Rare primary squamous cell carcinoma of the intrahepatic bile duct: A case report and review of literature.

BACKGROUND: Cholangiocarcinoma is the most common malignancy of the biliary tree and has a poor prognosis. Adenocarcinoma is the most common pathological type of cholangiocarcinomas, but rare squamous, adenosquamous, and mucinous variants have been reported without adequate clinical data. CASE SUMMARY: This report describes a rare case of primary squamous cell carcinoma (SCC) of the intrahepatic bile duct. The patient was admitted with a tumor in the hepatic caudate lobe with no obvious clinical symptoms. Examination revealed hepatitis B surface antigen positivity, a slight increase in alfa-fetoprotein to 16.34 ng/mL, and an irregular slightly heterogeneous enhancing lesion in the hepatic caudate lobe, which was initially thought to be hepatocellular carcinoma. Laparoscopic resection was performed, and the final pathology suggested a rare primary SCC of the intrahepatic bile duct. Immunohistochemistry indicated positivity for villin, partial positivity for p63, and negativity for hepatocyte, CK7, CK8, CK19, and CK20. The Ki-67 index was approximately 60%. The patient received six cycles of Tegio chemotherapy. A new lesion was detected in the liver after 15 months. The surgery was performed, and the patient was followed-up at a local hospital. To date, no new lesions have been observed. CONCLUSION: Surgery is the first choice for resectable lesions, and combined chemotherapy based on pathology is essential for increasing overall survival.

Langerhans cell histiocytosis with multiple spinal involvement.

To stress the clinical and radiologic presentation and treatment outcome of Langerhans cell histiocytosis (LCH) with multiple spinal involvements. A total of 42 cases with spinal LCH were reviewed in our hospital and 5 had multifocal spinal lesions. Multiple spinal LCH has been reported in 50 cases in the literature. All cases including ours were analyzed concerning age, sex, clinical and radiologic presentation, therapy and outcome. Of our five cases, three had neurological symptom, four soft tissue involvement and three had posterior arch extension. Compiling data from the eight largest case series of the spinal LCH reveals that 27.2% multiple vertebrae lesions. In these 55 cases, there were 26 female and 29 male with the mean age of 7.4 years (range 0.2-37). A total of 182 vertebrae were involved including 28.0% in the cervical spine, 47.8% in thoracic and 24.2% in the lumbar spine. Extraspinal LCH lesion was documented in 54.2% cases, visceral involvement in 31.1% and vertebra plana in 50% cases. Paravertebral and epidural extension were not documented in most cases. Pathological diagnosis was achieved in 47 cases including 8 open spine biopsy. The treatment strategy varied depending on different hospitals. One patient died, two had recurrence and the others had no evidence of the disease with an average of 7.2 years (range 1-21) of follow-up. Asymptomatic spinal lesions could be simply observed with or without bracing and chemotherapy is justified for multiple lesions. Surgical decompression should be reserved for the uncommon cases in which neurologic compromise does not respond to radiotherapy or progresses too rapidly for radiotherapy.

Differential proteomic profiling of chordomas and analysis of prognostic factors.

BACKGROUND: The recurrence rate of chordoma is high, and the prognosis is poor. METHODS: Differential proteomic analysis was performed on chordomas and adjacent normal tissues, with verification by Western blot. Protein expression was evaluated by immunohistochemistry of 37 chordomas. Association of candidate protein expression with clinical parameters, disease-free survival, and overall survival were analyzed. RESULTS: We identified 14 up-regulated and 5 down-regulated proteins in chordomas. Expression of alpha enolase (ENO1), pyruvate kinase M2 (PKM2), and gp96 was higher in recurrences than in primary tumors. Univariate analysis showed that significantly adverse factors for disease-free survival were overexpression of ENO1 and PKM2, involvement of contiguous vertebral levels, and inadequate surgical margin at initial surgery. Inadequate surgical margin without radiotherapy, involvement of contiguous vertebral levels, and cervical spine location were adverse factors for overall survival. By multivariate analysis, independent adverse prognostic factors were inadequate surgical margin and involvement of multiple contiguous vertebral levels for recurrence; upper cervical spine location and involvement of contiguous vertebral levels for tumor-related death. Multivariate analysis failed to show the significance of the proteins. CONCLUSIONS: Involvements of multiple contiguous vertebral levels and upper cervical spine, rather than overexpression of ENO1, PKM2, or gp96, are independent prognostic indicators for chordomas.

Langerhans cell histiocytosis of the atlas in an adult.

Langerhans cell histiocytosis (LCH), formerly known as histiocytosis X, is a rare disorder (approximately 1:1,500,000 inhabitants) characterized by clonal proliferation and excess accumulation of pathologic Langerhans cells causing local or systemic effects. The exact etiology of LCH is still unknown. LCH could affect patients of any age, although most present when they are children. The most frequent sites of the bony lesions are the skull, femur, mandible, pelvis and spine. A variety of treatment modalities has been reported, but there was no evidence suggesting that any one treatment was more advantageous than another. We present an adult with LCH of the atlas. A 26-year-old young man presented with a 2-month history of neck pain and stiffness. CT revealed osteolytic lesion in the left lateral mass of atlas with compression fracture. Histopathological diagnosis was Langerhans cell histiocytosis by percutaneous needle biopsy under CT guidance. The patient underwent conservative treatment, including Halo-vest immobilization and radiotherapy. At 7-year follow-up, the patient was asymptomatic except for mild motion restriction of the neck. CT revealed a significant reconstruction of the C1 lateral mass.

Upper cervical spine chordoma of C2-C3.

Chordoma is a rare low-grade malignant neoplasm derived from the remnants of the embryonic notochord. This locally invasive neoplasm is subject to recurrence after treatment. The median survival time is estimated to be 6.3 years. Various treatment approaches have been attempted, including radical excision, radiotherapy and chemotherapy. Treatment outcome is significantly influenced by the size and site of the chordoma. Recently, Imatinib, a molecular-targeted agent, has been shown to have antitumor activity in chordoma. Proton radiotherapy, stereotactic radiotherapy and intensity-modulated radiotherapy have also been used. Surgical treatment is still the primary choice for chordoma. It has become more aggressive in recent years, evolving from intralesional or partial excision to en bloc resection. However, upper cervical localizations make such en bloc resection in most cases not possible. We present and discuss the therapeutic challenges of a young female with large retropharyngeal chordoma who presented to our institution after conventional photon beam radiotherapy. This C2/3 tumor was classified IB according to the Enneking classification. It distributed to layers A-D and sectors 1-6 according to the Weinstein Boriani Biagini Classification. The left vertebral artery (VA) was encapsulated and displaced. One stage intralesional extracapsular tumor excision and reconstruction was achieved by combined bilateral high anterior cervical approaches and posterior approach. No recurrence or metastasis was observed 3 years after the operation. She returned to her previous occupation as office worker.

Ataxia telangiectasia-mutated-Rad3-related DNA damage checkpoint signaling pathway triggered by hepatitis B virus infection.

AIM: To explore whether acute cellular DNA damage response is induced upon hepatitis B virus (HBV) infection and the effects of the HBV infection. METHODS: We incubated HL7702 hepatocytes with HBV-positive serum, mimicking a natural HBV infection process. We used immunoblotting to evaluate protein expression levels in HBV-infected cells or in non-infected cells; immunofluorescence to show ATR foci ands Chk1 phosphorylation foci formation; flow cytometry to analyze the cell cycle and apoptosis; ultraviolet (UV) radiation and ionizing radiation (IR)-treated cells to mimic DNA damage; and Trypan blue staining to count the viable cells. RESULTS: We found that HBV infection induced an increased steady state of ATR protein and increased phosphorylation of multiple downstream targets including Chk1, p53 and H2AX. In contrast to ATR and its target, the phosphorylated form of ATM at Ser-1981 and its downstream substrate Chk2 phosphorylation at Thr-68 did not visibly increase upon infection. However, the level of Mre11 and p21 were reduced beginning at 0.5 h after HBV-positive serum addition. Also, HBV infection led to transient cell cycle arrest in the S and the G2 phases without accompanying increased apoptosis. Research on cell survival changes upon radiation following HBV infection showed that survival of UV-treated host cells was greatly increased by HBV infection, owing to the reduced apoptosis. Meanwhile, survival of IR-treated host cells was reduced by HBV infection. CONCLUSION: HBV infection activates ATR DNA damage response to replication stress and abrogates the checkpoint signaling controlled by DNA damage response.

Cellular DNA repair cofactors affecting hepatitis B virus infection and replication.

AIM: To investigate whether hepatitis B virus (HBV) infection activates DNA damage response and DNA repair cofactors inhibit HBV infection and replication. METHODS: Human hepatocyte cell line HL7702 was studied. Immunoblotting was performed to test the expression of ataxia telangiectasia-mutated (ATM)-Rad3-related protein (ATR), p21 and the level of phosphorylation of Chk1, p53, H2AX, ATM in HBV-infected or non-infected-cells. Special short RNAi oligos was transfected to induce transient ATR knockdown in HL7702. ATR-ATM chemical inhibitors caffeine (CF) and theophylline (TP), or Chk1 inhibitor 7-hydroxystaurosporine (UCN01) was studied to determine whether they suppress cellular DNA damage response and MG132 inhibits proteasome. RESULTS: The ATR checkpoint pathway, responding to single-strand breaks in DNA, was activated in response to HBV infection. ATR knockdown cells decreased the HBV DNA yields, implying that HBV infection and replication could activate and exploit the activated DNA damage response. CF/TP or UCN01 reduced the HBV DNA yield by 70% and 80%, respectively. HBV abrogated the ATR-dependent DNA damage signaling pathway by degrading p21, and introduction of the p21 protein before HBV infection reduced the HBV DNA yield. Consistent with this result, p21 accumulation after MG132 treatment also sharply decreased the HBV DNA yield. CONCLUSION: HBV infection can be treated with therapeutic approaches targeting host cell proteins by inhibiting a cellular gene required for HBV replication or by restoring a response abrogated by HBV, thus providing a potential approach to the prevention and treatment of HBV infection.

Effect of sevoflurane and halothane anesthesia on cognitive function and immune function in young rats.

In the current study, we scrutinized the effect of sevoflurane and halothane on cognitive and immune function in young rats. The rats were divided into following groups: sevoflurane, halothane and sevoflurane + halothane groups, respectively. The rats were regularly treated with the pre-determined treatment. We also scrutinized the serum proinflammatory cytokines including IL-10, IL-4 and IL-2; brain level IL-1ß; hippocampal neuronal apoptosis concentration were estimated. The water maze test was performed in rats for the estimation of cognitive ability. During the water maze test, on the 1st day the sevoflurane group showed the latency; sevoflurane and sevoflurane + halothane group demonstrated the declined latency gradually as compared to the control group rats after the 3 days. The latency of the control, halothane, sevoflurane + halothane group rats showed the reduced latency and also showed the reduced crossing circle times. The hippocampal neuron apoptosis was significantly increased in halothane and sevoflurane + halothane group as compared to control group rats, respectively. Control group rats demonstrated the increased neuron apoptosis. The proinflammatory cytokines including IL-10 and IL-4 was significantly higher in sevoflurane, halothane and sevoflurane + halothane group rats after anesthesia and the whole brain IL-1ß was significantly decrease in the sevoflurane, halothane and sevoflurane + halothane as compared to control group. Sevoflurane can inhibit the anesthesia effect of halothane on the immune and cognitive function of rats.

Icariine stimulates proliferation and differentiation of human osteoblasts by increasing production of bone morphogenetic protein 2.

BACKGROUND: Icariine is a flavonoid isolated from a traditional Chinese medicine Epimedium pubescens and is the main active compound of it. Recently, Epimedium pubescens was found to have a therapeutic effect on osteoporosis. But the mechanism is unclear. The aim of the study was to research the effect of Icariine on the proliferation and differentiation of human osteoblasts. METHODS: Human osteoblasts were obtained by inducing human marrow mesenchymal stem cells (hMSCs) directionally and were cultured in the presence of various concentrations of Icariine. 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) test was used to observe the effect of Icariine on cell proliferation. The activity of alkaline phosphatase (ALP) and the amount of calcified nodules were assayed to observe the effect on cell differentiation. The expression of bone morphogenetic protein 2 (BMP-2) mRNA was detected by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: Icariine (20 microg/ml) increased significantly the proliferation of human osteoblasts. And, Icariine (10 microg/ml and 20 microg/ml) increased the activity of ALP and the amount of calcified nodules of human osteoblasts significantly (P < 0.05). BMP-2 mRNA synthesis was elevated significantly in response to Icariine (20 microg/ml). CONCLUSIONS: Icariine has a direct stimulatory effect on the proliferation and differentiation of cultured human osteoblast cells in vitro, which may be mediated by increasing production of BMP-2 in osteoblasts.

[Single-stage combined anterior-posterior instrumentation for multiple level cervical spine fractures].

OBJECTIVE: To investigate the efficacy of single-stage combined anterior-posterior instrumentation for treatment of multiple level cervical spine fractures. METHODS: Nine patients with multiple-level fractures of the cervical spine, 8 males and 1 female aged 24 - 63, underwent ingle-stage combined anterior-posterior instrumentation. Seven patients with multiple contiguous fractures of the cervical spine were treated with anterior decompression and plating combined with posterior cervical lateral mass screw fixation; and 2 patients with non-contiguous cervical fractures, both with type II odontoid fracture and lower cervical fracture, were treated with both anterior odontoid screw and posterior cervical lateral mass screw fixation. Cranioskeletal traction with a weight of 5 kg was done before the operation. Follow-up was conducted for 31 months. ASIA motor scores were used to evaluate the neural function. RESULTS: Satisfactory reduction and fusion were obtained without any complication, and the neural function was improved. Nerve root function recovered in two patients and one patient's spinal cord function became normal. The average ASIA score was 63.8. CONCLUSION: A feasible option in the treatment of multiple level cervical spinal fractures, single-stage combined anterior-posterior instrumentation provides decompression and stabilization in a short time and helps the neural function to recover.

[The effect of early diagnosis of recurrence and revision after resection of primary spine tumors].

OBJECTIVE: To explore the effect of early diagnosis of recurrence and early revision after resection of primary spine tumors. METHODS: From March 1989 to September 2005, the relate clinic data of 55 patients with giant cell tumors, osteoblastomas, chondrosarcomas and chordomas in spine in big piecemeal and current fashion was analysed. RESULTS: In 55 cases, 43 patients were followed up and had complete materials. The follow-up time ranged from 1.6 to 16.5 years, averagely 5.8 years. Thirty-four patients followed up regularly, and 12 were found recurrent, in which one C(1) giant cell tumor was found extensively large 3 months after initial surgery and was undertaken palliatory curet. The other eleven lesions were small and re-operated with wide margin. As a result, six patients lived without tumors during the 1 approximately 9.5 years follow-up, one patient gave up revision when found recurred again for economic reason, another four patients recurred repeatedly, but they persisted in regular follow-up and took revision surgeries whenever the recurred lesion were found. As a result, 3 of them lived without tumor and the other one died of other disease without sign of recurrence. In contrast, there were another nine patients who came to follow up until they had symptoms and were confirmed recurrent extensively. Two of them were excised radically for the tumors located in the relatively easily exposed segments of spine and lived without tumor now. While the other seven patients only received palliatory curet and all died of tumors. CONCLUSIONS: Regular follow-up, early diagnosis of recurrence and early revision need to be regarded as part of radical excision and are very important of surgical treatment of spinal tumors, which can prolong the patients' survival time.

[Clinical characteristics and treatment of flexion-distraction stage I injuries in subaxial cervical spine].

OBJECTIVE: To study the clinical characteristics and treatment of flexion-distraction stage I injuries in subaxial cervical spine. METHODS: Twelve cases of flexion-distraction stage I injuries with delayed symptoms, admitted in our hospital between January 1995 and December 2004, were studied retrospectively. In acute phase, all of 12 cases had neck pain and limited neck movements, neurological deficits were found in 6 of 12 cases. Eight cases had a correct diagnosis, and 2 cases had a error diagnosis, 2 cases missed. All cases were satisfactory by the primary conservative treatment. After 274 days average asymptomatic intervals, all of 12 cases had recurrence of neck pain, delayed neurological deficits were found in 10. MRI showed that all of 12 cases were unstable injuries. RESULTS: All of the 12 patients were treated operatively. Decompression, fusion and fixation were performed by anterior approach in 9 cases, and by combined anterior and posterior approach in 3 cases. The average follow-up period was 33.1 months. Neck pain had great recovery in all cases, 10 cases with neurological deficits, 7 returned normal. Radiographic evidences of intervertebral bony fusion and good cervical alignment were observed in all of 12 cases. CONCLUSIONS: Flexion-distraction stage I injuries is often caused by ligament and disc injuries, and often missed with subtle symptoms and radiographic changes. Inadequate primary treatment options are often due to failure to recognize the instability, and maybe result in delayed injuries. MRI is helpful for the early accurate evaluation of spinal stability. Unstable injury require early surgical treatment. The anterior approach operation is recommended to most of these patients with acute and old injuries. Combined anterior and posterior approach operation should be considered in these patients who have old injuries with stiff kyphosis.

Endostatin promotes the anabolic program of rabbit chondrocyte.

Endostatin is a natural occurred angiogenesis inhibitor derived from collagenXVIII. So far its function during the angiogenesis process of bone formation and arthropathy has not been well studied yet. The present study addresses the function of endostatin in rabbit articular chondrocytes (RAC). We found that endostatin can promote RAC adhesion and spreading as well as its proliferation. In monolayer cultured RAC, CollagenII, TIMP1 and collagenXVIII transcription were up regulated by endostatin while collagenI and MMP9 were down regulated. Moreover collagenXVIII and endostatin antigens are present at synovial fluid. These findings indicate new function of endostatin as a homeostatic factor in cartilage metabolism.

[Surgical factors underlying the recurrence of primary spine tumor].

OBJECTIVE: To find the causes of the spinal primary tumors recurrence in surgical technique. METHODS: From 1989 to 2002, 38 cases of primary spine tumors, including giant cell tumor, osteoblastoma, chondrosarcoma and chordoma with wide resection via a piece-meal fashion. By adopting a retrospective method, the present study investigated the clinical and imaging materials of pre- and post-operation period and those in follow-up. RESULTS: The study included 18 cases of giant cell tumor, 6 osteoblastoma, 6 chondrosarcoma and 8 chordoma. In all cases, 63% of tumors were in cervical and cervicothoracic (C(7)-T(2)) spine; 29% in thoracolumbar (T(4)-L(5)) spine and 8% in sacrum. Tumors involved in multi-segment were 34%. And 71% patients had the tumor in the body and the arch simultaneously. And 71% of tumors formed paraspinal masses, 42% in both sides. The tumors invaded the channel in 58% of the cases. The compartment were invaded in 79% patients. Finally, 32 patients were followed up, from 1.0 approximately 14.9 years, 5.1 years average. Seventeen patients recurred after the surgery, the recurrence rate was 53%. The recurrence rate of giant cell tumor was 35%, osteoblastoma 50%, chondrosarcoma 75%, chordoma 100%. The recurrence rate of tumor in cervical and cervicothoracic spine was 63%, thoracic-lumbar 33%, sacrum 67%. The recurrence rate of multi-segment tumors was 80%, and that of single segment 41%. The recurrence rate of the tumors involving in vertebral body alone or involving the arch simultaneously reached 75% and 55% respectively; the recurrent rate in the arch alone was 33%. The recurrence rate of the tumors involving in vertebral body ranged in different segments. Those growing in cervical and cervicothoracic spine reached 73%; those growing in thoracolumbar spine was only 25%. The recurrence of the tumors without soft masses was 20%, those of single-sided soft masses was 45% and those of double-sided 91%. Among the 17 recurrent patients, 83% of the tumors were in the cervical and cervicothoracic spine. Those extending to the upper cervical and cervicothoracic amounted to 58%. All the 17 recurrent patients had body lesion and paraspinal soft masses. CONCLUSIONS: During the primary spinal tumor operation, that failure to get adequate exposure and full division is thought to be the cause of recurrence. So the precise design before surgery and adequate exposure of the tumor in the surgery is the guarantee of wide excision.

[Effects of Epimedium pubescens icariine on proliferation and differentiation of human osteoblasts].

OBJECTIVE: To study the effects of epimedium pubescens icariine on the proliferation and differentiation of human osteoblasts. METHOD: Human osteoblasts were obtained by inducting human marrow mesenchymal stem cells (hMSCs) directionally. MTT was used to observe the proliferation and activity of ALP was assayed to observe the differentiation of the third passage human osteoblasts cultured in vitro. The expression of BMP-2 mRNA was checked by RT-PCR. RESULT: Epimedium pubescens icariine at the dose of 20 microg x mL(-1) increased greatly the proliferation and differentiation of human osteoblasts and promoted the expression of BMP-2 mRNA. CONCLUSION: Epimedium pubescens icariine enhances significantly the proliferation and differentiation of human osteoblasts, which may be mediated by increasing the expression of BMP-2 mRNA.

[Immortalization of human osteoblast by transferring hTERT gene].

OBJECTIVE: To establish an immortalized osteoblast cell line used for basal and clinical research of orthopaedics. METHODS: Human marrow stromal cells (hMSCs) had been inducted into osteoblasts directionally, and human telomerase reverse transcriptase (hTERT) cDNA was transferred into the osteoblasts by retroviral vector pLPChTERT. The resultant stable clones reproduced successively and the expression of hTERT as well as the osteogenesis characteristics of different eras were identified. RESULT: hTERT gene has been transferred into human osteoblasts successfully. The transformed cells expressed telomerase activity and divided vigorously. p62 has been obtained so far. The expression of bone specific Alkaline phosphatase, Collagen type I and Osteopontin of p25, p55 were checked and it is proved that the immortalized cell line preserved typical osteogenesis characteristics. CONCLUSION: Osteoblasts can be immortalized by transferring exogenous hTERT gene to reconstitute telomerase activity, and the immortalized cell reserved osteogenesis characteristics.

[Detection and analysis of SARS coronavirus-specific antibodies in sera from non-SARS children].

OBJECTIVE: To examine the presence of severe acute respiratory syndrome (SARS) coronavirus-specific antibodies in the sera from non-SARS children. METHODS: Indirect immunofluorescent assay and double-antigen sandwich enzyme-linked immunosorbent assay (ELISA) were used to detect the virus-specific antibodies in sera of 1,060 non-SARS children in Guangzhou. RESULTS: All the serum samples from the 1,060 non-SARS children were negative for both IgG and IgM antibodies against SARS coronavirus as determined by indirect immunofluorescent assay, with only two serum samples showing weak positivity for SARS coronavirus-specific antibodies identified by double-antigen sandwich ELISA. CONCLUSION: No SARS coronavirus-specific antibody are present in the sera of non-SARS children.

[Evaluation of neck moving ability after anterior cervical fusion].

OBJECTIVE: To observe the relationship of adjacent segment degeneration and neck symptom after anterior cervical fusion. METHODS: Making follow-up to 66 cases who had accepted anterior cervical fusion for 1 - 16 years, average 10.5 years. Observe the mobilization and gliding degree of adjacent segment in flexion-extension X-ray film, neck symptom, and the relationship of them. In 59 of these patients, the mobilization of entire cervical spine and non-fusion segment was observed before/after operation. RESULTS: The incidence of adjacent segment instability in follow-up term was 72.7%, and 40.9% of all patients had significant neck symptom. The rate of significant neck symptom in patients who had instability was 48%, whereas which in patients without instability was 18.8%, and the difference was statistically significant (P < 0.05). The difference of mild instability and severe instability was not statistically significant (P > 0.1). The mobilization of entire cervical spine decreased obviously (P < 0.001). The mobilization of adjacent segment increased obviously (P < 0.01), and which of non-adjacent segment had no change (P > 0.05). CONCLUSION: Majority of patients who have accepted anterior cervical fusion possessed instability of adjacent segment, but many of them have no symptoms. Adjacent segment instability is one of the reasons that induce neck symptoms.

[The efficacy of allogenic strut bone graft and instrumentation for anterior cervical fusion following subtotal corpectomy and decompression in cervical myelopathy].

OBJECTIVE: To evaluate the efficacy of allogenic strut bone graft and instrumentation for anterior cervical fusion following subtotal corpectomy and decompression in cervical myelopathy. METHODS: Thirty-five patients with cervical myelopathy were treated by the procedure of allogenic strut bone graft and instrumentation for anterior cervical fusion following subtotal corpectomy and decompression. The preoperative average JOA scale score was 8.7 point (Range 4-15). RESULTS: Sixty-nine vertebral were corpectomized and 104 levels were decompressed and fused with an average of 3 levels. Among the cases, 1 vertebrae was corpectomized in 7 cases, 2 vertebra in 22 cases, 3 vertebra in 6 cases. There were no surgery-related complications. The patients were followed up from 11-37 months, with an average of 17.4 months. No plate breakage, screw loose, graft infection, lysis and absorption was discovered. The fusion rate was 100%, the average time of fusion was 9.3 months (range from 6-15 months). The postoperative average JOA scale score was 14.8 point (range 7-17), the recovery ratio was 73.5% and the excellent and good results was 82.8%. CONCLUSIONS: The use of allogenic strut bone graft and instrumentation for anterior cervical fusion following subtotal corpectomy and decompression in cervical myelopathy may not only simplify surgical procedure and decrease injuries and complications, but also the fusion is satisfactory and reliable.

[Diagnosis and treatment of esophageal fistula in anterior cervical spine surgery].

OBJECTIVE: To evaluate the causes, diagnosis, treatment and prevention of esophagocutaneous fistula in anterior cervical spine surgery. METHODS: Thirteen cases with esophagocutaneous fistula in anterior cervical spine surgery were studied. RESULTS: The causes includes: (1) During the operation, esophagus was oppressed by a clasp for so long time that made a pressure necrosis of the esophagus; (2) Esophagus was injured by loose plates and screws; (3) Loose bone grafts oppressed esophagus; (4) Esophagus was injured by operative appliance in the operation; (5) Esophagus was oppressed by the plate. DIAGNOSIS: After anterior cervical spine surgery if patients had a high fever, sore throat, swelling incision, and food sediment was found in the incision, esophagocutaneous fistula should be considered. The final diagnosis could be done by esophageal radiography. TREATMENT: Fasting cure, nasogastric tube and wound drainage should be used; When the inflammation ended, patients should undergo operation of closure of the esophageal fistula. CONCLUSIONS: The esophagocutaneous fistula in anterior cervical spine surgery has several causes mentioned above. We should take precautionary measures to avoid the complication, and use appropriate treatment to cure when it happens.