Oblique lumbar interbody fusion combined with anterolateral screw fixation and stress endplate augmentation for treating degenerative lumbar spondylolisthesis with osteoporosis.

PURPOSE: To evaluate the outcomes of Oblique lumbar interbody fusion (OLIF)combined with anterolateral screw fixation (AF) and Stress Endplate Augmentation(SEA) versus OLIF-AF in the treatment of degenerative lumbar spondylolisthesis (DLS)with osteoporosis (OP). METHODS: 30 patients underwent OLIF-AF-SEA (SEA group) were matched with 30 patients received OLIF-AF (control group), in terms of sex, age, body mass index (BMI) and bone mineral density (BMD). Clinical outcomes including visual analog scale (VAS) score of the lower back pain (VAS-LBP), leg pain (VAS-LP), and Oswestry Disability Index (ODI) were evaluated at different postoperative intervals and comparedwith their preoperative counterparts. Radiographic outcomes such as disk height (DH), slip distance (SD), lumbar lordosis (LL), segmental lordosis (SL), cage subsidence (CS) rate and fusion rate were evaluated at different postoperative intervals and compared with their preoperative counterparts. RESULTS: SEA group presented to be better at 3-month and 12-month follow-up, the VAS-LBP, VAS-LP and ODI scores of the SEA group were significantly lower than the control group (3-month SEA vs control: 2.30±0.70 vs 3.30±0.75, 2.03±0.72 vs 2.90±0.76,15.60±2.36 vs 23.23±3.07, respectively, all p<0.05. VAS-LBP and ODI 12-month SEA vs control: 1.27±0.74 vs 1.93±0.58, 12.20±1.88 vs 14.43±1.89,respectively, all p<0.05). At 24-month follow-up, both groups showed no difference in fusion rate (83.33% vs 90.00%, p=0.45), while SEA group showed a lower CS rate (13.33% vs 53.33%, p<0.05). CONCLUSION: OLIF-AF-SEA was safe with no adverse effects and resulted in lower CS rate and better sagittal balance. OLIF-AF-SEA is a promising surgical method for treating patients with DLS-OP.

MRI-based endplate bone quality score predicts cage subsidence following oblique lumbar interbody fusion.

BACKGROUND CONTEXT: Cage subsidence is a common complication after lumbar interbody fusion surgery, with low bone mineral density (BMD) being a significant risk factor. Endplate bone quality (EBQ) obtained from clinical MRI scans has been deemed reliable in determining regional BMD. However, the association between EBQ score and cage subsidence following oblique lumbar interbody fusion (OLIF) has not been clearly established. PURPOSE: This study aims to assess the relationship between EBQ score and cage subsidence in patients who underwent single-level OLIF. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: The study included adults with degenerative spinal conditions who underwent single-level OLIF at our institution. OUTCOME MEASURES: Cage subsidence, disc height, EBQ score, fusion rate. METHODS: This retrospective study analyzed data from patients who underwent single-level OLIF surgery at our institution between October 2017 and August 2022. Postoperative CT scans were used to measure cage subsidence, while the EBQ score was calculated using preoperative noncontrast T1-weighted MRI. To determine the predictive ability of the EBQ score, receiver operating characteristic (ROC) curve analysis was conducted. Additionally, univariable and multivariable logistic regression analyses were performed. RESULTS: In this study, a total of 88 patients were included and followed up for an average of 15.8 months. It was observed that 32.9% (n=29/88) of the patients experienced cage subsidence. The postsurgery disc height was significantly higher in patients who experienced subsidence compared to those who did not. The mean EBQ scores for patients with nonsubsidence and subsidence were 2.31±0.6 and 3.48±1.2, respectively, and this difference was statistically significant. The ROC curve analysis showed that the AUC for the EBQ score was 0.811 (95% CI: 0.717-0.905). The most suitable threshold for the EBQ score was determined to be 2.318 (sensitivity: 93.1%, specificity: 55.9%). Additionally, the multivariate logistic regression analysis revealed a significant association between a higher EBQ score and an increased risk of subsidence (odds ratio [OR]=6.204, 95% CI=2.520-15.272, p<.001). CONCLUSIONS: Our findings indicate that higher preoperative EBQ scores are significantly linked to cage subsidence following single-level OLIF. Preoperative measurement of MRI can serve as a valuable tool in predicting cage subsidence.

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Bacterial cellulose (BC) is a type of extracellular polymeric nanomaterial secreted by microorganisms over the course of their growth. It has gained significant attention in the field of bone tissue engineering due to its unique structure of three-dimensional fibrous network, excellent biocompatibility, biodegradability, and exceptional mechanical properties. Nevertheless, BC still has some weaknesses, including low osteogenic activity, a lack of antimicrobial properties, small pore size, issues with the degradation rate, and a mismatch in bone tissue regeneration, limiting its standalone use in the field of bone tissue engineering. Therefore, the modification of BC and the preparation of BC composite materials have become a recent research focus. Herein, we summarized the relationships between the production, modification, and bone repair applications of BC. We introduced the methods for the preparation and the modification of BC. Additionally, we elaborated on the new advances in the application of BC composite materials in the field of bone tissue engineering. We also highlighted the existing challenges and future prospects of BC composite materials.

Health-related Quality of Life (HRQOL) Outcomes of Selective/Nonselective Thoracic Fusion for Lenke 1C Adolescent Idiopathic Scoliosis (AIS) Patients with a Minimum 4-year Follow-up.

OBJECTIVE: Both the selective thoracic fusion (STF) and nonselective thoracic fusion (NSTF) are treatments for Lenke 1C adolescent idiopathic scoliosis (AIS). To date, the impacts of the two surgical strategies on patients' long-term quality of life remain unclear. Therefore, the purpose of this study was to explore the long-term effects of STF/NSTF on the quality of life in Lenke 1C AIS patients through a 4-10-year follow-up. METHODS: From January 2011 to April 2018, according to the inclusion and exclusion criteria, a retrospective single-center study of 75 surgical patients with Lenke 1C curves was performed (n = 75). They all underwent posterior fusion, and patients were divided into the selective thoracic fusion (STF) group (n = 42) and the nonselective thoracic fusion (NSTF) group (n = 33) based on their surgical approach. All participants received the survey of the visual analogue scale (VAS), SRS30, SF12, and Oswestry disability index (ODI) scales. Patients' gender, age, body mass index (BMI), surgical approach (STF/NSTF), surgical segments (UIV and LIV), follow-up time, complications, preoperative, postoperative, and last follow-up Cobb angles, and health-related quality of life (HRQOL) outcomes were collected, and analyzed through the Shapiro-Wilks test, Wilcoxon rank-sum test, t-test, and χ2 test. RESULTS: The mean follow-up of the entire cohort was 73 ± 5.6 months. The lumbar Cobb angle in the STF group improved from 31.8 ± 6.5° to 11.5 ± 5.1° after the operation and 10.3 ± 6.9° at the last follow-up. The postoperative correction rate of the lumbar curve was 63.8%, which increased to 67.7% at the last follow-up. In the NSTF group, the lumbar Cobb angle improved from 34.3 ± 11.3° to 4.3 ± 3.7° after the operation, and was 5.1 ± 3.1° at the last follow-up. The postoperative correction rate of the lumbar curve was 87.4%, and 85.1% at the last follow-up. At the last follow-up, the STF group had higher overall HRQOL scores than the NSTF group, and there were statistically differences between the different groups (STF/NSTF) in SRS-30-Mental health (p = 0.03), SRS-30-Satisfaction with management (p = 0.02), SRS-30-Pain (p = 0.03), ODI (p = 0.01), SF-12 PCS (p = 0.03), VAS back pain (p = 0.005) and VAS leg pain (p = 0.001). No statistically differences were found in SF12 MCS, SRS-30-Self-image/Appearance and SRS-30 Function/activity. CONCLUSION: After 4-10 years of follow-up, we found that the STF group achieved satisfactory correction results, and compared with the NSTF group, their overall HRQOL scores were higher, especially in terms of pain and satisfaction, where the STF group shows a significant advantage.

Comparison of predictive performance for cage subsidence between CT-based Hounsfield units and MRI-based vertebral bone quality score following oblique lumbar interbody fusion.

OBJECTIVE: To compare the predictive performance between CT-based Hounsfield units (HU) and MRI-based vertebral bone quality (VBQ) for cage subsidence (CS) following oblique lumbar interbody fusion combined with anterolateral single-rod screw fixation (OLIF-AF). METHODS: A retrospective study was performed on consecutive patients who underwent OLIF-AF at our institution from 2018 to 2020. CS was determined by CT according to the change in the midpoint intervertebral space height. The VBQ score and HU value were measured from preoperative MRI and CT, respectively. Then, we evaluated the predictive performance of those two parameters by comparing the receiver operating characteristic (ROC) curves. RESULTS: The mean global and segmental VBQ scores were significantly higher in the CS group, and the mean global and segmental HU values were significantly lower in the CS group. The area under the curve (AUC) of CS prediction was higher in the operative segments' VBQ score and HU value than the measurement in the global lumbar spine. Finally, the combined segmental VBQ score and segmental HU value demonstrated the highest AUC. CONCLUSION: Both MRI-based VBQ score and CT-based HU value can achieve accurate CS prediction. Moreover, the combination of those two measurements indicated the best predictive performance. CLINICAL RELEVANCE STATEMENT: Both MRI-based VBQ score and CT-based HU value can be used for cage subsidence prediction, in order to take preventive measures early enough. KEY POINTS: • Osteoporosis is a risk factor for CS, both MRI-based VBQ score and CT-based HU value are important predictors during vertebral bone quality evaluation. • The VBQ score and HU value measured in the operative segments are better predictors of CS than the measurement in the global lumbar spine. • Combined segmental VBQ score and segmental HU value achieved the best predictive performance for CS.

Tetrahedral Framework Nucleic Acids Inhibit Muscular Mitochondria-Mediated Apoptosis and Ameliorate Muscle Atrophy in Sarcopenia.

Sarcopenia is known as age-related muscle atrophy, which influences over a quarter of the elderly population worldwide. It is characterized by a progressive decline in muscle mass, strength, and performance. To date, clinical treatments in sarcopenia are limited to rehabilitative interventions and dietary supplements. Tetrahedral framework nucleic acids (tFNAs) represent a novel kind of DNA-based nanomaterial with superior antiapoptosis capacity in cells, tissues, organs, and systems. In our study, the therapeutic effect of tFNAs treatment on sarcopenia was evaluated both in vivo and in vitro. Results from muscular biophysiological characteristics demonstrated significant improvement in muscle function and endurance in the aged mouse model, and histologic examinations also showed beneficial morphological changes in muscle fibers. In vitro, DEX-induced sarcopenic myotube atrophy was also ameliorated through the inhibition of mitochondria-mediated cell apoptosis. Collectively, tFNAs treatment might serve as an alternative option to deal with sarcopenia in the near future.

D-dimer/fibrinogen ratio for the prediction of deep venous thrombosis after traumatic spinal cord injury.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To evaluate the predictive value of D-dimer/fibrinogen (D/F) ratio for deep vein thrombosis (DVT) in patients with traumatic spinal cord injury (SCI). SETTING: Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University. METHODS: SCI patients within 24 h of trauma were consecutively enrolled. DVT was diagnosed by DUS examination during hospitalization. Multivariable logistic regression analysis was performed to determine the relationship between D/F ratio and DVT. Stratified logistic regression analysis was performed to identify effect modifiers. The receiver operating characteristic (ROC) curve was conducted to assess the predictive value of D/F ratio. RESULTS: A total of 284 patients with SCI were included, of whom 106 (37.3%) developed DVT. D/F ratio was positively correlated with DVT (OR 1.17, 95% confidence interval [CI] 1.04-1.31, p = 0.009). Patients in the upper D/F ratio tertile (3.15-18.27) had a higher risk of DVT than patients in the lower tertile (0.08-0.97) after adjustment for potential confounders (OR 6.01, 95% CI 2.24-16.15, p < 0.001). The risk of DVT increased stepwise across D/F ratio tertiles (p for trend = 0.003). The area under the ROC curve (AUC) was 0.758 (95% CI 0.704-0.806). There was a significant interaction between D/F ratio and neurological level of injury (p for interaction = 0.003) and the association between D/F ratio and DVT remained significant only in patients with cervical injury. CONCLUSIONS: A higher D/F ratio was independently associated with a higher risk of DVT in a dose-dependent manner in patients with cervical SCI.

Association between neutrophil percentage-to-albumin ratio and pneumonia in patients with traumatic spinal cord injury.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To investigate the association between neutrophil percentage-to-albumin ratio (NPAR) and pneumonia in patients with SCI. SETTING: Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University. METHODS: SCI patients admitted to West China Hospital within 24 h of injury were consecutively enrolled. Blood samples were collected on admission. Pneumonia was diagnosed based on chest radiography and clinician records of patient symptoms and laboratory tests. Multivariable logistic regression analysis was performed to determine the relationship between NPAR and pneumonia. Receiver operating characteristic (ROC) curves were generated to assess the predictive value of NPAR. RESULTS: A total of 264 SCI patients were included, of whom 65 (24.6%) developed pneumonia. NPAR was positively correlated with pneumonia (OR 2.66, 95% CI, 1.06-6.71, p = 0.038). Patients in the upper NPAR tertile (2.35-3.71) had a higher risk of pneumonia than patients in the lower tertile (1.66-2.12) after adjustment for potential confounders (OR 2.55, 95% CI, 1.05-6.19, p = 0.039). The risk of pneumonia increased stepwise across NPAR tertiles (p for trend = 0.031). The optimal cutoff value of NPAR for predicting pneumonia was 2.17 with a sensitivity of 0.82 and a specificity of 0.50. There was a significant interaction between NPAR and neurological level of injury (p for interaction = 0.034), with no significant association between NPAR and pneumonia in patients with cervical SCI. CONCLUSIONS: A higher NPAR was independently associated with higher risk of pneumonia in a dose-dependent manner in patients with non-cervical SCI.

Low Hounsfield units on computed tomography are associated with cage subsidence following oblique lumbar interbody fusion (OLIF).

BACKGROUND CONTEXT: Cage subsidence is one of the most common complications following lumbar interbody fusion surgery. Low bone mineral density (BMD) is an important risk factor that contributes to cage subsidence. Hounsfield units (HU) obtained from clinical computed tomography (CT) scans provided a reliable method for determining regional BMD. The association between HU and cage subsidence following oblique lumbar interbody fusion (OLIF) remains unclear. PURPOSE: The objective of this study is to evaluate the association between vertebral HU value and cage subsidence following OLIF. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Adults with degenerative spinal conditions underwent single-level OLIF at our institution from October 2017 and August 2020 OUTCOME MEASURES: Cage subsidence, disc height, vertebral body global HU value, upper and lower instrumented vertebrae HU value, endplate HU value, fusion rate. METHODS: This retrospective study was conducted on patients who underwent single-level OLIF at one institution between October 2017 and August 2020. Cage subsidence was measured using the CT scan postoperatively based on the cage protrusion through the vertebral endplates. The HU values were measured from preoperative CT according to previously reported methods. RESULTS: A total of 70 patients with a mean follow-up of 15.4 months were included in the analysis. The subsidence rate was 25.7% (n=18/70). The average cage subsidence was 2.2 mm, with a range of 0-7.7 mm. No significant difference was found in age, sex, or body mass index (BMI) between the two groups. The mean global HU value of the lumbar vertebral body (L1-5) was 142.7±30.1 in nonsubsidence and 103.7±11.5 in subsidence (p=.004). The upper instrumented vertebrae (UIV) HU value was 141.4±29.7 in the nonsubsidence and 101.1±10.2 in subsidence, (p=.005). The lower instrumented vertebrae (LIV) HU value was 147.4±34.9 in nonsubsidence and 108.1±13.7 in subsidence, (p<.001). The AUC of the UIV HU value was 0.917 (95% CI: 0.853-0.981), and the most appropriate threshold of the HU value was 115 (sensitivity: 84.6%, specificity: 100%). The AUC of the LIV HU value was 0.893 (95%CI: 0.819-0.966), and the most appropriate threshold of the HU value was 125 (sensitivity: 76.9%, specificity: 100%). The mean upper endplate HU value was 235.4±50.9, and the mean lower endplate HU value was 193.4±40.3. No significant difference (upper endplate p=.314, lower endplate p=.189) was observed between the two groups. CONSLUSIONS: Lower preoperative vertebral body HU values were associated with cage subsidence after single-level OLIF. However, the endplate HU values were not associated with cage subsidence. Preoperative HU measurement is useful in the prediction of the cage subsidence.

Chylothorax following posterior low lumbar fusion surgery: A case report.

BACKGROUND: Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery; however, it is one of the rare complications in orthopedic surgery. This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery. The etiology, diagnosis, and treatment were analyzed and discussed. CASE SUMMARY: A 50-year-old woman was admitted with repeated back and leg pain. She was diagnosed with L4 degenerative spondylolisthesis, L4/L5 and L5/S1 intervertebral disc herniation and L5 instability, and underwent successful posterior L4-S1 instrumentation and fusion surgery. Unfortunately, thoracic effusion was identified 2 d after operation. The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests. The patient was discharged after 12-d persisting drainage, 3-d total parenteral nutrition and fasting, and other supportive treatments. No recurring symptoms were observed within 12 mo follow-up. CONCLUSION: Differential diagnosis is crucial for unusual thoracic effusion. Comprehensive diagnosis and treatment of chylothorax are necessary. Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.

Early Administration of Adrenaline for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.

Background The use of adrenaline in out-of-hospital cardiac arrest (OHCA) patients is still controversial. This study aimed to determine the effects of early pre-hospital adrenaline administration in OHCA patients. Methods and Results PubMed, EMBASE, Google Scholar, and the Cochrane Library database were searched from study inception to February 2019 to identify studies that reported OHCA patients who received adrenaline. The primary outcome was survival to discharge, and the secondary outcomes were return of spontaneous circulation, favorable neurological outcome, and survival to hospital admission. A total of 574 392 patients were included from 24 studies. The use of early pre-hospital adrenaline administration in OHCA patients was associated with a significant increase in survival to discharge (risk ratio [RR], 1.62; 95% CI, 1.45-1.83; P<0.001) and return of spontaneous circulation (RR, 1.50; 95% CI, 1.36-1.67; P<0.001), as well as a favorable neurological outcome (RR, 2.09; 95% CI, 1.73-2.52; P<0.001). Patients with shockable rhythm cardiac arrest had a significantly higher rate of survival to discharge (RR, 5.86; 95% CI, 4.25-8.07; P<0.001) and more favorable neurological outcomes (RR, 5.10; 95% CI, 2.90-8.97; P<0.001) than non-shockable rhythm cardiac arrest patients. Conclusions Early pre-hospital administration of adrenaline to OHCA patients might increase the survival to discharge, return of spontaneous circulation, and favorable neurological outcomes. Registration URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42019130542.

The efficacy and safety of ipriflavone in postmenopausal women with osteopenia or osteoporosis: A systematic review and meta-analysis.

OBJECTIVES: Ipriflavone (IP) is one of the over-the-counter drugs and found in foods, which is available for prevention of osteoporosis (OP) since 1989 in over 22 countries. Although some clinical trials have suggested that IP is appropriate for treatment of OP, there continues to be controversy regarding the efficacy and safety due to some contradictory reports. With the wide usage of IP for osteoporotic women, there is a critical need for evaluation of the evidence for IP in clinical practice. METHODS AND MATERIALS: We searched randomized control trials (RCTs) in PubMed, CENTRAL and CNKI which used the regimen of IP in postmenopausal women with osteopenia or OP. The efficacy referred to the absolute change and relative change in bone mineral density (BMD) and bone turnover markers. The safety profiles were associated with adverse events and the number of subject withdrawals due to adverse reactions. RESULTS: Eleven RCTs (n = 1605) met the eligibility criteria were included. The increase of the BMD in lumbar spine of the IP group is greater than that of the placebo group (random effect model: SMD = 0.36; 95%CI= (0.09, 0.62)). For safety profile, most frequent reactions are gastrointestinal symptoms, but withdrawals due to adverse reactions are similar in both the IP group and placebo control at the same time intervals. CONCLUSIONS: IP significantly increases BMD and has inhibitory effect on bone resorption markers in postmenopausal women with osteopenia or OP. Gastrointestinal symptoms may occur, but adverse drug withdrawal events were not statistically increased when compared with placebo group.

Percutaneous pulmonary valve implantation in patients with right ventricular outflow tract dysfunction: a systematic review and meta-analysis.

BACKGROUND: Pulmonary valve replacement is required for patients with right ventricular outflow tract (RVOT) dysfunction. Surgical and percutaneous pulmonary valve replacement are the treatment options. Percutaneous pulmonary valve implantation (PPVI) provides a less-invasive therapy for patients. The aim of this study was to evaluate the effectiveness and safety of PPVI and the optimal time for implantation. METHODS: We searched PubMed, EMBASE, Clinical Trial, and Google Scholar databases covering the period until May 2018. The primary effectiveness endpoint was the mean RVOT gradient; the secondary endpoints were the pulmonary regurgitation fraction, left and right ventricular end-diastolic and systolic volume indexes, and left ventricular ejection fraction. The safety endpoints were the complication rates. RESULTS: A total of 20 studies with 1246 participants enrolled were conducted. The RVOT gradient decreased significantly [weighted mean difference (WMD) = -19.63 mmHg; 95% confidence interval (CI): -21.15, -18.11; p < 0.001]. The right ventricular end-diastolic volume index (RVEDVi) was improved (WMD = -17.59 ml/m²; 95% CI: -20.93, -14.24; p < 0.001), but patients with a preoperative RVEDVi >140 ml/m² did not reach the normal size. Pulmonary regurgitation fraction (PRF) was notably decreased (WMD = -26.27%, 95% CI: -34.29, -18.25; p < 0.001). The procedure success rate was 99% (95% CI: 98-99), with a stent fracture rate of 5% (95% CI: 4-6), the pooled infective endocarditis rate was 2% (95% CI: 1-4), and the incidence of reintervention was 5% (95% CI: 4-6). CONCLUSIONS: In patients with RVOT dysfunction, PPVI can relieve right ventricular remodeling, improving hemodynamic and clinical outcomes.