autograft, hybrid graft, and γ-irradiated allograft. METHODS: This prospective, randomized controlled trial (with 5 years' follow-up) included 90 patients who underwent posterior cruciate ligament reconstruction with autograft (gracilis and semitendinosus tendons), hybrid graft (γ-irradiated tibialis anterior tendon allograft and semitendinosus tendon autograft), or γ-irradiated allograft (tibialis anterior tendons). All the γ-irradiated allografts (tibialis anterior tendons) received an irradiation dose of 2.5 Mrad before distribution. Patients in this study had undergone a preoperative magnetic resonance imaging scan and physical examination. Patients were excluded from the study if they had a concomitant injury to other knee ligaments, previous surgery on the injured knee, or articular cartilage lesions greater than Outerbridge grade II. Clinical and proprioceptive evaluation results were collected preoperatively and at 3, 6, 12, 24, 36, and 60 months after surgery. RESULTS: The autograft, allograft, and hybrid graft groups were followed up for 5.5 ± 0.2 months (range, 5 to 6 years), 5.7 ± 0.3 months (range, 5 to 6 years), and 5.6 ± 0.5 months (range, 5 to 6 years), respectively. No statistically significant differences were found among the 3 groups regarding preoperative demographic factors (P > .05). The differences in physical examination findings and subjective evaluations among the 3 groups were not significant (P > .05). However, a significant difference was detected in instrumented anteroposterior measurements, with more laxity shown in the γ-irradiated allograft group than in the other 2 groups (P = .006). CONCLUSIONS: The differences in proprioceptive and functional outcomes among the 3 groups were not significant. In contrast, a significant difference was detected in instrumented anteroposterior measurements, which showed more laxity in the γ-irradiated allograft group than in the other 2 groups. However, this may not be clinically significant. LEVEL OF EVIDENCE: Level II, prospective comparative study.

[Chemical constituents from the twigs and leaves of Harrisonia perforate].

This study was performed to investigate the chemical constituents in the twigs and leaves of Harrisonia perforate. Six compounds were isolated from the 95% EtOH extract of the twigs and leaves of Harrisonia perforate by silica gel, ODS, Sephadex LH-20 column chromatographies and preparative HPLC. On the basis of chemical properties and spectra data, these compounds were identified as harriperfin E (1), kihadanin A (2), kihadanin B (3), 6α-acetoxyobacunol acetate (4), gardaubryone C (5), and ß-sitosterol methyl ether (6), respectively. Compound 1 is a new chromone, and compounds 2-6 are isolated from this plant for the first time.

AP-1 is a regulatory transcription factor of inflammaging in the murine kidney and liver.

Aging is characterized by chronic low-grade inflammation in multiple tissues, also termed "inflammaging", which represents a significant risk factor for many aging-related chronic diseases. However, the mechanisms and regulatory networks underlying inflammaging across different tissues have not yet been fully elucidated. Here, we profiled the transcriptomes and epigenomes of the kidney and liver from young and aged mice and found that activation of the inflammatory response is a conserved signature in both tissues. Moreover, we revealed links between transcriptome changes and chromatin dynamics through integrative analysis and identified AP-1 and ETS family transcription factors (TFs) as potential regulators of inflammaging. Further in situ validation showed that c-JUN (a member of the AP-1 family) was mainly activated in aged renal and hepatic cells, while increased SPI1 (a member of the ETS family) was mostly induced by elevated infiltration of macrophages, indicating that these TFs have different mechanisms in inflammaging. Functional data demonstrated that genetic knockdown of Fos, a major member of the AP-1 family, significantly attenuated the inflammatory response in aged kidneys and livers. Taken together, our results revealed conserved signatures and regulatory TFs of inflammaging in the kidney and liver, providing novel targets for the development of anti-aging interventions.

Comparison of C2 dome-like laminectomy with C2 partial laminectomy for upper cervical ossification of the posterior longitudinal ligament.

Objective: To compare surgical outcomes of C2 dome-like laminectomy with C2 partial laminectomy in patients with ossification of the posterior longitudinal ligament (OPLL) up to the C2 level and above. Methods: 32 patients underwent surgical treatment for OPLL up to C2 and were divided into: C2 dome-like laminectomy group (C2-DOM group, n = 16) and C2 partial laminectomy group (C2-PL group, n = 16). The cervical curvature (CCI), dura width at C2/3, Japanese orthopedic association (JOA) score, recovery rate (RR), neck disability index (NDI) score, and visual analogue scale (VAS) score were evaluated and compared preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year, and annually thereafter. Results: The JOA score and NDI significantly improved at the final follow-up in both groups with no significant intergroup differences. There were no significant differences in preoperative dura width at C2/3 and VAS between the two groups. At the final follow-up, dura width at C2/3 in the C2-PL group was significantly larger than the C2-DOM group, while the VAS of C2-DOM group was significantly lower than C2-PL group. The CCI in both groups decreased compared with before surgery, and there was no significant difference in CCI between the two groups. Conclusion: C2-DOM is less demolitive and reduces postoperative neck pain, while C2-PL can achieve more adequate decompression without increasing the risk of postoperative cervical kyphosis.

Repair of cerebrospinal fluid leak during posterior thoracolumbar surgery using paraspinal muscle flap combined with fat graft.

Objective: This study aimed to propose a novel surgical method via combination of fat graft and paraspinal muscle flap, in order to treat cerebrospinal fluid (CSF) leak during posterior thoracolumbar surgery. The clinical outcomes were also evaluated. Methods: Data of a total of 71 patients who were diagnosed with intraoperative incidental durotomy and CSF leak after posterior thoracolumbar surgery in our hospital form January 2019 to January 2021 were retrospectively collected and analyzed. Among them, 34 and 37 patients were assigned into conventional suturing (CS) group and fat graft and paraspinal muscle flap (FPM) group, respectively. Patients' demographic and clinical data were compared between the two groups. Results: The average drainage tube time in the FPM group was 3.89 ± 1.17 days, which was shorter than that in the CS group (5.12 ± 1.56, P < 0.001). The drainage volume in the FPM group (281.08 ± 284.76 ml) was also smaller than that in the CS group (859.70 ± 553.11 ml, P < 0.001). Besides, 15 (44.11%) patients in the CS group complained of postural headache, which was more than that in the FPM group (7 patients, 18.91%). There was a statistically significant difference in postoperative visual analogue scale (VAS) score between the two groups (P = 0.013). Two patients underwent revision surgery resulting from incision nonunion and delayed meningeal cyst. Conclusion: Fat graft combined with paraspinal muscle flap showed to be an effective method to repair CSF leak during posterior thoracolumbar surgery. The proposed method significantly reduced postoperative drainage tube time and postoperative drainage volume. It also decreased the incidence and the degree of postural headache. The proposed method showed satisfactory clinical outcomes, and it is worthy of promotion.

Repair of Delayed Meningeal Cyst after Spinal Surgery with Paraspinal Muscle Flap under Microscope.

BACKGROUND: Delayed meningeal cyst (DMC) is a rare complication after spinal surgery that is often ignored by clinicians, and its in-depth research is infrequent. In particular, no consensus has been reached about its surgical treatment. We found that patients with a DMC failed after conservative treatment, epidural blood patch, subarachnoid drainage, and initial attempts to eliminate the meningeal cyst. Therefore, we introduce the application of a paraspinal muscle flap repair under a microscope for the treatment of DMC. METHODS: In this study, 13 patients who were repaired by a paraspinal muscle flap under a microscope for DMC from January 2007 to January 2017 were retrospectively reviewed. Their ages were 18-68 years old (mean age 48.7 years). The course of the disease ranged from 3 weeks to 28 months after the operation for the primary disease, with an average of 10.6 months. Length >5 cm was called a large DMC and length >8 was called a giant DMC. By analyzing the effect of surgical treatment, we summarized the treatment experience of DMC and evaluated the risk factors for the formation of DMC. RESULTS: All patients were treated with paraspinal muscle flap repair under a microscope, and they healed well after the operation. There was no cerebrospinal fluid leakage or other operation-related complication. The mean follow-up was 16.5 months. Reexamination of the spine MRI showed no recurrence of the DMC. CONCLUSIONS: The application of paraspinal muscle flap under a microscope combined with glue, bedrest, and CSF drain, was an effective option for the patients with DMC.

Predictors and Correlative Factors for Low Back Pain after Long Fusion Arthrodesis in Patients with Adult Scoliosis.

INTRODUCTION: Low back pain (LBP) still exists at the follow-up visit in some cases after long fusion arthrodesis for adult scoliosis. However, few available studies have elaborated the reasons and factors associated with this symptom. Therefore, the aim of the current study was to identify the correlative factors and predictors of postoperative LBP after long fusion arthrodesis and provide evidence to improve the surgical strategy. METHODS: Seventy-nine patients with adult scoliosis who underwent long fusion arthrodesis were divided into a group with no or mild LBP (NLBP group) and one with moderate or severe LBP (MLBP group) according to the average Oswestry Dability Index (ODI) at the last follow-up visit. The Japanese Orthopaedic Association (JOA) score, ODI and complications were used to evaluate clinical outcomes. %Fat infltration area (%FIA), sagittal and coronal parameters were recorded to evaluate radiological outcomes. Multivariate logistic regression analysis was conducted to identify the predictors and correlative factors for postoperative LBP. RESULTS: Thirty-three patients (41.77%) with ODI (30.06% ± 6.92%) higher than the average at the last follow-up were divided into the MLBP group, while the rest (58.23%) with last follow-up ODI (13.26% ± 5.31%) lower than the average were divided into the NLBP group. In multivariate logistic regression, the preoperative sagittal vertical axis (SVA) (P < 0.001), %FIA (P = 0.003) and osteoporosis (P = 0.016) were identified to be predictors and last follow-up SVA (P < 0.001), last follow-up lumbar lordosis (LL) (P = 0.031) and adjacent segment degeneration (ASD) (P = 0.043) were identified as correlative factors. The receiver-operating characteristic (ROC) curve showed satisfactory accuracy in preoperative SVA (P < 0.001) and %FIA (P < 0.001) to predict postoperative LBP. CONCLUSION: Postoperative LBP after long fusion arthrodesis for adult scoliosis was common. Postoperative LBP was associated with increased SVA and decreased LL and ASD. Preoperative SVA > 3.54 cm, %FIA > 24.82% and osteoporosis showed good accuracy to predict the postoperative symptoms. Optimal surgical methods should be used for patients with these factors to decrease the incidence and degree of postoperative LBP.

Simultaneous or staged operation for tandem spinal stenosis: surgical strategy and efficacy comparison.

BACKGROUND: Tandem spinal stenosis (TSS) has a complex clinical presentation, and there is no consensus on the optimal surgical strategy. This study retrospectively compared the efficacy of different staged operations and simultaneous decompression for patients with TSS. METHODS: We reviewed data from 132 patients with TSS who received surgical procedures from January 2011 to June 2018. Patients were classified into three groups according to the most symptomatic area of compression (group C: first-stage surgery for cervical compression; group L: first-stage surgery for lumbar compression; group CL: simultaneous surgery for both). Medical records were reviewed for age, gender, comorbidities, operation time, combined estimated blood loss, and time of hospitalization. The JOA-C, JOA-L, NDI, and ODI scores, and complications were also examined. RESULTS: Postoperative outcomes were followed for 32.1 ± 5.4 months. There were significant differences in the re-operation rate and the interval time between the two types of staged operations (p = 0.005 and p = 0.001, respectively). There were no significant differences in gender (p = 0.639), operation time (p = 0.138), combined estimated blood loss (p = 0.116), or complications (p = 0.652) among the three groups, while the simultaneous group was significantly younger (p = 0.027), with fewer comorbidities (p < 0.001) and a shorter hospitalization time (p < 0.001). At the final follow-up, the JOA-C and JOA-L scores were increased, while the NDI and ODI scores were decreased, compared with the preoperative scores. CONCLUSIONS: TSS can be effectively managed by either simultaneous or staged decompressions. First-stage surgery for cervical stenosis significantly lowers the requirement for second-stage lumbar surgery. One-stage simultaneous decompression is safe and effective with the advantage of reduce hospitalization time, without an increase in operative time or bleeding. However, the surgical indications should be strictly controlled and is recommended for younger patients with fewer comorbidities.

Dissatisfaction Risk Factors of Patients after Laminectomy for Thoracic Ossification of Ligamentum Flavum: A Retrospective Cohort Study of Different Follow-Up Periods.

OBJECTIVES: To explore the influencing factors of satisfaction with postoperative treatment in patients diagnosed with thoracic ossification of the ligamentum flavum during different follow-up periods. METHODS: This was a retrospective study of 57 patients who were diagnosed with thoracic ossification of ligamentum flavum (TOLF) and treated with laminectomy in the Spine Surgery Department of the Third Hospital of Hebei Medical University from January 2010 to January 2017. The Patient Satisfaction Index (PSI) was collected at discharge and at 6-month, 1-year, and the last follow-up. According to the evaluation results, the patients could be divided into a satisfied group and a dissatisfied group. The patient's Japanese Orthopaedic Association (JOA) score improvement rate was evaluated at the last follow-up. Possible influencing factors of the two groups of patients were compared and the related influencing factors of satisfaction with postoperative treatment in patients during different follow-up periods were summarized. RESULTS: At the time of discharge, the dissatisfied and satisfied groups had significant differences in variables of diabetes mellitus, duration of preoperative symptoms, urination disorder, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, hospital stay, hospitalization expenses, postoperative pain in LE VAS, delayed wound healing, postoperative depression, and intercostal pain (P < 0.05). There were also significant differences in urination disorder, postoperative pain according to the LE VAS, JOA score, and postoperative depression during the 6-month follow-up (P < 0.05). There were no significant differences in other variables between the two groups (P > 0.05). One year after the operation, there were significant differences between the dissatisfied group and the satisfied group in urination disorder, JOA score, and symptom recurrence (P < 0.05). There were also significant differences in the JOA score and symptom recurrence at the final follow-up (P < 0.05). For further analysis, the duration of preoperative symptoms in the satisfied group was less than 24 months and the duration of preoperative symptoms in the dissatisfied group was more than 24 months. The JOA scores of patients in the satisfied group and the dissatisfied group increased gradually with the improvement of neurological function in different follow-up periods, but, at the last follow-up, the JOA scores of patients in the satisfied group were significantly higher than those in the dissatisfied group. CONCLUSIONS: In conclusion, for thoracic ossification of ligamentum flavum patients who received laminectomy, dissatisfaction with the early and medium-term postoperative results may be related to diabetes, the duration of preoperative symptoms, hospitalization expenses, delayed wound healing, intercostal pain, and urination disorder, and dissatisfaction with the long-term postoperative results might be related to the low JOA score improvement rate and symptom recurrence.