Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis.

The aim of the current study was to use a Bayesian network meta-analysis to evaluate the relative benefits and risks of balloon kyphoplasty (BK), percutaneous vertebroplasty (PVP), and non-surgical treatment (NST) for patients with osteoporotic vertebral compression fractures (OVCFs). The results demonstrate that for pain and functional status, PVP was significantly better than NST, while the three treatments did not significantly differ in other outcomes. INTRODUCTION: BK, PVP, and NST are widely used to treat OVCFs, but preferable treatment is unknown. The aim of the current study was to use a Bayesian network meta-analysis to evaluate the relative benefits and risks of BK, PVP, and NST for patients with OVCFs. METHODS: PubMed, EMBASE, and the Cochrane Library were screened. Based on the preplanned eligibility criteria, we screened and included randomized controlled trials that compared BK, PVP, and NST in treating patients with OVCFs. The risk of bias for individual studies was appraised. The data were pooled using a Bayesian network meta-analysis and a traditional direct comparison meta-analysis. RESULTS: Of the 1057 relevant studies, 15 were eligible and included. Compared with NST, PVP significantly reduced pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ). The comparative efficacy of BK and PVP was similar for pain (mean difference (MD) 0.51, 95% credible interval (CrI) - 0.35 to 1.4), ODI (MD 0.11, 95% CrI - 13 to 13), and RMDQ (MD 1.2, 95% CrI - 2.7 to 5.4). The European Quality of Life-5 Dimensions (EQ-5D) and Physical Component Summary subscales of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36 PCS) did not differ significantly. There were also no substantial differences in the risks of subsequent vertebral fractures, adjacent vertebral fractures, and re-fractures at the treated level across all comparators. The results of pairwise meta-analyses were almost consistent with those of network meta-analyses. The treatment ranking indicated that PVP had the highest probability of being the most effective for pain, ODI, RMDQ, and EQ-5D. BK had the highest probability of improving SF-36 PCS and of reducing the risk of subsequent vertebral fractures and re-fractures at the treated level. NST was ranked first in preventing adjacent vertebral fractures. CONCLUSION: PVP was the most effective method for improving pain, functional status, and quality of life (based on EQ-5D). BK emerged as the best intervention for decreasing the risk of subsequent vertebral fractures and re-fractures at the treated level. NST could be ranked first in reducing adjacent vertebral fractures. The future directions of OVCFs treatment will depend on the outcomes of additional and larger randomized trials in comparing BK with PVP.

Traumatic spinal cord injury in Tianjin, China: a single-center report of 354 cases.

STUDY DESIGN: Hospital-based retrospective study. OBJECTIVES: The objective of this study was to describe the epidemiological profile of traumatic spinal cord injury (TSCI) in Tianjin Medical University General Hospital, China, from 2009 to 2014. SETTING: Tianjin Medical University General Hospital. METHODS: Hospital medical records of patients with TSCI admitted to hospital from 1 January 2009 to 31 December 2014 were reviewed. Collected variables included gender, age, marital status, ethnic group, occupation, etiology, neurological level of injury, American Spinal Injury Association (ASIA)-ISCoS impairment scale at admission, the severity, death and its cause, concomitant injuries and treatment choice. RESULTS: During the study period, 354 cases were identified. Male-to-female ratio was 2.34:1, with a mean age of 50.1±15.5 years. Falls (55.1%), comprising low falls and high falls (33.6% and 21.5%, respectively), were the leading cause, followed by motor vehicle collisions (MVCs) (35.9%). The most common injury site was the cervical spinal cord, especially C4-C6, accounting for 59.3%. Surgery was the major treatment choice (57.6%). CONCLUSION: The number of TSCI patients increased annually in our center. The mean age at the time of injury was older, and the proportion of males was higher. The leading two causes were falls and MVCs. The SCIs caused by MVCs were increasing. Peasants, workers and unemployed individuals were those at higher risk. Surgery was the major treatment choice. These data may be useful to implement those preventive strategies focused on the characteristics of different groups and pay more attention to high-risk populations.

[Mid- to long-term outcomes of cervical disc arthroplasty for symptomatic cervical disc disease: a meta-analysis].

Objective: To compare the benefits and harms of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion(ACDF) for symptomatic cervical disc disease at mid- to long-term follow-up. Methods: Electronic searches were made in PubMed, EMBASE, and the Cochrane Library for randomized controlled trials with at least 48 moths follow-up.Outcomes were reported as relative risk or standardized mean difference.Meta-analysis was carried out using Revman version 5.3 and Stata version 12.0. Results: Seven trials were included, involving 2 302 participants.The results of this meta-analysis indicated that CDA brought about fewer secondary surgical procedures, lower neck disability index (NDI) scores, lower neck and arm pain scores, greater SF-36 Physical Component Summary (PCS) and Mental Component Summary(MCS) scores, greater range of motion (ROM) at the operative level and less superior adjacent-segment degeneration(P<0.05) than ACDF.CDA was not statistically different from ACDF in inferior adjacent-segment degeneration, neurological success, and adverse events (P>0.05). Conclusions: CDA can significantly reduce the rates of secondary surgical procedures compared with ACDF.Meanwhile, CDA is superior or equivalent to ACDF in other aspects.As some studies without double-blind are included and some potential biases exites, more randomized controlled trials with high quality are required to get more reliable conclusions.

Epidemiology of traumatic cervical spinal cord injury in Tianjin, China.

STUDY DESIGN: A retrospective epidemiological study. OBJECTIVE: To describe the recent epidemiological characteristics of traumatic cervical spinal cord injury (TCSCI) in adults in Tianjin. SETTING: Tianjin Medical University General Hospital. METHODS: This study included all TCSCI patients aged ≥ 15 years who were admitted to a general hospital from December 2008 to November 2011. Epidemiological characteristics including gender, age, marital status, occupation, etiology, level of injury, severity and America Spinal Injury Association (ASIA) impairment scale were recorded. RESULTS: A total of 143 patients with TCSCI were included in the study. Mean age was 54.6 ± 14.6 years (men 53.5 ± 14.9 years, women 54.2 ± 12.1 years), with a range of 18-87 years, and the male/female ratio was 5:1. The leading cause was falls (49.7%), followed by motor vehicle accidents (36.4%). The most common injury site was C5, accounting for 42%. In all, 74 (51.7%) patients had complications; the most common complication was hyponatremia (30.1%), followed by urinary infection (23.1%), respiratory infection (18.2%), bedsore (9.8%) and deep venous thrombosis (4.9%). As for the severity, ASIA grade D was encountered most frequently. Six patients died, five of whom died from respiratory failure. CONCLUSION: The epidemiology of TCSCI has its own characteristics. Falls were the leading causes, and TCSCI occurred most frequently in the middle-aged and elders. Therefore, establishing public policies aimed at preventing injuries should focus on falls and more attention should be paid to the aged regarding their vulnerability to low fall. Additionally, complications should be prevented in TCSCI patients.

Epidemiology of traumatic spinal cord injury in Tianjin, China.

STUDY DESIGN: A retrospective epidemiological study. OBJECTIVES: To provide recent epidemiological characteristics of traumatic spinal cord injuries (TSCIs) in adults living in Tianjin. SETTING: Tianjin, China. METHODS: This study included all TSCI patients aged 15 years or older who were admitted to tertiary hospitals in Tianjin from 2004 to 2008. Epidemiological characteristics, such as age, sex, date of admission, causes of injury, level of injury, America Spinal Injury Association impairment scale and date of discharge were included. RESULTS: A total of 869 patients were included, with an estimated annual incidence was 23.7 per million populations. The male/female ratio was 5.63:1. Mean age of TSCI was 46.0±14.2 years (men 45.8±14.2 years, women 47.5±14.5 years), with a range of 16-90 years. Falls were regarded as the leading causes of injury, followed by motor vehicle collisions. The lesion level was cervical in 71.5%, thoracic in 13.3% and lumbar/sacral in 15.1%. The frequency of tetraplegia (71.5%) was higher than paraplegia (28.5%), and roughly four-fifth of tetraplegia cases were incomplete injury. CONCLUSION: To our knowledge, national or local epidemiological study of spinal cord injury (SCI) has not been carried out previously in China. The number of SCI patients in this country is large and would increase gradually. Similar to other developing countries, falls were the main causes of TSCI. Low falls were more common in those over 60 years old. As the ageing society coming, the number of low falls-induced TSCI would increase gradually, which poses a challenge to the society health system.

Rhodiola sacra aqueous extract (RSAE) improves biochemical and sperm characteristics in cryopreserved boar semen.

Although Rhodiola sacra aqueous extract (RSAE) has been used in many studies as an antioxidant, its effects on semen characteristics and its antioxidant properties during cryopreservation of boar sperm have never been evaluated. Semen was collected from five Duroc boars (2-4-year-old) twice weekly and frozen-thawed in extender with RSEA. Motion characteristics were assessed with a computer-aided semen analysis (CASA) system, whereas other sperm quality end points were assessed by routine methods. The effective concentration of RSEA in extender ranged from 4 to 8mg/L and the effect of RSEA on sperm quality was better in glycerol-free extender than extender containing glycerol (P<0.05). In frozen-thawed boar semen, there was a direct correlation (P<0.05) between RSEA concentration and glutathione (GSH) concentrations, mitochondrial activity, and hypoosmotic swelling test (HOST), and an inverse correlation (r=-0.982, P<0.05) between RSEA concentration and malondialdehyde (all end points were significantly higher at 6mg/L than in the control group). In summary: (i) the effective concentration of RSEA in extender ranged from 4 to 8mg/L; (ii) the effect of RSEA on sperm quality was better in extender without glycerol; and (iii) there was a significant correlation between RSEA concentrations and concentrations of GSH and MAD in frozen-thawed boar semen (antioxidant effects of RSEA were concentration-dependent). Further studies are needed to define the active ingredient in RSEA that protects boar sperm against ROS.