The efficacy of platelet-rich plasma applicated in spinal fusion surgery: A meta-analysis.

Objective: The purpose of this meta-analysis is to evaluate the effect of the application of platelet-rich plasma (PRP) in spinal fusion surgery on the fusion rate of the spine. Methods: A comprehensive search of the PubMed, Embase, Cochrane Library, and Science Direct databases was conducted to identify randomized control trials (RCTs) or observational cohort studies that evaluated the efficacy and safety of PRP in spinal fusion. Data on final fusion rate, changes in the visual analog scale (VAS), estimated blood loss (EBL), and operative time was collected from the eligible studies for meta-analysis. Patients were divided into PRP and non-PRP groups according to whether PRP was used during the spinal fusion procedure. Results: According to the selection criteria, 4 randomized controlled trials and 8 cohort studies with 833 patients and 918 levels were included. The outcomes indicated that PRP application is associated with a lower fusion rat (OR = 0.62, 95% CI: (0.43, 0.89), P = 0.009) at final follow-up (>24 months). Subgroup analysis showed a lower rate of spinal fusion in the PRP group compared to the non-PRP group (OR = 0.35, 95% CI: (0.21, 0.58), P < 0.001) when spinal fusion was assessed using only anterior-posterior radiographs. When the bone graft material was a combination of autologous bone + artificial bone, the spinal fusion rate was lower in the PRP group than in the non-PRP group (OR = 0.34, 95% CI: (0.16, 0.71), P = 0.004). The PRP and non-PRP groups showed no significant differences in VAS changes at the 24th postoperative month (WMD = 0.36, 95% CI: (-0.37, 1.09), P = 0.33); Application of PRP does not reduce the estimated blood loss (WMD = -86.03, 95% CI: (-188.23, 16.17), P = 0.10). In terms of operation time, using PRP does not prolong operation time (WMD = -3.74, 95% CI: (-20.53, 13.04), P = 0.66). Conclusion: Compared with bone graft fusion alone, PRP cannot increase the rate of spinal fusion. Inappropriate methods of spinal fusion assessment or mixing PRP with artificial/allograft bone may have been responsible for the lower rate of spinal fusion in the PRP group. Systematic Review Registration: doi: 10.37766/inplasy2022.5.0055.

[Effects and mechanism of morroniside on osteogenic differentiation and proliferation of mouse MC3T3-E1 cells].

Objective: To study the effects of morroniside (MOR) on the proliferation and osteogenic differentiation of mouse MC3T3-E1 cells. Methods: The 4th generation MC3T3-E1 cells were randomly divided into 6 groups: control group (group A), MOR low dose group (10 µmol/L, group B), MOR medium-low dose group (20 µmol/L, group C), MOR medium dose group (40 µmol/L, group D), MOR medium-high dose group (80 µmol/L, group E), and MOR high dose group (100 µmol/L, group F). The proliferation activity of each group was detected by cell counting kit 8 (CCK-8) assay; the bone differentiation and mineralized nodule formation of each group were detected by alizarin red staining; real-time fluorescence quantitative PCR (RT-qPCR) was performed to detect cyclin-dependent kinase inhibitor 1A (P21), recombinant Cyclin D1 (CCND1), proliferating cell nuclear antigen (PCNA), alkaline phosphatase (ALP), collagen type Ⅰ (COL-1), bone morphogenetic protein 2 (BMP-2), and adenosine A2A receptor (A2AR) mRNA expressions; Western blot was used to detecte the expressions of osteopontin (OPN), Runt-related transcription factor 2 (RUNX2), and adenosine A2AR protein. Results: The CCK-8 assay showed that the absorbance ( A) values of groups B to F were significantly higher than that of group A at 24 hours of culture, with group C significantly higher than the rest of the groups ( P<0.05). The MOR concentration (20 µmol/L) of group C was selected for the subsequent CCK-8 assay; the results showed that the A values of group C were significantly higher than those of group A at 24, 48, and 72 hours of culture ( P<0.05). Alizarin red staining showed that orange-red mineralized nodules were visible in all groups and the number of mineralized nodules was significantly higher in groups B and C than in group A ( P<0.05). RT-qPCR showed that the relative expressions of P21, CCND1, and PCNA mRNAs were significantly higher in group C than in group A ( P<0.05). The expressions of ALP, BMP-2, COL-1, and adenosine A2AR mRNAs in groups B to E were significantly higher than those in group A, with the expressions of ALP, BMP-2, COL-1 mRNAs in group C significantly higher than the rest of the groups ( P<0.05). Compared with group A, the expressions of OPN and RUNX2 proteins in groups B and C were significantly increased, while those in group D and E were significantly inhibited ( P<0.05). There was no significant difference between groups B and C and between groups D and E ( P>0.05). The relative expression of adenosine A2AR protein in groups B to E was significantly higher than that in group A, with group C significantly higher than the rest of the groups ( P<0.05). Conclusion: MOR can promote the proliferation and osteogenic differentiation of MC3T3-E1 cells; the mechanism of MOR may be achieved by interacting with adenosine A2AR.

Robot-Assisted Kyphoplasty Improves Clinical and Radiological Features Better Than Fluoroscopy-Assisted Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Meta-Analysis.

Purpose: This meta-analysis aimed to determine whether patients treated with robot-assisted kyphoplasty for vertebral compression fractures have superior clinical and radiographic improvement than those treated with fluoroscopy. Methods: A comprehensive search of the PubMed, Embase, Cochrane Library, Science Direct, and CNKI (China National Knowledge Infrastructure) databases was conducted to find randomized control trials (RCTs) or observational cohort studies that compared robotic-assisted kyphoplasty (RA-kyphoplasty) with fluoroscopy-assisted kyphoplasty (FA-kyphoplasty) in treating vertebral compression fractures. Preoperative, postoperative, and final follow-up data on vertebral height (VH), vertebral kyphosis angle (VKA), visual analog scale (VAS) for back pain, and cement leakage rate were collected from eligible studies for meta-analysis. Patients were divided into RA and FA groups depending on whether the operation was robotically or fluoroscopically guided. Results: We included 6 cohort studies with 491 patients and 633 vertebrae. The results of the meta-analysis showed that the RA group had a higher VH than the FA group at both postoperation (p < 0.001) and final follow-up (p < 0.001); the VKA in the RA group was lower than that in the FA group at postoperation (p < 0.001) and final follow-up (p < 0.001); the back pain VAS score was lower in the RA group than in the FA group at postoperation (p = 0.01) and final follow-up (p = 0.03); and the cement leakage rate in the RA group was lower than those in the FA group (p < 0.001). Conclusion: This meta-analysis demonstrated that RA-kyphoplasty outperformed FA-kyphoplasty in vertebral height restoration, kyphosis angle correction, VAS score reduction for back pain, and lower cement leakage rate in the treatment of vertebral compression fractures.

Comparison of radiological and clinical outcomes of 3D-printed artificial vertebral body with Titanium mesh cage in single-level anterior cervical corpectomy and fusion: A meta-analysis.

Propose: This meta-analysis aimed to determine whether 3D-printed artificial vertebral body have superior clinical and radiographic outcome than Titanium Mesh Cage(TMC) in single-level anterior cervical corpectomy and fusion. Methods: A comprehensive search of the PubMed, Embase, Cochrane Library, Web of Science, and CNKI (China National Knowledge Infrastructure) databases was conducted to find randomized control trials (RCTs) or cohort studies that compared 3D-printed artificial vertebral body with conventional Titanium Mesh Cage (TMC) in single-level anterior cervical corpectomy and fusion (SL-ACCF). Operation time; intraoperative blood loss; subsidence of vertebral body; preoperative, and final follow-up C2-C7 Cobb angle, Japanese Orthopedic Association (JOA) scores, and Visual Analog Scale(VAS) scores were collected from eligible studies for meta-analysis. Results: We included 6 cohort studies with 341 patients. The results of the meta-analysis showed that the 3D group has a shorter operation time than the traditional TMC group(p = 0.04) and the TMC group had more severe subsidence(≥3 mm) of vertebral body than the 3D group(p < 0.0001). And the cervical C2-C7 Cobb angle in the 3D group was larger than that in the TMC group at the final follow-up. Conclusion: This meta-analysis demonstrates that 3D-printed artificial vertebral body is superior to traditional TMC in reducing the operation time and maintaining the postoperative vertebral height and restoring sagittal balance to the cervical spine in single-level anterior cervical corpectomy and fusion.

Identification of potential gene signatures associated with osteosarcoma by integrated bioinformatics analysis.

BACKGROUND: Osteosarcoma (OS) is the most primary malignant bone cancer in children and adolescents with a high mortality rate. This work aims to screen novel potential gene signatures associated with OS by integrated microarray analysis of the Gene Expression Omnibus (GEO) database. MATERIAL AND METHODS: The OS microarray datasets were searched and downloaded from GEO database to identify differentially expressed genes (DEGs) between OS and normal samples. Afterwards, the functional enrichment analysis, protein-protein interaction (PPI) network analysis and transcription factor (TF)-target gene regulatory network were applied to uncover the biological function of DEGs. Finally, two published OS datasets (GSE39262 and GSE126209) were obtained from GEO database for evaluating the expression level and diagnostic values of key genes. RESULTS:  In total 1,059 DEGs (569 up-regulated DEGs and 490 down-regulated DEGs) between OS and normal samples were screened. Functional analysis showed that these DEGs were markedly enriched in 214 GO terms and 54 KEGG pathways such as pathways in cancer. Five genes (CAMP, METTL7A, TCN1, LTF and CXCL12) acted as hub genes in PPI network. Besides, METTL7A, CYP4F3, TCN1, LTF and NETO2 were key genes in TF-gene network. Moreover, Pax-6 regulated four key genes (TCN1, CYP4F3, NETO2 and CXCL12). The expression levels of four genes (METTL7A, TCN1, CXCL12 and NETO2) in GSE39262 set were consistent with our integration analysis. The expression levels of two genes (CXCL12 and NETO2) in GSE126209 set were consistent with our integration analysis. ROC analysis of GSE39262 set revealed that CYP4F3, CXCL12, METTL7A, TCN1 and NETO2 had good diagnostic values for OS patients. ROC analysis of GSE126209 set revealed that CXCL12, METTL7A, TCN1 and NETO2 had good diagnostic values for OS patients.

Glucose-induced decrease of cystathionine ß-synthase mediates renal injuries.

Exogenous hydrogen sulfide (H2 S) protects kidneys from diabetic injuries in animal models. In order to explore the role of endogenous H2 S in diabetic nephropathy, we determined the renal H2S producing enzymes in vivo and in vitro. In diabetic mice, H2 S levels in blood and kidney were decreased while cystathionine ß-synthase (CBS), mainly located in mouse renal proximal convoluted tubules (PCT), was reduced selectively. In cultured mouse PCT cells treated with high glucose, CBS protein and activity was reduced while ubiquitinated CBS was increased, which was abolished by a proteasome inhibitor MG132 at 1 hour; high glucose drove CBS colocalized with proteasome 26S subunit ATPase6, indicating an involvement of ubiquitination proteasome degradation. At 48 hours, high glucose also selectively decreased CBS protein, concentration-dependently, but increased the ubiquitination of CBS; silence of CBS by siRNA increased nitrotyrosine, a marker for protein oxidative injury. Nitrotyrosine was also increased by high glucose treatments. The increases of nitrotyrosine either by cbs-siRNA or by glucose were restored by GYY4137, indicating that the H2 S donor may protect kidney from oxidative injury induced by CBS deficiency. In diabetic kidneys, ubiquitinated CBS and nitrotyrosine were increased but restored by GYY4137. The treatment also ameliorated albuminuria and renal morphologic changes in diabetic mice. Our findings suggest that high glucose induces reduction of renal CBS protein and activity in vivo and in vitro that is critical to the pathogenesis of diabetic kidney disease.

General and fast synthesis of graphene frameworks using sugars for high-performance hydrogen peroxide nonenzymatic electrochemical sensor.

3D graphene frameworks (GFs) are fast and scalably synthesized via a general and facile method from the rich biomass of sugars with the aid of molten salts, using glucose as the prototype, to obtain an effective sensing platform for sensitive nonenzymatic hydrogen peroxide (H2O2) detection. The electroactive area of the GFs/GCE (0.1437 cm2) is obviously higher than that of bare GCE (0.0653 cm2). The GFs are found to exhibit remarkable electrocatalytic activity toward H2O2 reduction while avoiding enzyme loading. The electrochemical sensor for H2O2 based on GFs displays a low detection limit of 0.032 ± 0.005 µM (S/N = 3) at a working potential of - 0.55 V in 0.01 M N2-saturated phosphate-buffered saline (PBS, pH = 7.4) by an amperometric method. The sensor has good selectivity over other compounds such as ascorbic acid, dopamine, uric acid, NaCl, citric acid, and glucose. Moreover, the sensor shows excellent reproducibility with a relative standard deviation of 3.7% and acceptable stability after 30 days of usage. Furthermore, it can detect H2O2 released from living tumorigenic cells in real time. Most importantly, it is demonstrated that such GFs can be obtained from a variety of sugars (sucrose, fructose, lactose, and maltose). This work may offer a new general avenue for the synthesis of 3D GFs and promote the development of electrochemical sensors. Graphical abstract We have reported a general and fast method to synthesize GFs from sugars (glucose, sucrose, fructose, lactose, and maltose) with the addition of molten Na2CO3 salt as a template. The developed GFs can be applied as excellent electrode materials for efficient electrochemical sensing of H2O2.

8-Hydroxyquinoline functionalized covalent organic framework as a pH sensitive carrier for drug delivery.

A porous 8-hydroxyquinoline functionalized organic covalent framework (named COF-HQ) was synthesized. The as-prepared COF-HQ showed stable crystal structure, suitable pore size, excellent dispersibility in physiological solution and pH sensitivity, which would be employed as a potential nanocarrier for drug transport and controlled release. The drug loading experiment with 5-Fluorouracil (5-FU) as the model molecule proved that the drug loading capacity of COF-HQ was significantly improved due to the introduction of quinoline groups. The drug release profiles of 5-FU from 5-FU loaded COF-HQ (termed 5-FU@COF-HQ) under different pH showed that its release was controlled by pH owing to the pH sensitivity of conjugated nitrogen atoms from quinoline groups and CN. The in vitro hemolysis and in vivo biocompatibility experiments further verified the good biocompatibility of COF-HQ. Importantly, 5-FU@COF-HQ-treated B16F10 cell-induced tumor models showed that 5-FU@COF-HQ displayed enhanced anti-tumor efficacy than other groups. These results suggested that the drug-loading COF-HQ delivery system showed the potential for effective cancer therapy with advantages of high drug loading, good biocompatibility and the pH-sensitive release of the tumor microenvironment. Overall, our research provided a new functionalized COF-HQ drug delivery system, which further expanded the application of COFs as carriers in the field of cancer treatment.

miR­95 promotes osteosarcoma growth by targeting SCNN1A.

Osteosarcoma (OS) is a common malignant bone tumor, presenting particularly in children and young adults, and accounts for approximately 19% of all malignant bone cancers. Despite advances in OS treatment, long­term prognosis remains poor. miRNAs are non­coding single­stranded RNAs ~22 nucleotides in length. Increasing evidence suggests that numerous miRNAs may play critical roles in tumorigenesis and tumor progression; however, the role of miR­95 in OS has not been examined. In the present study, we investigated the role of miR­95 in OS using in vitro and in vivo models and publicly available expression data. Our findings indicate that abnormal miR­95 expression occurs in OS, according to the Gene Expression Omnibus (GEO) database. The miR­95 inhibitor reduced cell proliferation and promoted apoptosis in OS cell lines as detected by EdU staining, TUNEL staining and flow cytometry. Furthermore, a dual luciferase reporter assay revealed that miR­95 regulates the cell cycle of OS cells and apoptosis by targeting sodium channel epithelial 1α subunit (SCNN1A). Additionally, miR­95 antagomir suppressed the growth of U2OS xenograft tumors in a mouse model. In summary, our results suggest that miR­95 induces OS growth in vitro and in vivo by targeting SCNN1A. Our results help clarify the mechanism underlying the miR­95­mediated effects on OS tumor growth, thus potentially establishing it as a diagnostic target.

miR-532-3p inhibits osteogenic differentiation in MC3T3-E1 cells by downregulating ETS1.

BACKGROUND: Many studies had identified that MicroRNAs (miRNAs) could affect bone metabolism by regulating the expression of various proteins. This study explored the effect and mechanism of miR-532-3p on osteogenic differentiation. METHODS: We analyzed the content of miR-532-3p in osteoporosis patients, osteoporosis rats, and osteogenic induced MC3T3-E1 cells. MiR-532-3p mimic or inhibitor utilized to alter intracellular miR-532-3p content. MTT method executed to detect the effect of miR-532-3p on osteoblast proliferation. Real-time qPCR, Western blot, alkaline phosphatase staining, and alizarin red staining utilized to ascertain the influence of miR-532-3p on osteogenic differentiation. Then, databases and a dual-luciferase reporter gene assay used to verify the target of miR-532-3p. Furthermore, the lentiviral vector was utilized to overexpress interesting target gene expression and checked whether the target gene was involved in the regulation of osteogenic differentiation by miR-532-3p. RESULTS: MiR-532-3p expression boosted in low bone mineral density (BMD) patients and rats. In MC3T3-E1 cells, miR-532-3p expression gradually decreased as osteogenic induction matures. MiR-532-3p mimic negatively regulated succinate dehydrogenase (SDH) activity, alkaline phosphatase (ALP) activity, mineralization ability, the osteogenic-associated gene (Col1A1, Runx2, ALP, OPN, and OCN) and E-26 transformation specific-1 (ETS1) expression of MC3T3-E1 cells. Things are the opposite of the miR-532-3p inhibitor. ETS1 identified as the miR-532-3p target gene, and miR-532-3p could inhibit its expression. Besides, improved ETS1 expression could rescue the suppressive effect of miR-532-3p mimic on osteogenic differentiation. CONCLUSION: miR-532-3p can suppress osteogenic differentiation by downregulating ETS1 expression.

Astragalus root extract inhibits retinal cell apoptosis and repairs damaged retinal neovascularization in retinopathy of prematurity.

Since the functions of Astragalus root extract in retinopathy remain to be unraveled, this study is performed to elucidate whether Astragalus root extract functions in retinal cell apoptosis and angiogenesis in retinopathy of prematurity (ROP). Newborn mice were selected for establishing mice models of oxygen-induced retinopathy (OIR), which were treated with high-, medium- or low-Astragalus root extract. Evans Blue (EB) was perfused to detect the blood retinal barrier. Additionally, the vascular morphology, number of endothelial cell nuclei of neovascularization, proliferation of blood vessels, ultrastructural changes were determined via a series of assays. Moreover, levels of reactive oxygen species (ROS), expression of other factors such as VEGF, PEDF, IGF-1, HIF-1α, Bax, Bcl-2, eNOS, nNOS, and iNOS were detected. Astragalus root extract was found to protect blood-retinal barrier in the OIR model mice through repairing the structure and morphology of retina, inhibiting ROS production, retinal cell apoptosis, as well as improving retinal vascular angiogenesis. Astragalus root extract was also found to decrease VEGF and HIF-1α expression, but enhance PEDF and IGF-1 expression in the OIR model mice, thereby protecting retinas in ROP. This study highlights that Astragalus root extract is able to suppress retinal cell apoptosis and repair damaged retinal neovascularization in ROP, which provides basis for ROP therapy.

Application of continuous epidural anesthesia in transforaminal lumbar endoscopic surgery: a prospective randomized controlled trial.

OBJECTIVE: This study aimed to compare intraoperative lower back pain and leg pain, surgical time, and intraoperative X-ray dose in patients offered local infiltration anesthesia or continuous epidural anesthesia for transforaminal endoscopic spine system (TESSYS) surgery. METHODS: A total of 98 patients who received TESSYS treatment for single-segmental lumbar disc herniation were included, and were randomly divided into two groups: group A (49 cases; local infiltration anesthesia) and group B (49 cases; continuous epidural anesthesia). Surgical duration, intraoperative X-ray dose, and visual analog scale (VAS) scores of lower back pain and leg pain before surgery, during surgery, and 48 h after surgery were recorded and compared. RESULTS: After surgery, the VAS scores of both lower back pain and leg pain decreased in group A, and similar findings were found in group B. Group B had a shorter surgical duration, lower intraoperative X-ray dose, and lower intraoperative VAS scores of lower back pain and leg pain compared with group A. CONCLUSION: Compared with local infiltration anesthesia, continuous epidural anesthesia was more effective for pain relief during TESSYS for single-segmental lumbar disc herniation, and also contributed to a shorter surgical duration and lower X-ray exposure.

Treatment of cerebrospinal fluid leak after spine surgery.

Owing to the complexity of spinal surgery, there is a great prevalence of dural tear causing cerebrospinal fluid (CSF) leakage. Many studies focused on suture repair for dural tear to stop CSF leak. Now some new treatment strategies have shown a promising effect that is listed as follows: 1) creating watertight dural closure to stop CSF leak with the help of dural substitute material; and 2) retarding CSF leak by changing pressure difference, including reducing the subarachnoid fluid pressure, increasing the epidural space pressure and both. In fact several methods mentioned above are usually combined to treat CSF leak. However, no update review summarized the relevant studies implemented in recent years. In this review, the authors would compare the effects of different dural closure techniques, and introduce the latest treatment methods and mechanisms.

Subfascial drainage for management of cerebrospinal fluid leakage after posterior spine surgeryd---A prospective study based on Poiseuille's law.

PURPOSE: Up to date, some approaches retarding the flow of cerebrospinal fluid (CSF) could be regarded as direct applications of the fluid mechanics (Poiseuille's law). However, there is a lack of the research on the efficacy of subfascial drainage for management of CSF leak after spine surgery based on the law. This is a prospective and comparative study on subfascial drainage for CSF. METHODS: Every four months in the three years from January 2010 to December 2012, the patients were enrolled respectively in Group A, Group B and Group C, in which, the drainage tube was discontinued within postoperative 3-4 days, 5-6 days, 7-10 days. Results and complications of postoperative CSF leak were investigated, and mean wound healing time (MWHT) of the three groups was compared. RESULTS: A total of 108 cases (Group A/B/C:35/32/41) of CSF leak following posterior spine surgery were admitted to Tianjin Union Medicine Center, and 92 cases have been followed up for more than 1 year (follow-up rate of 85.2%). Preoperative demographics were similar among the 3 groups. In Group A, 7 patients developed CSF leak through the wound (CSFLW), of which 5 cases had to undergo reoperation. One case in Group A was confirmed to have pseudomeningocele at the 1st month after surgery. The MWHT was (16.6±3.6) days. In Group B, 3 patients developed CSFLWand cured by reoperation, in which 1 case of superficial infection recovered well after reoperation. MWHT was (11.4±2.2) days. In Group C, CSFLWwas not found and MWHT was (10.1±2.9) days. The differences of MWHT among Groups A, B and C were statistically significant. CONCLUSION: Postoperative subfascial drainage, which is used to decrease the subfascial space pressure (P2), would help wound healing. When it is placed for more than 7 days, the wound resistance (Rw) would be strong enough to withstand the subarachnoid pressure (P1). Meanwhile, the power trans- duction in a sequence of Rw > P2 > P1 will indirectly retard CSF leak at the durotomy site and accordingly facilitate the healing of damaged spinal dura mater.

[CLINICAL OBSERVATION OF POSTERIOR CERVICAL DECOMPRESSIVE LAMINECTOMY AND LATERAL MASS SCREW FIXATION COMBINED WITH FORAMINOTOMY FOR CERVICAL RADICULO-MYELOPATHY].

OBJECTIVE: To evaluate the effectiveness of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy for treating cervical radiculo-myelopathy. METHODS: Between January 2010 and January 2012, 58 patients with cervical radiculo-myelopathy were treated by posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy. There were 31 males and 27 females, with an average age of 52.7 years (range, 41-72 years). The mean disease course was 5.4 years (range, 3-15 years). The preoperative Japanese Orthopaedic Association (JOA) score was 7.8±1.3, and visual analogue scale (VAS) score was 6.8±1.7. There were 37 cases of inter-vertebral disc herniation and ligamentum flavum hypertrophy, 11 cases of vertebral osteophyte formation with the osteophyte spinal canal occupational ratio of 51.7%±18.1%, and 10 cases of inter-vertebral disc herination with cervical instability. Preoperative cervical curvature was (-5.5±12.5)°. The fixed segments included C3-7 in 29 cases, C4-7 in 19 cases, and C3-6 in 10 cases. Foraminotomy was performed in 135 nerve foramina (mean, 2.33 foramina). RESULTS: The mean operation time was 204 minutes (range, 167-260 minutes), and the mean blood loss was 273 mL (range, 210-378 mL). No injury of vertebral artery or nerve root occurred during operation. Postoperative subcutaneous hematoma and cervical axial pain occurred in 1 case and 8 cases, respectively; and no nerve root palsy was observed. The patients were followed up 2.1-4.3 years (mean, 3.4 years). The postoperative JOA score was significantly increased to 14.1±1.7 (t=-27.672, P=0.000), with an improvement rate of 68.5%±21.9%. Postoperative VAS score was significantly decreased to 2.1±1.1 (t=15.168, P=0.000). The imaging examination showed adjacent segmental degeneration in 1 patient, who had no clinical symptom. There was no screw loosening or pseudoarthrosis formation during follow-up. The cervical curvature was (13.6±5.1)° at 5 days and was (13.2±4.8)° at 2 years, showing significant difference when compared with preoperative one (P<0.05). The osteophyte spinal canal occupational ratio was 36.5%±10.4% at 2 years, showing significant difference when compared with preoperative one (t=6.921, P=0.000). CONCLUSIONS: The procedure of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy is effect in treating cervical radiculo-myelopathy. The spinal cord and nerve root can be adequately decompressed by laminectomy and foraminotomy. The lateral mass screw fixation can correct the cervical curvature and further reduce the tension to spinal cord.

[COMPARATIVE STUDY ON TWO SURGICAL TREATMENT OF ISTHMIC SPONDYLOLISTHESIS].

OBJECTIVE: To compare the effectiveness of treatment of isthmic spondylolisthesis between two different fusion surgeries combined with pedicle screw fixation system. METHODS: A retrospectively analysis was made on the clinical data of 98 patients with lumbar isthmic spondylolisthesis treated between February 2009 and May 2012. Of 98 cases, 53 underwent posterior lumbar interbody fusion (PLIF) combined with internal fixation (group A), and 45 underwent posterolateral fusion (PLF) with internal fixation (group B). There was no significant difference in gender, age, disease duration, segmental lesions, and degree of spondylolisthesis between 2 groups (P > 0.05). The operation time, intraoperative blood loss, reduction rate of spondylolisthesis, reduction loss rate, fusion rate, intervertebral space height, Japanese Orthopedic Association (JOA) score, and the recovery rate of JOA score were compared between 2 groups. RESULTS: The operation time and intraoperative blood loss of group A were significantly higher than those of group B (P < 0.05). Dural tear occured in 4 cases of group A and 1 case of group B during operation; 6 cases had radicular symptoms after operation in group A; incision infection was found in 1 case of 2 groups respectively. The follow-up time was 24-36 months in group A and was 26-40 months in group B. No significant difference was found in the JOA score at preoperation and 2 weeks after operation between 2 groups (P > 0.05). The JOA score and the recovery rate of JOA score of group A were significantly better than those of group B at 2 years after operation (P < 0.05). X-ray film showed that the reduction rate of group A was significantly higher than that of group B after 2 weeks of operation (P < 0.05); the reduction loss rate of group A was significantly lower than that of group B after 2 years after operation (P < 0.05). The intervertebral space height of group A was significantly higher than that of group B at 2 weeks and 2 years after operation (P<0.05). The fusion rate of group A was significantly better than that of group B at 2 years after operation (P < 0.05). CONCLUSION: PLIF can achieve a greater degree of reduction, better restore disc height, and lumbar curvature than PLF. PLIF is superior to PLF in maintaining intervertebral height after operation. And PLIF has higher fusion rate, restores the stability of the spine in a greater extent, and it also can achieve a better long-term outcome.

[Analysis of risk factors of axial symptoms after single door laminoplasty for cervical myelopathy].

OBJECTIVE: To investigate the risk factors of axial symptoms after single door laminoplasty for cervical myelopathy. METHODS: A retrospective analysis was made on the clinical data of 102 patients with cervical myelopathy who underwent single door laminoplasty and were accorded with selective standard between February 2009 and October 2011. There were 59 males and 43 females, aged 35 to 72 years (mean, 58 years). The disease duration was 1-70 months (mean, 18 months). The operated segments included C3-7 in 58 cases, C3-6 in 23 cases, C4-7 in 15 cases, and C3-5 in 6 cases. The visual analogue scale (VAS) was used to determine whether the patient had axial symptoms (group A) or not (group B). The logistic regression analysis was used to analyze the risk factors of postoperative axial symptoms by assessing the following indexes: preoperative VAS score, preoperative Japanese Orthopaedic Association (JOA) score, gender, age, disease duration, operated segment, operation time, intraoperative blood loss, wearing collar time, preoperative encroachment rate of anterior spinal canal, preoperative cervical curvature, and preoperative cervical range of motion. RESULTS: A total of 102 cases were followed up 18-26 months (mean, 24 months). And no postoperative spinal cord injury, cerebrospinal fluid leakage, or infection occurred. Of 102 cases, 50 had axial symptoms (group A) and 52 had no axial symptoms (group B). There were significant differences in age, wearing collar time, preoperative cervical range of motion, preoperative cervical curvature, and preoperative encroachment rate of anterior spinal canal between 2 groups (P < 0.05), but no significant difference was found in preoperative JOA score and VAS score, blood loss, gender, disease duration, operated segment, and operation time (P > 0.05). The logistic regression analysis showed that the increased preoperative encroachment rate of anterior spinal canal, reduced preoperative cervical curvature, and preoperative cervical range of motion loss were the risk factors for cervical axial symptoms. CONCLUSION: Age, wearing collar time, preoperative cervical range of motion, preoperative encroachment rate of anterior spinal canal, and preoperative cervical

[The significance of lumbar MRI in the diagnosis of recurrented lumbar disc herniation after surgery].

OBJECTIVE: To retrospectively evaluate the clinical evaluation of preoperative lumbar T2 sagittal MRI image in predicting the recurrent lumbar disc herniation (RLDH). METHODS: Between January 2009 and April 2011, 28 patients were diagnosed as recurrent L4-5 disc herniation within 2.5 years after surgery, and 25 of them were included in the study as relapse group. At the same time, selected 25 patients implemented the same surgical methods in the same level as a control group randomly, they were all with good to excellent result and the follow-up time was at least 2.5 years. There was no statistical significance between the two groups in gender, age and body mass index(BMI) (P > 0.05). The lumbar MRI image of two groups of patients before surgery were collected and analyzed, with the disc degeneration grade classified. The χ(2) test was used to analyzed the difference of degeneration between the two groups of patients before surgery. Rank correlation analysis evaluated the correlation between disc degeneration and the period of time from the first operation to the recurrence. RESULTS: In terms of preoperative lumbar disc degeneration, there were 22 cases of low-grade disc degeneration and 3 cases of advanced disc degeneration in the relapse group and 5 cases and 20 cases respectively in the control group. there was significant difference between two groups (χ(2) = 23.27, P < 0.05), low-grade disc degeneration (gradesIand III) was significantly more frequent in the relapse group than in the control group. The patients with low-grade disc degeneration had a higher risk of recurrence, that was the risk of recurrent disc herniation increased by a factor of 4.4 from advanced disc degeneration to low-grade disc degeneration(OR = 4.4, 95%CI:1.983-9.765, P < 0.05). In cases of recurrence, the time interval between primary surgery and the recurrence of the patient with advanced disc degeneration was longer compared with low-grade disc degeneration (r = 0.733, P < 0.05). CONCLUSIONS: Preoperative lumbar MRI image may suggest the possibility of the recurrence lumbar disc herniation.Light disc degeneration is an important risk factor for recurrent disc herniation, and the time interval between primary surgery and the recurrence is positively correlated with severity of disc degeneration.