[Lateral position one-stage combined anteroposterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures].

OBJECTIVE: To compare the medium and long-term outcomes of lateral position one-stage plus anteroposterior versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures. METHODS: A total of 47 patients with thoracolumbar burst fractures were divided into 2 groups according to surgical approaches. Group A underwent lateral position one-stage plus anteroposterior approach while group B had posterior approach with subtotal corpectomy, decompression and reconstruction of spine. During a follow-up period of 36-68 months, their clinical and radiological outcomes were retrospectively evaluated. The perioperative volume of blood loss, operative duration, complications, pulmonary functions, Frankel scale and American Spinal Injury Association (ASIA) motor scores were recorded and analyzed. And the heights of anterior edge of vertebral body and Cobb angle were examined for radiological outcomes. RESULTS: At the latest follow-up, all patients achieved solid fusion with significant neurological improvements. The perioperative volumes of blood loss were less, operative duration was shorter and postoperative pulmonary functions were better in the group B (P < 0.05). The ASIA motor score and radiological outcomes were not significantly different at all timepoints between two groups (P < 0.05). But the neurological functions of two groups improved by approximately 1.4 Frankel grade (group A) versus 1.41 (group B) at the final follow-up. CONCLUSION: Lateral position one-stage plus anteroposterior and posterior approaches with subtotal corpectomy, decompression, and reconstruction of spine are adequate surgical treatments for thoracolumbar burst fractures. But the latter has the major advantages of less perioperative volume of blood loss, fewer complications, shorter operative duration and better pulmonary functions.

[Surgical options and clinical outcomes in patients of lumbar disc herniation with Modic changes].

OBJECTIVE: To retrospectively evaluate medium and long-term outcomes of conventional fenestration discectomy versus posterior lumbar interbody fusion in lumbar disc herniation with Modic changes. METHODS: From January 2002 to January 2007, a total of 486 patients of lumbar disc herniation with Modic changes were analyzed retrospectively. They were divided into fenestration group (n = 215) and fusion group (n = 271) according to the operative approaches. The scores of Oswestry disability index (ODI) and visual analog scale (VAS) pre-and post-operative 3, 6, 12 month and annually were recorded and analyzed. RESULTS: All of them had complete records during a mean follow-up period of 88.9 (60-120) months. At the end of the latest follow-up, all symptoms were relieved postoperatively. Significantly difference existed in the improvement rate of back pain VAS between two groups (77.9% vs 68.0%). In the fenestration group, the improvement rate of VAS (back pain) of Modic type I I was better than that of Modic type I (72.8% vs 64.9%). And the difference was statistically significant. For those with Modic type I changes, the improvement rate of ODI and VAS (back pain) of the fusion group were better than those of the fenestration group (78.3% vs 70.4% and 77.4% vs 64.9%). And the differences were statistically significant (P < 0.05). CONCLUSION: The patients with Modic I and II changes were recommended to undergo lumbar fusion and undergo fenestration discectomy respectively.

A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety.

BACKGROUND AND STUDY AIM: Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3-C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. PATIENTS AND METHODS: Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. RESULTS: There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). CONCLUSION: Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.

[Anterior cervical discectomy and fusion in the treatment of Hangman's fracture].

OBJECTIVE: To evaluate the efficacies and features of treating Hangman's fracture by anterior cervical discectomy and fusion (ACDF). METHODS: Since June 2005 to December 2008, 36 cases with Hangman's fracture were analyzed with their clinical data including history, symptoms, signs, radiological findings and treatments. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangman's fractures, they were subdivided into type I (n = 9) (conservative therapy), type II (n = 17) and type IIA (n = 10). Conservative therapy was offered to type I in 9 cases, while ACDF with cervical gear protection for 4 weeks after surgery was performed to type II in 17 cases and type IIA in 10 cases. A combination of operation time, days of hospitalization, complications, neurological improvement and fusion rate was assessed. RESULTS: An average follow-up of 15 months (range: 10 - 36) was achieved. No vertebral redisplacement and angulation deformity occurred. Axial pain was relieved in each case. The preoperative neurological deficits in all patients got improvements. No spinal cord injury, vertebral artery injury or cerebrospinal fluid leakage occurred. No complication related to internal fixator was found. Average operative time and hospitalization were similar to those of ACDF for lower cervical spine (98 minutes vs. 9 days). Fusion was achieved within 6 months in all cases. CONCLUSION: ACDF at C2-C3 may be an effective and safe way to treat Hangman's fracture.

A multimodal therapeutic approach improves the clinical outcome of auricular keloid patients.

OBJECTIVE: We retrospectively studied the efficacy of personalized therapy with surgical resection plus prophylactic management of postsurgical auricular keloids by intralesional injection of betamethasone and local pressure therapy using magnets in patients with auricular keloids. METHODS: Surgical excision was performed in all patients, and surgical techniques including fusiform excision of the keloid scar, core excision of the keloid scar followed by flap repair, and scar graft were chosen. RESULTS: A total of 85 patients with 98 auricular keloids were eligible. Seventy-two (74%) patients had primary auricular keloids, and 13 patients had recurrent keloids after surgical excision. Keloids, were located in the helix in 28 (32.9%) cases, in the earlobe in 45 (52.9%) cases, and in the entire auricle in 12 (14.1%) cases. The size of auricular keloids ranged from 10 to 35 mm. Surgical resection was uneventful in all cases. Twenty-one (21.4%) patients received fusiform excision, 47 (47.9%) patients underwent core excision and flap repair, and 30 (30.6%) patients received skin grafts. The patients were followed up for median duration of 1 year (range: 12-24 months). The cure rate was 87.2%, and the recurrence rate was 12.8%. CONCLUSION: A personalized surgical approach based on the characteristics of auricular keloids in each patient and a multimodal therapeutic regimen including surgical excision, glucocorticoid blockade, and intralesional injection of glucocorticoids and pressure therapy improve the cure rate and reduce the recurrence rate of auricular keloids.

miR-221 alleviates the inflammatory response and cell apoptosis of neuronal cell through targeting TNFAIP2 in spinal cord ischemia-reperfusion.

This study aimed to examine the role of miR-221 in inflammatory response and apoptosis of neuronal cells after spinal cord ischemia/reperfusion (I/R) injury. Blood samples were obtained from 20 I/R patients and that of 20 healthy individuals were used as a control. AGE1.HN and SY-SH-5Y neuronal cell lines subjected to oxygen-glucose deprivation (OGD) stress were used in cell experiments. Real-time PCR and western blot were used to evaluate the expression of miR-221, tumor necrosis factor-α, and TNFAIP2. TUNEL assay analyzed cell apoptosis. I/R patients had lower serum levels of miR-221 than healthy controls. In OGD-AGE1.HN and SY-SH-5Y cells, miR-221 was significantly downregulated and TNFAIP2 mRNA and protein were upregulated; meanwhile, both proinflammatory cytokine tumor necrosis factor-α and anti-inflammation cytokine interleukin-6 were elevated and the percentage of apoptotic cells was increased. This inflammatory response and cell apoptosis induced by OGD stress were attenuated by miR-221 overexpression and enhanced by miR-221 knockdown. TNFAIP2 is a target gene for miR-221 and could be regulated negatively by the miR-221 mimic or the miR-221 inhibitor with or without OGD stress. Accordingly, TNFAIP2 overexpression reversed the inflammatory response and cell apoptosis induced by miR-221 under OGD stress. Downregulation of miR-221 occurs in spinal cord I/R injury and in cell lines subjected to oxygen-glucose deprivation. miR-221 regulates the inflammatory response and apoptosis of neuronal cells through its impact on TNFAIP2.