Less Vertebral Bone Mass after Treatment with Macitentan in Mice: A Pilot Study.

PURPOSE: Blood vessels and skeleton interact together. Endothelin-1 is a potent vasoconstrictor and also has an effect on bone metabolism. The dual antagonist to both endothelin-1 type A and B receptors, Macitentan, has been approved for clinical management of pulmonary arterial hypertension while little is known about the secondary effect of the drug on spine. We aimed to answer how vertebral bone mass responded to Macitentan treatment in mice. METHODS: Sixteen male balb/c mice at 6 months were randomly assigned into 2 groups. Vehicle and Macitentan were administrated via intraperitoneal injection to Control group and Treatment group, respectively, for 4 months. At sacrifice, plasma endothelin-1 was evaluated with ELISA and vertebral bone mass was evaluated with Microcomputed Tomography and histological analysis. RESULTS: We found higher plasma endothelin-1 level (p<0.01) and less vertebral bone mass (p<0.05) in Treatment group compared to controls. Moreover, less osteoblasts and more osteoclasts were observed in the vertebral trabecular bone in the Treatment group compared to controls, by immunohistochemistry of the cell-specific markers. CONCLUSIONS: Treatment with Macitentan is associated with significant lower vertebral bone mass and therefore the secondary effect of dual antagonists to endothelin-1 receptors on the skeleton should be monitored and investigated in clinical practice. Both osteoblasts and osteoclasts may be involved while the molecular mechanism needs to be further explored.

Microendoscopy-Assisted Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: 5-Year Outcomes.

OBJECTIVE: We sought to evaluate 5-year outcomes between microendoscopy-assisted minimally invasive (MIS) and open transforaminal lumbar interbody fusion (TLIF). METHODS: Sixty single-level MIS and open surgeries were performed (30 patients in either group). Perioperative parameters including operative duration, intraoperative estimated blood loss, fluoroscopy time, postoperative analgesic usage, ambulatory time, and complications were recorded. Visual analog scale (back and leg), Japanese Orthopaedics Association score, and Oswestry Disability Index were obtained. Finally, self-evaluation of surgical outcomes (modified MacNab criteria), interbody fusion rate (Bridwell grade 1), and prevalence of adjacent segment degeneration were assessed. RESULTS: Intraoperative estimated blood loss and postoperative analgesia usage were reduced in the MIS group, and patients undergoing microendoscopy-assisted MIS-TLIF ambulated earlier than those receiving open TLIF postoperatively. Nevertheless, surgical duration and fluoroscopy time were prolonged in the MIS group. Complication incidences were similar in both groups. Visual analog scale (back and leg), Japanese Orthopaedics Association, and Oswestry Disability Index were improved at 1 month, 2 years, and 5 years postoperatively in both groups when compared with preoperative scores. Significant improvements in these scores were found in the MIS group at 1 month postoperatively, while at 2 years and 5 years postoperatively, both groups revealed comparable aforementioned scores. Excellent and perfect scale rating, interbody fusion rate, and adjacent segment degeneration prevalence between the groups were almost similar. CONCLUSIONS: Microendoscopy-assisted MIS-TLIF is comparable with open TLIF in terms of 5-year outcomes with additional benefits of reduced intraoperative iatrogenic injury, decreased initial pain, minimized activity restrictions, and accelerated ambulation recovery after surgery.

Prospective evaluation of preoperative concerns for Chinese patients with spinal degenerative disease.

Objective of this study is to analyze preoperative concerns of patients suffering from spinal degenerative disease in a Chinese population. A total of 94 patients with spinal degenerative disease were included, and they were divided into four groups: male and female group, older (≥60 year-old) and younger group (<60 year-old). Questionnaire was designed through patients counseling, preliminary formulation, pilot test and final revision. Each patient was required to select three items of greatest concern. "Attention rate" (AR) was defined as ratio of selected times of one item upon case number within the group. AR of three most concerned items between male and female group, as well as older and younger group were compared and analyzed. All participants selected "recurrence of symptoms following operation" (41/94), "clinical outcome" (35/94) and "postoperative rehabilitation and daily activity" (30/94) as their three top items of concern. Both male and female groups selected "recurrence of symptoms following operation" (22/47, 19/47), "clinical outcome" (21/47, 14/47), "postoperative rehabilitation and daily activity" (15/47, 15/47) and "limb paralysis" (13/47, 14/47) as their most concerned items, revealing no statistical difference (P>0.05). Older group chose "clinical outcome" (17/46) as their most concerned item, followed by "limb paralysis" (14/46), "postoperative rehabilitation and daily activity" (14/46) and "recurrence of symptoms following operation" (12/46). Younger group chose "recurrence of symptoms following operation" (29/48), "clinical outcome" (18/48) and "postoperative rehabilitation and daily activity" (16/48) as their three top concerned items. AR of "recurrence of symptoms following operation" between older and younger group demonstrated statistical difference (P<0.001), while AR of remaining items of greatest concern between both groups were not statistically different (P>0.05). For Chinese patients, high level concerns are associated with surgical outcome and most of them reveal no gender-associated or age-associated difference. Assessing preoperative concerns empowers better preoperative counseling between surgeons and patients and more informed decision for patients.