The contribution of preoperative balanced halo-pelvic traction to severe rigid spinal deformity correction.

PURPOSE: The aim of this study was to assess the clinical efficacy of balanced halo-pelvic traction (HPT) and evaluate its contribution to the correction surgery in treating adult severe rigid spinal deformity. METHODS: One hundred and eight adult patients with severe rigid spinal deformity who underwent preoperative HPT and correction surgery were reviewed. The main coronal curve, segmental kyphotic angle, coronal balance (CB), sagittal balance (SVA), and the length of spine were measured before HPT, after HPT, post-operatively, and at final follow-up. The HPT contribution rates to deformity correction were calculated. RESULTS: The pre-HPT main coronal curve was 103.4 ± 10.6°, improved to 61.0 ± 13.4° after traction and further improved to 44.2 ± 10.2° after surgical correction, and maintained at 50.3 ± 9.9° at final follow-up. CB started at 4.2 ± 4.8 cm, improved to 2.1 ± 2.5 cm after HPT, 0.8 ± 1.2 cm after operation, and 0.7 ± 0.9 cm at final follow-up. The pre-HPT sagittal segmental kyphotic angle was 67.3 ± 17.7°, was then improved to 42.2 ± 27.5° after traction and further improved to 34.9 ± 10.2° after surgery, and maintained at 35.4 ± 10.4° at final follow-up. The length of spine improved from 35.9 ± 5.9 to 42.6 ± 6.0 cm via HPT, reached up to 45.0 ± 6.0 cm after operation, and maintained at 44.3 ± 5.2 cm at final follow-up. CONCLUSION: HPT is effective for the treatment of severe rigid spinal deformity. Balanced HPT can dramatically improve coronal and sagittal deformity as well as spinal length before corrective surgery.

First Report of Root Rot caused by Coniella fragariae on Paeoniae radix Rubra in China.

Paeoniae radix Rubra is a traditional Chinese herbal medicine, which has the effect of clearing heat and cooling blood, activating blood and removing stasis. It has become popular in the Chinese market in recent years due to its extremely high medicinal value and showy flower color. In May 2021, typical symptoms of root rot were observed in a field (35°7'12″ N, 103°58'48″ E) in Dingxi, Gansu province, China. Approximately 10% of the plants in the field had typical root rot symptoms, and the root of each affected plant is at least 5% severe. The roots of the naturally infected plants in the field discolored and decayed with black brown spots on the surface of the root bark, the root bark detached from the phloem，and some leaves were chlorosis, shrunken and smaller, and the branches were dead and underdeveloped. In the transverse section, the xylem was black diffusion and abnormal odor. Three diseased plants with typical symptoms were chosen at random and brought back to the lab. Small pieces cut from the margins of lesions were surface disinfested with 75% ethanol for 15 s, and 0.5% NaClO solution for 30 s, rinsed three times in sterile distilled water, dried on sterile filter paper, plaed onto potato dextrose agar (PDA), and incubated at 25 ± 1℃ for 7 days in the dark. The pure cultures were obtained by single-spore isolation. All isolates produced wavy on the surface, radial from the inside out, initially white or milky white to orange colonies with abundant black brown oily conidiomata pycnidia on PDA at 25 ± 1℃ after 15 days in the dark. The conidiomata pycnidia is spherical to irregularly spherical, 231.5 to 512.4 µm, initially transparent with age turning brown, with a dark brown internal conidial mass inside, and with a 13.1 to 45.4 µ m wide ostiole central. Young conidia (n=100) developed from conidiogenous cells, which were simple, tapering, hyaline, smooth, and 12.3 to 18.0 × 2.5 to 4.6 µm, 1.0 to 1.5 µm wide at apex. Mature conidia (n=100) were ellipsoid, apices tapering, subobtusely rounded, brown, and 6.5 to 11.0 × 4.1 to 7.5 µm. The morphological characteristics of the isolates were consistent with previous descriptions of the genus Coniella (Crous et al., 2014). A representation isolate CS-1 was deposited in the Institute of Plant Protection, Gansu Academy of Agricultural Sciences and used for further studies. To confirm the identity of the causal fungus, the internal transcribed spacer (ITS), 28S large subunit of nuclear ribosomal RNA (LSU) and partial translation elongation factor 1-alpha (TEF1-α) gene of the representative isolate CS-1 were amplified and sequenced using primers ITS1/ITS4 (White et al., 1990), LROR/LR7 (Chethan et al., 2017) and EF1-728F/EF1-986R (Carbone and Kohn, 1999), respectively, and deposited on GenBank with accession numbers OP824764 (ITS), OP824767 (LSU)/span>and OP903926 (TEF1-α). Blastn analysis of all sequences resulted in E-value of 0.0 (ITS and LSU) and nearly 0.0 (TEF1-α), with Query cover values of 90% to 99% identity with C. fragariae, confirming the hypothesis based on morphological features examination. To conduct a pathogenicity test, three root segments of healthy plants were wounded using sterilized needles and inoculated by pipetting 10 µL of conidial suspension (1×107 conidia/mL) onto each wound, and controls were inoculated with 10 µL sterile distilled water. These root segments were kept in a moist chamber at 25°C in the dark. The experiment was repeated three times. After 14 days, root rot symptoms were observed on all of the inoculated root segments and identical to those observed in the field, whereas control root segments did not develop symptoms. The pathogen was re-isolated from the lesions of inoculated root segments, fulfilling Koch's postulates. To the best of our knowledge, this is the first report of C. fragariae causing root rot on P. radix Rubra in China. This identification can aid in the selection of appropriate management measures for this disease.

Global realignment after posterior vertebral column resection in severe thoracolumbar post-tubercular kyphosis: correlation with patient-reported outcomes.

PURPOSE: To investigate spinal realignment in patients with severe post-tubercular kyphosis (PTK) who underwent posterior vertebral column resection (PVCR) and its correlation with patient-reported outcomes (PROs). METHODS: Eighty-two patients were included in this study. Spinopelvic parameters (focal scoliosis (FS), coronal balance (CB), sagittal vertical axis (SVA), focal kyphosis (FK), C2-7 lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and pelvic incidence minus lumbar lordosis (PI-LL)) and PROs (Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)) were analyzed. The correlation between spinopelvic parameters and PROs was evaluated. RESULTS: FK, FS, CL, TK, LL, and PI-LL significantly changed after surgery. FK decreased from pre-operative 108.5 ± 16.4° to 31.8 ± 4.5° at three months after surgery and increased to 38.7 ± 6.6° at final follow-up (P < 0.001). FS decreased from pre-operative 20.9 ± 2.2° to 5.1 ± 2.2° at final follow-up (P < 0.001). CL decreased from pre-operative 7.2 ± 7.3° to 3.3 ± 8.3° at final follow-up (P = 0.002). TK improved from pre-operative - 5.6 ± 7.1° to 12.9 ± 8.2° at final follow-up (P < 0.001). LL decreased from pre-operative 75.5 ± 12.6° to 45.5 ± 7.9° at final follow-up (P < 0.001). PI-LL improved from pre-operative - 24.8 ± 13.4° to 4.8 ± 9.9° at final follow-up (P < 0.001). The improvement of PROs was found to be significantly correlated with the variations of FK, CL, TK, LL, and PI-LL. The multiple regression analysis revealed that FK was an independent predictor for the improvement of VAS and ODI. CONCLUSIONS: PVCR is effective in treating severe PTK, which can significantly improve patients' clinical and radiographic outcomes. Spine surgeons should pay more attention to reducing the residual kyphosis.

A novel classification of osteotomized debridement based on the range of focus in treating active thoracolumbar tuberculosis: a multicenter study.

INTRODUCTION: Osteotomized debridement (OD) is increasingly used in the treatment of active thoracolumbar tuberculosis (TB). So far, no nomenclature has been established to describe the patterns of OD, and thus the surgical outcomes cannot be directly analyzed and compared among the patients treated with different extents of OD. The purpose of this study was to establish a reliable classification of OD for further study of spinal TB. MATERIALS AND METHODS: This was a multicenter retrospective study. The proposed classification included 6 grades of OD based on sagittal range of vertebral body destruction: grade 0 involves single-level intervertebral disc and adjacent superficial endplates; grade 1 involves adjacent endplates and vertebral bodies, but no pedicle is involved; grade 2 involves adjacent endplates, vertebral bodies, and a lower or upper pedicle; grade 3 involves adjacent endplates, vertebral bodies, and both of lower and upper pedicles; grade 4 involves an entire vertebral body and an adjacent lower or upper pedicle; grade 5 involves two continuous entire vertebral bodies. Two hundred and five patients with active thoracolumbar TB who underwent OD surgery were included, and all ODs were classified. The reliability of this classification was evaluated twice by 10 readers, and Fleiss kappa coefficients were calculated. RESULTS: In the 205 patients, 208 ODs were performed. Grade 2 OD was the commonest type (98/208, 47.1%), followed by grade 1 (50/208, 24.0%), grade 3 (26/208, 12.5%), grade 0 (20/208, 9.6%), grade 4 (8/208, 3.8%), and grade 5 (6/208, 2.9%). The average accuracy of the two readings was 86.2% and 90.1%, respectively. The intra-rater reliability for the classification was "almost perfect agreement" with a Fleiss kappa coefficient average of 0.92. The inter-rater reliability was "almost perfect agreement" with a coefficient average of 0.89 for two readings. CONCLUSIONS: This classification proved to be intuitive and reliable. The graded OD provides a platform for preoperative evaluation and allows comparative analysis of clinical outcomes in different extents of OD.

Osteotomized debridement versus curetted debridement in posterior approach in treating thoracolumbar tuberculosis: a comparative study.

PURPOSE: This study aimed to compare osteotomized debridement (OD) with traditional curetted debridement (CD) in treating thoracolumbar tuberculosis (TB). METHODS: A total of 188 patients were diagnosed with active thoracolumbar TB and underwent one-stage posterior surgery at our institution. Of the 188 patients, 85 patients were treated with OD, and 103 patients were treated with traditional CD. The patient information, laboratory results, imaging findings, and clinical effectiveness were, respectively, compared between the two groups. RESULTS: Group OD consumed less operation time and blood loss than group CD (P < 0.05 for both values). No significant difference in hospitalization time was found between the two groups (P > 0.05). The values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in both groups returned to the normal range within one month postoperatively. All patients had significant improvement in visual analog scale (VAS) and oswestry disability index (ODI) postoperatively. The mean fusion time in group OD was shorter than that in group CD (P < 0.05). There was no statistically significant difference in preoperative kyphotic angle between the two groups (P > 0.05), but group OD showed less correction loss than group CD at the final follow-up (P < 0.05). The rate of recurrence and surgery-related complications in group OD was lower than group CD. CONCLUSIONS: Posterior OD, reconstruction with titanium mesh cages (TMCs), and instrumentation is feasible and effective in treating thoracolumbar TB. Compared with the traditional CD, OD can achieve radical lesion removal, more effective kyphosis correction, lower recurrence rate, and fewer complications.

The Correlation of Global Spinal Realignment With the Quality of Life After Corrective Surgery for Delayed Thoracolumbar Osteoporotic Fracture-Related Kyphosis.

BACKGROUND AND OBJECTIVES: Few studies have been conducted to evaluate the precise impact of corrective surgery on sagittal spinal realignment and clinical outcomes in cases of delayed thoracolumbar osteoporotic fracture-related kyphosis. To assess the efficacy of corrective surgery on sagittal spinal alignment and investigate the relationship between spinal alignment and health-related quality of life (HRQoL) in patients with delayed thoracolumbar osteoporotic fracture-related kyphosis. METHODS: A total of 78 patients were enrolled. The characteristics and surgical variables were meticulously documented. The sagittal spinal parameters were measured, and the HRQoL was evaluated using Oswestry Disability Index (ODI), SF-12 Physical Component Score (SF-12 PCS), and Scoliosis Research Society-22 Patient Questionnaire (SRS-22) before and after surgery. The changes in spinal parameters and HRQoL were analyzed through the paired t -test. The Pearson correlation analysis was performed to analyze the correlation of parameters with HRQoL. Then, a multiple stepwise regression analysis was performed with HRQoL scores as the dependent variable and spinal parameters as the independent variable. RESULTS: The operative time was 185.9 ± 33.2 min, and the estimated blood loss was 782.8 ± 145.2 mL. The results of the paired t -test revealed a significant difference preoperatively and at the final follow-up in the thoracic kyphosis, thoracolumbar kyphosis (TLK), lumbar lordosis, T9 tilt, pelvic tilt, sacral slope, sagittal vertical axis, and spinosacral angle as well as the ODI, SF-12 PCS, and SRS-22 ( P < .05). Multiple stepwise regression analysis revealed that TLK and pelvic tilt, TLK and sagittal vertical axis, and TLK were the primary parameters affecting the ODI, SF-12 PCS, and SRS-22, respectively. CONCLUSION: Corrective surgery can effectively realign the global spine and improve HRQoL in patients with delayed thoracolumbar osteoporotic fracture-related kyphosis. The change of TLK is a driving factor to realign the global spine.

Improvement of pulmonary function and reconstructed 3D lung volume after deformity correction for thoracic spinal posttubercular kyphosis: a multicenter study.

OBJECTIVE: The aim of this study was to investigate the influence of corrective surgery on thoracic spinal posttubercular kyphosis (PTK) with respect to lung volume and pulmonary function. METHODS: This was a retrospective study of 126 patients (72 males and 54 females) who underwent posterior vertebral column resection (PVCR) for severe thoracic spinal PTK between September 2013 and June 2020. The patients' spinal parameters, results of their pulmonary function test (PFT), and CT-based 3D lung volume were recorded and analyzed preoperatively and at final follow-up. The correlation of kyphosis correction with the PFT and lung volume was evaluated. RESULTS: The mean local kyphosis decreased from 112.5° to 37.2°, and the mean local scoliosis decreased from 20.9° to 5.2°; C2-7 lordosis, thoracic kyphosis, and lumbar lordosis also significantly improved after surgery. The mean CT-based lung volume significantly increased from 2.9 L preoperatively to 3.6 L at the final follow-up. The indices of PFT, including forced vital capacity (FVC), percent predicted FVC, total lung capacity, and forced expiratory volume in 1 second, were also significantly improved, and 60 patients with pulmonary dysfunction recovered to normal at the final follow-up. The correlation analysis revealed that the correction of local kyphosis was closely correlated with the improvement in PFT and the increase in lung volume. CONCLUSIONS: PVCR cannot only effectively realign the spine in patients with severe thoracic spinal PTK deformity but also significantly improve pulmonary function. Adequate local kyphosis correction should be highly valued, as it is a key factor in increasing lung volume.

Improvement of Pulmonary Function and Reconstructed 3-Dimensional Lung Volume After Halo-Pelvic Traction Combined With Posterior Correction for Severe Rigid Spinal Scoliosis: A Multicenter Study.

BACKGROUND AND OBJECTIVES: Severe rigid spinal scoliosis (SRSS) leads to severe restrictive ventilation dysfunction. Currently, the reports about the influence of preoperative halo-pelvic traction (HPT) combined with correction surgery on pulmonary function in patients with SRSS were relatively few. This study aims to investigate (1) the influence of preoperative HPT on lung volume and pulmonary function, (2) the further influence of the following correction surgery on lung volume and pulmonary function, and (3) the relationship among deformity correction, pulmonary function test outcomes, and computed tomography-based lung volume. METHODS: A total of 135 patients with SRSS who underwent preoperative HPT and followed low-grade osteotomy correction surgery were reviewed. Spinal parameters, including proximal thoracic curve, main thoracic curve (MTC), lumbar curve, coronal balance, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pulmonary function test outcomes (forced vital capacity [FVC], the percentage of predicted forced vital capacity [FVC%], forced expiratory volume in 1 second [FEV1], total lung capacity [TLC]), and lung volume (Vin), were analyzed before, after HPT and at the final follow-up, respectively. RESULTS: The mean FVC, FVC%, FEV1, and TLC increased from 1.67 L, 51.13%, 1.47 L, and 2.37 L to 1.95 L, 64.35%, 1.75 L, and 2.78 L, respectively, after HPT and further improved to 2.22 L, 72.14%, 1.95 L, and 3.15 L, respectively, at the final follow-up. The mean Vin increased from 1.98 L to 2.42 L after traction and further increased to 2.76 L at the final follow-up. The variation of MTC was correlated with the improvement of FVC (r = 0.429, P = .026), FVC% (r = 0.401, P = .038), FEV1 (r = 0.340, P = .043), and TLC (r = 0.421, P = .029) and the variation of Vin (r = 0.425, P = .015) before HPT and after surgery. CONCLUSION: Preoperative HPT can improve preoperative pulmonary function and enhance the preoperative lung volume. There were significant correlations among the variations of MTC, pulmonary function indexes, and lung volume before HPT and after surgery in patients with SRSS.

Global Spinal Realignment After Osteotomized Debridement in Active Lumbar Spinal Tuberculosis: Correlation with Patient-Reported Outcomes.

OBJECTIVE: Osteotomized debridement (OD) has been proved to be highly effective in treating active thoracolumbar tuberculosis (TB); however, no research has investigated how OD affects spinal alignment. The goal of this study was to explore the global alignment compensatory mechanism after lumbar OD, as well as the correlation between spinopelvic parameters and patient-reported outcomes (PROs). METHODS: Sixty-two patients with active lumbar spinal TB who underwent OD surgery were included. Spinopelvic parameters (C2-7 Cobb angle [C2-7 CA], sagittal vertical axis [SVA], proximal thoracic kyphosis, thoracic kyphosis, lumbar lordosis [LL], sacral slope [SS], pelvic tilt [PT], pelvic incidence [PI], spinosacral angle, and PI minus LL [PI-LL]) and PROs (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS] score) were reviewed. The correlation between spinopelvic realignment and improved PROs was evaluated. RESULTS: Compared with preoperative measurements, C2-7 CA, proximal thoracic kyphosis, thoracic kyphosis, LL, SS, and spinosacral angle significantly increased after OD, whereas SVA, PT, and PI-LL significantly decreased. ODI and VAS score significantly improved postoperatively. The improvement of VAS was observed to be correlated with variations of C2-7 CA, SVA, LL, and PI-LL. The improvement of ODI was found to be correlated with variations of SVA, LL, and PI-LL. The multiple stepwise regression analysis showed that LL was an independent predictor for ODI and VAS score. CONCLUSIONS: The whole spine and pelvis are involved in realignment after lumbar spinal OD, which is closely related to PROs. More attention should be drawn to restoring an appropriate LL in lumbar TB surgery.

Two-Level Pedicle Subtraction Osteotomy in Lateral Position for an Ankylosing Spondylitis Patient With Severe Thoracolumbar Kyphosis and Hip Flexion Contracture: A Case Report.

BACKGROUND AND IMPORTANCE: Spinal osteotomy and total hip replacement (THR) are the most common surgical interventions for ankylosing spondylitis (AS). It is recommended that patients with AS with severe thoracolumbar kyphotic deformity (TLKD) and flexed hips receive spinal osteotomy before THR to reduce the risk of hip prosthesis dislocation after THR. Standardly, spinal osteotomy is performed in the prone position; however, it is impractical to place patients with AS with kyphosis and closed hips in a prone position. In this report, we present an AS case with severe TLKD and closed hips who underwent spinal osteotomy in a lateral position first, then THR in the second stage. CLINICAL PRESENTATION: The patient with AS was a 40-year-old woamn with severe TLKD and a closed hip. Back pain, difficulty walking, and gaze loss are the chief complaints. In consideration of the infeasibility of adopting the prone position, the patient was placed in a lateral position and underwent 2-level pedicle subtraction osteotomy at L1 and L3 with a long instrumentation from T10 to S1 at the first stage. Then, THR was performed at the second stage. The patient achieved pain relief, horizontal gaze, and nearly normal ambulation after spinal deformity correction and THR. After 2-year follow-up, the spinal alignment remains good and hip function was satisfactory. DISCUSSION: The sequence of spinal osteotomy and THR performed for AS patients with TLKD and hip flexion contracture remains inconclusive. According to previous studies, patients treated with THR under a sagittal malaligned spine may require revision of the acetabular component to accommodate to the re-orientated acetabula resulting from the subsequent spinal osteotomy and realignment. Thus, we believe it is more reasonable to perform spinal osteotomy first. For osteotomy in lateral position, one of the key points is that the operation table should be tilted away from the surgeon side at a certain angle. Another point is that contralateral cancellous bone should be removed as much as possible when performing osteotomy at the side of vertebral away from the table. The satisfactory outcomes of this case revealed the feasibility of osteotomy in a lateral position for such severe AS with closed hip. CONCLUSION: Performing double-level spinal osteotomy in a lateral position first could be an alternative for patients with AS who cannot be placed in the prone position because of the severe deformity of the spine and hips.

Case Report of Angular Post-Tuberculotic Kyphosis Corrected Through Pedicle Subtraction Osteotomy Above C7.

BACKGROUND AND IMPORTANCE: Angular cervical kyphosis and its association with syringomyelia were rarely described. Correcting this kind of deformity from the front is extremely difficult or even impossible. Meanwhile, no study has made a report about correcting angular cervical kyphosis through pedicle subtraction osteotomy (PSO) above C7 because of the special anatomy of the vertebral artery. This is the first case of cervical deformity correction through PSO above C7. CLINICAL PRESENTATION: We present the case of a 52-yr-old man who previously underwent debridement, decompression, and skull traction for cervical tuberculosis at age 6 yr. The sequelae of right-hand weakness occurred after surgery, and cervical kyphosis formed gradually. The patient recently started to complain of a severe neck pain. X-rays showed a cervical sagittal malalignment due to the angular kyphosis. Computed tomography scans revealed a fused angular kyphosis at C6-7, and MRI showed a long syringomyelia distal to the kyphosis. The definite diagnosis of the patient was post-tuberculotic cervical angular kyphosis, and because of the extremely narrow surgery corridor from the front, we decided to perform the surgery in a posterior approach. Hence, the patient was treated with the PSO with a long-segment pedicle screw fixation from C3 to T5 and received satisfactory angular kyphosis correction. CONCLUSION: PSO above C7 to correct angular cervical kyphosis is feasible and reasonable when there is no other better solution, and it can achieve a satisfactory kyphotic deformity correction.

Ball Tip Technique for S2AI Screw Placement in Sacropelvic Fixation: A Comparative Study with Conventional Freehand Technique.

OBJECTIVE: To evaluate the efficiency of the ball tip technique for S2AI screw placement and introduce this technique. METHODS: Sixty-three patients who underwent pelvic fixation with S2AI screws were retrospectively reviewed. They were 29 males and 34 females with an average age of 59.6 ± 12.5 years. Among these patients, 35 patients (14 males and 21 females with an average age of 58.8 ± 11.3 years) received ball tip technique and 28 patients (15 males and 13 females with an average age of 63.7 ± 12.6 years) received conventional freehand technique. Ball tip technique was used in ball tip technique group. After a pedicle probe just penetrated the sacroiliac joint, a ball-tipped probe consisting of a ball shaped metal tip with a flexible shaft was malleted to make a guide track within ilium. This ball-tipped probe could bend automatically away from the cortex and forward through the cancellous bone when the tip met the cortical lamina of ilium, which can avoid penetration. After repeating the procedures, a guide hole was gradually formed. S2AI screw was inserted along the guide hole after tapping. In the conventional freehand group, S2AI screw was placed according to the conventional method. Postoperative computed tomography (CT) was used to assess the accuracy of screws. The time cost of screw insertion and screw-related complications were recorded. Independent t-test was used to compare the time cost between ball tip group and conventional freehand group. A chi-square test was used to compare the accuracies of the ball tip group with the conventional group. RESULTS: There were 35 patients (70 S2AI screws) in ball tip group and 28 patients (56 S2AI screws) in conventional freehand group. No screw-related complication occurred in all patients. Time costs were 9.8 ± 4.5 mins in ball tip group and 20.2.0 + 8.6 mins in conventional freehand group, respectively (P < 0.05). Four screws penetrated iliac cortex in the ball tip group vs 10 screws in conventional freehand group (5.7% vs 17.9%) (P < 0.05). CONCLUSIONS: The ball tip technique enhances the accuracy of screw placement and has less time cost compared with conventional freehand technique.

Posterior Approach With Osteotomized Debridement Versus Combined Anterior and Posterior Approach in Treating Thoracolumbar Tuberculosis: A Retrospective Cohort Study.

STUDY DESIGN: Retrospective cohort. OBJECTIVES: To compare outcomes of posterior osteotomized debridement (OD) with combined anterior and posterior approach (AP) in treating thoracolumbar tuberculosis (TB). METHODS: This study reviewed 178 patients who were diagnosed as active thoracolumbar TB and surgically treated in our center. One hundred and two patients underwent posterior OD, interbody fusion with titanium mesh cage (TMC), and instrumentation (group A). Seventy-six patients underwent one-stage posterior instrumentation, anterior debridement, and interbody fusion with TMC (group B). Patients' clinical outcomes were compared between the 2 groups. RESULTS: Erythrocyte sedimentation rate and C-reactive protein in all patients returned to normal levels within 3 months after surgery, and no recurrence occurred during the follow-up. Compared with AP approach, OD surgery was less invasive and with a lower cost (¥ 70 581 ± 17 645 vs ¥ 87 600 ± 27 328; P < .05). Patients treated by OD showed more significant improvements in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) than those treated by AP approach 3 months postoperatively (VAS: 3.0 ± .7 vs 3.7 ± .9; ODI: 14.7 ± 4.4 vs 20.6 ± 4.6). Two groups showed similar postoperative kyphosis correction and final follow-up correction loss (P = .361 and P = .162, respectively). The OD method had a lower complication rate than AP approach (9.8% [10/102] vs 35.5% [27/76]; P < .05). CONCLUSIONS: Posterior OD is effective in treating active thoracolumbar TB. Compared with traditional AP approach, OD surgery has less surgical invasiveness, lower complication rate, and shorter fusion time.

LncRNA FOXP4-AS1 Promotes Progression of Ewing Sarcoma and Is Associated With Immune Infiltrates.

Ewing sarcoma (ES) is a highly malignant primary bone tumor with poor prognosis. Studies have shown that abnormal expression of lncRNA influences the prognosis of tumor patients. Herein, we established that FOXP4-AS1 was up-regulated in ES and this correlated with poor prognosis. Further analysis illustrated that FOXP4-AS1 down-regulation repression growth, migration, along with invasion of ES. On the contrary, up-regulation of FOXP4-AS1 promoted the growth, migration, as well as invasion of ES. To explore the mechanism of FOXP4-AS1, Spearman correlation analysis was carried out to determine genes that were remarkably linked to FOXP4-AS1 expression. The potential functions and pathways involving FOXP4-AS1 were identified by GO analysis, Hallmark gene set enrichment analysis, GSEA, and GSVA. The subcellular fractionation results illustrated that FOXP4-AS1 was primarily located in the cytoplasm of ES cells. Then a ceRNA network of FOXP4-AS1 was constructed. Analysis of the ceRNA network and GSEA yielded two candidate mRNAs for FOXP4-AS1. Results of the combined survival analysis led us to speculate that FOXP4-AS1 may affect the expression of TMPO by sponging miR-298, thereby regulating the malignant phenotype of ES. Finally, we found that FOXP4-AS1 may modulates the tumor immune microenvironment in an extracellular vesicle-mediated manner. In summary, FOXP4-AS1 correlates with poor prognosis of ES. It promotes the growth, migration, as well as invasion of ES cells and may modulate the tumor immune microenvironment.