Comparisons between needle puncture and chondroitinase ABC to induce intervertebral disc degeneration in rabbits.

PURPOSE: This study aimed to compare the effect of needle puncture and chondroitinase ABC (ChABC) injection on inducing intervertebral disc (IVD) degeneration (IVDD) in rabbits. METHODS: Sixteen New Zealand white rabbits were used in this study. Briefly, the rabbits were divided into four groups. In the annulus fibrosis (AF) needle puncture group, a 16-G needle was used to puncture the L5-6 and L6-7 IVDs, while in the sham group, these IVDs were not punctured. In the ChABC group, 30 µL 0.5 Unit/mL ChABC was injected into L5-6 and L6-7 IVDs using a 26-G needle, while in the vehicle group, these IVDs were injected with 30 µL phosphate-buffered saline (PBS). X-ray and MRI scans were performed at the 4th, 12th and 16th weeks postoperatively. Histological, immunohistochemical and biochemical analyses were performed at the 16th week postoperatively. RESULTS: Both needle puncture and ChABC successfully established IVDD in rabbits at 4th, 12th and 16th weeks, confirmed by X-ray and MRI scan. The progression of IVDD went in a time-dependent manner. The IVDD in the ChABC group was less severe than in the needle puncture group throughout the study. Aggrecan and type II collagen significantly decreased, while tumor necrosis factor-α and superoxide dismutase 2 increased in the needle puncture and ChABC groups, compared with the sham and PBS groups. CONCLUSIONS: Both AF needle puncture and ChABC injection can successfully induce IVDD in rabbits. Compared with ChABC injection, AF needle puncture can induce more severe IVDD.

Relation Between Neck Pain and Modic Changes in Cervical Spondylotic Myelopathy.

BACKGROUND Modic changes on magnetic resonance imaging (MRI) represent lesions in the bone marrow of the vertebral body that may be associated with pain. This study investigated the relationship between neck pain and cervical Modic changes, and risk factors for neck pain (NP). MATERIAL AND METHODS This study included 168 patients diagnosed with cervical spondylotic myelopathy between February 2013 and April 2017. Basic patient information about demographic and lifestyle variables was obtained from medical records. Radiographic images provided cervical alignment (C2-C7 Cobb), T1 slope and C7 slope. All patients underwent MRI to evaluate the presence of Modic changes. Univariate analyses identified the variables as potential factors. Variables with a p<0.10 were included in the multivariate logistic regression analysis models. P-values <0.05 were statistically significant. RESULTS Only 93 patients (55.4%) had NP. Modic changes in patients with NP were significantly higher than those without Modic changes (p=0.002). Eighty-five patients had Modic changes types I, II, III; 41 (48.2%), 29 (34.1%), 15 (17.6%), respectively. The distribution of these Modic changes varied with NP (p<0.001). Type I Modic changes were seen with NP more frequently than other types of Modic changes. Univariate and multivariate analyses showed that age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.16) and Modic changes (OR 1.25; 95% CI, 0.09-1.46) were significant independent factors for NP. CONCLUSIONS In cervical spondylosis, age and Modic changes were associated with NP. Modic change type I is more likely to occur with NP.

Epidemiologic characteristics of traumatic fractures in elderly patients during the outbreak of coronavirus disease 2019 in China.

PURPOSE: This study aimed to describe the epidemiologic characteristics of fracture in the elderly during the COVID-19. METHODS: This was a retrospective multi-centre study, which included patients who sustained fractures between 20 January and 19 February 2020. The collected data included patients' demographics (age and gender), injury-related (injury type, fracture location, injury mechanism, places where fracture occurred), and treatment modality. SPSS 23.0 was used to describe the data and perform some analysis. RESULTS: A total of 436 patients with 453 fractures were included; there were 153 males and 283 females, with an average age of 76.2 years (standard deviation, SD, 7.7 years; 65 to 105). For either males or females, 70-74 years was the most commonly involved age group. A total of 317 (72.7%) patients had their fractures occurring at home. Among 453 fractures, there were 264 (58.3%) hip fractures, accounting for 58.3%. Fall from standing height was the most common cause of fracture, making a proportion of 89.4% (405/453). Most fractures (95.8%, 434/453) were treated surgically, and 4.2% (19/453) were treated by plaster fixation or traction. Open reduction and internal fixation (ORIF) was the most used surgical method, taking a proportion of 49.2% (223/453). CONCLUSION: These findings highlighted the importance of primary prevention (home prevention) measures and could be used for references for individuals, health care providers, or health administrative department during the global pandemic of COVID-19.

Aberrantly expressed long non-coding RNAs in air pollution-induced congenital defects.

Air pollution has been a serious public health issue over the past few decades particularly in developing countries. Air pollution exposure during pregnancy poses potential threat to offspring as the deleterious substances might pass through placenta to alter foetal development. A growing number of studies have demonstrated that long non-coding RNAs (lncRNAs) participate in the development of many diseases, including congenital defects. Here, we used RNA sequencing to identify differentially expressed lncRNAs in air pollution-exposed rat embryos compared with control group. Our data suggested that 554 lncRNAs (216 up-regulated and 338 down-regulated) were significantly differentially expressed in the air pollution-exposed embryos. Moreover, potential cellular functions of these deregulated lncRNAs were predicted via KEGG signal pathway/GO enrichment analyses, which suggested the possible involvements of neurological process, sensory perception of smell and the G-protein signalling pathway. Furthermore, potential functional network of deregulated lncRNAs and their correlated mRNAs in the development of congenital spinal abnormality was established. Our data suggested that lncRNAs may play a vital role in the pathophysiology of air pollution-exposed congenital spinal malformation.

MicroRNA signature of air pollution exposure-induced congenital defects.

Air pollution exposure has been increasing extensively and there are evidence suggesting that exposure to air pollution during pregnancy can lead to congenital defects in the offspring. Recent findings suggested that microRNAs (miRNAs) might play important roles in the pathogenesis of developmental defects. However, the miRNAs profile pattern in the air pollution-exposed embryos remains unknown. RNA sequencing was performed to determine the differentially expressed miRNAs in the rat embryos (gestation day 9) with or without air pollution exposure. The potential functions and the associated mechanisms of these differentially expressed miRNAs were determined using Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) analyses. The regulatory networks of mRNA-miRNA interactions were also reconstructed. As compared with the control group, a total of 291 miRNAs were differentially expressed in the rat embryos from the air pollution-exposed group, in which 204 and 87 miRNAs were significantly downregulated and upregulated, respectively. These miRNAs were predicted to deregulate mitotic spindle organization, cellular respiration, glycolate metabolism, and proteasome. Extensive regulation of target genes by miR-346, miR-504, miR-214-3p and miR-1224 was also predicted. Our results suggested that miRNAs may play crucial roles in the pathogenesis of air pollution-induced congenital spinal defects through deregulating multiple biological processes.

Insertion/deletion polymorphism in the 3' untranslated region of COL1A2 disrupts its interaction with microRNA-382 and leads to decreased susceptibility to osteoporotic fracture.

A growing body of evidence has proved that the expression of COL1A2 is associated with a reduced risk of osteoporotic fracture. One single-nucleotide polymorphism (rs3917) located within the 3'-untranslated region of COL1A2 may "alter" binding site of miR-382 and thereby associated with the risk of osteoporotic fracture. Bioinformatic analysis, luciferase reporter assay, site-directed mutagenesis, Western blot and real-time PCR were performed in this study. In this study, we validated COL1A2 as a target of miR-382 in osteoblast. In addition, bone tissue samples were genotyped as wild-type rs3917, heterozygous rs3917, and homozygous rs3917. The expression of miR-382 was comparable between the genotype groups, whereas the expression of COL1A2 mRNA and protein was much higher in heterozygous rs3917 and homozygous rs3917 than the wild-type rs3917 group. Furthermore, we transfected the wild-type rs3917 and heterozygous rs3917 cells with miR-382 mimics or inhibitors and found that the transfection with miR-382 mimics significantly increased the level of the miR-382 in the cells of both genotypes, and the introduction of miR-382 inhibitors substantially suppressed the level of miR-382 in both cells. In wild-type rs3917 cells, transfection of miR-382 mimics and COL1A2 small interfering RNA (siRNA) similarly and substantially downregulated the expression of COL1A2, while in heterozygous rs3917 cells, only COL1A2 siRNA notably reduced the expression of COL1A2, whereas introduction of miR-382 mimics left expression of COL1A2 intact. The findings showed rs3917 polymorphism interfered with the interaction between COL1A2 mRNA and miR-382, and minor allele is associated with a reduced risk of osteoporotic fracture.

Risk Factors of Secondary Vertebral Compression Fracture After Percutaneous Vertebroplasty or Kyphoplasty: A Retrospective Study of 650 Patients.

BACKGROUND In this study, we aimed to investigate the risk factors contributing to secondary vertebral compression fractures (SVCF) in patients undergoing percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) due to osteoporotic vertebral compression fracture (OVCF). MATERIAL AND METHODS Between January 2010 and December 2017, 650 patients with regular follow-up were identified and retrospectively analyzed in this study. Of these patients, 410 patients underwent PVP and 240 patients underwent PKP surgery. Patients were followed for 24 months on average, ranging from 6 months to 36 months follow-up. Possible risk factors screened for were age, gender, regional distribution, outdoor activity (ODA), bone mineral density (BMD), surgical methods (unilateral or bilateral), bone cement dose, bone cement leakage, chronic disease history, postoperative anti-osteoporosis treatment, and level of preoperative OVCF. Logistic regression analysis was applied to determine potential risk factors. RESULTS As a result, 102 patients (15.7%) suffered SVCF after PVP/PKP surgery at the last follow-up. Binary logistic regression model showed that older age increased the risk of developing SVCF [odds ratio (OR)=2.48, P=0.031] while high-level BMD (OR=0.31, P<0.001) and ODA (OR=0.38, P=0.001) decreased the risk. Binary logistic regression model showed the following: Logit (P)=1.03+0.91X1-1.18X2-0.97X3 (X1=age, OR=2.48, P=0.031; X2=BMD, OR=0.31, P<0.001; X3=ODA, OR=0.38, P=0.001). CONCLUSIONS In conclusion, older age and lower BMD were identified as risk factors of SVCF for OVCF patients following PVP/PKP surgery, whereas more ODA played a protective role in SVCF development.

Posterior atlantoaxial dislocation without fracture or neurological symptoms treated by transoral-posterior approach surgery: a case report and literature review.

BACKGROUND: Atlantoaxial dislocation usually results from hyperextension trauma and is almost always accompanied by odontoid fracture and neurological symptoms. In most cases, patients with atlantoaxial dislocation die instantly. This is a rare report of posterior atlantoaxial dislocation without fracture and neurological symptoms effectively treated by transoral-posterior approach surgery, and only eleven similar cases have been previously reported. OBJECTIVE: To describe the very rare case of an adult posterior atlantoaxial dislocation patient without fracture who was neurologically treated using transoral-posterior approach surgery and to review the relevant literature. METHOD: A 52-year-old man riding a motorcycle was rear-ended by a car. Using X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI), he was diagnosed with posterior atlantoaxial dislocation without a related fracture or a significant change in spinal cord signal. Transoral-posterior approach surgery with sustained skull traction was used after failed closed reduction. RESULT: During a 6-month follow-up observation, the lateral cervical spine radiography and sagittal reconstructions of CT scans demonstrated no instability of the atlantoaxial complex. Few patients experience posterior atlantoaxial dislocation without a related fracture or spinal cord deficit. For a patient who experiences trauma with hyperextension, such as in rear-end collisions, X-ray, CT scan and MRI should be performed to ensure that this injury is diagnosed. It is necessary to perform surgery to recover atlantoaxial stability, even in the absence of fracture or neurological symptoms. CONCLUSION: Transoral-posterior approach surgery is a safe and effective way to manage irreducible posterior atlantoaxial dislocation.

Relationship between the incidence of de Quervain's disease among teenagers and mobile gaming.

OBJECTIVE: To assess the relationship between the incidence of de Quervain's disease (DD) and mobile gaming. METHODS: We conducted an experimental cross-sectional study and surveyed specialized students with different majors from Xingtai Technician Institute. We applied the stratified clustered sampling method to recruit 500 students aged 16 to 20 years as survey respondents. We diagnosed DD by conducting Finkelstein's test. Chi-square test or Fisher's exact test was used to determine the correlation between different variables and Finkelstein's test results. SPSS 20 statistical software was used to perform all the statistical analyses. RESULTS: Among the five hundred students providing the valid data, there were 302 males and 198 females, with a male-to-female ratio of 3:2. Of them, 216, 159, 77, and 48 reported they played mobile games for < two, two to four, four to six, and > six hours per day, respectively. A total of 246 students (49%) had a positive result in Finkelstein's test. Three hundred and five (61.0%) students played mobile games with their wrist in dorsiflexion position, and among them, 192 had a positive result in Finkelstein's test. The statistical analyses showed that more frequent play, prolonged mobile gaming time per day, and changes in wrist position were significantly correlated with the positive rate of Finkelstein's test (p < 0.05). DISCUSSION: Our results show that the incidence of DD in students in the school was 49.0%. More frequent play, prolonged duration of mobile gaming, and change in wrist position were associated with higher risk of DD. We advocate the restricted time to less than 2.25 hours per day and the frequency in mobile gaming to prevent or reduce DD.

Anatomical study of the communicating branches of cords of the brachial plexus and their clinical implications.

The aim of this study was to investigate the occurrence and patterns of the communicating branches of cords of the brachial plexus (BPs). This study was performed with 50 fixed adult cadavers (all 100 sides). The BPs were exposed, the presence of the communicating branches of BPs were determined, measured, and photographed. The communicating branches were identified in 27 sides of the BPs. According to enthesis, the communicating branches between the medial and lateral cords (25 sides) were divided into five types. The most common branches connected the lateral cord with the medial root of the median nerve (16 sides). All the communicating branches between the lateral and medial cords obliquely crossed anterior to the axillary artery and passed below the thoracoacromial artery trunk. The distance of the communicating branch with the origin of thoracoacromial artery trunk was 1.60 ± 0.64 cm. The length, transverse diameter, and anteroposterior diameter of communicating branch were 1.67 ± 0.62 cm, 1.77 ± 0.63 mm, and 1.91 ± 0.34 mm, respectively. These anatomical data about the communicating branches will be helpful for surgeons who perform surgical procedures in the cervical and axillary regions.

Development and validation of a deep learning-based model to distinguish acetabular fractures on pelvic anteroposterior radiographs.

Objective: To develop and test a deep learning (DL) model to distinguish acetabular fractures (AFs) on pelvic anteroposterior radiographs (PARs) and compare its performance to that of clinicians. Materials and methods: A total of 1,120 patients from a big level-I trauma center were enrolled and allocated at a 3:1 ratio for the DL model's development and internal test. Another 86 patients from two independent hospitals were collected for external validation. A DL model for identifying AFs was constructed based on DenseNet. AFs were classified into types A, B, and C according to the three-column classification theory. Ten clinicians were recruited for AF detection. A potential misdiagnosed case (PMC) was defined based on clinicians' detection results. The detection performance of the clinicians and DL model were evaluated and compared. The detection performance of different subtypes using DL was assessed using the area under the receiver operating characteristic curve (AUC). Results: The means of 10 clinicians' sensitivity, specificity, and accuracy to identify AFs were 0.750/0.735, 0.909/0.909, and 0.829/0.822, in the internal test/external validation set, respectively. The sensitivity, specificity, and accuracy of the DL detection model were 0.926/0.872, 0.978/0.988, and 0.952/0.930, respectively. The DL model identified type A fractures with an AUC of 0.963 [95% confidence interval (CI): 0.927-0.985]/0.950 (95% CI: 0.867-0.989); type B fractures with an AUC of 0.991 (95% CI: 0.967-0.999)/0.989 (95% CI: 0.930-1.000); and type C fractures with an AUC of 1.000 (95% CI: 0.975-1.000)/1.000 (95% CI: 0.897-1.000) in the test/validation set. The DL model correctly recognized 56.5% (26/46) of PMCs. Conclusion: A DL model for distinguishing AFs on PARs is feasible. In this study, the DL model achieved a diagnostic performance comparable to or even superior to that of clinicians.

Induction of Lumbar Disc Degeneration in Rabbits Through a Transabdominal Approach.

Lower back pain is an extremely common medical issue in populations worldwide. One of the main contributors to lower back pain is intervertebral disc (IVD) degeneration. An ideal animal model of IVD degeneration is essential to study the pathophysiology of lower back pain and investigate potential therapeutic strategies. Rabbit models are reliable, economical, and easily established animal models. The retroperitoneal approach has been widely used to induce IVD degeneration in rabbit models. However, there are reported complications associated with this technique, such as the avulsion of segmental arteries and nerve root injury. In this paper, we aim to show a surgical protocol using needle puncture to establish rabbit lumbar disc degeneration via a transabdominal approach. Consequently, radiological checks and histological analyses indicated that lumbar disc degeneration was successfully established in rabbits. This surgical protocol presents the precise location of target discs and high reproducibility of IVD degeneration models with fewer complications.

Employing a sort of "we" based VBN model to gauge Chinese tourists' intentions to support low-carbon tourism.

Low-carbon tourism behaviors by tourists can directly reduce carbon emissions and resource consumption, providing an effective way to promote the high-quality development of tourism. Therefore, promoting low-carbon tourism behaviors among tourists has become a key concern in academia. Most existing studies have investigated the influence of tourists' cognitive, emotional and normative drivers of low-carbon tourism behavior from the perspective of tourists. However, the nature of tourism activities is social interaction, which can have a significant impact on tourists' low-carbon tourism behavior. Moreover, the study of Chinese tourists' low-carbon tourism behavior requires attention to the core elements of Chinese culture. Thus, there is an urgent need to study the low-carbon tourism behavior of tourists as it is embedded in social interactions and strongly influenced by the local Chinese culture. The sense of mianzi and the sense of group consistency are two key Chinese cultural norms that have self-regulatory (personal norms) and other-regulatory (social norms) effects on Chinese social interaction behaviors. This paper uses VBN (value-belief-norm) theory as the basic framework, incorporates two normative factors that reflect Chinese cultural characteristics, mianzi consciousness and group consistency consciousness, and modifies the general VBN model based on Chinese cultural characteristics to construct an integrated model to explain Chinese tourists' low-carbon tourism behavior. The results show that tourists' traditional values have a significant effect on their low-carbon tourism intention through beliefs and personal norms. In addition, we find that the more sensitive tourists' sense of mianzi (personal norms) is, the more significant the effect of perceived group consistency pressure (social norms) is on their low-carbon tourism behavior. This study integrates Chinese cultural normative factors and classical Western environmental behavior theoretical models to extend the study of the influence of Chinese cultural factors on Chinese tourists' low-carbon tourism behavior.

How to facilitate employees' green behavior? The joint role of green human resource management practice and green transformational leadership.

Given the severity of today's environmental issues, companies are increasingly making green concepts a key component of their operational strategies. As an essential complement to corporate environmental strategy, employees' green behavior has received attention from all sectors of society. Based on resource conservation theory, this study explores the formation mechanism of employees' green behaviors in enterprises starting from two green management tools: green human resource management (HRM) practices and green transformational leadership. Through two-stage questionnaire research, 296 sample data points were obtained, and the research hypotheses were tested by using linear regression analysis. The results showed that green HRM practices in enterprises enhance employees' green mindfulness and thus stimulate their green behaviors and that green transformational leadership and green self-efficacy play a positive moderating role in the above relationship. These results support the applicability of resource conservation theory in green management and suggest that green HRM practices and green transformational leadership can be used together in the process of green management.

Energy-efficient distributed heterogeneous re-entrant hybrid flow shop scheduling problem with sequence dependent setup times considering factory eligibility constraints.

In the face of energy crisis, manufacturers pay more and more attention to energy-saving scheduling. In the paper, we consider the distributed heterogeneous re-entrant hybrid flow shop scheduling problem (DHRHFSP) with sequence dependent setup times (DHRHFSP-SDST) considering factory eligibility constraints under time of use (TOU) price, which means that each job can only be assigned to its available set of factories and all factories have different number of machines and processing capacity, and so on. To deal with DHRHFSP-SDST, a multi-objective Artificial Bee Colony Algorithm (MOABC) is proposed to optimize both the makespan and total energy consumption. For the MOABC, firstly, a hybrid initialization method is presented to initialize the population; then, due to the electricity price shows significant differences vary from periods under TOU price, the energy saving operator based on right-shift strategy is proposed to avoid processing jobs with the high electricity price without affecting the productivity; thirdly, based on the full consideration of distributed heterogeneous and factory eligibility, crossover and mutation operators, three neighborhood search operators and new food sources generation strategy are designed; lastly, extensive experiments demonstrate the effectiveness of the proposed algorithm on solving the DHRHFSP-SDST.

Factors affecting the adoption of green prevention and control techniques by family farms: Evidence from Henan province of China.

Encouraging farmers to adopt green prevention and control techniques (GCTs) is conducive to ensuring the quality and safety of agricultural products, the ecological environment and agricultural production in China. To explore the factors influencing vegetable farmers' adoption of GCTs, this study utilized the "information-motivation-behavior" intervention (IMB) model and ordered logistic model to empirically study the adoption behavior of 653 vegetable farmers in Henan Province, China. Estimation results indicated that the IMB model significantly predicted farmers' adoption of GCTs: 1) From the perspective of adoption decisions, 88.82% of the farmers have adopted GCTs, but the degree of adoption is low. 2) the farmers' adoption of GCTs IMB model specifies that higher levels of GCTs information, motivation, and behavioral skills should result in a greater likelihood of engaging in GCTs adoption behavior. 3) Motivation and behavioral skills are activated through information. 4) Finally, motivation can indirectly affect farmers' GCTs adoption behavior through behavioral skills. The results of this study support the need for the government to promote the use of GCTs for vegetable pest control, as well as advance integrated prevention and control in the agricultural industry.

Analysis of lumbar vertebrae fractures among inpatients in a primary hospital: A 10-year epidemiological study.

BACKGROUND: To analyze the epidemiological characteristics and changing trends of lumbar fractures in Xingtai Orthopedic Hospital in the past 10 years, and to improve the prevention and treatment of lumbar fractures. METHODS: Using the hospital information system, data on patients with lumbar fractures in our hospital from 2009 to 2018 were collected regarding their age, gender, fracture time, injury mechanism, and the type of fracture. The epidemiological characteristics and trends of lumbar fractures for the period were summarized and analyzed. RESULTS: The age of male patients with a high incidence of lumbar fractures was 61 to 70 years, followed by 51 to 60 years. The age of female patients with the highest incidence rate was 61 to 70 years, followed by 51 to 60 years (19.22%). Lumbar fractures in group A were predominantly of men. The majority of lumbar fractures in group B were of women. In group A, the incidence rate was higher in young men (21-50 years) than in women and higher in women >51 years. Most of the affected individuals were women. In group B, there were more middle-aged and young men (21-50 years) than women; however, there were more women than men aged ≥51 years. Car accident injury was the main cause of fractures, but in group B women, low-energy injuries were the main cause of fractures. The periods of high incidence in groups A and B were 4 to 6 years and 7 to 9 years, respectively. The number of injuries in group A was the highest and burst fracture was the main fracture type. In group B, the number of fall injuries was the highest, followed by car accident injuries, and compression fracture was the main fracture type. CONCLUSION: The number of lumbar fractures in women caused by low-energy injuries showed an increasing trend. The type of compression fracture increased, which might be related to osteoporosis caused by the decrease in the estrogen level after menopause.

Biomechanical Characterization of Unilateral and Bilateral Posterior Lumbar Interbody Fusion Constructs.

Objectives: To compare the biomechanical stability of two-level PLIF constructs with unilateral and bilateral pedicle screw fixations. Methods: Six cadaveric lumbar segments were evaluated to assess biomechanical stability in response to pure moment loads applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Each specimen was tested in six sequential configurations: (1) intact baseline; (2) facetectomy; (3) unilateral pedicle screws (UPS); (4) bilateral pedicle screws (BPS); (5) unilateral pedicle screws and cage (UPSC); and (6) bilateral pedicle screws and cage (BPSC). Results: Significant reductions in motion were observed when comparing all instrumented conditions to the intact and facetectomy stages of testing. No significant differences in motion between UPS, BPS, UPSC, or BPSC were observed in response to FE range of motion (ROM) or neutral zone (NZ). ROM was significantly higher in the UPS stage compared to BPS in response to LB and AT loading. ROM was significantly higher in UPSC compared to BPSC in response to LB loading only. Similarly, NZ was significantly higher in UPSC compared to BPSC in response to only LB loading. In response to AT loading, ROM was significantly higher during UPS than BPS or BPSC; however, no significant differences were noted between UPSC and BPSC with respect to AT ROM or NZ. Conclusion: BPS fixation is biomechanically superior to UPS fixation in multilevel PLIF constructs. This was most pronounced during both LB loading. Interbody support did contribute significantly to immediate stability.

Diagnostic agreement between 3.0-T MRI sequences of nerve root and surgery in patients with cervical radiculopathy: A retrospective study.

ABSTRACT: Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.

One Approach Anterior Decompression and Fixation with Posterior Unilateral Pedicle Screw Fixation for Thoracolumbar Osteoporotic Vertebral Compression Fractures.

OBJECTIVE: The objective of the present paper was to explore the clinical effect of one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporosis vertebral compression fractures (OVCF). METHODS: This is a single-center retrospective analysis. A total of six thoracolumbar OVCF patients (four women and two men) with an average age of 65.2 years (58-72 years) who were treated between June 2016 and May 2018 were enrolled in the present study. The lesion segments included: 1 case at T11, 1 case at T12, 3 cases at L1, and 1 case at L2. The six thoracolumbar OVCF patients were treated with one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation. After general anesthesia, patients were placed in the right lateral decubitus position, an approximately 10-15-cm oblique incision was made along corresponding ribs, and the conventional left retroperitoneal and/or the extrapleural approach was performed for anterior lateral exposure. First, anterior decompression and fixation were performed, and then through the unilateral paraspinal muscle approach, posterior pedicle screw fixation was performed under the same incision. The back pain visual analogue scale (VAS), the Oswestry disability index (ODI), and the MacNab criteria were used to evaluate the clinical outcome. The radiographic analysis included the regional kyphosis angle and the fusion rate. Neurological status, operation time, intraoperative bleeding, the time of ambulation, hospital stay, and surgical complications were also assessed. RESULTS: Surgery was successful in all six patients, who were followed up for 31.6 months (range, 23-46 months). The operation time was 125-163 min, with a median of 135 min. The preoperative blood loss was 580-1230 mL, with a median of 760 mL. The time of ambulation was 3-5 days, with a median of 4.2 days. The hospital stay was 8-15 days, with the median of 10.5 days. According to the Frankel classification of neurological deficits, of two patients with grade C preoperatively, one had improved to grade D and one had improved to grade E at final follow up; among four patients with grade D preoperatively, at the final follow up one remained the same and three had improved to grade E. The postoperative back pain VAS score decreased significantly, from 6.17 ± 0.75 preoperatively to 0.83 ± 0.41 postoperatively (P < 0.05). The mean ODI score was 73.7 ± 5.86 preoperatively and reduced to 21.85 ± 3.27 postoperatively (P < 0.05). According to the MacNab criteria, at the final follow up, two patients rated their satisfaction as excellent, three patients as good, and one patient as fair. The mean regional kyphosis angle was 22.17° ± 6.01°before surgery, which improved to 9.33° ± 3.88° at the final follow up (P < 0.05). At the final follow up, there were two patients who had achieved a grade 2 bony fusion (33.3%), three patients grade 3 (50.0%), and one patient grade 4 (16.7%). No incision infections, internal fixation failures or other complications were found during the perioperative and the follow-up period. CONCLUSION: One approach anterior decompression and fixation with posterior unilateral pedicle screw fixation provides a novel method for thoracolumbar OVCF disease, with a satisfactory clinical outcome.