Bi-needle technique versus transforaminal endoscopic spine system technique for percutaneous endoscopic lumbar discectomy in treating intervertebral disc calcification: a propensity score matched cohort analysis.

OBJECTIVE: The aim of this study was to evaluate the clinical results of a Bi-needle technique and conventional transforaminal endoscopic spine system (TESSYS) technique for percutaneous endoscopic lumbar discectomy (PELD) in treating patients with intervertebral disc calcification (IDC). BACKGROUND: PELD has gained acceptance for treating patients with IDC. The Bi-needle technique was designed to improve the efficiency and safety of PELD. METHOD: Bi-needle and TESSYS group within each cohort were balanced using 1:1 propensity score matching. Finally, 32 patients with IDC treated by Bi-needle technique from December 2015 to September 2017 were enrolled and 25 patients treated by TESSYS technique from the same spine surgery center between January 2013 and October 2017 were enrolled as controls. RESULTS: Propensity score matching generated 22 Bi-needle and 22 TESSYS patients. There were no significant differences in visual analog scale and lumbar Japanese Orthopaedic Association scores between Bi-needle and TESSYS group. Operative time and rate of complications in the Bi-needle was significantly better than the TESSYS group (p < 0.01). CONCLUSIONS: Both surgical methods achieved good clinical outcomes. However, compared with the TESSSY technique, operative time of the Bi-needle technique is shorter, and rate of complications is lower.

Timing of surgical decompression for traumatic cervical spinal cord injury.

PURPOSE: Although there have been numerous studies aimed at determining the effects and safety of early vs. late surgical decompression for traumatic cervical spinal cord injury, controversies still exist regarding the optimal timing of surgery for this serious spinal trauma. This study was conducted to evaluate the effectiveness and safety of early vs. late surgical decompression for lower cervical spine trauma associated with spinal cord injury. METHODS: A retrospective review of was performed on consecutive patients who underwent surgical decompression for lower cervical (C3-C7) spine trauma associated with spinal cord injury at six institutions across China from January 2007 to January 2012. These patients were analysed according to the timing of surgical intervention. The early group comprised patients who underwent surgery within the first 72 hours after being injured, whilst the late group comprised patients who underwent surgery after the first 72 hours. For analysis of neurologic improvement, patients who had completed a follow-up of at least six months were assessed. Other outcomes analysed were hospitalisation periods, complications and mortality. RESULTS: A total of 595 patients were identified (456 men and 139 women at an average age of 41.4 years), with 212 in the early group and 383 in the late group. Patients in both groups had made a significant neurologic improvement in the final follow-up, but no statistically significant difference was noted between groups. Patients in the early group had a significantly shorter hospital stay (15.4 vs. 18.3 days, p <0.001) but realised no benefits in terms of intensive care unit length of stay and ventilator days. No significant differences were identified between groups with regards complications (pneumonia, pulmonary embolism, wound infection, sepsis and urinary tract infection). Compared with the late group, the early group had a significantly higher incidence of postoperative neurological deterioration (6.6 vs. 0.7 %, p <0.001) and mortality (7.1 vs. 2.1 %, p = 0.003). CONCLUSION: The timing of surgery for patients sustaining traumatic lower cervical spine injury with neurological involvement did not affect neurological recovery. Early surgical intervention was associated with a higher incidence of mortality and neurological deterioration compared with late surgical intervention, indicating that surgery after the first 72 hours might be relatively safe.

Cervical arthroplasty with Discover prosthesis: clinical outcomes and analysis of factors that may influence postoperative range of motion.

PURPOSE: The aim of this current study was to analyze the clinical outcomes after Discover cervical disc replacement and its effects on maintaining cervical lordosis and range of motion (ROM). The possible factors influencing postoperative ROM were analyzed. METHOD: 27 men and 28 women with a mean age of 46.4 ± 8.7 years were prospectively followed up for 2 years. Clinical outcomes were assessed using Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), visual analog scale (VAS) and Odom's criteria. Radiographic information including segment and overall alignment, functional spinal unit (FSU) and overall ROM, and disc heights were prospectively collected during the follow-up. The correlations between the postoperative FSU ROM at last follow-up and influencing factors were analyzed. RESULTS: Mean NDI, JOA and VAS scores showed statistical improvements at last follow-up. Anterior migration of the prosthesis was detected in six cases. Heterotopic ossification was observed in ten patients. Mean FSU angle, endplate angle of the treated level and mean overall cervical alignment were all improved significantly at last follow-up (P < 0.001). However, mean FSU ROM of the treated segment significantly decreased postoperatively (P = 0.008), while mean overall ROM showed no significant differences. A significant correlation was found between preoperative FSU ROM and postoperative FSU ROM by the Pearson correlation coefficient (r = 0.325, P = 0.034). Multiple linear regression analysis confirmed that preoperative FSU ROM contributed independently to a model with a coefficient of determination of 0.37 (P = 0.034). CONCLUSIONS: In the 2 years follow-up, the Discover cervical disc arthroplasty has provided satisfactory clinical outcomes. It was able to substantially restore segment and overall cervical alignment while partially maintaining segment and overall cervical ROM. Additionally, we found that postoperative FSU ROM positively correlated with preoperative FSU ROM.

The effect of multilevel anterior cervical fusion on neck motion.

BACKGROUND: Anterior cervical decompression and fusion (ACDF) procedures are successful in treating multilevel cervical radiculopathy and cervical myelopathy. It was reported that this procedure would result in a loss of cervical range of motion. However, few studies have focused on the exact impact of multilevel (more than 3 levels) ACDF on cervical range of motion. METHODS: 29 patients underwent a 3-level or 4-level ACDF. In all the patients, preoperative active cervical ROM measurement was performed, and postoperative measurement was performed at 1-year follow-up by a CROM device. The pre- and postoperative data were compared to each other using paired t tests (α = 0.05). RESULTS: The patients had significantly less ROM after the surgery in all planes of motion. Major reduction was observed in flexion (39.5%), left and right lateral flexion (25.7 and 25.9%), with relatively minor impact on extension (18.3%), left and right rotation (14.0 and 14.4%) observed. In the three cardinal planes, major reduction was observed in the sagittal plane (28.2%) and coronal plane (25.8%), while minor impact observed in the horizontal plane (14.1%). CONCLUSIONS: The patients of cervical spondylotic myelopathy had an obvious reduction in active cervical ROM following multilevel ACDF. However, patients might not experience great difficulties in performing daily activities with regard to the loss of neck motion after fusion.

[Efficacies of anterior approach for cervical spinal canal stenosis].

OBJECTIVE: To evaluate the therapeutic efficacies and surgical procedures of anterior approach for cervical spinal canal stenosis. METHODS: A total of 162 cases of cervical spinal canal stenosis underwent anterior surgical procedure from March 2007 to March 2010. The operative duration, the volume of blood loss and the days of postoperative hospital stay were recorded and analyzed. The Cobb angle and canal sagittal diameter were measured. The bone graft fusion and nerve functions were evaluated postoperatively. RESULTS: The average operative duration was 86.4 minutes with an intraoperative blood loss of 80.2 ml and a postoperative hospital stay of 5.3 days. A follow-up visit of 9-18 months (average: 12.8) showed that bone graft fusion was achieved in all cases and Cobb angle increased by an average of 7.2 degree. The spinal canal sagittal diameter increased by 4.23 mm. And the JOA (Japanese Orthopedic Association) score increased by an average of 6.1 points at 3 Month post-operation. CONCLUSION: For cervical spinal canal stenosis, the pressure comes mostly from the front part. The anterior surgical procedure can decompress directly with a shorter operative duration, a smaller volume of blood loss, a shorter hospitalization stay and an effective recovery of cervical curvature and canal volume.

Somatosensory evoked potential from S1 nerve root stimulation.

The objective of this study was to detect cerebral potentials elicited by proximal stimulation of the first sacral (S1) nerve root at the S1 dorsal foramen and to investigate latency and amplitude of the first cerebral potential. Tibial nerve SEP and S1 nerve root SEP were obtained from 20 healthy subjects and 5 patients with unilateral sciatic nerve or tibial nerve injury. Stimulation of the S1 nerve root was performed by a needle electrode via the S1 dorsal foramen. Cerebral potentials were recorded twice to document reproducibility. Latencies and amplitudes of the first cerebral potentials were recorded. Reproducible cerebral evoked potentials were recorded and P20s were identified in 36 of 40 limbs in the healthy subjects. The mean latency of P20 was 19.8 ± 1.6 ms. The mean amplitude of P20-N30 was 1.2 ± 0.9 µV. In the five patients, P40 of tibial nerve SEP was absent, while well-defined cerebral potentials of S1 nerve root SEP were recorded and P20 was identified from the involved side. This method may be useful in detecting S1 nerve root lesion and other disorders affecting the proximal portions of somatosensory pathway. Combined with tibial nerve SEP, it may provide useful information for diagnosis of lesions affecting the peripheral nerve versus the central portion of somatosensory pathway.

[Application of aided three-dimension CT navigation system in craniocervical junction malformation disease surgery].

OBJECTIVE: To investigate the related problems of three-dimension CT navigation system applied to craniocervical junction malformation diseases surgery. METHODS: The clinical data of 61 patients with craniocervical junction malformation disease who underwent surgical treatment from July 2015 to March 2018 was retrospectively analyzed. There were 39 males and 22 females aged from 25 to 73 years old with a mean of (46.20±12.09) years. According to the different ways of screw placements, these patients were divided into navigation group (30 cases) and non navigation group (31 cases). The screws insertion in the navigation group were guided under three-dimension CT computer-aided navigation system, while the screws insertion were guided by C-arm fluoroscopy and intraoperative anatomical landmarks in non-navigation group. All surgeries were performed by the same group of surgeons. All cases were scanned by CT after operation to assess the accuracy of the screw insertion. RESULTS: A total of 122 screws were inserted in the study, including 60 screws in navigation group and 62 screws in non-navigation group. The screw positions in navigation group were all satisfactory, and there were no screw-related complications. The position of 3 screws (4.83%) in non-navigation group was not satisfactory, and there was no obvious neurological symptoms after operation. The operation time of navigation group was from 87.5 to 112.5 min with a mean of (99.6± 12.0) min;and non-navigation group was from 87.5 to 107.5 min, with a mean of (97.5±10.5) min. There was no statistically significant difference in the operation time between two groups (P>0.05). The screw insertion time in navigation group was from 1.50 to 4.20 min, with a mean of (2.51±1.02) min;and non navigation group was from 1.80 to 5.10 min, with a mean of (3.25±1.05) min. The screw insertion time in navigation group was shorter than that in non-navigation group (P<0.05). The intraoperative blood loss in navigation group was from 122 to 153 ml, with a mean of (137.57±9.48) ml, which in non-navigation group wasfrom 121 to 158 ml, with a mean of (138.75±8.56) ml, there was no statistically significant difference between two groups (P>0.05). CONCLUSION: The three-dimensional CT computer-aided navigation system has the characteristics of clear imaging and accurate positioning, which can help improve the accuracy and safety of the screw insertion in craniocervical junction malformation disease surgery.

Retrospective analysis of anterior correction and fusion for adolescent idiopathic thoracolumbar/lumbar scoliosis: the relationship between preserving mobile segments and trunk balance.

The objective of this paper was to investigate the surgical strategy of the selection of the lowest instrumented vertebrae (LIV) in anterior correction for adolescent idiopathic scoliosis (AIS) and to discuss the relationship between the LIV and trunk balance. From 1998 to 2004, 28 patients with thoracolumbar/lumbar AIS (Lenke 5 type) were treated by anterior correction and fusion with a mean follow-up of 1.5 years. Specific radiographic parameters were observed respectively and the correlation between disc wedging immediately below the LIV and these parameters was analysed. The mean corrective rate of major curves was 74.84%. The preoperative disc angle distal to LIV was 2.96 +/- 1.43 degrees and postoperatively it was -3.60 +/- 1.75 degrees . The postoperative disc wedging was most correlated with LIV obliquity. The postoperative LIV-CSVL (centre sacral vertical line) distance, which reflects regional balance, was correlated with various preoperative parameters. LIV determination was correlated with multiple preoperative radiographic parameters. Disc wedging distal to LIV occurs most often when a short fusion excluding the lower end vertebra (LEV) and the subjacent disc are nearly parallel.

Percutaneous Endoscopic Lumbar Discectomy in Treating Calcified Lumbar Intervertebral Disc Herniation.

BACKGROUND: We retrospectively analyzed and report the clinical results of percutaneous endoscopic lumbar discectomy (PELD) in treating patients with calcified lumbar intervertebral disc herniation (CLDH). METHODS: The data from 40 patients with CLDH treated with PELD in our hospital from June 2013 to June 2017 were reviewed. Of the 40 patients, 27 (19 men; 8 women; average age, 45.5 ± 7.5 years) had undergone percutaneous endoscopic transforaminal discectomy and 13 (8 men, 5 women; average age, 46.9 ± 6.9 years) had undergone percutaneous endoscopic interlaminar discectomy. The Peak method was used for both groups. The preoperative demographic data of both groups were analyzed. The pre- and postoperative leg visual analog scale scores and Oswestry disability index were compared and complications were evaluated. RESULTS: All procedures were performed successfully, and follow-up data were obtained for all patients for 24 months. The leg visual analog scale and Oswestry disability index scores at the last follow-up visit had decreased in both groups and were significantly different statistically from the preoperative data. No nerve root injury, intestinal injury, intervertebral disc infection, or recurrence was detected in any patient. Dural tear and cerebrospinal fluid leakage were observed in 3 patients (2, percutaneous endoscopic transforaminal discectomy; 1, percutaneous endoscopic interlaminar discectomy), because of adhesions between the calcification and nerve root. However, their symptoms resolved, and they were discharged after 1 week of bed rest. CONCLUSIONS: With the application of Peak philosophy, PELD is safe and effective in treating patients with CLDH. The use of PELD results in good neurological recovery, pain relief, and a low incidence of complications.

Effectiveness of Bi-Needle Technique (Hybrid Yeung Endoscopic Spine System/Transforaminal Endoscopic Spine System) for Percutaneous Endoscopic Lumbar Discectomy.

OBJECTIVE: The bi-needle technique is a new technique for percutaneous endoscopic lumbar discectomy. This technique combines the advantages of Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) techniques. The aim of this study was to evaluate effectiveness of the bi-needle technique for percutaneous endoscopic lumbar discectomy and compare it with the TESSYS technique. METHODS: We reviewed 86 patients with single-level lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy in our hospital from June 2013 to December 2015. Bi-needle technique was used in 49 patients (30 men, 19 women; average age 40.4 ± 5.2 years). TESSYS technique was used in 37 patients (19 men, 18 women; average age 42.8 ± 6.4 years). Clinical results were evaluated and compared between the 2 groups. RESULTS: Symptoms in both groups were significantly improved at the last follow-up (P < 0.01). There was no statistical difference in visual analog scale and lumbar Japanese Orthopaedic Association scores between bi-needle and TESSYS groups at last follow-up (P = 0.69 and P = 0.33, respectively). Operative time was shorter in the bi-needle group (P < 0.01). Recurrence rate and reoperation rate were lower in the bi-needle group (P = 0.04 and P = 0.03, respectively). Discitis was diagnosed in 2 patients in the TESSYS group. There were no patients with postoperative discitis in the bi-needle group. CONCLUSIONS: The bi-needle technique is safe and effective for treatment of lumbar disc herniation. Compared with TESSYS technique, operative time is shorter, and recurrence and reoperation rates are lower.

[Clinical characteristics and results of cervical spinal cord injury in the patients with ossification of the posterior longitudinal ligament].

OBJECTIVE: To investigate the clinical characteristics and results of cervical spinal cord injury (SCI) in the patients with ossification of the posterior longitudinal ligament (OPLL). METHODS: Nineteen patients with cervical SCI associated with OPLL were retrospectively analyzed. Data collection included: pre- and postoperative neurological function, OPLL-type, MRI signal changes and surgical approaches. RESULTS: Spinal cord associated with OPLL was injured severely by mild trauma. Methylprednisolone sodium succinate was used within 8 h after trauma in 12 cases. Two of them died of complications. The neurological functions were markedly improved in the other 10 cases. Seventeen cases had surgical treatment. The neurological functions (Frankel grade) were improved significantly in the operated patients except for one, who died 27 d after operation. CONCLUSIONS: The patients with OPLL are prone to have severe SCI, which directly associates with the preexisting OPLL-type and hyper-intensity signal change in the spinal cord on MRI. Both of using methylprednisolone sodium succinate administration within 8 h after trauma and surgical decompression may improve the neurological outcomes.

[Surgical strategy for severe cervical spine dislocations].

OBJECTIVE: To evaluate the rate of open reduction and surgical strategy of severe cervical dislocation. METHODS: From March 2001 to March 2006, the data of 92 cases of cervical dislocation over 1/2 were retrospectively studied. Garden Well traction with 1 - 3 kg weight were performed before operation. The patients were performed with diskectomy and reduction with anterior approach initially, for those that can not be reduced, corpectomy were performed and reduction procedures were repeated. The posterior reduction and fixation were followed when reduction can not be reached with anterior approach only. The succeed rate of reduction, rate of tracheotomy were recorded and fusion rate, Frankel score and visual analog scale (VAS) were evaluated. RESULTS: Reduction succeed in 38 cases after diskectomy, 44 after corpectomy and 7 after combined anterior-posterior-anterior procedure. Three cases got incompleteness reduction. Tracheotomy was done in 29 cases. The Frankel score increased 0.5 degree and VAS was 2 averagely at the last follow-up. CONCLUSIONS: The succeed rate of anterior open reduction was 89.2%, and only 10.8% patients needs an additional combined posterior and anterior approach. For patients with completed spinal cord injury with dislocation above C(4), or with dislocation below C(5) but the edema on MRI T2 image are above C(4) level need tracheotomy. The operation be done until respiratory function stable. For patients with completed spinal cord injury with dislocation below C(4) and uncompleted spinal cord injury with dislocation above C(4), the rate of tracheotomy is relatively lower and early operation is recommended.

Tantalum-coated pedicle screws enhance implant integration.

Because titanium alloy (Ti) has the natural advantage of a low elastic modulus, it has become the most commonly used material for the manufacturing of pedicle screws. However, its poor shear strength and osteogenic ability are undesirable properties. The superior osteoinductivity demonstrated by tantalum (Ta) in oral and maxillofacial surgery and joint surgery leads us to assume that the tantalum-coated pedicle screws may have better osteogenic properties and bone anchoring strength. To verify this hypothesis, MC3T3-E1 cells and human mesenchymal stem cells (hBMSCs) were seeded on the surface of Ta and Ti disks to compare the effects of two different metals on cell adhesion, proliferation, and differentiation. At the same time, we observed the inhibitory effect of Ta on osteoclasts. As an in vivo study, conventional Ti pedicle screws and Ta-coated screws were implanted in bilateral pedicles of Bama pigs. The results showed that compared to titanium, tantalum promoted greater cell adhesion and proliferation and improved the level of hBMSC mineralization, and Ta-coated screws exerted an inhibitory effect on osteoclasts. More importantly, we found that the effect of tantalum on osteogenic differentiation was mediated through the Wnt/ß-catenin and TGF-ß/smad signaling pathways. Ta-coated screws significantly promoted trabecular bone growth compared with Ti as evidenced by micro-CT, histology and biomechanical examination. Our study clearly indicated that tantalum was a superior promoter of osteogenesis and proved that tantalum coating is an effective improvement for titanium alloy implants.

Twenty-nine-Year Follow-up of Nonoperatively Treated Three-Level Lumbar Spondylolysis: A Case Report and Review of the Literature.

This article was updated on May 25, 2016, because of a previous error. On page 4, in the address block, one of the e-mail addresses was incorrectly identified. The line had previously read "E-mail address for Y.-Y. Chen: yugangg@163.com." The sentence now reads "E-mail address for Y. Chen: yugangg@163.com." CASE: Multilevel spondylolysis, especially involving more than two levels, is rarely encountered in clinical practice. We present a case of three-level spondylolysis with two-level spondylolisthesis followed for twenty-nine years after nonoperative treatment. The patient was a forty-six-year-old man who presented with stabbing pain in the lower left portion of his back without radiating symptoms or neurological deficit. Lumbar radiographs showed bilateral pars defects at L3, L4, and L5 and grade-I spondylolisthesis at L4/L5 and L5/S1, but flexion and extension views showed no obvious translation. Review of medical records showed that the patient had already had three-level bilateral spondylolysis at L3, L4, and L5 almost thirty years ago. The patient had no history of lumbar surgery during the intervening years. Nonsteroidal anti-inflammatory drugs were initially prescribed. Physical therapy was prescribed for eight weeks, and the low back pain improved. CONCLUSION: For patients with multilevel lumbar spondylolysis without neurological symptoms and with slippage of <25%, we recommend conservative treatment with regular follow-up.

BMP7 enhances the effect of BMSCs on extracellular matrix remodeling in a rabbit model of intervertebral disc degeneration.

Intervertebral discs (IVDs) provide stability and flexibility to the spinal column; however, IVDs, and in particular the nucleus pulposus (NP), undergo a degenerative process characterized by changes in the disc extracellular matrix (ECM), decreased cell viability, and reduced synthesis of proteoglycan and type II collagen. Here, we investigated the efficacy and feasibility of stem cell therapy using bone marrow mesenchymal stem cells (BMSCs) over-expressing bone morphogenetic protein 7 (BMP7) to promote ECM remodeling of degenerated IVDs. Lentivirus-mediated BMP7 over-expression induced differentiation of BMSCs into an NP phenotype, as indicated by expression of the NP markers collagen type II, aggrecan, SOX9 and keratins 8 and 19, increased the content of glycosaminoglycan, and up-regulated ß-1,3-glucuronosyl transferase 1, a regulator of chondroitin sulfate synthesis in NP cells. These effects were suppressed by Smad1 silencing, indicating that the effect of BMP7 on ECM remodeling was mediated by the Smad pathway. In vivo analysis in a rabbit model of disc degeneration showed that implantation of BMSCs over-expressing BMP7 promoted cell differentiation and proliferation in the NP, as well as their own survival, and these effects were mediated by the Smad pathway. The results of the present study indicate the beneficial effects of BMP7 on restoring ECM homeostasis in NP cells, and suggest potential strategies for improving cell therapy for the treatment of disc diseases.

[The study of total spondylectomy in the treatment of cervical spinal tumors].

OBJECTIVE: To study the surgical indications, approaches and the clinical results of the total spondylectomy and instrumentation reconstruction in the treatment of cervical spinal tumor. METHODS: From October 1998 to October 2003, 39 patients with lower cervical bone tumors, including 34 cases with primary tumor and 5 cases with metastatic tumor, were admitted and operated on with total spondylectomy. The patients underwent anteroposterior total spondylectomy including anterior cervical plating, titanium mesh reconstruction and posterior instrumentation based on the location of tumor lesions in the lower cervical spine. One vertebral level total spondylectomy was performed in 29 cases, two level in 7 cases and three level in 3 cases. RESULTS: The postoperative follow-up ranged from 6 months to 4 years. A majority of patients achieved good results postoperatively. Nineteen cases had complete relief of neurological status. One patient died of multiple metastases and systemic failure 24 months later. One case with malignant neurilemmoma developed local recurrence one year postoperatively. CONCLUSION: Anteroposterior total spondylectomy and reconstruction can reduce local recurrence, improve neurological function and increase operation therapeutic effect. Meanwhile, the technique of cervical total spondylectomy carries relatively greater risks and should be more attention to the operation indication.

[Investigation of resection and reconstruction procedure of high-sacrum tumors].

OBJECTIVE: To investigate the way of resection of high-sacrum tumors and the way and duration of the spinal-pelvic TSRH or ISOLA internal fixation. METHOD: From October 1998 through April 2002, 35 patients with sacral tumor were enrolled in our hospital, including 4 cases in L(5)-S(1), 2 in L(5)-S(2), 4 in S(1), 8 in S(1 - 2), 6 in S(1 - 3), 6 in S(1 - 4), 5 in S(1 - 5). 35 patients were followed by lumbo-pelvic TSRH or ISOLA internal fixation and corresponding chemotherapy and radiotherapy. RESULTS: In the follow-up period of 6 - 42 months, the short-term results were satisfactory with the lumbosacral pain reduced and the neurological function improved in different degrees, however dysuria occurred in 1 case and skin necrobiosis at coccygeal incision occurred in 1 case; two cases experienced cerebrospinal fluid leakage and 1 case experienced postoperative infection and delayed healing, 1 case with chordoma and 2 cases with malignant fibrous histiocytoma recurred 1 year after postoperation, one of these 2 cases with malignant fibrous histiocytoma suffered from lung metastasis and died of system failure 19 months after postoperation. No fractured rod occurred. CONCLUSION: Surgical procedure and postoperative comprehensive treatment have important effects on the prognosis. High-sacral tumor resection and reconstruction are effective means of achieving stabilization, providing significant pain relief and preserving ambulatory capacity.

Neck motion following multilevel anterior cervical fusion: comparison of short-term and midterm results.

OBJECT: Multilevel anterior cervical decompression and fusion is indicated for patients with multilevel compression or stenosis of the spinal cord. Some have reported that this procedure would lead to a loss of cervical range of motion (CROM). However, few studies have demonstrated the exact impact of the procedure on CROM. Here, the authors describe short- and midterm postoperative CROM following multilevel anterior cervical decompression and fusion. METHODS: Thirty-five patients underwent a 3- or 4-level anterior cervical decompression and fusion. In all patients, active CROM was measured preoperatively and at both the short-term (3-4 months) and midterm (12-15 months) follow-ups by using a CROM device. The preoperative and postoperative data were analyzed using ANOVA (α = 0.05). RESULTS: Patients had significantly less ROM in all planes of motion postoperatively. The greater limitation in CROM was observed at the short-term follow-up. However, at the midterm follow-up, an obvious increase in CROM was observed in each cardinal plane compared with that in the short-term (sagittal plane 17.4%, coronal plane 14.1%, and horizontal plane 19.5%). A gradual increase in the CROM in each cardinal plane was observed during the recovery period in 5 patients. In the 6 conventional motions, the major recovery of CROM was observed in flexion (27.5%), while relatively less recovery was seen in extension (10.5%). CONCLUSIONS: Patients had an obvious reduction in active CROM following multilevel anterior cervical decompression and fusion. The greater limitation in CROM was observed at the short-term follow-up. In the midterm follow-up, however, an obvious recovery in CROM was observed in each cardinal plane, reducing the restriction of neck motion further.

Loss of p16INK4, alone and with overexpression of osteopontin, correlates with survival of patients with spinal metastasis from hepatocellular carcinoma.

The survival of patients with hepatocellular carcinoma (HCC) has been improved with various diagnostic tools and treatment modalities. Consequently, spinal metastases from HCC are diagnosed more frequently. We investigated the clinical biomarkers of HCC patients presenting with spinal metastasis. Between January 2001 and December 2007, we recruited 30 consecutive HCC patients presenting with spinal metastasis. Their tissue samples were collected and analyzed by immunohistochemistry in a tissue microarray. A total of 16 proteins were assessed in the tissue microarray; we found that expression of p16(INK4) correlated with the survival time (log-rank test, P = 0.05), and loss of p16(INK4) was significantly associated with osteopontin overexpression (Fisher exact test: P = 0.045, logistic regression: P = 0.024, OR = 0.184, 95% CI 0.035-0.963). Patients with osteopontin (-) and with p16(INK4) (+) lived longer than patients with osteopontin (+) and with p16(INK4) (-). We found that p16(INK4) and osteopontin might be the biomarkers of patients with spinal metastasis from HCC, a more large-scaled randomized study might be required to confirm the result and study the mechanism.