Effects of Testosterone in Mediating the Relationship Between Daytime Napping and Osteoporosis in European Populations: A Mendelian Randomization Study.

We aimed to explore the causal effect of daytime napping on the risk of osteoporosis and the mediation role of testosterone in explaining this relationship. Summary data for Mendelian randomization (MR) analysis were obtained from the IEU OpenGWAS database. Univariable MR(UVMR) analysis and multiple sensitivity analyses were applied to explore the casual relationship between daytime napping and bone mineral density (BMD)/osteoporosis. We also conducted multivariable Mendelian randomization (MVMR) analysis to evaluate the correlation between testosterone-associated single-nucleotide variations and BMD/osteoporosis. Then, mediation analysis was performed to explore whether the association between daytime napping and BMD/osteoporosis was mediated via testosterone. Genetically predicted daytime napping was significantly associated with femoral neck BMD (ß [95% CI]: 0.2573 [0.0487, 0.4660]; P = 0.0156), lumbar spine BMD (ß [95% CI]: 0.2526 [0.0211, 0.4840]; P = 0.0324), and osteoporosis (OR [95% CI]: 0.5063 [0.2578, 0.9942]; P = 0.0481). ß and 95%CIs indicate the standard deviation (SD) unit of BMD increase per category increase in daytime napping. OR and 95%CIs represent the change in the odds ratio of osteoporosis per category increase in daytime napping. We observed a potentially causal effect of more frequent daytime napping on higher BMD and a lower risk of osteoporosis. Daytime napping was causally associated with a higher level of bioavailable testosterone (ß [95% CI]: 0.1397 [0.0619, 0.2175]; P = 0.0004). ß and 95%CIs represent the change in the SD of testosterone per category increase in daytime napping. Furthermore, the causal effects of daytime napping on BMD/osteoporosis were partly mediated by bioavailable testosterone. Daytime napping can efficiently increase BMD and reduce the risk of osteoporosis, and testosterone plays a key mediating role in this process.

Biological performance of a bioabsorbable magnesium-magnesium phosphate cement interbody fusion cage in a porcine lumbar interbody fusion model: a feasibility study.

PURPOSE: The aim of the study was to evaluate the feasibility of a bioabsorbable cage consisting of magnesium and magnesium phosphate cement (MPC) in a porcine lumbar interbody fusion model. METHODS: Twelve male Ba-Ma mini pigs underwent lumbar discectomy and fusion with an Mg-MPC cage or a PEEK cage at the L3/L4 and L4/L5 level. Computed tomography (CT) scans were made to evaluate the distractive property by comparing average disc space height (DSH) before and at 6, 12, and 24 weeks after the operation. After the lumbar spines were harvested at 6 or 24 weeks after the operation, micro-CT examination was conducted to analyze the fusion rate, and stiffness of motion segments was investigated through mechanical tests. A histological study was performed to evaluate the tissue type, inflammation, and osteolysis in the intervertebral space. RESULTS: CT scans showed no significant difference between the two groups in average DSH at each time point. Micro-CT scans revealed an equal fusion rate in both groups (0% at 6 weeks, 83.3% at 24 weeks). Both groups showed time-dependent increases in stability, the Mg-MPC cages achieved an inferior stiffness at 6 weeks and a comparable stiffness at 24 weeks. Histologic evaluation showed the presence of newly formed bone in both groups. However, empty spaces were observed at the interface or around the Mg-MPC cages. CONCLUSION: Compared with the PEEK cages, the Mg-MPC cages achieved comparable distraction, fusion rate, and spinal stability at 24 weeks after the operation. However, due to inferior stiffness at the early stage and fast degradation, further modification of material composition and design are necessary.

Biomechanical effect of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion: a finite element study.

BACKGROUND: Adjacent segment degeneration (ASD) is a common complication of lumbar interbody fusion; the paraspinal muscles significantly maintain spinal biomechanical stability. This study aims to investigate the biomechanical effects of proximal multifidus injury on adjacent segments during posterior lumbar interbody fusion (PLIF). METHODS: Data from a lumbosacral vertebral computed tomography scan of a healthy adult male volunteer were used to establish a normal lumbosacral vertebral finite element model and load the muscle force of the multifidus. A normal model, an L4/5 PLIF model (PFM) based on a preserved proximal multifidus, a total laminectomy PLIF model (TLPFM), and a hemi-laminectomy PLIF model based on a severed proximal multifidus were established, respectively. The range of motion (ROM) and maximum von Mises stress of the upper and lower adjacent segments were analyzed along with the total work of the multifidus muscle force. RESULTS: This model verified that the ROMs of all segments with four degrees of freedom were similar to those obtained in previous research data, which validated the model. PLIF resulted in an increased ROM and maximum von Mises stress in the upper and lower adjacent segments. The ROM and maximum von Mises stress in the TLPFM were most evident in the upper adjacent segment, except for lateral bending. The ROM of the lower adjacent segment increased most significantly in the PFM in flexion and extension and increased most significantly in the TLPFM in lateral bending and axial rotation, whereas the maximum von Mises stress of the lower adjacent segment increased the most in the TLPFM, except in flexion. The muscle force and work of the multifidus were the greatest in the TLPFM. CONCLUSIONS: PLIF increased the ROM and maximum von Mises stress in adjacent cranial segments. The preservation of the proximal multifidus muscle contributes to the maintenance of the physiological mechanical behavior of adjacent segments, thus preventing the occurrence and development of ASD.

Ciliary IFT80 is essential for intervertebral disc development and maintenance.

The intervertebral disc degeneration (IVDD)-related diseases occur in more than 90% of the population older than 50 years. Owing to the lack of understanding of the cellular mechanisms involved in IVDD formation effective treatment options are still unavailable. Primary cilia are microtubule-based organelles that play important roles in the organ development. Intraflagellar transport (IFT) proteins are essential for the assembly and bidirectional transport within the cilium. Role of cilia and IFT80 protein in intervertebral disc (IVD) development, maintenance, and degeneration are largely unknown. Using cilia-GFP mice, we found presence of cilia on growth plate (GP), cartilage endplate (EP) annulus fibrosus (AF), and nucleus pulposus (NP) with varying ciliary length. Cilia length in NP and AF during IVDD were significantly decreased. However, cilia numbers increased by 63% in AF during repair. Deletion of IFT80 in type II collagen-positive cells resulted in cilia loss in GP and EP, and disrupted IVD structure with disorganized and decreased GP, EP, and internal AF (IAF), and less compact and markedly decreased gel-like matrix in the NP. Deletion of IFT80 in type I collagen-positive cells led to a disorganized outer AF (OAF) with thinner, loosened, and disconnected fiber alignment. Mechanistic analyses showed that loss of IFT80 caused a significant increase in cell apoptosis in the IVD, and a marked decrease in expression of chondrogenic markers - type II collagen, sox9, aggrecan, and hedgehog (Hh) signaling components, including Gli1 and Patch1 in the IVD of IFT80fl/fl ; Col2-creERT mice, and Gli1 and Patch1 expression in the OAF of IFT80fl/fl ; Col1-creERT mice. Interestingly, Smoothened agonist-SAG rescued OAF cell proliferation and osteogenic differentiation. Our findings demonstrate that ciliary IFT80 is important for the maintenance of IVD cell organization and function through regulating the cell survival and Hh signaling.

Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures.

BACKGROUND: Vertebral compression fracture is one of the most common complications of osteoporosis. In this study an unilateral curved vertebroplasty device was developed, and the safety, effectiveness, and surgical parameters of curved vertebroplasty (CVP) in the treatment of painful osteoporotic vertebral compression fractures was investigated and compared with traditional bipedicular vertebroplasty (BVP). METHODS: We investigated 104 vertebral augmentation procedures performed over 36 months. CVP and BVP procedures were compared for baseline clinical variables, pain relief (Visual Analog Scale, VAS), disability improvement (Oswestry Disability Index, ODI), operation time, number of fluoroscopic images, volume of cement per level, and cement leakage rate for each level treated. Complications and refracture incidence were also recorded in the two groups. RESULTS: The VAS and ODI in both group had no significant difference preoperative (P > 0.05), and a significant postoperative improvement in the VAS scores and ODI was found in both group (P < 0.001). However, the CVP group had significantly lower operation time, number of fluoroscopic images, and cement leakage rate per level than the BVP group (P < 0.05); however, the volumes of cement per level were similar in the two groups (P > 0.05). Neither group had any serious complications. Five and two patients in the BVP group developed refractures at non-adjacent and adjacent levels, respectively, with one patient developing refractures twice; however, none of the patients in the CVP group developed refractures at any level. CONCLUSIONS: Our findings revealed that both CVP and BVP were safe and effective treatments for osteoporotic vertebral compression fractures, and CVP entails a shorter operation time, less exposure to fluoroscopy, and lower rate of cement leakage.

Maximizing Specific Loss Power for Magnetic Hyperthermia by Hard-Soft Mixed Ferrites.

Maximized specific loss power and intrinsic loss power approaching theoretical limits for alternating-current (AC) magnetic-field heating of nanoparticles are reported. This is achieved by engineering the effective magnetic anisotropy barrier of nanoparticles via alloying of hard and soft ferrites. 22 nm Co0.03 Mn0.28 Fe2.7 O4 /SiO2 nanoparticles reach a specific loss power value of 3417 W g-1metal at a field of 33 kA m-1 and 380 kHz. Biocompatible Zn0.3 Fe2.7 O4 /SiO2 nanoparticles achieve specific loss power of 500 W g-1metal and intrinsic loss power of 26.8 nHm2 kg-1 at field parameters of 7 kA m-1 and 380 kHz, below the clinical safety limit. Magnetic bone cement achieves heating adequate for bone tumor hyperthermia, incorporating an ultralow dosage of just 1 wt% of nanoparticles. In cellular hyperthermia experiments, these nanoparticles demonstrate high cell death rate at low field parameters. Zn0.3 Fe2.7 O4 /SiO2 nanoparticles show cell viabilities above 97% at concentrations up to 500 µg mL-1 within 48 h, suggesting toxicity lower than that of magnetite.

Optimal chin-brow vertical angle for sagittal visual fields in ankylosing spondylitis kyphosis.

PURPOSE: Chin-brow vertical angle (CBVA) is very important in correction of thoracolumbar kyphotic deformity in ankylosing spondylitis (AS), especially for the patients with cervical ankylosis. In previous study, Suk et al. stated that the patients with CBVA between -10° and 10° had better horizontal gaze. Unfortunately, in our clinical practice, we found the patients with CBVA between -10° and 10° after surgery usually complained of difficulty in cooking, cleaning, desk working and the like, although they had excellent horizontal gaze. In other words, for the patients with cervical ankylosis, good horizontal gaze existed together with poor downward gaze. Then, which condition do the patients prefer? Is there a compromise solution that makes a better quality life possible for the patients? In this research, we studied AS patients with cervical ankylosis, aiming to investigate the optimal CBVA for deformity correction. METHODS: 25 AS thoracolumbar kyphotic patients with cervical ankylosis were studied, whose function and expectation of visual field related to life quality were assessed by questionnaire before and after surgery. Pre- and post-operative CBVA were obtained on lateral photos of the patients with free-standing posture, and 50 cases of CBVA were included, which were divided into six groups according to the angle irrespective of surgery (Group A, CBVA <0°; Group B, 0° ≤ CBVA < 10°; Group C, 10° ≤ CBVA < 20°; Group D, 20° ≤ CBVA < 30°; Group E, 30° ≤ CBVA < 40°; Group F, CBVA ≥ 40°). Kruskal-Wallis test was used to assess all the groups in terms of various items in the questionnaire, while Mann-Whitney test was used to assess every two groups. RESULTS: In overall evaluation, Group C (10°-20°) obtained the optimal expectation (p < 0.05); Group B, C and D (0°-30°) obtained better function (p < 0.05), and there was no significant difference between the 3 groups. In appearance, Group A, B and C (<20°) were better than the other groups both in function and expectation (p < 0.05), without dramatic difference among the three groups. In outdoor activities, Group A, B, C and D (<30°) were better in most of the items (p < 0.05). In indoor activities, Group C and D (10-30°) were much better (p < 0.05). CONCLUSION: AS thoracolumbar kyphotic patients with cervical ankylosis had the best satisfaction when 10° ≤ CBVA < 20°.

Hilus pulmonis as the center of gravity for AS thoracolumbar kyphosis.

INTRODUCTION: The sagittal vertical axis (SVA) is a meaningful measurement and widely used for evaluating sagittal balance, and is considered a design standard for surgery, including most ankylosing spondylitis (AS) kyphotic deformity planning. However, recent research indicates that the C7 plumb line is actually not the center of gravity (CG) line. Therefore, whether there is a better radiological marker as the CG of the trunk for AS thoracolumbar kyphosis remains unknown. This research is to investigate a radiological marker for the CG of the trunk in lateral radiographs for AS thoracolumbar kyphosis. MATERIALS AND METHODS: The center of gravity of an irregular object can be obtained by hanging or supporting it in different points and directions, and the CG will be on the point of intersection. According to this principle of mechanics, we could use the pre- and post-operative hip axis vertical lines to locate the CG of the trunk. We evaluated 38 AS-fixed thoracolumbar kyphotic patients with pedicle subtraction osteotomies. Full-length, free-standing lateral radiographs, including the spine and pelvis, were available for all patients. Pre- and post-operative radiological parameters were measured, including SVA, horizontal distance between hip axis and C7 (HDHC), horizontal distance between hip axis and T5 (HDHT5), horizontal distance between hip axis and T9 (HDHT9), and horizontal distance between hip axis and hilus pulmonis (HDHH). Pre- and post-operative radiological parameter changes were compared by paired samples t tests. The intraclass correlation coefficient (ICC) was used to determine the intra- and interobserver reliabilities of HDHH. RESULTS: Pre-operative SVA, HDHC, HDHT5, HDHT9, and HDHH values were, respectively, 21.1, 12.7, 3.5, -3.8, and 2.7 cm, and their post-operative values were, respectively, 9.1, 4.2, -2.1, -5.6, and 0.9 cm. Changes in SVA, HDHC, HDHT5, and HDHT9 were significant (p < 0.05), while the change in HDHH was not (p > 0.05). The ICC for overall interobserver reliability was 0.958 (p < 0.001), and it was 0.963 (p < 0.001) for overall intraobserver reliability. CONCLUSION: The hilus pulmonis fell approximately on the hip axis both pre- and post-operatively. It was a better marker as the center of gravity of the trunk for deformity planning for AS thoracolumbar kyphosis.

Clinical efficacy and complications of MIS-TLIF and TLIF in the treatment of upper lumbar disc herniation: a comparative study.

BACKGROUND: The optimal treatment modality for upper lumbar disc herniation remains unclear. Herein, we compared the clinical efficacy and application value of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and transforaminal lumbar interbody fusion (TLIF) for upper lumbar disc herniation. We aimed to provide new evidence to guide surgical decisions for treating this condition. METHODS: We retrospectively analyzed the clinical data of 81 patients with upper lumbar disc herniation admitted between January 2017 and July 2018, including 41 and 40 patients who underwent MIS-TLIF and TLIF, respectively. Demographic characteristics, preoperative functional scores, perioperative indicators, and postoperative complications were compared. We performed consecutive comparisons of visual analog scale (VAS) scores of the lumbar and leg regions, Oswestry disability index (ODI), Japanese Orthopaedic Association scores (JOA), and MacNab scores at the final follow-up, to assess clinical outcomes 5 years postoperatively. RESULTS: VAS scores of the back and legs were significantly lower in the MIS-TLIF than the TLIF group at 3 months and 1 year postoperatively (P < 0.05). Intraoperative bleeding and postoperative hospitalization time were significantly lower, and the time to return to work/normal life was shorter in the MIS-TLIF than in the TLIF group (P < 0.05). The differences in JOA scores and ODI scores between the two groups at 3 months, 1 year, and 3 years postoperatively were statistically significant (P < 0.05). CONCLUSION: The early clinical efficacy of MIS-TLIF was superior to that of TLIF, but no differences were found in mid-term clinical efficacy. Further, MIS-TLIF has the advantages of fewer medical injuries, shorter hospitalization times, and faster postoperative functional recovery.

Risk Factors for New Adjacent and Remote Vertebral Fracture After Percutaneous Vertebroplasty.

OBJECTIVE: To analyze the risk factors of new adjacent vertebral fractures (AVF) and remote vertebral fractures (RVF) after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). METHODS: Patients who underwent additional PVP for new OVCFs were enrolled. In addition, we set a 1:1 age-, sex-, surgical segment-, and surgical date-matched control group, in which patients underwent PVP without new OVCFs. Data on body mass index, occurrence time of second PVP, vertebral computed tomography (CT) Hounsfield Unit (HU) at the fracture adjacent segment, and RVF segment were collected. RESULTS: A total of 44 patients who underwent additional PVP for new OVCFs at our hospital were included. AVF occurred significantly earlier than RVF (13.5 ± 14.1 vs. 30.4 ± 20.1 months, P = 0.007). Compared to the control group, the AVF segment CT HU was significantly lower in patients with AVF (28.7 ± 16.7 vs. 61.3 ± 14.7, P = 0.000), while there was no significant difference between patients with RVF and control group including both adjacent and RVF segment CT HU. Receiver operating characteristic curves identified a cutoff value of 43 for using adjacent segment CT HU to differentiate patients with AVF from controls, with a sensitivity of 80% and a specificity of 88.9%. CONCLUSIONS: Our study showed that the risk factors for AVF and RVF after PVP surgery were different. The occurrence of AVF was earlier and associated with low adjacent segment CT HU values, whereas the preoperative CT HU in both adjacent and RVF segments was not found to be associated with RVF.

Comparison of Fusion Rate and Clinical Outcomes in Minimally Invasive and Conventional Posterior Fusion for Lumbar Degenerative Disease: A Network Meta-Analysis.

BACKGROUND: The fusion rate, clinical efficacy, and complications of minimally invasive fusion surgery and open fusion surgery in the treatment of lumbar degenerative disease are still unclear. METHODS: We conducted a literature search using PubMed, Embase, Cochrane Library, CNKI, and WANFANG databases. RESULTS: This study included 38 retrospective studies involving 3097 patients. Five intervention modalities were considered: unilateral biportal endoscopic-lumbar interbody fusion (UBE-LIF), percutaneous endoscopic-lumbar interbody fusion (PE-LIF), minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF), transforaminal lumbar interbody fusion (TLIF), and posterior lumbar interbody fusion (PLIF). Quality assessment indicated that each study met acceptable quality standards. PE-LIF demonstrated reduced low back pain (Odds Ratio = 0.50, Confidence Interval: 0.38-0.65) and lower complication rate (Odds Ratio = 0.46, Confidence Interval: 0.25-0.87) compared to PLIF. However, in indirect comparisons, PE-LIF showed the lowest fusion rates, with the ranking as follows: UBE-LIF (83.2%) > MIS-TLIF (59.6%) > TLIF (44.3%) > PLIF (39.8%) > PE-LIF (23.1%). With respect to low back pain relief, PE-LIF yielded the best results, with the order of relief as follows: PE-LIF (96.4%) > MIS-TLIF (64.8%) > UBE-LIF (62.6%) > TLIF (23.0%) > PLIF (3.2%). Global and local consistency tests showed satisfactory results, and heterogeneity tests indicated good stability. CONCLUSIONS: Compared to conventional open surgery, minimally invasive fusion surgery offered better scores for low back pain and Oswestry Disability Index, lower complication rates, reduced bleeding, and shorter hospital stays. However, minimally invasive fusion surgery did not show a significant advantage in terms of fusion rate and had a longer operative time.

Modulation of fracture healing by senescence-associated secretory phenotype (SASP): a narrative review of the current literature.

The senescence-associated secretory phenotype (SASP) is a generic term for the secretion of cytokines, such as pro-inflammatory factors and proteases. It is a crucial feature of senescent cells. SASP factors induce tissue remodeling and immune cell recruitment. Previous studies have focused on the beneficial role of SASP during embryonic development, wound healing, tissue healing in general, immunoregulation properties, and cancer. However, some recent studies have identified several negative effects of SASP on fracture healing. Senolytics is a drug that selectively eliminates senescent cells. Senolytics can inhibit the function of senescent cells and SASP, which has been found to have positive effects on a variety of aging-related diseases. At the same time, recent data suggest that removing senescent cells may promote fracture healing. Here, we reviewed the latest research progress about SASP and illustrated the inflammatory response and the influence of SASP on fracture healing. This review aims to understand the role of SASP in fracture healing, aiming to provide an important clinical prevention and treatment strategy for fracture. Clinical trials of some senolytics agents are underway and are expected to clarify the effectiveness of their targeted therapy in the clinic in the future. Meanwhile, the adverse effects of this treatment method still need further study.

[Effects of wide posterior release on the correction of severe and rigid thoracic scoliosis in sagittal plane].

OBJECTIVE: To explore the effects of wide posterior release on the correction of severe and rigid thoracic scoliosis in sagittal plane. METHODS: A total of 37 idiopathic scoliosis patients (26 females and 11 males) with severe and rigid thoracic curves corrected with posterior pedicle screw system between 2006 and 2009 were recruited. Their average age was 17.3 years (range: 14 - 22) at operation and the thoracic Cobb angle was between 70 - 100°. They were separated into 2 groups: group A (n = 15) with wide posterior release and group B (n = 22) with posterior soft tissue release alone. The preoperative, postoperative and latest standing posteroanterior and lateral radiographs during follow-ups were reviewed. RESULTS: All patients were operated successfully. No statistic difference existed in the average operative duration between two groups (P > 0.05). The average volume of blood loss was 874 ml in Group A versus 712 ml in Group B (P < 0.05). The average coronal Cobb angle on postoperative standing photograph was 27.4° (68.1% correction) in Group A and 35.6° (56.9% correction) in Group B. For comparing sagittal correction results in patients with similar thoracic sagittal deformities, we distinguished subgroup A1 (preoperative TKA < 40°) from subgroup A2 (preoperative TKA > 40°) in group A and subgroup B1 (preoperative TKA < 40°) from subgroup B2 (preoperative TKA > 40°) in group B. The postoperative TKA was 26.8° (> 9.2° than preoperation) in subgroup A1 and 12.5° (3.1° < preoperation) in subgroup B1 (P < 0.05). The postoperative TKA was 28.4° (24.9° < preoperation) in subgroup A2 and 39.1° (10.3° < preoperation) in subgroup B2 (P < 0.05). There was one case of dural leakage in group A. A leakage of cerebrospinal fluid was cured with a prone position and wound compression. One case of infection in superficial part of wound in group B was cured after debridement. No nerve system injury, deep infection or instrumentation failure was found. During a follow-up period of 2 years, there was no obvious correction loss or trunk decompensation. CONCLUSION: In idiopathic scoliosis patients with severe and rigid thoracic curves, wide posterior release via a posterior approach may help to correct the deformity in sagittal plan and achieve more coronal correction in these curves.

[A feasibility research of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation for recurrent lumbar disc herniation].

OBJECTIVE: To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation. METHODS: From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years (35-68 years) were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of perioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI). RESULTS: All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was (148 ± 75) minutes, the average operative blood loss was (186 ± 226) ml, the average postoperative ambulation time was (32 ± 15) hours, and the average hospitalization time was (6 ± 4) days. The average length of incision was (29 ± 4) mm, and the average length of translaminar facets screw was (52 ± 6) mm. The mean follow-up was 16.5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845, P = 0.000;leg pain VAS:F = 113.480, P = 0.000;ODI:F = 36.665, P = 0.000). CONCLUSION: Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision, and the advantage including less invasion and quickly recovery.

Comparison between oblique lumbar interbody fusion and posterior lumbar interbody fusion for the treatment of lumbar degenerative diseases: a systematic review and meta-analysis.

BACKGROUND: Although oblique lumbar interbody fusion (OLIF) has produced good results for lumbar degenerative diseases (LDDs), its efficacy vis-a-vis posterior lumbar interbody fusion (PLIF) remains controversial. This meta-analysis aimed to compare the clinical efficacy of OLIF and PLIF for the treatment of LDDs. METHODS: A comprehensive assessment of the literature was conducted, and the quality of retrieved studies was assessed using the Newcastle-Ottawa Scale. Clinical parameters included the visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain, disability, and functional levels. Statistical analysis related to operative time, intraoperative bleeding, length of hospital stay, lumbar lordosis angle, postoperative disc height, and complication rates was performed. The PROSPERO number for the present systematic review is CRD42023406695. RESULTS: In total, 574 patients (287 for OLIF, 287 for PLIF) from eight studies were included. The combined mean postoperative difference in ODI and lumbar VAS scores was - 1.22 and - 0.43, respectively. In postoperative disc, height between OLIF and PLIF was 2.05. The combined advantage ratio of the total surgical complication rate and the mean difference in lumbar lordosis angle between OLIF and PLIF were 0.46 and 1.72, respectively. The combined mean difference in intraoperative blood loss and postoperative hospital stay between OLIF and PLIF was - 128.67 and - 2.32, respectively. CONCLUSION: Both the OLIF and PLIF interventions showed good clinical efficacy for LDDs. However, OLIF demonstrated a superior advantage in terms of intraoperative bleeding, hospital stay, degree of postoperative disc height recovery, and postoperative complication rate.

Biomechanical effects of iatrogenic muscle-ligaments complex damage on adjacent segments following posterior lumbar interbody fusion: A finite element analysis.

OBJECTIVE: To analyze the biomechanical effects of proximal iatrogenic muscle-ligaments complex (MLC) damage on adjacent segments following posterior lumbar interbody fusion (PLIF) by finite element (FE) analysis. METHODS: The multifidus muscle force was loaded in the validated intact lumbosacral finite element model. Based on whether undergoing PLIF or the proximal MLC damage, three models were established. Range of motion (ROM) and the maximum von Mises (VM) stress of adjacent segments were analyzed, as well as the average muscle force and work capacity in four loading directions. RESULTS: PLIF results in significant changes in ROM and stress. ROM changed significantly in the upper adjacent segment, the PLIF model changed the most in extension, and the largest change in the lower adjacent segment occurred after MLC damage. The VM stress of the upper adjacent segment occurred in extension of the PLIF model, and that of the lower adjacent segment occurred in rotation after MLC damage. In flexion, ROM, and stress of the damaged MLC fusion model were significantly increased compared with the normal and PLIF models, there was a stepwise amplification. The average muscle force comparison of three models was 5.8530, 12.3185, and 13.4670 N, respectively. The total work capacity comparison was close to that of muscle force. CONCLUSION: PLIF results in increased ROM and the VM stress of adjacent segments, the proximal MLC damage will aggravate this change. This may increase the risk of ASD and chronic low back pain. Preserving the proximal MLC reduces the biomechanical effects on adjacent segments.

Trans-intervertebral osteotomy classification of posterior spinal corrective osteotomy procedures via the intervertebral space.

•This is a diagnostic study for a classification for posterior spinal osteotomy procedures via the intervertebral space.•Proposed â€‹a novel classification â€‹with â€‹excellent reliability â€‹and â€‹validity, differ from the SRS-Schwab osteotomy classification.•Give a novel definition of "trans-intervertebral osteotomy" (TIO) for posterior spinal osteotomy procedures.•Thoroughly discussed about the histories of posterior spinal osteotomy procedures via the intervertebral space.•Systematically introduced the TIO technique with fine original schematics.

[Clinical efficacies of skipping two-level transpedicular wedge osteotomy for correction of severe kyphosis in ankylosing spondylitis].

OBJECTIVE: To explore the clinical efficacies of skipping two-level transpedicular wedge osteotomy in the correction of severe kyphotic deformity in ankylosing spondylitis (AS). METHODS: From January 2003 to December 2009, a total of 38 consecutive patients with AS and severe kyphosis (chin-brow vertical angle (CBVA) or global thoraco-lumbar kyphosis angle (TLKA) over 70°) undergoing skipping two-level transpedicular wedge osteotomy at the Department of Orthopedics of Chinese PLA General Hospital were reviewed retrospectively. There were 32 males and 6 females with an average age of 38.0 years (range: 22 - 65). The preoperative parameters of TLKA, T11-L2 kyphotic angle, L1-S1 lordosis angle, sagittal imbalance and CBVA were obtained from the total spine radiography or computed tomography and clinical lateral photograph. According to the characteristic curves and normal spinal alignment, their profiles of osteotomy location and angle were determined and confirmed by computer simulations. Improvement in postoperative parameters was observed and treatment satisfaction evaluated RESULTS: The average operating duration was 309 minutes and the average volume of blood loss was 2050 ml. The parameters of TLKA, T11-L2 kyphotic angle and L1-S1 lordosis angle improved from 101.0° ± 21.3°, 45.2° ± 13.6°, -28.2° ± 23.3° at preoperation to 26.0° ± 12.1°, 2.8° ± 11.6°, 28.9° ± 13.3° postoperation respectively (P < 0.01). CBVA improved from 79.4° ± 15.9° to 13.6 ° ± 10.9° (P < 0.01). The sagittal imbalance distance improved from (49 ± 13) to (15 ± 7) cm (P < 0.01). All patients could walk with orthophoria and lie horizontally postoperatively. The average follow-up was 32 months (range: 24 ∼ 78 months). Fusion of osteotomy was achieved in all patients and there was no event of loss of correction or implant failure. The SRS-22 average score improved from 1.8 to 4.2. CONCLUSION: For severe kyphosis in AS, skipping two-level transpedicular wedge osteotomy is a satisfactory and reliable approach for the correction of kyphotic deformity and it may improve appearance and function significantly.

Correlation Between Different Sagittal Parameters in Patients With Degenerative Kyphosis.

Objective: To explore the relationship between different sagittal parameters and identify the fitting formula of spino-pelvic parameters in patients with degenerative kyphosis (DK). Summary of Background: Sagittal balance is increasingly recognized as a predictor of clinical outcomes in patients with DK, while the relationship between different sagittal parameters in patients with DK remains unidentified. Methods: A retrospective study with 279 participants was conducted. There were 168 DK patients which were divided into a sagittal balance group (SB:52 cases) and sagittal imbalance (SIB:116 cases). Radiographic measurements included thoracolumbar kyphosis (TLK), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), and pelvic tilt (PT). The correlations were analyzed between different sagittal parameters. Results: There were significant differences between the SB and SIB groups in terms of TLK, LL, PI-LL, PT, SVA, sacral slope (SS), and TK. For patients with DK, the LL was correlated with PT and TK. The linear regression was LL = 22.76-0.28 × PT + 0.62 × TK. In the SB group, TK was the influencing factor for LL and the linear regression analysis showed that LL = 33.57 + 0.33 × TK. While in the SIB group, PT and TK were in synergistic effect with PI-LL, the linear regression analysis showed that LL = 22.76-0.28 × PT + 0.62 × TK. Conclusion: From the present study, we can see that LL has a significant correlation with PT and TK in patients with DK, while in SB, the LL was only correlated with TK. Therefore, the correction of LL in a different group should be calculated to avoid the incidence of proximal junction kyphosis (PJK).

Rapidly Progressive Paraplegia Resulting from Latent Cervical Dural Arteriovenous Fistula After Lumbar Surgery: A Case Report.

CASE: A 68-year-old woman developed symptoms of acute paraplegia due to an occult cervical dural arteriovenous fistula (DAVF) after a minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). She was subsequently diagnosed by angiography and treated with vascular embolization. A 2-year follow-up showed that the patient's upper limb muscle strength returned to normal, and the lower limb muscle strength partially improved with remnant motor dysfunction. CONCLUSION: For patients with symptoms of nerve injury inconsistent with the spinal surgery site, a possibility of DAVF should be considered, and related investigations should be performed. Once diagnosed, active treatment is required.