Comparison of the clinical outcomes of VBE-TLIF versus MIS-TLIF for single-level degenerative lumbar diseases.

OBJECTIVE: This research aims to compare the clinical outcomes of VBE-TLIF and MIS-TLIF for the treatment of patients with single-level degenerative lumbar diseases. METHODS: Ninety patients were enrolled in this study. The estimated blood loss, operation time, postoperative hospitalization days, time to functional exercise, amount of surgical drain and inflammatory index were recorded. The visual analog scale, Oswestry dysfunction index and modified MacNab criteria were used to assessed the patient's back and leg pain, functional status and clinical satisfaction rates. RESULTS: The average operation time of the VBE-TLIF group was longer than that of the MIS-TLIF group. The time for functional exercise, length of hospital stay, estimated blood loss and amount of surgical drain in the VBE-TLIF group were relative shorter than those in the MIS-TLIF group. Additionally, the levels of CRP, neutrophil, IL-6 and CPK in the VBE-TLIF group were significantly lower than those in the MIS-TLIF group at postoperative days 1 and 3, respectively (P < 0.001). Patients undergoing VBE-TLIF had significantly lower back VAS scores than those in the MIS-TLIF group on postoperative days 1 and 3 (P < 0.001). No significant differences were found in the clinical satisfaction rates (95.83 vs. 95.24%, P = 0.458) or interbody fusion rate (97.92 vs. 95.24%, P = 0.730) between these two surgical procedures. CONCLUSIONS: Both VBE-TLIF and MIS-TLIF are safe and effective surgical procedures for patients with lumbar diseases, but VBE-TLIF technique is a preferred surgical procedure with merits of reduced surgical trauma and quicker recovery.

Minimally invasive transforaminal lumbar interbody fusion by a novel two-medium compatible bichannel endoscopy system, technique note and preliminary clinical results.

PURPOSE: Our team designed a novel two-medium compatible bichannel endoscopy system for spinal surgery, V-shape bichannel endoscopy (VBE) system. Hereby, this study will introduce minimally invasive transforaminal lumbar interbody fusion (TLIF) with VBE system and report its preliminary clinical results. METHODS: Fifty-two participants, who accepted VBE-assisted TLIF surgery (VBE-TLIF) in our hospital were included in this study. The duration of operation, off-bed time, and days of hospitalization were recorded. Besides, the patient's preoperative and postoperative pain were evaluated via visual analog scale (VAS), the functional status was evaluated via Oswestry dysfunction index (ODI) and modified MacNab criteria. Patients were asked to follow-up in the outpatient department at the 3rd, 6th, 12th, and 24th month after surgery. X-ray or CT was examined to evaluate the internal fixation position and interbody fusion result. RESULTS: All patients received unilateral decompression with an average operation duration of 178.49 ± 27.49 min. After the surgery, their VAS score of leg pain and back pain reduced significantly. At the last follow-up, the VAS score of leg pain and back pain was 0.80 ± 0.69 and 0.86 ± 0.75 separately. The difference shows statistically significant with p < 0.05. At the last follow-up, the ODI was 15.20 ± 5.75. According to modified MacNab criteria, 39 patients rated their function as excellent, and 10 patients were good. The overall satisfaction rate reached 94%. CONCLUSION: The VBE system reported in the current study can complete TLIF surgery safely and effectively.

Potential Role of lncRNAs in Contributing to Pathogenesis of Intervertebral Disc Degeneration Based on Microarray Data.

BACKGROUND: Our study intended to identify potential long non-coding RNAs (lncRNAs) and genes, and to elucidate the underlying mechanisms of intervertebral disc degeneration (IDD). MATERIAL AND METHODS: The microarray of GSE56081 was downloaded from the Gene Expression Omnibus database, including 5 human control nucleus pulposus tissues and 5 degenerative nucleus pulposus tissues, which was on the basis of GPL15314 platform. Identification of differentially expressed lncRNAs and mRNAs were performed between the 2 groups. Then, gene ontology (GO) and pathway enrichment analyses were performed to analyze the biological functions and pathways for the differentially expressed mRNAs. Simultaneously, lncRNA-mRNA weighted coexpression network was constructed using the WGCNA package, followed by GO and KEGG pathway enrichment analyses for the genes in the modules. Finally, the protein-protein interaction (PPI) network was visualized. RESULTS: A total of 135 significantly up- and 170 down-regulated lncRNAs and 2133 significantly up- and 1098 down-regulated mRNAs were identified. Additionally, UBA52 (ubiquitin A-52 residue ribosomal protein fusion product 1), with the highest connectivity degree in PPI network, was remarkably enriched in the pathway of metabolism of proteins. Eight lncRNAs - LINC00917, CTD-2246P4.1, CTC-523E23.5, RP4-639J15.1, RP11-363G2.4, AC005082.12, MIR132, and RP11-38F22.1 - were observed in the modules of lncRNA-mRNA weighted coexpression network. Moreover, SPHK1 in the green-yellow module was significantly enriched in positive regulation of cell migration. CONCLUSIONS: LncRNAs LINC00917, CTD-2246P4.1, CTC-523E23.5, RP4-639J15.1, RP11-363G2.4, AC005082.12, MIR132, and RP11-38F22.1 were differentially expressed and might play important roles in the development of IDD. Key genes, such as UBA52 and SPHK1, may be pivotal biomarkers for IDD.

The polymorphisms of melatonin receptor 1B gene (MTNR1B) (rs4753426 and rs10830963) and susceptibility to adolescent idiopathic scoliosis: a meta-analysis.

OBJECTIVE: To determine whether MTNR1B rs4753426 and rs10830963 polymorphisms are correlated with AIS. Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity, while its etiology remains uncertain. Melatonin receptor 1B (MTNR1B) gene polymorphisms have been found to be significantly associated with AIS risk; however, some of these results are controversial. METHODS: An systematic online search was performed using PubMed, EMBASE, Web of Science and the Cochrane Library to identify case-control studies investigating the relationship between MTNR1B rs4753426 and rs10830963 polymorphisms and the susceptibility of AIS. The pooled odds ratio (OR) with 95 % confidence interval (95 % CI) was calculated to assess the associations, and subgroup meta-analyses were performed according to the ethnicity of the study populations. RESULTS: A total of five studies involving 2395 cases and 3645 controls met the inclusion criteria after assessment by two reviewers. Overall, no significant associations were found between MTNR1B rs4753426 polymorphism and AIS risk (C vs. T: OR = 1.11, 95 % CI 0.94-1.30, P = 0.21; CC vs. TT: OR = 1.15, 95 % CI 0.97-1.36, P = 0.12; CT vs. TT: OR = 1.14, 95 % CI 0.97-1.35, P = 0.10; CC/CT vs. TT: OR = 1.14, 95 % CI 0.98-1.33, P = 0.09; CC vs. CT/TT: OR = 1.10, 95 % CI 0.84-1.45, P = 0.48), as well as the MTNR1B rs10830963 polymorphism (G vs. C: OR = 0.99, 95 % CI 0.88-1.12, P = 0.91; GG vs. CC: OR = 0.99, 95 % CI 0.74-1.33, P = 0.96; CG vs. CC: OR = 1.00, 95 % CI 0.84-1.18, P = 0.88; GG/CG vs. CC: OR = 0.99, 95 % CI 0.84-1.17, P = 0.93; GG vs. CG/CC: OR = 0.99, 95 % CI 0.75-1.30, P = 0.92). When stratified by ethnicity, there were no significant associations between MTNR1B rs4753426 and MTNR1B rs10830963 polymorphisms and AIS risk in either Asian or Caucasian populations. CONCLUSION: MTNR1B rs4753426 and MTNR1B rs10830963 polymorphisms are not obviously associated with risk of AIS in either Asian populations or Caucasian populations.

Proximal junctional kyphosis in Lenke 5C adolescent idiopathic scoliosis after selective posterior thoracolumbar/lumbar fusion: risk factors and predictive index.

BACKGROUND: Although several studies have reported that selective posterior thoracolumbar/lumbar (TL/L) fusion can yield satisfactory results in Lenke 5C adolescent idiopathic scoliosis (AIS), the proximal junctional kyphosis (PJK) is still a common complication that occurs after surgery. The purpose of this study is to analyse the risk factors for postoperative proximal junctional kyphosis in Lenke 5C patients who underwent selective posterior TL/L fusion and explore whether PJK can be predicted. METHODS: A total of 83 AIS patients with Lenke 5C curves who met the inclusion criteria were analysed. All patients were divided into two groups based on the occurrence of postoperative PJK. Univariate and multivariate analyses were used to identify independent factors significantly associated with PJK, and an PJK index was proposed and verified. RESULTS: PJK was observed in 27 of 83 (32.5%) patients in the study. Preoperative thoracic kyphosis (TK) and the immediate postoperative proximal junctional angle (PJA) were the primary factors identified by the binary logistic regression analysis. The PJK index was defined as 1.1× preoperative TK + 2.3× immediate postoperative PJA. The receiver operating characteristics curve indicated that the occurrence rate of PJK was 85% and non-occurrence rate was 82% when the PJK index was greater than 42. CONCLUSION: Large preoperative TK and a large immediate postoperative PJA play important roles in the development of PJK in Lenke 5C patients treated with selective posterior thoracolumbar/lumbar fusion. The PJK index can be used to predict the occurrence of PJK with high accuracy. To prevent the occurrence of PJK, we should pay attention to the TLK, and preserving more posterior proximal intervertebral elements at the upper instrumented vertebral level would be an important part of corrective surgery; however, moderate correction of the lumbar curve is recommended.

Long-term outcomes of one-stage anterior debridement, bone grafting, and internal fixation for the treatment of lower cervical tuberculosis with kyphosis.

BACKGROUND: Patients with spinal deformities and nerve compression due to spinal tuberculosis often require surgical intervention. The objective of this study was to assess the long-term therapeutic effectiveness of one-stage anterior debridement, bone grafting, and internal fixation for lower cervical tuberculosis with kyphosis. METHODS: Twenty-one patients with lower cervical tuberculosis and cervical kyphosis received one-stage anterior debridement, autologous iliac bone grafting, and internal plate fixation. Patients were followed-up postoperatively for at least 5 years. Outcome measures included neck pain using Visual Analogue Scale (VAS) scores, Frankel classification of spinal cord injury, and Cobb angle of cervical kyphosis. RESULTS: Eighteen patients had lesions in 2 vertebrae and 3 had lesions in 3 vertebrae. Cervical tuberculosis was cured in all patients. The mean preoperative VAS score for neck pain was 8 (range: 6-10), whereas the mean best postoperative VAS score was 0.6 (range: 0-3). Mean final VAS score was significantly higher than the best VAS score (2.14 vs. 0.62). Of the 13 patients with symptoms of spinal cord compression, 9 improved by 1 grade and 4 improved by 2 grades according to Frankel classification at final follow-up. The mean preoperative Cobb angle of cervical kyphosis was 29° (range: 15°-50°), whereas the mean postoperative Cobb angle at final follow-up was -1.8° (range: 2-7°). CONCLUSIONS: One-stage anterior debridement, bone grafting, and internal fixation can effectively remove lesions, decompress the nerve, reduce pain, and correct kyphosis in patients with cervical tuberculosis and associated kyphosis. Long-term postoperative outcomes were satisfactory.

A sub-pathway based method to identify candidate agents for Ankylosing Spondylitis.

The need for new therapeutics for Ankylosing Spondylitis (AS) is highlighted by the general lack of efficacy for most agents currently available for this disease. Many recent studies have detailed molecular pathways in AS, and several molecule-targeting agents are undergoing evaluation. We aimed to explore the mechanism of AS and identify biologically active small molecules capable of targeting the sub-pathways which were disregulated in the development of AS. By using the GSE25101 microarray data accessible from the Gene Expression Omnibus database, we first identified the differentially expressed genes (DEGs) between AS samples and healthy controls, followed by the sub-pathway enrichment analysis of the DEGs. In addition, we propose the use of an approach based on targeting sub-pathways to identify potential agents for AS. A total of 3,280 genes were identified as being significantly different between patients and controls with p-values < 0.1. Our study showed that neurotrophic signaling pathway and some immune-associated pathways may be involved in the development of AS. Besides, our bioinformatics analysis revealed a total of 15 small molecules which may play a role in perturbing the development of AS. Our study proposes the use of an approach based on targeting sub-pathways to identify potential agents for AS. Candidate agents identified by our approach may provide the groundwork for a combination therapy approach for AS.

All-pedicle-screw versus hybrid hook-screw instrumentation for posterior spinal correction surgery in adolescent idiopathic scoliosis: a curve flexibility matched-pair study.

INTRODUCTION: Comparisons of all-pedicle-screw (PS) and hybrid hook-screw (HS) instrumentation for the treatment of adolescent idiopathic scoliosis (AIS) have produced conflicting results. The aim of this study was to compare all-pedicle-screw and hybrid hook-screw instrumentation for the treatment of AIS using a matched-pair study design in which preoperative flexibility was matched. METHODS: In this retrospective study conducted at one medical center, 21 all-pedicle-screw/hybrid hook-screw pairs of Lenke type I AIS patients matched for age, height, weight, body mass index, sex, and preoperative curve flexibility who had been treated at our institution from January 2000 to October 2006 were selected. Postoperative and 2-year postoperative coronal curve correction, postoperative kyphosis, blood transfusion needs, operation time, and hospital cost were measured and analyzed statistically. RESULTS: The PS group compared with the HS group had better postoperative correction (P = 0.0231) and 2-year coronal curve correction (P = 0.016). While statistically significant (P = 0.0073), the postoperative Cobb angle was only 3° less in the PS group, Maintenance of correction after 2 years was better in the PS group (P = 0.0016). The PS group had less blood loss (P < 0.0001) and shorter operation time (P < 0.0001), but the hospital cost for the PS group was higher (P < 0.0001). CONCLUSIONS: All-pedicle-screw and hybrid hook-screw instrumentations are comparable with regard to curve correction, but all-pedicle screw instrumentation reduces blood loss during surgery and shortens the operation time, which may help shorten healing time.

Using side-bending radiographs to determine the distal fusion level in patients with single thoracic idiopathic scoliosis undergoing posterior correction with pedicle screws.

STUDY DESIGN: Prospective. OBJECTIVES: To evaluate a strategy to determine the distal fusion level in posterior pedicle screw correction of single thoracic idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: No standard method for selecting the lowest instrumented vertebra (LIV) for the correction of thoracic adolescent idiopathic scoliosis with posterior all-pedicle screw instrumentations exists. METHODS: Thirty-eight patients with single right thoracic (Lenke 1A) adolescent idiopathic scoliosis undergoing posterior pedicle screw fixation were studied. The LIV was determined using guidelines based on preoperative side-bending radiographs. In brief, (1) the whole thoracic Cobb curve should be included in the fusion mass, and the LIV should not be superior to the lower-end vertebra of the Cobb measurement. (2) On the right side-bending radiographs, the LIV should be derotated to neutral in skeletally immature (Risser 0 to 3) patients and the disc immediately below the LIV must open on the left side by at least 5 degrees. (3) On the left side-bending radiographs, the disc immediately below the LIV must be open on the right side by at least 0 degree. The first segment meeting the criteria when proceeding from the lower-end vertebra caudally is chosen as the LIV. Outcomes were based on the standing radiographs. RESULTS: Minimum follow-up was 2 years. The mean preoperative thoracic curve was 48.4±9.2 degrees and 12.6±6.1 degrees at final follow-up, resulting in a mean correction of 74.7%±8.5%. The mean preoperative compensatory lumbar curve of 23.7±7.5 degrees was 6.3±4.8 degrees at final follow-up. A change in lumbar lordosis from -41.2±11.9 degrees preoperatively to -38.2±9.9 degrees at final follow-up occurred. All patients achieved coronal balance and no decompensation or adding-on phenomenon was observed. Compared with the recommended fusion end by the Harrington stable zone method, 86.9% patients were saved 1 or more motion segment. CONCLUSIONS: The method described was effective in obtaining satisfactory curve correction, adequate trunk balance, and preservation of motion segments.

The effect of differing spinal fusion instrumentation on the occurrence of postoperative crankshaft phenomenon in adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective. OBJECTIVE: To compare the occurrence of the crankshaft phenomenon in patients with adolescent idiopathic scoliosis (AIS) who underwent hybrid, consecutive pedicle screw or interval pedicle screw instrumentation for posterior spinal fusion. SUMMARY OF BACKGROUND DATA: Scoliosis may progress after posterior spinal fusion in skeletally immature patients with AIS. The crankshaft phenomenon occurs when the anterior column continues to grow in the face of posterior fusion causing characteristic twisting of the fused segment. The optimal surgical method for preventing the occurrence of this complication has not been determined. METHODS: Sixty seven patients with AIS who underwent posterior fusion over a 6-year period were divided into groups according to fixation method: hybrid instrumentation, interval pedicle screw placement, or consecutive pedicle screw placement. Preoperative, postoperative, and follow-up radiographic measures, including Cobb angle, apical vertebral rotation (AVR), apical vertebral transposition (AVT), rib vertebral angle difference (RVAD) and trunk shift (TS) were assessed. The occurrence of the crankshaft phenomenon was determined. RESULTS: The mean follow-up duration was 36 months. There were no between-the-group differences in demographics or preoperative or immediate postoperative measures. At the last follow-up, significant differences among the groups were apparent for Cobb angle, AVR, AVT, RVAD, and TS (all P<0.05). Cobb angle, AVR, AVT, RVAD, and TS significantly increased between the postsurgery and the last follow-up in the hybrid instrumentation group (all P<0.0167). Only TS increased significantly in the 2 other groups. There were 7 cases of crankshaft phenomenon occurrence in the hybrid instrumentation group (33%), but none in the other 2 groups. CONCLUSIONS: These findings suggest that in skeletally immature patients with AIS, hybrid instrumentation cannot effectively prevent occurrence of the crankshaft phenomenon, whereas interval and consecutive pedicle screw instrumentation may be more (and equally) efficacious in this regard.

[Analysis of posterior pedicle screw-only constructs in surgical treatment of adolescent idiopathic scoliosis with a minimum three-year follow-up].

OBJECTIVE: To evaluate clinical outcomes of a group of adolescent idiopathic scoliosis (AIS) patients undergoing posterior pedicle screw-only instrumentations. METHODS: Between April 2002 and July 2006, 121 AIS patients (93 female and 28 male, average age at operation was 15.5 years which ranged from 10 to 20 years) received posterior pedicle screw-only instrumentation and fusion. All the patients were evaluated by the various-parameters measured in X-ray films before and after surgery, including Cobb angle on coronal plane, Cobb angle on sagittal plane, clavicle angle and shoulder height difference, lowest instrumented vertebrae (LIV) angulation, proximal junction kyphotic angle, the distances of central sacral vertical line (CSVL) to the LIV, to the apical vertebra and to the C(7) plumb line respectively. Complications were followed. RESULTS: An average of (11.0 + or - 1.5) levels was fused. An average coronal correction of proximal thoracic curve was 41.8%, of thoracic curve was 70.8%, of thoracolumbar/lumbar curves was 74.0%. No significant change was found in sagittal alignment. Shoulder balance and apex vertebral to central sacral line were restored well. There were no pseudoarthroses and loss of correction during the follow-ups. One adding-on, 4 proximal thoracic decompensation and 15 proximal junction kyphosis were found during the follow-ups. CONCLUSION: Posterior pedicle screw-only instrumentation and fusion has excellent radiographic and clinical results with minimal complications in the surgical treatment of AIS.

Muscone Ameliorates Ovariectomy-Induced Bone Loss and Receptor Activator of Nuclear Factor-κb Ligand-Induced Osteoclastogenesis by Suppressing TNF Receptor-Associated Factor 6-Mediated Signaling Pathways.

Postmenopausal osteoporosis is caused by the deficiency of estrogen, which breaks bone homeostasis and induces levels of pro-inflammatory cytokines. Muscone is a potent anti-inflammatory agent and is used to treat bone fracture in traditional Chinese medicine. However, its anti-osteoclastogenic effects remain unclear. For in vitro study, morphology tests of osteoclastogenesis were firstly performed. And then, factors in RANK-induced NF-κB and MAPK pathways were examined by RT-PCR and Western blot, and the binding of TNF receptor-associated factor (TRAF)6 to RANK was inspected by coimmunoprecipitation and immunofluorescence staining. For in vivo experiments, C57BL/6 ovariectomized (OVX) mice were used for detection, including H&E staining, TRAP staining, and micro CT. As a result, muscone reduced OVX-induced bone loss in mice and osteoclast differentiation in vitro, by inhibiting TRAF6 binding to RANK, and then suppressed NF-κB and MAPK signaling pathways. The expression of the downstream biomarkers was finally inhibited, including NFATc1, CTR, TRAP, cathepsin K, and MMP-9. The inflammatory factors, TNF-a and IL-6, were also reduced by muscone. Taken together, muscone inhibited the binding of TRAF6 to RANK induced by RANKL, thus blocking NF-kB and MAPK pathways, and down-regulating related gene expression. Finally, muscone inhibited osteoclastogenesis and osteoclast function by blocking RANK-TRAF6 binding, as well as downstream signaling pathways in vitro. Muscone also reduced ovariectomy-induced bone loss in vivo.

Reduced Puncture Time and Radiation Exposure of Percutaneous Transpedicular Puncture with Electronic Conductivity Device: A Randomized Clinical Trial.

OBJECTIVES: The present study introduced an electronic conductivity device (ECD) to reduce time of percutaneous transpedicular puncture and frequency of patient valid radiation exposure in percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP). METHODS: A randomized self-control clinical study was undertaken. Medical records of patients with vertebral compression fractures (VCFs) for bilateral PKP or PVP were collected, and each side was performed randomly with ECD or conventional trocar. RESULTS: We enrolled 61 patients (44 women, 17 men) with 75 vertebras with VCF. Compared with the conventional fluoroscopy group, significant reductions in puncture time (504.33 ± 152.03 vs. 652.68 ± 167.60 seconds; P < 0.001) and fluoroscopy frequency (5.11 ± 1.23 vs. 8.15 ± 1.83; P < 0.001) for each percutaneous puncture were observed in the ECD group. When compared with the VCFs ≤50% group, the 2 indexes in the VCFs >50% group were significantly increased. And in the ECD group, the learning curve in the VCFs >50% group showed a steeper decreasing trend than that in the VCFs ≤50% group. No complications were observed in any patient. CONCLUSIONS: ECD could reduce puncture time of percutaneous transpedicular puncture and exposure of radiation in PVP and PKP. ECD has more benefits in complicated transpedicular puncture in patients with vertebral compression >50%.

Abnormal ossification as a cause the progression of adolescent idiopathic scoliosis.

Although, there is no generally accepted scientific theory for the etiology of adolescent idiopathic scoliosis (AIS), the relative anterior spinal column overgrowth has been postulated as a mechanism of AIS progression by many morphological studies. The normal spinal growth involves both kinds of ossification: endochondral and membranous ossification. Considering the uncoupled anterior-posterior column growth of AIS patients, the uncoupled endochondral-membranous ossification could possibly play an important role in the progression of AIS. Meanwhile, other observations found that the uncoupling of ossification was not limited to the spinal column, but rather a systemic phenomenon. This consideration leads us to carefully dissect the underlying abnormal molecular pathways, cytokines or receptors of ossification, such as BMP-Smads, Runx2, FGFR-3, and will raise the hope to detect the AIS progression potentiality and help to formulate the appropriately personalized treatment strategy for patients.

Does spinal fusion to T2, T3, or T4 affects sagittal alignment of the cervical spine in Lenke 1 AIS patients: A retrospective study.

The aim of this stusy was to investigate whether spinal fusion to T2, T3, or T4 affects sagittal alignment of the cervical spine in Lenke 1 adolescent idiopathic scoliosis (AIS) patients.A retrospective study comprised of 64 Lenke 1 AIS patients was performed to assess the radiographic and clinical outcome. According to the upper instrumented vertebrae (UIV) (T2, T3, or T4), the patients were divided into 3 groups. Comparison analyses were performed among these 3 groups of patients as between pre-op, immediate post-op, and final follow-up, as well as between these groups.Between groups, comparison analyses did not detect a statistical difference in cervical lordosis (CL) preoperatively (P = .501), immediately after surgery (P = .795), and at follow-up (P = .510). Immediately after surgery, CL increased significantly in all groups (T2, P = .004, T3, P < .001 and T4, P = .002 respectively). Compared with immediate postoperatively, CL at final follow-up increased in T2 group (P = .037), and T4 group (P = .010). Furthermore, CL at follow-up was significantly correlated with the following parameters: preoperative (coronal plane balance [r = .349, P = .004], pelvic tilt [r = 0.347, P = .004), pelvic incidence [r = 0.261, P = .031], and CL [r = 0.471, P < .001]) immediately postoperative (CL [r = 0.946, P < .001], T1-slope [r = -0.646, P < .001], and thoracic kyphosis [TK] [r = -0.353, P = .003]), and at follow-up (TK [r = -0.342, P = .004], and T1-slope [r = -0.821, P < .001]). However, there was no significant correlation between a selection of UIV and CL at follow-up (r = 0.031, P = .802). Moreover, Scoliosis Research Society (SRS-22) scores between groups were similar preoperatively (P = .242), immediately after surgery (P = .828), and at follow-up (P = .219).In Lenke 1 AIS patients, the selection of UIV mainly affects the coronal plane, especially shoulder balance. Fusion to T2, T3, or T4 did not affect the alignment of the cervical spine, and the SRS-22 score. LEVEL OF EVIDENCE: Level IV.

Selecting the LSTV as the Lower Instrumented Vertebra in the Treatment of Lenke Types 1A and 2A Adolescent Idiopathic Scoliosis: A Minimal 3-year Follow-up.

STUDY DESIGN: Retrospective study. OBJECTIVE: The purpose of this study was to verify the last substantially touched vertebra (LSTV) as the ideal lower instrumented vertebra (LIV) and to identify predictive factors of adding-on in patients with Lenke type 1A and 2A curve patterns when LSTV was chosen as the LIV. SUMMARY OF BACKGROUND DATA: Although several studies have indicated that the use of the LSTV as the LIV can obtain favorable outcomes in Lenke 1A and 2A curves, the factors identifying patients with Lenke 1A and 2A curve patterns who should undergo a fusion extending beyond the LSTV have not been identified. METHODS: A total of 120 patients with Lenke 1 and 2 curves after posterior instrumentation and fusion to the LSTV were evaluated. All patients had a minimum 3-year follow-up. Patients were grouped based on the occurrence of the distal adding-on phenomenon: an adding-on group and a no adding-on group. We analyzed the significant independent factors associated with adding-on via univariate analysis and then via stepwise logistic regression analysis. RESULTS: Distal adding-on was observed in 16 patients (13.33%). Binary logistic regression analysis showed that the Risser sign (OR = 0.592, P = 0.033), preoperative distance between the LIV and the center sacral vertical line (CSVL) (LIV-CSVL) (OR = 1.286, P = 0.002), and postoperative thoracic kyphosis (T5-T12) (OR = 0.784, P = 0.002) were primary factors for distal adding-on. CONCLUSION: Selecting the LSTV as the LIV simplifies the selection of the LIV and is an effective operation strategy in patients with Lenke 1A and 2A curve types. Patients with lower Risser sign, larger preoperative LIV-CSVL, and postoperative thoracic hypokyphosis are more likely to develop distal adding-on at 3-year follow-up. LEVEL OF EVIDENCE: 4.

Role of T1 Pelvic Angle in Assessing Sagittal Balance in Outpatients With Unspecific Low Back Pain.

The aim of the study was to explore the significance of T1 pelvic angle (TPA) for assessment of sagittal balance in a cohort of Chinese patients with unspecific low back pain. TPA has been commonly used to assess sagittal balance in adult spinal deformity. However, whether TPA could be used to assess sagittal balance in patients with unspecific low back pain effectively remains unanswered. Medical records of outpatients with unspecific low back pain who received treatment in our outpatient clinic between September 2013 and November 2014 were reviewed. Demographic data and radiographic data were collected. Correlation coefficients between TPA and other sagittal parameters were analyzed, and the intraclass correlation coefficient (ICC) analysis was performed to assess the inter- and intra-observer reliability of TPA. Patients were divided into 2 groups according to whether they were well-aligned (TPA ≤ 20°) or poorly aligned (TPA > 20°), and then demographic and sagittal parameters were compared between the 2 groups of patients. A total of 97 patients with unspecific low back pain were included in this study. The inter- and intraobserver reliability of the TPA measure had excellent agreement (ICC = 0.985 and 0.919, respectively). There were significant correlations between TPA and age, LL, PT, PI, T1SPI, SVA, and NRS (all P < 0.05). Of the 38 well-aligned patients in Group A, SVA was ≤5 cm in 33 (86.84%) patients and >5 cm in the other 5 (13.16%) patients, and of the 59 poorly aligned patients in Group B, SVA was >5 cm in 42 (71.19%) patients and ≤5 cm in the other 17 (28.81%) patients. There were significant differences in age, LL, SS, PT, PI, T1SPI, SVA, and NRS between the 2 groups of patients, but no significant difference was observed in TK and TL. TPA could be used to assess sagittal balance in outpatients with unspecific low back pain effectively.

Application of 3D rapid prototyping technology in posterior corrective surgery for Lenke 1 adolescent idiopathic scoliosis patients.

A retrospective study to evaluate the effectiveness of 3-dimensional rapid prototyping (3DRP) technology in corrective surgery for Lenke 1 adolescent idiopathic scoliosis (AIS) patients. 3DRP technology has been widely used in medical field; however, no study has been performed on the effectiveness of 3DRP technology in corrective surgery for Lenke 1 AIS patients. Lenke 1 AIS patients who were preparing to undergo posterior corrective surgery from a single center between January 2010 and January 2012 were included in this analysis. Patients were divided into 2 groups. In group A, 3-dimensional (3D) printing technology was used to create subject-specific spine models in the preoperative planning process. Group B underwent posterior corrective surgery as usual (by free hand without image guidance). Perioperative and postoperative clinical outcomes were compared between 2 groups, including operation time, perioperative blood loss, transfusion volume, postoperative hemoglobin (Hb), postoperative complications, and length of hospital stay. Radiological outcomes were also compared, including the assessment of screw placement, postoperative Cobb angle, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis. Subgroup was also performed according to the preoperative Cobb angle: mean Cobb angle <50° and mean Cobb angle >50°. Besides, economic evaluation was also compared between 2 groups. A total of 126 patients were included in this study (group A, 50 and group B, 76). Group A had significantly shorter operation time, significantly less blood loss and transfusion volume, and higher postoperative Hb (all, P < 0.001). However, no significant differences were observed in complication rate, length of hospital stay, and postoperative radiological outcomes between 2 groups (all, P>0.05). There was also no significant difference in misplacement of screws in total populations (16.90% vs 18.82%, P = 0.305), whereas a low misplacement rate of pedicle screws was observed in patients whose mean Cobb angle was >50° (9.15% vs 13.03%, P = 0.02). Besides, using 3DRP increased the economic burden of patients (157,000 ±â€Š9948.85 Ren Min Bi (RMB) vs 152,500 ±â€Š11,445.52 RMB, P = 0.03). Using the 3D printing technology before posterior corrective surgery might reduce the operation time, perioperative blood loss, and transfusion volume. There did not appear to be a benefit to using this technology with respect to complication rate and postoperative radiological outcomes; however, 3D technology could reduce the misplacement rate in patients whose preoperative mean Cobb angle was >50°. Besides, it also increased the patients' hospital cost. Therefore, future prospective studies are needed to elucidate the efficacy of this emerging technology.

Basic study for ultrasound-based navigation for pedicle screw insertion using transmission and backscattered methods.

The purpose of this study was to understand the acoustic properties of human vertebral cancellous bone and to study the feasibility of ultrasound-based navigation for posterior pedicle screw fixation in spinal fusion surgery. Fourteen human vertebral specimens were disarticulated from seven un-embalmed cadavers (four males, three females, 73.14 ± 9.87 years, two specimens from each cadaver). Seven specimens were used to measure the transmission, including tests of attenuation and phase velocity, while the other seven specimens were used for backscattered measurements to inspect the depth of penetration and A-Mode signals. Five pairs of unfocused broadband ultrasonic transducers were used for the detection, with center frequencies of 0.5 MHz, 1 MHz, 1.5 MHz, 2.25 MHz, and 3.5 MHz. As a result, good and stable results were documented. With increased frequency, the attenuation increased (P<0.05), stability of the speed of sound improved (P<0.05), and penetration distance decreased (P>0.05). At about 0.6 cm away from the cortical bone, warning signals were easily observed from the backscattered measurements. In conclusion, the ultrasonic system proved to be an effective, moveable, and real-time imaging navigation system. However, how ultrasonic navigation will benefit pedicle screw insertion in spinal surgery needs to be determined. Therefore, ultrasound-guided pedicle screw implantation is theoretically effective and promising.

Screening of diagnostic markers for osteosarcoma.

Osteosarcoma, which is the most common type of highly malignant bone tumor in children and adolescents, has poor diagnosis and 2-year survival rates of 15-20% following surgery or radiotherapy, and has therefore generated marked attention. In order to investigate the potential biomarkers for diagnosing osteosarcoma, the expression profiling data from normal and disease tissues were compared, respectively, and the differentially­expressed genes were analyzed by three different statistical tests. Interacting proteins were determined and an interaction network was constructed by Search Tool for the Retrieval of Interacting Genes database. Subsequently, the protein interaction network was decomposed and Gene Otology annotation using Cytoscape, Mcode and Bingo, was conducted on the function modules. Finally, three differentially­expressed genes GJA1, COL1A2 and COL5A2 were identified, and an interaction network was successfully generated with COL1A2 and COL5A2 at the core. From the results, it was observed that COL1A2 and COL5A2 interact with a number of genes of the matrix metalloprotease (MMP) family, including MMP1, MMP2, MMP3 and MMP14, TGFß and RUNX2. Furthermore, these genes have been confirmed to be important in the tumorigenesis of osteosarcoma. It was hypothesized that the upregulation of the COL gene family may be considered as a diagnostic marker for osteosarcoma and collagen may be administered as a therapy.