Benefits of Music Intervention on Anxiety, Pain, and Physiologic Response in Adults Undergoing Surgery: A Systematic Review and Meta-analysis.

PURPOSE: Evidence on factors influencing the variations of music's effect on anxiety and pain in surgical patients is unclear. We aimed to elucidate the effects of music intervention on anxiety and pain throughstudy characteristics. METHODS: We conducted a search on the PubMed, CINAHL, Embase, Cochrane, and Web of Science databases from March 7 to April 21, 2022, for randomized controlled trials (RCTs) for the effect of music intervention on anxiety, pain, and physiological responses in surgical patients. We included studies published within the last 10 years. We assessed the risk of bias in the study using the Cochrane risk of bias tool for randomized trials and performed meta-analyses using a random-effects model for all outcomes. We used change-from-baseline scores as summary statistics and computed bias-corrected standardized mean differences (Hedges'g) for anxiety and pain outcomes and mean differences (MD) for blood pressure and heart rate. RESULTS: Of the 454 records retrieved, 30 RCTs involving 2280 participants were found to be eligible. Music intervention was found to be superior to standard care in reducing anxiety (Hedges' g = -1.48, 95% confidence interval: -1.97 to -0.98), pain (Hedges's g = -0.67, -1.11 to -0.23), systolic blood pressure (MD = -4.62, -7.38 to -1.86), and heart rate (MD = -3.37, -6.65 to -0.10) in surgical patients. The impact of music on anxiety and pain relief varied significantly depending on the duration of the intervention. The largest effect was observed in interventions lasting between 30 and 60 minutes, with a decrease in anxiety and pain. CONCLUSIONS: Music intervention is an effective way to reduce anxiety, pain, and physiological responses in surgical patients. Future reviews examining the influence of different types of surgery on the effects of music would add to the body of knowledge in this field. This study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42022340203, with a registration date of July 4, 2022.

Role of oral pentosan polysulfate in Bacillus Calmette-Guérin therapy in patients with non-muscle-invasive bladder cancer.

PURPOSE: Intravesical Bacillus Calmette-Guérin (BCG) instillation, although an important treatment for non-muscle-invasive bladder cancer, exerts local and systemic adverse effects. Pentosan polysulfate (PPS) is a bladder mucosal protective drug that acts by replacing mucus in the glycosaminoglycan layer of the damaged urothelium. We hypothesized that co-administration of oral PPS with BCG instillation would relieve BCG-related adverse effects without affecting its efficacy. MATERIALS AND METHODS: A total of 217 patients receiving BCG instillation were enrolled. They were placed in two groups and analyzed retrospectively: group A (n=122) received BCG instillation only and group B (n=95) received 100 mg of PPS thrice daily during the BCG treatment. RESULTS: After BCG instillation, the rate of BCG-treatment discontinuation owing to adverse effects was 15.6% in group A and 6.3% in group B (p=0.034). The proportion of patients with bacteriuria after BCG was higher in group B; however, no statistical difference was observed (28.7% vs. 41.1%; p=0.057). The proportion of patients with pyuria was significantly higher in group B (81.1% vs. 91.6%; p=0.029). The proportion of patients using antibiotics was significantly higher in group A (73.8% vs. 43.2%; p=0.001). The recurrence rate within 1 year was 29 (23.8%) in group A vs. 19 (20.0%) in group B (p=0.507). Univariate and multivariate analyses showed that antibiotic use had a statistically significant effect on BCG discontinuation. CONCLUSIONS: Oral PPS effectively decreased the discontinuation rate and antibiotic use without affecting the BCG efficacy.

Second-Generation JK-206 Targets the Oncogenic Signal Mediator RHOA in Gastric Cancer.

Ras homologous A (RHOA), a signal mediator and a GTPase, is known to be associated with the progression of gastric cancer (GC), which is the fourth most common cause of death in the world. Previously, we designed pharmacologically optimized inhibitors against RHOA, including JK-136 and JK-139. Based on this previous work, we performed lead optimization and designed novel RHOA inhibitors for greater anti-GC potency. Two of these compounds, JK-206 and JK-312, could successfully inhibit the viability and migration of GC cell lines. Furthermore, using transcriptomic analysis of GC cells treated with JK-206, we revealed that the inhibition of RHOA might be associated with the inhibition of the mitogenic pathway. Therefore, JK-206 treatment for RHOA inhibition may be a new therapeutic strategy for regulating GC proliferation and migration.

Targeting senescent retinal pigment epithelial cells facilitates retinal regeneration in mouse models of age-related macular degeneration.

Although age-related macular degeneration (AMD) is a multifactorial disorder with angiogenic, immune, and inflammatory components, the most common clinical treatment strategies are antiangiogenic therapies. However, these strategies are only applicable to neovascular AMD, which accounts for less than 20% of all AMD cases, and there are no FDA-approved drugs for the treatment of dry AMD, which accounts for ~ 80% of AMD cases. Here, we report that the elimination of senescent cells is a potential novel therapeutic approach for the treatment of all types of AMD. We identified senescent retinal pigment epithelium (RPE) cells in animal models of AMD and determined their contributions to retinal degeneration. We further confirmed that the clearance of senescent RPE cells with the MDM2-p53 inhibitor Nutlin-3a ameliorated retinal degeneration. These findings provide new insights into the use of senescent cells as a therapeutic target for the treatment of AMD.

Dissection of soybean populations according to selection signatures based on whole-genome sequences.

BACKGROUND: Domestication and improvement processes, accompanied by selections and adaptations, have generated genome-wide divergence and stratification in soybean populations. Simultaneously, soybean populations, which comprise diverse subpopulations, have developed their own adaptive characteristics enhancing fitness, resistance, agronomic traits, and morphological features. The genetic traits underlying these characteristics play a fundamental role in improving other soybean populations. RESULTS: This study focused on identifying the selection signatures and adaptive characteristics in soybean populations. A core set of 245 accessions (112 wild-type, 79 landrace, and 54 improvement soybeans) selected from 4,234 soybean accessions was re-sequenced. Their genomic architectures were examined according to the domestication and improvement, and accessions were then classified into 3 wild-type, 2 landrace, and 2 improvement subgroups based on various population analyses. Selection and gene set enrichment analyses revealed that the landrace subgroups have selection signals for soybean-cyst nematode HG type 0 and seed development with germination, and that the improvement subgroups have selection signals for plant development with viability and seed development with embryo development, respectively. The adaptive characteristic for soybean-cyst nematode was partially underpinned by multiple resistance accessions, and the characteristics related to seed development were supported by our phenotypic findings for seed weights. Furthermore, their adaptive characteristics were also confirmed as genome-based evidence, and unique genomic regions that exhibit distinct selection and selective sweep patterns were revealed for 13 candidate genes. CONCLUSIONS: Although our findings require further biological validation, they provide valuable information about soybean breeding strategies and present new options for breeders seeking donor lines to improve soybean populations.

Oncogenic KRAS Sensitizes Lung Adenocarcinoma to GSK-J4-Induced Metabolic and Oxidative Stress.

Genetic and epigenetic changes (e.g., histone methylation) contribute to cancer development and progression, but our understanding of whether and how specific mutations affect a cancer's sensitivity to histone demethylase (KDM) inhibitors is limited. Here, we evaluated the effects of a panel of KDM inhibitors on lung adenocarcinomas (LuAC) with various mutations. Notably, LuAC lines harboring KRAS mutations showed hypersensitivity to the histone H3K27 demethylase inhibitor GSK-J4. Specifically, GSK-J4 treatment of KRAS mutant-containing LuAC downregulated cell-cycle progression genes with increased H3K27me3. In addition, GSK-J4 upregulated expression of genes involved in glutamine/glutamate transport and metabolism. In line with this, GSK-J4 reduced cellular levels of glutamate, a key source of the TCA cycle intermediate α-ketoglutarate (αKG) and of the antioxidant glutathione, leading to reduced cell viability. Supplementation with an αKG analogue or glutathione protected KRAS-mutant LuAC cells from GSK-J4-mediated reductions in viability, suggesting GSK-J4 exerts its anticancer effects by inducing metabolic and oxidative stress. Importantly, KRAS knockdown in mutant LuAC lines prevented GSK-J4-induced decrease in glutamate levels and reduced their susceptibility to GSK-J4, whereas overexpression of oncogenic KRAS in wild-type LuAC lines sensitized them to GSK-J4. Collectively, our study uncovers a novel association between a genetic mutation and KDM inhibitor sensitivity and identifies the underlying mechanisms. This suggests GSK-J4 as a potential treatment option for cancer patients with KRAS mutations. SIGNIFICANCE: This study not only provides a novel association between KRAS mutation and GSK-J4 sensitivity but also demonstrates the underlying mechanisms, suggesting a potential use of GSK-J4 in cancer patients with KRAS mutations.

c-MYC Drives Breast Cancer Metastasis to the Brain, but Promotes Synthetic Lethality with TRAIL.

Brain metastasis in breast cancer is particularly deadly, but effective treatments remain out of reach due to insufficient information about the mechanisms underlying brain metastasis and the potential vulnerabilities of brain-metastatic breast cancer cells. Here, human breast cancer cells and their brain-metastatic derivatives (BrMs) were used to investigate synthetic lethal interactions in BrMs. First, it was demonstrated that c-MYC activity is increased in BrMs and is required for their brain-metastatic ability in a mouse xenograft model. Specifically, c-MYC enhanced brain metastasis by facilitating the following processes within the brain microenvironment: (i) invasive growth of BrMs, (ii) macrophage infiltration, and (iii) GAP junction formation between BrMs and astrocytes by upregulating connexin 43 (GJA1/Cx43). Furthermore, RNA-sequencing (RNA-seq) analysis uncovered a set of c-MYC-regulated genes whose expression is associated with higher risk for brain metastasis in breast cancer patients. Paradoxically, however, increased c-MYC activity in BrMs rendered them more susceptible to TRAIL (TNF-related apoptosis-inducing ligand)-induced apoptosis. In summary, these data not only reveal the brain metastasis-promoting role of c-MYC and a subsequent synthetic lethality with TRAIL, but also delineate the underlying mechanism. This suggests TRAIL-based approaches as potential therapeutic options for brain-metastatic breast cancer. IMPLICATIONS: This study discovers a paradoxical role of c-MYC in promoting metastasis to the brain and in rendering brain-metastatic cells more susceptible to TRAIL, which suggests the existence of an Achilles' heel, thus providing a new therapeutic opportunity for breast cancer patients.

Anti-Melanogenic Activity of Gagunin D, a Highly Oxygenated Diterpenoid from the Marine Sponge Phorbas sp., via Modulating Tyrosinase Expression and Degradation.

Tyrosinase is the rate-limiting enzyme critical for melanin synthesis and controls pigmentation in the skin. The inhibition of tyrosinase is currently the most common approach for the development of skin-whitening cosmetics. Gagunin D (GD), a highly oxygenated diterpenoid isolated from the marine sponge Phorbas sp., has exhibited cytotoxicity toward human leukemia cells. However, the effect of GD on normal cells and the molecular mechanisms remain to be elucidated. In the present study, we identified for the first time the anti-melanogenic activity of GD and its precise underlying mechanisms in mouse melan-a cells. GD significantly inhibited melanin synthesis in the melan-a cells and a reconstructed human skin model. Further analysis revealed that GD suppressed the expression of tyrosinase and increased the rate of tyrosinase degradation. GD also inhibited tyrosinase enzymatic activity. In addition, GD effectively suppressed the expression of proteins associated with melanosome transfer. These findings suggest that GD is a potential candidate for cosmetic formulations due to its multi-functional properties.

Analysis of prostate bed motion using an endorectal balloon and cone beam computed tomography during postprostatectomy radiotherapy.

BACKGROUND: The authors conducted this prospective study to analyze the amount of interfractional prostate bed motion (PBM) and quantify its components with the use of an endorectal balloon (ERB). METHODS: A total of 1,348 cone beam computed tomography images from 46 patients who underwent postprostatectomy radiotherapy were analyzed. For the pilot image, electronic portal imaging, guided by skin marks was performed to ensure proper positioning and inflation of the ERB. Then, for bone matching, manual or automatic registration of the planning and each cone beam computed tomography was performed, based on the bony anatomy of the pelvis. Shifts (bony misalignment [BM]) in three directions were recorded at each treatment session. For prostate bed matching, manual matching was conducted based on the anterior rectal wall and the shift (PBM) was recorded. Total setup error was defined as the shift from the skin mark to the prostate bed matching, based on anterior rectal wall stretched by the ERB. PBM was defined as the difference between the total setup error and BM. RESULTS: Systematic errors for the total setup error were 1.0, 1.3, and 1.0 mm in the right-left, anterior-posterior, and superior-inferior directions, with random errors of 1.9, 2.4, and 1.9 mm, respectively. Systematic errors were 1.6, 1.6, and 0.3 mm for BM and 0.8, 1.1, and 0.9 mm for PBM, with random errors of 2.4, 2.5, and 1.1 mm for BM and 1.8, 2.2, and 1.9 mm for PBM. CONCLUSION: The BM was the main component of the total setup error, suggesting that interfractional PBM was well controlled by the ERB device. Planning target volume margins of <5 mm were needed to include 95% of the interfractional variations when using an ERB.

Novel method for setting up 3D navigation system with skin-fixed dynamic reference frame in anterior cervical surgery.

PURPOSE: To introduce easy and useful methods using 3D navigation system with skin-fixed dynamic reference frame (DRF) in anterior cervical surgery and to validate its accuracy. METHODS: From September 2012 to May 2013, 31 patients underwent anterior cervical surgery and a total of 48 caspar distraction pins were inserted into each cervical vertebra. Every operation was performed using O-arm® navigation system with skin-fixed DRF. To validate the accuracy of these methods, a custom-made metal sleeve was used. In surgical field, through the metal sleeve, the tip of a navigation probe promptly contacts to the tip of caspar pin. We measured the vertical and horizontal distances and the angular deviation in sagittal plane between the caspar pin and the navigation probe on the virtual images and evaluated accuracy of navigation system with skin fixed DRF. RESULTS: Total 31 (males 20, females 11) patients and 48 caspar pins were included in this study. The mean horizontal distance between the caspar pin and the navigation probe displayed in navigation monitor was 0.49 ± 0.71 mm. The mean vertical distance between the caspar pin and the navigation probe displayed in navigation monitor was 0.88 ± 0.93 mm. And the mean angular deviation in sagittal plane between the caspar pin and the navigation probe displayed in navigation monitor was 0.59 ± 0.55°. CONCLUSIONS: 3D navigation system with skin-fixed DRF in anterior cervical surgery is a simple and reliable method and it can be a helpful supplement to a spine surgeon's judgement.

Clinical significance of achieving a flexion limitation with a tension band system in grade 1 degenerative spondylolisthesis: a minimum 5-year follow-up.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To evaluate the effect of the limitation of flexion rotation clinically and radiologically after interspinous soft stabilization using a tension band system in grade 1 degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA: Although several studies have been published on the clinical effects of limiting rotatory motion using tension band systems, which mainly targets the limitation of flexion rather than that of extension, they were confined to the category of pedicle screw-based systems, revealing inconsistent long-term outcomes. METHODS: Sixty-one patients with a mean age of 60.6 years (range, 28-76 yr) who underwent interspinous soft stabilization after decompression for grade 1 degenerative spondylolisthesis with stenosis between 2002 and 2004 were analyzed. At follow-up, the patients were divided into 2 groups on the basis of their achievement or failure to achieve flexion limitation. The clinical and radiological findings were analyzed. A multiple linear regression analysis was performed to determine the prognostic factors for surgical outcomes. RESULTS: At a mean follow-up duration of 72.5 months (range, 61-82 mo), 51 patients were classified into the flexion-limited group and 10 into the flexion-unlimited group. Statistically significant improvements were noted only in the flexion-limited group in all clinical scores. In the flexion-unlimited group, there were significant deteriorations in flexion angle (P = 0.009), axial thickness of the ligamentum flavum (P = 0.013), and the foraminal cross-sectional area (P = 0.011), resulting in significant intergroup differences. The preoperative extension angle was identified as the most influential variable for the flexion limitation and the clinical outcomes. CONCLUSION: The effects of the limitation of flexion rotation achieved through interspinous soft stabilization using a tension band system after decompression were related to the prevention of late recurrent stenosis and resultant radicular pain caused by flexion instability. The extension potential at the index level was recognized as a major prognostic factor that can predict the flexion limitation and the clinical results. LEVEL OF EVIDENCE: 4.

Rapid replacement of human respiratory syncytial virus A with the ON1 genotype having 72 nucleotide duplication in G gene.

Human respiratory syncytial virus (HRSV) is the main cause of severe respiratory illness in young children and elderly people. We investigated the genetic characteristics of the circulating HRSV subgroup A (HRSV-A) to determine the distribution of genotype ON1, which has a 72-nucleotide duplication in attachment G gene. We obtained 456 HRSV-A positive samples between October 2008 and February 2013, which were subjected to sequence analysis. The first ON1 genotype was discovered in August 2011 and 273 samples were identified as ON1 up to February 2013. The prevalence of the ON1 genotype increased rapidly from 17.4% in 2011-2012 to 94.6% in 2012-2013. The mean evolutionary rate of G protein was calculated as 3.275 × 10(-3) nucleotide substitution/site/year and several positively selected sites for amino acid substitutions were located in the predicted epitope region. This basic and important information may facilitate a better understanding of HRSV epidemiology and evolution.

The efficacy of hydroxyapatite for screw augmentation in osteoporotic patients.

The stability of screw constructs is of considerable importance in determining the outcome, especially in spinal osteoporosis. Polymethylmethacrylate (PMMA) has been proven as an effective material for increasing the pullout strength of pedicle screws inserted into the osteoporotic bones. However, PMMA has several disadvantages, such as its exothermic properties, the risk of neural injury in the event of extravasation, and difficulties in performing revision surgery. In the current study, we used hydroxyapatite (HA) cement for screw augmentation in spinal osteoporosis. We conclude that HA cement is a useful tool for screw augmentation and recommend it as a promising option for spinal instrumentation in osteoporotic patients.

Solid fusion after lumbosacral arthroplasty.

A 55-year-old female was diagnosed with L5-S1 degenerative disc disease (DDD). Initial scores by the visual analogue scale (VAS) were 5 (back) and 9 (leg) and the Oswestry disability index (ODI) was 32. Arthroplasty was performed. Clinical and radiographic monitoring took place thereafter at one month, three months, six months and annually. At one month, VAS scores were 2 (back) and 3 (leg), ODI was 12 and ROM was 2.1° by radiographs. At two years, VAS scores were 1 (back) and 2 (leg), ODI was 6 and ROM was approaching 0. Five years after surgery, the entire operated segment (L5-S1) was solidly fused. A malpositioned disc implant may impair normal spinal movement, culminating in heterotopic ossification or complete fusion of the operated segment.

Complete genome sequence of human respiratory syncytial virus genotype A with a 72-nucleotide duplication in the attachment protein G gene.

The complete genome sequence of human respiratory syncytial virus genotype A (HRSV-A) with a 72-nucleotide duplication in the C-terminal part of the attachment protein G gene was determined and analyzed. The genome was 15,277 bp in length, and 0.46 to 6.03% variations were identified at the nucleotide level compared with the previously reported complete genome of HRSV-A. Characterization of the genome will improve understanding of the diversity of the HRSV-A major antigens and enable an in-depth analysis of its genetics.

The accuracy of 3D image navigation with a cutaneously fixed dynamic reference frame in minimally invasive transforaminal lumbar interbody fusion.

OBJECTIVE: In contrast to preoperative image-based 3D navigation systems, which require surgeon-dependent registration, an intraoperative cone-beam computed tomography (cb-CT) image-based 3D navigation system allows automatic registration during the acquisition of 3D images intraoperatively. Thus, the need for spinal exposure for point matching is obviated, making a cb-CT image-based navigation system ideal for use in minimally invasive spinal procedures. Conventionally, the dynamic reference frame (DRF) is mounted to an adjacent spinous process or iliac bone through a separate incision. However, the close proximity of the DRF to the surgical area may result in its interfering with the surgical procedure or causing streak artifacts on the navigation images. Cutaneous placement of the DRF overlying the sacral hiatus is one possible solution to these problems, but such a placement does not provide a solid bony fixation point and is distant from the surgical area, both of which factors may hinder the accuracy of the navigation. The purpose of this study was to evaluate the accuracy of a novel idea for DRF placement in a series of mini-open transforaminal lumbar interbody fusion (TLIF) procedures performed with intraoperative cb-CT image-based 3D navigation. METHODS: From June 2009 to December 2009, 20 patients underwent mini-open TLIF for a total 82 pedicle screws placed in the lumbar spine with cutaneous placement of the DRF overlying the sacral hiatus. The pedicle screws were inserted under navigational guidance using cb-CT data acquired intraoperatively with a Medtronic O-arm. Screw positions were subsequently checked with a final intraoperative cb-CT scan. Nineteen patients underwent single-level fusion (8 at L4-5, 6 at L5-S1, 4 at L3-4, and 1 at L2-3) and one patient underwent two-level fusion (from L3-5). RESULTS: There were 4 (4.9%) pedicle perforations greater than 2 mm out of the 82 pedicle screw insertions in the 20 patients. Two of these breached screws were repositioned and confirmed to be in place with a final intraoperative cb-CT. There were no complications of neural injury associated with these perforations. CONCLUSION: A cutaneously mounted DRF overlying the sacral hiatus provides accuracy in intraoperative 3D image guided navigation for mini-open TLIF that is comparable to that obtained in other reported series using a fixed bony attachment point for the DRF.

Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine: the utilization of a volume-controlled pseudomeningocele.

STUDY DESIGN: Retrospective review OBJECTIVE: To determine the efficacy of management of cerebrospinal fluid (CSF) leakage after the anterior thoracic approach. SUMMARY OF BACKGROUND DATA: CSF leakage after incidental durotomy commonly occurs after anterior thoracic ossification of posterior longitudinal ligament (OPLL) surgery. Pseudomeningocele will invariably form under such circumstances. Among them, uncontrolled CSF leakage with a fistulous condition is problematic. As a solution, we have managed these durotomies with chest drains alone without any CSF drainage by the concept of a "volume-controlled pseudomeningocele." METHODS: Between 2001 and 2009, CSF leakage occurred in 26 patients (37.7%) of the total 69 patients who underwent anterior decompression for thoracic OPLL. In the initial 11 cases, subarachnoid drainage was utilized as an augmentive measure in combination with chest tube drainage in the postoperative period (group A). In the subsequent 15 cases, the durotomy was managed in a similar manner but in the absence of any subarachnoid drainage (group B). Various parameters such as the duration of postoperative hospital stay, clinical outcome score, drainage output, resolution of CSF leakage, complications, and additional surgery performed were analyzed and compared between the 2 groups. A resolution of the CSF leakage grading system was also proposed for the residual pseudomeningocele that formed in each group. RESULTS: There were statistically no significant differences in the outcome parameters between the 2 groups and also in patients with grade I or grade II residual pseudomeningocele of the new grading system. Two complications occurred in group A. No reexploration for persistent CSF leakage was required in both groups. CONCLUSIONS: CSF leakage managed with controlled chest tube drainage can produce a comparable result with those with additional subarachnoid drainage when watertight dural repair is impossible. The concept of controlled pseudomeningocele may be a useful and practical technique for the treatment of CSF leakage after anterior thoracic OPLL surgery.

Factors affecting clinical outcomes in treating patients with grade 1 degenerative spondylolisthesis using interspinous soft stabilization with a tension band system: a minimum 5-year follow-up.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To explore the factors influencing the clinical outcomes and motion-preserving stabilization after interspinous soft stabilization (ISS) with a tension band system for grade 1 degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Despite increasing recognition of the benefits of dynamic stabilization systems for treating lumbar degenerative disorders, the factors affecting the clinical and radiological outcomes of these systems have rarely been identified. METHODS: Sixty-five patients (mean age, 60.3 years) who underwent ISS with a tension band system between 2002 and 2004 were analyzed. The mean follow-up period was 72.5 months. The patients were divided according to the postsurgical clinical improvements into the optimal (n = 44) and suboptimal groups (n = 21), and the radiological intergroup differences were analyzed. Multiple linear regression analysis was performed to determine the impact of the radiological factors on the clinical outcomes. RESULTS: Significant intergroup differences were observed on the follow-up clinical examination. Radiologically, total lumbar lordosis (TLL) and segmental lumbar lordosis (SLL) were significantly improved only in the optimal group, resulting in significant intergroup differences in TLL (P = 0.023), SLL (P = 0.001), and the L1 tilt (P = 0.002). All these measures were closely associated with postoperative segmental lumbar lordosis, which also was the most influential radiological variable for the clinical parameters. CONCLUSION: In the patients with grade 1 DS, the back pain relief and functional improvement following ISS were affected by the improvements in the sagittal spinal alignment through the achievement of segmental lumbar lordosis. ISS can be an alternative treatment to fusion surgery for grade 1 DS in patients who do not require fixation or reduction.

MRI versus CT for the diagnosis of lumbar spinal stenosis.

OBJECTIVE: The purpose of the study was to compare the effectiveness of CT and MRI in visualizing soft tissues in lumbar spinal stenosis (LSS), and to correlate the images with preoperative symptoms. MATERIALS AND METHODS: A total of 163 patients who had undergone unilateral laminotomy for bilateral decompression to treat LSS at L4-5 were retrospectively analyzed. The narrowed spinal canal area was measured on axial images with CT and MRI, and compared with the acquired dimensions from preoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. RESULTS: The mean compromised spinal canal areas were 75.08 mm(2) on MRI and 63.13 mm(2) on CT, which were significantly different. Mean VAS for back pain was 5.37, and 7.94 for leg pain. Mean ODI was 55.17%. There was no significant correlation noted between clinical parameters and narrowed spinal canal area. CONCLUSION: Spinal canal area was more narrowed on CT than on MRI in axial cuts. This finding can be explained by the superior ability of multidetector CT to discriminate cortical bone from soft tissue such as the ligamentum flavum. Our study highlights the value of CT examination in combination with MRI prior to LSS surgery.

A comparison of unilateral and bilateral laminotomies for decompression of L4-L5 spinal stenosis.

STUDY DESIGN: A retrospective review of clinical and radiographic data was performed at a single institution. OBJECTIVES: To compare clinical and radiologic outcomes between unilateral and bilateral laminotomies for bilateral decompression in patients with L4­L5 spinal stenosis. SUMMARY OF BACKGROUND DATA: Laminotomy has been shown to be comparable with laminectomy with the advantage of potentially maintaining more stability by preserving more of the osseous structures. However, the comparison between unilateral and bilateral laminotomies is available only for short-term follow-up. METHODS: Fifty-three patients at one institution having decompressive surgery for L4­L5 spinal stenosis, including grade 1 degenerative spondylolisthesis without instability, were entered into this study with a minimum of 3-year follow-up. Clinical outcomes were assessed with visual analog scale for back and leg pain and the Oswestry disability index. Radiographic measurements were performed and included translational motion, angular motion, and epidural cross-sectional area. RESULTS: The average age of the patients was 62.4 years (range: 31­82). The mean follow-up period was 49.3 months (range: 40­61). Clinical outcomes and complication rates were similar in both groups. Intraoperative blood loss and operative time were less in the unilateral laminotomy group. Radiographically, the amount of increased translational motion was significantly increased in the bilateral laminotomy group (P 0.012), but the amount of increased angular motion was not significantly different (P 0.195) between the two groups. Postoperative radiographic instability was detected more frequently in bilateral laminotomy group than in the unilateral group, without statistical significance. CONCLUSIONS: Both unilateral and bilateral laminotomies provide sufficient decompression of spinal stenosis and excellent pain reduction. However, unilateral laminotomy can be performed with shorter operative times and less blood loss. Radiologically, the use of a unilateral laminotomy induces less translational motion increase after surgery; thus, it may reduce the risk of late instability when compared with a bilateral laminotomy.