Vertebral artery injury following combination Jefferson fracture of C1 and Type II odontoid fracture: A case report.

Traumatic posterior atlantoaxial dislocation combined with Jefferson fracture and odontoid process fracture with vertebral artery injury is rare. The management of such injury raises controversial issues and is still open to debate. A 74-year-old Chinese male presented with sustained neck pain and stiffness after falling from height. The patient was neurologically intact. Preoperative radiographs demonstrated a Jefferson burst fracture with a posterior dislocation of the atlantoaxial joints and odontoid process Anderson and D'alonzo type II fracture. A computed tomography angiography (CTA) showed an occluded left vertebral artery. Coil embolization in the proximal portion of the occluded vertebral artery was performed to prevent further cerebral infarction due to distal embolization of the thrombus. Then a second stage occipito-cervical fusion was performed to reconstruct cervical spine stability. A systematic screening of blunt trauma vertebral artery injuries through CTA is required when dealing with upper cervical fracture. For cases with vertebral artery occlusion secondary to cervical spine injury, endovascular treatment preceding cervical spine surgery is a feasible and a safe treatment.

Dancr-BRG1 regulates Nfatc1 transcription and Pgc1ß-dependent metabolic shifts in osteoclastogenesis.

Long non-coding RNA (lncRNA) serves as a vital regulator of bone metabolism, but its role in pathologically overactive osteoclast differentiation remains elusive. Here, we identify lncRNA Dancr (Differentiation Antagonizing Non-protein Coding RNA) as a critical suppressor of osteoclastogenesis and bone resorption, which is down-regulated in response to estrogen deficiency. Global or osteoclast-specific Dancr Knockout mice display significant trabecular bone deterioration and enhanced osteoclast activity, but minimal alteration of bone formation. Moreover, the bone-targeted delivery of Dancr by Adeno-associated viral remarkably attenuates ovariectomy-induced osteopenia in mice. Mechanistically, Dancr establishes a direct interaction with Brahma-related gene 1 to prevent its binding and preserve H3K27me3 enrichment at the nuclear factor of activated T cells 1 and proliferator-activated receptor gamma coactivator 1-beta promoters, thereby maintaining appropriate expression of osteoclastic genes and metabolic programs during osteoclastogenesis. These results demonstrate that Dancr is a key molecule maintaining proper osteoclast differentiation and bone homeostasis under physiological conditions, and Dancr overexpression constitutes a potential strategy for treating osteoporosis.

Endothelial Cell-Derived Lactate Triggers Bone Mesenchymal Stem Cell Histone Lactylation to Attenuate Osteoporosis.

Blood vessels play a role in osteogenesis and osteoporosis; however, the role of vascular metabolism in these processes remains unclear. The present study finds that ovariectomized mice exhibit reduced blood vessel density in the bone and reduced expression of the endothelial glycolytic regulator pyruvate kinase M2 (PKM2). Endothelial cell (EC)-specific deletion of Pkm2 impairs osteogenesis and worsens osteoporosis in mice. This is attributed to the impaired ability of bone mesenchymal stem cells (BMSCs) to differentiate into osteoblasts. Mechanistically, EC-specific deletion of Pkm2 reduces serum lactate levels secreted by ECs, which affect histone lactylation in BMSCs. Using joint CUT&Tag and RNA sequencing analyses, collagen type I alpha 2 chain (COL1A2), cartilage oligomeric matrix protein (COMP), ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), and transcription factor 7 like 2 (TCF7L2) as osteogenic genes regulated by histone H3K18la lactylation are identified. PKM2 overexpression in ECs, lactate addition, and exercise restore the phenotype of endothelial PKM2-deficient mice. Furthermore, serum metabolomics indicate that patients with osteoporosis have relatively low lactate levels. Additionally, histone lactylation and related osteogenic genes of BMSCs are downregulated in patients with osteoporosis. In conclusion, glycolysis in ECs fuels BMSC differentiation into osteoblasts through histone lactylation, and exercise partially ameliorates osteoporosis by increasing serum lactate levels.

Artificial intelligence-based radiomics in bone tumors: Technical advances and clinical application.

Radiomics is the extraction of predefined mathematic features from medical images for predicting variables of clinical interest. Recent research has demonstrated that radiomics can be processed by artificial intelligence algorithms to reveal complex patterns and trends for diagnosis, and prediction of prognosis and response to treatment modalities in various types of cancer. Artificial intelligence tools can utilize radiological images to solve next-generation issues in clinical decision making. Bone tumors can be classified as primary and secondary (metastatic) tumors. Osteosarcoma, Ewing sarcoma, and chondrosarcoma are the dominating primary tumors of bone. The development of bone tumor model systems and relevant research, and the assessment of novel treatment methods are ongoing to improve clinical outcomes, notably for patients with metastases. Artificial intelligence and radiomics have been utilized in almost full spectrum of clinical care of bone tumors. Radiomics models have achieved excellent performance in the diagnosis and grading of bone tumors. Furthermore, the models enable to predict overall survival, metastases, and recurrence. Radiomics features have exhibited promise in assisting therapeutic planning and evaluation, especially neoadjuvant chemotherapy. This review provides an overview of the evolution and opportunities for artificial intelligence in imaging, with a focus on hand-crafted features and deep learning-based radiomics approaches. We summarize the current application of artificial intelligence-based radiomics both in primary and metastatic bone tumors, and discuss the limitations and future opportunities of artificial intelligence-based radiomics in this field. In the era of personalized medicine, our in-depth understanding of emerging artificial intelligence-based radiomics approaches will bring innovative solutions to bone tumors and achieve clinical application.

In Situ Enzymatic Reaction Generates Magnesium-Based Mineralized Microspheres with Superior Bioactivity for Enhanced Bone Regeneration.

Bone is a naturally mineralized tissue with a remarkable hierarchical structure, and the treatment of bone defects remains challenging. Microspheres with facile features of controllable size, diverse morphologies, and specific functions display amazing potentials for bone regeneration. Herein, inspired by natural biomineralization, a novel enzyme-catalyzed reaction is reported to prepare magnesium-based mineralized microspheres. First, silk fibroin methacryloyl (SilMA) microspheres are prepared using a combination of microfluidics and photo-crosslinking. Then, the alkaline phosphatase (ALP)-catalyzed hydrolysis of adenosine triphosphate (ATP) is successfully used to induce the formation of spherical magnesium phosphate (MgP) in the SilMA microspheres. These SilMA@MgP microspheres display uniform size, rough surface structure, good degradability, and sustained Mg2+ release properties. Moreover, the in vitro studies demonstrate the high bioactivities of SilMA@MgP microspehres in promoting the proliferation, migration, and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Transcriptomic analysis shows that the osteoinductivity of SilMA@MgP microspheres may be related to the activation of the PI3K/Akt signaling pathway. Finally, the bone regeneration enhancement units (BREUs) are designed and constructed by inoculating BMSCs onto SilMA@MgP microspheres. In summary, this study demonstrates a new biomineralization strategy for designing biomimetic bone repair materials with defined structures and combination functions.

Deubiquitinase USP13 regulates glycolytic reprogramming and progression in osteosarcoma by stabilizing METTL3/m6A/ATG5 axis.

Reprogramming metabolism is a hallmark of cancer cells for rapid progression. However, the detailed functional role of deubiquitinating enzymes (DUBs) in tumor glycolytic reprogramming is still unknown and requires further investigation. USP13 was found to upregulate in osteosarcoma (OS) specimens and promote OS progression through regulating aerobic glycolysis. Interestingly, the m6A writer protein, METTL3, has been identified as a novel target of USP13. USP13 interacts with, deubiquitinates, and therefore stabilizes METTL3 at K488 by removing K48-linked ubiquitin chains. Since METTL3 is a well-known m6A writer and USP13 stabilizes METTL3, we further found that USP13 increased global m6A abundance in OS cells. The results of RNA sequencing and methylated RNA immunoprecipitation sequencing indicated METTL3 could bind to m6A-modified ATG5 mRNA, which is crucial for autophagosome formation, and inhibit ATG5 mRNA decay on an IGF2BP3 dependent manner, thereby promoting autophagy and the autophagy-associated malignancy of OS. Using a small-molecule inhibitor named Spautin-1 to pharmacologically inhibit USP13 induced METTL3 degradation and exhibited significant therapeutic efficacy both in vitro and in vivo. Collectively, our study results indicate that USP13 promotes glycolysis and tumor progression in OS by stabilizing METTL3, thereby stabilizing ATG5 mRNA and facilitating autophagy in OS. Our findings demonstrate the role of the USP13-METTL3-ATG5 cascade in OS progression and show that USP13 is a crucial DUB for the stabilization of METTL3 and a promising therapeutic target for treating OS.

Comparison of surgical outcomes of C1-2 fusion surgery between O-arm-assisted operation and C-arm assisted operation in children with atlantoaxial rotatory fixation.

Objective: Placement of the pedicle screw is technically challenging during C1-2 fusion surgery in children and different intraoperative image-guided systems have been developed to reduce the risk of screw malposition. The purpose of the present study was to compare surgical outcomes between C-arm fluoroscopy and O-arm navigated pedicle screw placement in the treatment of atlantoaxial rotatory fixation in children. Methods: We retrospectively evaluated charts of all consecutive children with atlantoaxial rotatory fixation who underwent C-arm fluoroscopy or O-arm navigated pedicle screw placement from April 2014 to December 2020. Outcomes including operative time, estimated blood loss (EBL), accuracy of screw placement (Neo's classification) and completed fusion time were evaluated. Results: A total of 340 screws were placed in 85 patients. The accuracy of screw placement of the O-arm group was 97.4%, which was significantly higher than that of the C-arm group (91.8%). Both groups had satisfied bony fusion (100%). Statistical significance (230.0 ± 34.6 ml for the C-arm group and 150.6 ± 47.3 ml for the O-arm group, p < 0.05) was observed with respect to the median blood loss. There were no statistically significant difference (122.0 ± 16.5 min for the C-arm group and 110.0 ± 14.4 min for the O-arm group, p = 0.604) with respect to the median operative time. Conclusion: O-arm-assisted navigation allowed more accurate screw placement and less intraoperative blood loss. Both groups had satisfied bony fusion. O-arm navigation did not prolong the operative time despite the time required for setting and scanning.

Sectional Correction Technique in Dystrophic Scoliosis Secondary to Neurofibromatosis Type 1: A Comparison with Traditional 2-Rod Correction Technique.

OBJECTIVE: The purpose of this study was to compare the traditional 2-rod correction technique with the sectional correction technique in terms of radiographic results and clinical outcomes for patients with dystrophic scoliosis caused by neurofibromatosis type 1 (NF1). METHODS: From May 2015 to April 2018, 53 patients with dystrophic scoliosis caused by NF1 underwent 1-stage posterior corrective surgery. Patients were separated into 2 groups based on technique: the sectional correction technique (SC group) and the traditional 2-rod technique (TT group). Before surgery and at the final follow-up, the demographic information, radiographic parameters, and clinical outcomes were compared between the groups using independent-sample t tests. RESULTS: The SC group consisted of 24 patients, while the TT group consisted of 29 patients. Patients in the SC group showed a higher coronal balance distance after the operation (8.3 ± 8.2 mm vs. 16.2 ± 8.8 mm, P = 0.002) and at the final follow-up (9.5 ± 9.3 mm vs. 19.3 ± 10.1 mm, P < 0.0001). At the last follow-up, the loss of correction in the SC group was 2.2 ± 0.9 and 2.1 ± 0.7 in the coronal and sagittal planes, respectively, and these values were significantly lower than those in the TT group (5.3 ± 1.6 in the coronal plane and 4.5 ± 1.9 in the sagittal plane, both P < 0.05). The SC group had better improvement based on appearance and satisfaction score at the final follow-up. CONCLUSIONS: The sectional correction technique using a concave domino connector can restore coronal imbalance and reduce the risk of implant failure.

Pulmonary Recovery Following Corrective Surgery in Adult Patients With Severe Scoliosis: A Minimum of Five-Year Follow-Up.

Background: Halo gravity traction (HGT) has been reported to be a safe and effective adjunctive method for the management of scoliosis. However, the direct effects of HGT on the lung recovery of adult patients with scoliosis remain obscure. Objective: To investigate changes in lung volume and pulmonary function in adult patients with severe scoliosis who underwent posterior spinal fusion concomitant with preoperative halo gravity traction. Methods: A total of 47 patients with a minimum 5-year follow-up who underwent posterior spinal instrumentation and fusion using preoperative halo-gravity traction were analyzed. Pulmonary function tests and three-dimensional CT were performed to evaluate changes in lung function and lung volume, respectively. Results: There was significant change in the Cobb angle of the major curve after halo gravity traction (P < 0.0001). Significant improvement in both Cobb angle (P < 0.0001) and thoracic kyphosis (P = 0.034) after corrective surgery was observed. Pulmonary function did not change significantly during traction. However, a significant decline in absolute and percent-predicted pulmonary function values was noted following surgery. The average change in lung volume did not show statistical differences during traction. At 5-year postoperative follow-up, the mean values revealed a significant increase in total lung volume (P < 0.0001) and concave lung volume (P < 0.0001) with surgical correction, but no statistically significant change in lung volume on the convex side (P = 0.57). Postoperative pulmonary complications occurred in nine cases with lower preoperative pulmonary function, indicating the importance of performing spirometry before corrective surgery. Conclusions: We found that halo gravity traction prior to corrective surgery was less useful in improving pulmonary function in adult patients with severe scoliosis. However, these patients were expected to have increased lung volume after correction of the deformity.

Hemi-atlas resection by combined approach: case report, literature review, and technical note.

PURPOSE: Hemivertebra within the craniovertebral junction is a rare but complex spinal deformity. Torticollis caused by hemi-atlas is extremely rare. There is no consensus on the treatment of these patients. We present our experience with one case of hemi-atlas excision and torticollis correction via a combined anterior-posterior surgical approach and short-segment fixation. METHODS: An 11-year-old girl with progressive torticollis due to hemi-atlas underwent surgery consisting of combined anterior-posterior hemivertebra resection and instrumentation and had a follow up of 20 months. Pre- and postoperative radiographic features, as well as clinical outcomes, were evaluated. RESULTS: The patient had complete recovery of torticollis at a 20-month follow-up. Radiographs showed favorable deformity correction, well-balanced coronal and sagittal alignment, and solid bony fusion. CONCLUSION: For patients with congenital cervical hemivertebra within the craniovertebral junction, combined anterior-posterior hemivertebra resection with instrumentation allows for satisfactory deformity correction and good cosmetic improvement.

Intraoperative halo-femoral traction during posterior spinal arthrodesis for adolescent idiopathic scoliosis curves between 70° and 100°: a randomized controlled trial.

OBJECTIVE: Surgical management of scoliosis curves between 70° and 100° remains controversial. The authors designed this randomized controlled trial to validate the efficacy of intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), Cobb angles between 70° and 100°, and flexibility < 35%. METHODS: The authors prospectively recruited and randomized 29 patients with severe AIS scheduled for posterior surgery into a traction group or control (nontraction) group. The primary outcome measures were operative time, blood loss, and length of hospital stay. Secondary outcomes included degree of spine deformity correction, traction-related complications, and health-related quality of life. RESULTS: In the traction group, the average preoperative Cobb angle was 83.2°, with an average 20.6% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.3° at the final follow-up. In the control group, the average preoperative major curve was 80.3° with 22.8% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.1° at the final follow-up. The operative duration was 325.7 minutes for the traction group and 385.4 minutes for the control group (p = 0.018). Compared with the control group, the traction group had a 29.5% reduction in intraoperative blood loss and a significantly lower rate of blood transfusion (13.3% vs 50.0%, p = 0.033). There were no neurological complications in either group. One patient in the traction group had a superficial infection at the traction site. CONCLUSIONS: Use of IOHFT contributed to significant reductions in operative time and blood transfusion requirements, with no added morbidity. It is an effective and safe method to assist correction of AIS curves between 70° and 100° and flexibility < 35%.

Comparing Thoracic Extensive Laminoplasty (TELP) and Laminectomy in Treating Severe Thoracic Ligamentum Flavum Ossification: A Proposed Novel Technique and Case-Control Study.

OBJECTIVE: (1) To propose a novel technique named thoracic extensive laminoplasty (TELP) in curing severe thoracic ligamentum flavum ossification (STOLF) and (2) to compare outcomes between TELP and laminectomy in curing STOLF. METHODS: Cases with fused or tuberous STOLF (Sato classification) treated from Jan 2015 to Jan 2017 were reviewed and divided into the TELP group (G1) and laminectomy group (G2) according to their surgical management. Data on demographics, complications, pre- and postoperative symptoms, residual spinal canal area (RSCA-1), residual spinal cord area (RSCA-2), modified Japanese Orthopedic Association score (mJOA), and health-related quality of life (HRQOL, based on the SF-36) were collected. RESULTS: Fifty-nine G1 and sixty-two G2 patients were enrolled. No significant differences in demographic data or preoperative data of RSCA-1, RSCA-2, mJOA, or HRQOL were observed between the two groups (p > 0.05). Patients in G1 and G2 showed similar postoperative improvements in RSCA-1 and RSCA-2 at the final follow-up (p > 0.05). However, patients in G1 showed higher postoperative improvements in mJOA (OR = 2.706, 95% CI: 1.279~5.727, p = 0.008) at the final follow-up. Patients in G1 also showed higher postoperative improvements in HRQOL than patients in G2 (p < 0.05) at the final follow-up, and patients with more severe STOLF presented with better improvements in HRQOL in G1 (p < 0.05). Dural laceration and cerebrospinal fluid leakage were observed in seven G2 patients, and no complications were found in G1 patients after surgery. CONCLUSION: TELP is a novel, effective, and safer surgical technique in treating STOLF and could be a substitute for traditional laminectomy.

Reliability and Validity of the Adapted Chinese Version of the Satisfaction of Adolescents with Postoperative Pain Management - Idiopathic Scoliosis (SAP-S) Scale.

STUDY DESIGN: A prospective study. OBJECTIVE: The aim of this study was to evaluate the internal reliability and structure validity of an adapted simplified Chinese version of the Satisfaction of Adolescents with Postoperative pain management - idiopathic Scoliosis (SAP-S) scale in mainland China. SUMMARY OF BACKGROUND DATA: Pain management is a major issue for adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusions. There is a lack of valid scales for evaluating patients' satisfaction with postoperative pain management. The SAP-S was proven to be a valid and reliable measure in English and French. METHODS: The SAP-S was translated into Chinese according to the internationally recognized guidelines. A total of 95 AIS patients undergoing posterior fusion surgery completed the CSAP-S, along with other self-reported questionnaires, including the 36-Item Short Form Health Survey (SF-36) and Scoliosis Research Society-22 (SRS-22) questionnaires. The internal consistency, test-retest reliability, and construct validity of the CSAP-S were determined. RESULTS: The SAP-S was successfully translated into Chinese. All patients completed the CSAP-S twice and the other instruments. The CSAP-S had good internal consistency and test-retest reliability with Cronbach's alpha coefficient measuring 0.895 and intraclass correlation coefficient (ICC) measuring 0.97. Elimination of any one item did not result in a value of Cronbach's alpha of <0.80. A good construct validity was shown by good correlation with bodily pain (r=0.883, p=0.004) and social functioning (r=0.786, p=0.002) domains of SF-36 and pain (r=0.752, p=0.001) and satisfaction with management (r=0.746, p=0.005) domains of SRS-22. CONCLUSION: The CSAP-S demonstrated good internal consistency, reliability, and construct validity, and may be used for the evaluation of AIS patients' satisfaction with postoperative pain management in mainland China.

Comparison between tension band and cerclage with X-Plate and lag screws in treatment of comminuted patellar fractures.

BACKGROUND: Comminuted patellar fractures are not rare, and the ideal treatment method remains controversial. The present study was conducted to evaluate effects and compare complications of two different methods used to treat comminuted patellar fractures. METHODS: From March 2010 to August 2016, 102 cases of 34-C2 or 34-C3 comminuted patellar fractures were treated at our hospital, wherein patients received two different treatments: titanium cable tension band with cerclage method (group A) and intrafragmentary screws with X-shaped plating technique (group B). At follow-ups, articular step-off, range of motion (ROM), Lysholm scores, time of union, and complications were recorded and analyzed. Radiographic and clinical data as well as rate of complications were statistically analyzed. RESULTS: In total, 87 patients were included in the final analysis (n = 47 in group A and n = 40 in group B). No significant differences were noted in terms of cost of implant, age, gender, rate of 34-C3 fractures, rate of layered inferior pole fractures, postoperative articular step-off and union time. At 2-year follow-up, average Lysholm scores, ROM and rate of complications were (89.0 ± 4.5), (122°±12°) and (27.7%) in group A and (90.2 ± 3.9), (124°±11°) and (17.5%) in group B, respectively, with no significant differences (p > 0.05). The mean time of surgery in group B was shorter than that in group A with significant difference (p < 0.05). CONCLUSIONS: Treatment using the intrafragmentary screws and plate method for amenable comminuted patellar fractures achieved similar complication rate and favorable functional outcomes at the 2-year follow-up, which was comparable to the titanium cable tension band with cerclage method. Thus, the intrafragmentary screws and plate method is effective, safe and convenient for 34-C2/C3 comminuted patellar fractures, especially appropriate for patients with layered fragments.

Influence of Insurance Status on Curve Magnitude in Adolescent Idiopathic Scoliosis in Mainland China.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To determine whether there is an association between insurance status and curve magnitude in idiopathic scoliosis pediatric patients in mainland China. METHODS: Medical records of patients with adolescent idiopathic scoliosis in 4 tertiary spine centers across China from January 2013 to December 2017 were analyzed. Data was extracted on insurance status, curve magnitude, recommended treatment at presentation, source of referral, and treatment initiated. Additional information was collected for patients requiring corrective surgery, including time from recommendation for surgery to surgery and clinically relevant parameters such as, postoperative complications, and pre-/postoperative Scoliosis Research Society-22 scores were also collected for patients requiring corrective surgery. RESULTS: Of the 1785 patients included, 1032 were Urban Resident Basic Medical Insurance Scheme (URBMS) insured and 753 were New Rural Cooperative Medical Scheme (NRCMS) insured. NRCMS patients presented with a larger major curve than URBMS patients (32.9° ± 15.1° vs 29.3° ± 12.6°, P = .028). For patients having surgery recommended, NRCMS patients presented with a larger mean Cobb angle at the first presentation (57.7° vs 50.9°, P < .0001) and at time of surgery (61.3° vs 52.2°, P < .0001), and experienced a significantly longer time from surgery recommendation to decision for surgery. Complication rates were comparable between the 2 groups, except for pulmonary complications (NRCMS 7.3% vs URBMS 2.8%, P = .04). Postoperatively, patients covered by NRCMS insurance experienced greater overall improvement in health-related quality of life and were less satisfied with the treatments. CONCLUSIONS: This study shows that health insurance may influence the severity of scoliosis on presentation, with implications on early diagnosis and surgery time.

Exogenous HMGN2 inhibits the migration and invasion of osteosarcoma cell lines.

BACKGROUND: Osteosarcoma (OS) is among the most prevalent forms of malignant tumors seen in children and teenagers. Early metastasis is a hallmark of OS, and it is therefore important to find new and more effective treatment targets to improve the survival time of patients with the disease. High mobility group N (HMGNs) is a family of proteins that contributes to the development of a number of different tumors. In particular, HMGN2 was found in our earlier study to be an anti-tumor factor and was seen to impede the metastasis of OS when it was overexpressed. This study aims to further investigate the potential of HMGN2 in anti-tumor treatment. METHODS: We overexpressed HMGN2 in 293FT cells via transfection with recombinant lentiviruses and purified HMGN2 protein with flag tags to treat OS cell lines. The cellular location of exogenous HMGN2 was detected by immunocytochemistry, and wound healing and transwell assays were used to study differences in the rates of migration and invasion of cells between each group. RESULTS: We found that exogenous HMGN2 enters OS cells in a concentration-dependent manner and inhibits the migration and invasion of OS cells, and exogenous HMGN2 regulates the expression of matrix metalloproteinase 2 (MMP2) and MMP9 in OS cells. CONCLUSIONS: Our results demonstrated that exogenous HMGN2 plays a role in inhibiting OS metastasis, which could act as a basis for new ideas for future anti-tumor therapy research.

Asymmetric expression of GPR126 in the convex/concave side of the spine is associated with spinal skeletal malformation in adolescent idiopathic scoliosis population.

PURPOSE: To determine the relationship between the bone formation-related functions of GPR126 and the structural asymmetry of spine in adolescent idiopathic scoliosis (AIS). METHODS: Vertebral body samples were obtained from 51 AIS patients during spinal surgery between October 2014 and November 2017, and the expression pattern of GPR126 in the convex/concave sides of AIS spine was identified by RT-qPCR. Next, we explored the bone formation-related functions of GPR126 by knocking down and overexpressing GPR126 in human mesenchymal stem cells (hMSC) and further performing osteogenic differentiation. We also applied overexpression of N-terminal fragments derived from GPR126 (GPR126-NTFs) and osteogenic differentiation experiments to determine the functional part of GPR126 in skeletal development. RESULTS: We provided evidence that GPR126 showed a marked convex/concave asymmetric expression in the spine of AIS. Further RNA detection found that exon6-included transcripts of GPR126 (GPR126-exon6in) were significantly higher expressed in the convex side of AIS patients. Knocking down of GPR126 accelerated ossification of hMSCs during osteogenic differentiation, and overexpression of GPR126-exon6in delayed this process. Overexpression of GPR126-NTFs revealed that NTF is a functional fragment and exon6-included NTF (NTF-exon6in) delayed ossification of hMSCs. CONCLUSION: Our findings indicated that GPR126-NTFs play a role in skeletal development, and the inclusion/exclusion of exon6 may regulate the bone formation-related functions of GPR126. The convex/concave asymmetric expression of GPR126-exon6in may be an important factor in abnormal bone formation of AIS. These slides can be retrieved under Electronic Supplementary Material.

Acquired scoliosis following Nuss procedure for pectus excavatum: A case report.

RATIONALE: Nuss procedure is a safe and popular minimally invasive surgical technique for the correction of pectus excavatum in adolescents. Acquired scoliosis over 50 degrees after Nuss procedure has never been reported. PATIENT CONCERNS: A 14-year-old boy was referred to pediatric surgery for pectus excavatum deformity. He underwent a successful Nuss procedure. At follow up, the patient was noted having an asymmetric back whole spine X-ray showed a right-sided thoracic curve with a Cobb angle of 54 degrees. INTERVENTIONS AND OUTCOMES: We obtained a satisfactory result by removing the pectus bar and prescribing the patient a brace. LESSONS: This report demonstrates that the spine should be evaluated routinely before and after Nuss procedure. Besides, spinal fusion is not recommended for acquired scoliosis following pectus excavatum surgery.

A Prospective Single-blind Randomized Controlled Trial of Chewing Gum on Bowel Function Recovery After Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis.

PURPOSE: To evaluate the effectiveness of chewing gum on promoting bowel function recovery in adolescent idiopathic scoliosis patients undergoing surgical correction. MATERIALS AND METHODS: Adolescent idiopathic scoliosis patients scheduled for posterior spinal fusion surgery at our institution were randomized to either group 1 (chewing gum) or group 2 (control). The primary endpoints were time to flatus, time to bowel movement, length of hospital stay, and time to liquid or solid. The secondary endpoints were postoperative opioid consumption, incidence of complications, pain scores, and nausea scores. In addition, a meta-analysis of available data from the literature was performed identifying 2 studies with quantitative data on the efficacy of gum chewing after scoliosis correction surgery. RESULTS: In total, 125 patients (63 gum; 62 control) were included in our analysis after randomization. There was no significant difference in time to first flatus (P=0.087), time to bowel movement (P=0.307), time to liquid or solid, length of postoperative hospital stay (P=0.954), postoperative complications, opioid consumption, and postoperative nausea scores between the 2 groups. The postoperative pain scores on postoperative day 1 were significantly lower (P=0.027). There was a significant decrease in the time to the first flatus for patients having selective thoracic fusion in both groups than those having fusion to lumbar spine. Meta-analysis also indicated there was no significant difference in outcomes of bowel function between the 2 groups. CONCLUSIONS: Our institutional data and meta-analysis collaboratively suggested that chewing gum did not hasten the return of bowel function.

Coronal Imbalance after Selective Posterior Thoracic Fusion in Patients with Lenke 1 and 2 Adolescent Idiopathic Scoliosis.

Coronal decompensation is a common complication in Lenke 1 or 2 AIS patients after selective thoracic fusion (STF). However, the majority who developed immediately postoperative coronal decompensation experienced improvement and the related factors are not fully understood. The aim of this retrospective study was to investigate the prevalence of coronal imbalance in patients with Lenke 1 or 2 AIS and to explore radiological factors associated with spontaneous correction of coronal balance after surgery. Lenke 1 or 2 AIS patients receiving STF in our center from January 2013 to March 2015 were analyzed. Anteroposterior and lateral films were evaluated before surgery, at 1 month's and 2 years' follow-up. Patients were divided into 2 groups according to whether coronal imbalance occurred in the early postoperative period (1 month). Various radiological parameters as well as Scoliosis Research Society-22 were statistically compared between groups. Coronal decompensation was observed in 33 patients preoperatively, in 48 patients immediately postoperatively, and in 2 patients at final follow-up. Lowermost instrumented vertebra (LIV) disc angle (0.9° vs. 6.7°, p=0.019) and LIV- C7 plumb line and central sacral vertical line (CSVL) (-3.4mm vs. -13.7mm, p=0.020) increased in the final follow-up in the imbalanced group of type A modifier. The magnitude of lumbar curve was greater in the imbalanced group of type B or C modifier in the early postoperative period (19.5° vs. 12.6°, p=0.006; 25.5° vs. 13.7°, p<0.01), and this difference disappeared in the final follow-up. No differences in SRS-22 outcome scores were noted between groups in different time. Coronal imbalance was frequently detected immediately after STF in Lenke 1 or 2 AIS patients, with type C modifier slightly higher than A or B. Distal adding-on may help compensate for coronal imbalance in patients with type A modifier, while spontaneous correction of lumbar curve attributes to the improvement of coronal imbalance in patients with type B or C modifier.