Clinical characteristics analysis of pediatric spinal cord injury without radiological abnormality in China: a retrospective study.

PURPOSE: This study aims to analyze the clinical characteristics of Chinese children with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) and explore their contributing factors and mechanisms of occurrence. METHODS: A retrospective analysis was conducted on the clinical data of pediatric patients diagnosed with SCIWORA from January 2005 to May 2020. Epidemiological, etiological, mechanistic, therapeutic, and outcome aspects were analyzed. RESULTS: A total of 47 patients with SCIWORA were included in this study, comprising 16 males and 31 females. The age range was 4 to 12 years, with an average age of 7.49 ± 2.04 years, and 70% of the patients were below eight. Sports-related injuries constituted 66%, with 70% attributed to dance backbend practice. Thoracic segment injuries accounted for 77%. In the American Spinal Injury Association (ASIA) classification, the combined proportion of A and B grades accounted for 88%. Conservative treatment was chosen by 98% of the patients, with muscle atrophy, spinal scoliosis, hip joint abnormalities, and urinary system infections being the most common complications. CONCLUSION: SCIWORA in Chinese children is more prevalent in those under eight years old, with a higher incidence in females than males. Thoracic spinal cord injuries are predominant, dance backbend as a primary contributing factor, and the social environment of "neijuan" is a critical potential inducing factor. Furthermore, the initial severity of the injury plays a decisive role in determining the prognosis of SCIWORA.

Prognostic factors in spinal chordoma: A systematic review.

OBJECTIVE: Discovering reliable prognostic factors for spinal chordoma remains a challenge. We attempted to identify evidence-based prognostic factors in the literature since its inception and to establish pooled relative risks (RR) of such factors. METHODS: MEDLINE and Embase search (inception to December 2014). Two reviewers independently selected papers involving spinal chordoma prognostic factors, and studied them for methodological quality and valuable new factors. Subsequently, we attempted to pool the results. RESULTS: Of 1465 citations, we studied 65 papers closely, and found several "new" prognostic factors. However, only eight papers were of adequate quality for analysis. Location in the upper cervical spine (pooled RR=5.46, 95% confidence interval [CI]: 2.23-13.34), worse preoperative Frankel score (pooled RR=2.77, 95% CI: 1.73-4.42), intralesional surgery (pooled RR=2.68, 95% CI: 1.66-4.32), greater extent of invasion (pooled RR=5.09, 95% CI: 1.49-17.41), and revision surgery (pooled RR=2.42, 95% CI: 1.34-4.36) appeared to be independent factors for worse outcome. CONCLUSIONS: Despite the wealth of literature available, disappointingly few papers are of sufficient quality for drawing valid conclusions related to spinal chordoma prognostic factors. The heterogeneity of the studies renders results pooling almost impossible. More accurate individual prognostication requires methodologically high-quality studies with more uniform study design and data reporting.

Reduced expression of miRNA-1237-3p associated with poor survival of spinal chordoma patients.

PURPOSE: Aberrant expression of miRNAs has been demonstrated to contribute to human carcinogenesis. This study was aimed at profiling differentially expressed miRNAs in formalin-fixed and paraffin-embedded tissues of spinal chordoma and testing the potential for using altered expression of miRNAs as prognostic markers for spinal chordoma patients. METHODS: A miRNA array was used to profile differentially expressed miRNAs in spinal chordoma and nucleus pulposus tissues. Four of these differentially expressed miRNAs was then validated in spinal chordoma and control patients using quantitative RT-PCR. Bioinformatical analysis identified potential GO terms and signaling pathways affected by these microRNAs. Altered miR-1237-3p expression was then found to be associated with clinicopathological characteristics and prognosis of spinal chordoma patients. RESULTS: The miRNA arrays identified 29 differentially expressed miRNAs in spinal chordoma tissues, four of which were verified by qRT-PCR in 42 spinal chordomas and 14 control tissues. Bioinformatical analysis revealed that the potential target genes of these miRNAs were mainly involved in gene transcription, cell junction proteins, and gene pathways in cancer and endocytosis. Reduced miR-1237-3p expression was associated with tumor invasion and worse recurrence-free survival of spinal chordoma patients (χ (2) = 16.217, p = 0.000, log-rank test). Multivariate analyses showed that miR-1237-3p expression was an independent prognostic factor for patients with spinal chordoma (HR = 0.001, 95 % CI 0.000-0.136, p = 0.005). CONCLUSION: The data from the current study identified a total of 29 differentially expressed miRNAs in chordoma tissues and reduced miR-1237-3p expression was associated with chordoma invasion and worse recurrence-free survival of the patients.

Spinal tuberculosis of the lumbar spine after percutaneous vertebral augmentation (vertebroplasty or kyphoplasty).

BACKGROUND CONTEXT: Spinal tuberculosis occurring after percutaneous vertebral augmentation has rarely been described. To date, only two such cases have been documented in the literature. Vertebral augmentation may reactivate a quiescent tuberculous lesion and promote the infective process in elderly patients with or without immunosuppression, thereby resulting in poor outcomes. PURPOSE: The purposes of this study were to present two cases in which spinal tuberculosis occurred after vertebroplasty or kyphoplasty, to highlight the clinical features and need for early diagnosis of this pathology, and to postulate probable reasons for this association. STUDY DESIGN: This study is based on a clinical case series and literature review. METHODS: In this report, we review the clinical histories of two old women undergoing vertebral augmentation with subsequent spinal tuberculosis. RESULTS: The first patient responded favorably to conservative treatment with multidrug antitubercular therapy and spinal braces. The second patient underwent surgical debridement through a posterior approach alone, without instrumentation, combined with adjuvant chemotherapy. By 1 year after treatment, both patients had experienced almost complete recovery and continued to be seen for follow-up visits. CONCLUSIONS: Suspicion should be high, and magnetic resonance imaging is warranted in cases with deteriorating clinical symptoms and signs of acute infection after vertebral augmentation. We propose obtaining exhaustive microbiologic and histologic evidence via needle biopsy or open surgery in a timely fashion to establish an accurate diagnosis because tubercular spondylitis occurring in such a situation may progress rapidly.

Postoperative initial single fungal discitis progressively spreading to adjacent multiple segments after lumbar discectomy.

OBJECTIVE: To report multiple cases and investigate etiology of initially single fungal spondylodiscitis that progressively spread to adjacent segments following lumbar discectomy, resulting in multiple spinal involvements. METHODS: From January 2005 to May 2013, ten adult patients were admitted or referred to our institution with postoperative discitis. Fungal infections were confirmed by microbiologic and pathologic examinations. The clinical appearance, radiographic features, and treatments of this pathology were investigated. RESULTS: All the patients were previously healthy. The average interval between the occurrence of symptoms and primary lumbar discectomy was 61 days (range, 15-120 days). All the patients were treated with anterior surgical debridement, interbody fusion, and prolonged antifungal therapy. Three patients additionally received combined posterior instrumented fusion. Despite aggressive surgical debridement and antifungal therapy, spread of the infections to adjacent multiple discs was observed. No deaths, severe neurologic deficits, or deterioration of neurologic status were noted. The infections were completely resolved in all cases with spontaneous fusion within an average follow-up of 32.4 months. CONCLUSION: Fungal spondylodiscitis after surgery represents an intractable and troublesome complication, and surgical debridement may not impede the progression of the infection in cases where an insufficient course of antifungal treatment is administered. Such cases may require prolonged antifungal treatment with regular consultation by an infectious disease specialist.

Identification of miR-140-3p as a marker associated with poor prognosis in spinal chordoma.

OBJECTIVE: To investigate the expression profile of miR-140-3p in formalin-fixed paraffin-embedded (FFPE) tissues of spinal chordoma, and its correlation with the prognosis of spinal chordoma patients. METHODS: Dysregulated miRNAs in FFPE tissues of spinal chordoma were identified by microarray analysis. MiR-140-3p expression in surgically removed spinal chordoma tissues of 42 spinal chordoma patients (27 males and 15 females, aged 29-76 years) and corresponding nucleus pulposus tissues of 14 patients with disc herniation as the healthy control group (8 males and 6 females, aged 24-73 years) was measured by real-time quantitative RT-PCR assay. The association of miR-140-3p expression with clinicopathologic characteristics of spinal chordoma patients was analyzed. Additionally, we investigated the prognostic significance of miR-140-3p with the use of Kaplan-Meier methods and a Cox proportional hazard model. RESULTS: The expression of miR-140-3p was significantly higher in chordoma tissues than nucleus pulposus tissues (t = 3.530, P = 0.001). The expression of miR-140-3p positively correlated with surrounding muscle invasion. The Kapan-Meier survival analysis showed that the patients with high miR-140-3p expression had a significantly worse recurrence-free survival than those with a low expression (χ (2) = 31.270, P = 0.000, log-rank test). In addition, univariate and multivariate analyses for recurrence-free survival showed that miR-140-3p expression was an independent prognostic factor for patients with spinal chordoma (HR = 1.361, 95% CI: 1.135-1.633, P = 0.001). CONCLUSION: Over-expression of miR-140-3p is correlated with recurrence and tumor invasion, suggesting that miR-140-3p could be a new predictor for recurrence and prognosis in patients with spinal chordoma.

Treatment of thoracic or lumbar spinal tuberculosis complicated by resultant listhesis at the involved segment.

PURPOSE: The purpose of this study was to present a singular pathological process of thoracic or lumbar spinal tuberculosis contributing to listhesis at the involved site, with special focus on clinical features and management of this disorder. METHODS: We retrospectively reviewed the medical records of 14 patients (5 males and 9 females, including 2 boys) admitted to our institution from April 2007 to March 2010 and were subsequently diagnosed with thoracic or lumbar spinal tuberculosis with resultant listhesis at the involved level. All patients underwent posterior instrumentation and reduction combined with single-stage anterior radical debridement and interbody fusion. Patients were followed-up clinically and radiographically. RESULTS: The average follow-up duration was 54.6 months. All patients had a successful fusion. Complete reduction was achieved in 10 cases. Preoperative neurological injury was observed in six patients and all recovered after surgery. The average postoperative Frankel grade improvement was 1.2. The preoperative median value of the extent of listhesis was 26.2%, which fell to zero at the final follow-up (Z=-3.296, P=0.001). Pre- and postoperative median spinal stenosis rates were 45.9% and 8.4%, respectively (Z=-3.296, P=0.001). The preoperative neurologic level was positively correlated with the listhesis distance before surgery (rs=0.770, P=0.001). Postoperatively, the spinal stenosis rate was positively correlated with listhesis distance (rs=0.691, P=0.006). The correlation between neurologic level and age or spinal stenosis rate was not significant. The standardized coefficient of listhesis distance was greater than that of spinal stenosis rate in our multiple linear regression analysis model. No implant failure or recurrence of tuberculosis occurred. CONCLUSION: Treatment of this rare pathology aims to restore good spinal alignment, radical debridement, and permanent stability. A reasonable surgical strategy may be the combination of posterior reduction, anterior debridement, and supportive graft fusion. This strategy can safely and effectively achieve all of the therapeutic goals in one step.

Taurine inhibits serum deprivation-induced osteoblast apoptosis via the taurine transporter/ERK signaling pathway

Taurine has positive effects on bone metabolism. However, the effects of taurine on osteoblast apoptosis in vitro have not been reported. The aim of this study was to investigate the activity of taurine on apoptosis of mouse osteoblastic MC3T3-E1 cells. The data showed that 1, 5, 10, or 20 mM taurine resulted in 16.7, 34.2, 66.9, or 63.75 percent reduction of MC3T3-E1 cell apoptosis induced by the serum deprivation (serum-free α-MEM), respectively. Taurine (1, 5, or 10 mM) also reduced cytochrome c release and inhibited activation of caspase-3 and -9, which were measured using fluorogenic substrates for caspase-3/caspase-9, in serum-deprived MC3T3-E1 cells. Furthermore, taurine (10 mM) induced extracellular signal-regulated kinase (ERK) phosphorylation in MC3T3-E1 cells. Knockdown of the taurine transporter (TAUT) or treatment with the ERK-specific inhibitor PD98059 (10 μM) blocked the activation of ERK induced by taurine (10 mM) and abolished the anti-apoptotic effect of taurine (10 mM) in MC3T3-E1 cells. The present results demonstrate for the first time that taurine inhibits serum deprivation-induced osteoblast apoptosis via the TAUT/ERK signaling pathway.

Taurine inhibits serum deprivation-induced osteoblast apoptosis via the taurine transporter/ERK signaling pathway.

Taurine has positive effects on bone metabolism. However, the effects of taurine on osteoblast apoptosis in vitro have not been reported. The aim of this study was to investigate the activity of taurine on apoptosis of mouse osteoblastic MC3T3-E1 cells. The data showed that 1, 5, 10, or 20 mM taurine resulted in 16.7, 34.2, 66.9, or 63.75% reduction of MC3T3-E1 cell apoptosis induced by the serum deprivation (serum-free α-MEM), respectively. Taurine (1, 5, or 10 mM) also reduced cytochrome c release and inhibited activation of caspase-3 and -9, which were measured using fluorogenic substrates for caspase-3/caspase-9, in serum-deprived MC3T3-E1 cells. Furthermore, taurine (10 mM) induced extracellular signal-regulated kinase (ERK) phosphorylation in MC3T3-E1 cells. Knockdown of the taurine transporter (TAUT) or treatment with the ERK-specific inhibitor PD98059 (10 µM) blocked the activation of ERK induced by taurine (10 mM) and abolished the anti-apoptotic effect of taurine (10 mM) in MC3T3-E1 cells. The present results demonstrate for the first time that taurine inhibits serum deprivation-induced osteoblast apoptosis via the TAUT/ERK signaling pathway.

[Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation].

OBJECTIVE: To evaluate the minimally invasive efficacy and surgical outcome of full-endoscopic discectomy via interlaminar approach for lumbar disc herniation (LDH). METHODS: From August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy (FED) group included 16 males and 12 females, the age was 20 - 51 years with a mean (36 ± 8) years, and the course of disease was 18 - 120 d with a mean (68 ± 26) days. There was L(5)-S(1) LDH in 22 and L(4-5) LDH in 6. Headlamp-assisted mini-open discectomy (HAMOD) group, there were 17 males and 11 females. The age was 17-53 years with an average age of (35 ± 9) years, the course of disease was 19 - 110 d with an average (66 ± 24) days, and the herniated disc located at L(5)-S(1) in 15 cases, and L(4-5) in 13 cases. Perioperative parameters (operation time, bleeding volume and length of hospital stay), complications and VAS of leg and back pain (preoperatively, 3 months postoperatively and final follow-up) were statistically analyzed. RESULTS: All patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was (71 ± 30) min and the headlamp group was (60 ± 12) min, which there was no statistical difference (P > 0.05). There was no measurable bleeding in full endoscopic group, and the headlamp group was (59 ± 10) ml. The average hospital days in full endoscopic group was (5.7 ± 1.4) days, and the headlamp group was (12.3 ± 3.0) days, there was statistically significant difference in both groups (P < 0.01). The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference (P > 0.05). There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up. With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group (P > 0.05). However, there was statistical significance in VAS back pain between the two groups (P < 0.01). CONCLUSIONS: Compared to the headlamp assisted mini-open technique, the full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.

Surgical treatment of cervical kyphosis.

Cervical kyphosis is an uncommon but potentially debilitating and challenging condition. We reviewed the etiology, presentation, clinical and radiological evaluation, and treatment of cervical kyphosis. Based on the current controversy as to the ideal mode of surgical management, we paid particular attention to the available surgical strategies. There are three approaches for cervical kyphosis: the anterior, posterior or combined procedures. The principal indication for the posterior strategy is a flexible kyphosis or kyphosis caused by ankylosing spondylitis. The main point of debate is between the choice of the anterior or the combined strategy. The two strategies were compared with regard to clinical outcome, correction of deformity, rate of fusion, complications, revision surgery, and mortality. The combined strategy appears to result in a greater degree of correction than the anterior-alone strategy, and it is more likely to improve the cervical alignment to achieve a lordosis. However, the procedure carries a higher rate of postoperative neurological deterioration, complications, revision surgery, and mortality. Although the anterior-alone strategy achieves a smaller reduction of cervical kyphosis, it has a lower rate of postoperative neurological deterioration, complications, revision surgery, and mortality. We recommend that the surgical treatment of cervical kyphosis should be planned on an individual basis. A multicenter, prospective, randomized controlled study would be necessary to determine the ideal mode of treatment for complex cervical kyphosis.

[One-stage combined anterior and posterior strategy in treating active tuberculosis of thoracic and lumbar spine complicated with severe kyphotic deformity].

OBJECTIVE: To explore an effective and reasonable surgical strategy for active spinal tuberculosis with severe kyphotic deformity (kyphotic angle >or= 45 degrees). METHODS: From January 2004 to January 2008, 30 consecutive patients of active spinal tuberculosis complicated with significant angulation were enrolled in this study, including 8 male and 22 female. The average age was 35 years (range, 7 - 60 years), with average angle of kyphosis of 58 degrees (range, 45 degrees - 70 degrees). There were 28 patients complicated with intraspinal abscess, of which 10 patients presented with incomplete paraplegia. According to the Frankel's scoring system, there were 2 patients with Frankel Grade B, 6 with Grade C, 2 with Grade D. After antituberculous chemotherapy (HREZ) for at least 2 weeks, all patients underwent posterior multiple-level pedicle screw instrumentation and kyphotic correction, and then received anterior debridement, decompression and supportive bone grafting, all of which were completed in the same day. The postoperative standardized chemotherapy was 6HREZ/6-12HRE. The angle of kyphosis, curve correction after surgery, and recovery of paraplegia were analyzed. Fusion status and erythrocyte sedimentation rate were recorded to determine the presence of active disease. RESULTS: Operative time was 4 to 6 hours (average 5.2 h), blood loss was 600 to 900 ml (average 760 ml). No perioperative severe complications occurred. The kyphotic angle was corrected to 0 degrees - 10 degrees, and the maximum corrected angle was 65 degrees . The average follow-up duration was 18 months (range, 12 - 48 m). All patients showed evidence of solid fusion and healing of the active disease at 6 months follow-up. Neurologic deficits were improved: 2 patients from B to D, 6 patients from C to E, 2 patients from D to E. No recurrence of the tuberculosis infection or instrumentation failure happened at final follow-up. CONCLUSION: Combined posterior instrumentation and anterior debridement, fusion surgery in one stage is proved to be successful in treating spinal tuberculosis, correcting the kyphosis, and providing solid fusion.

[Complications of one stage posterior vertebral column resection for the treatment of severe rigid spinal deformities].

OBJECTIVE: to summarize the complications of posterior vertebral column resection (pVCR) and pedicle screw fixation for the treatment of rigid thoracic and lumber spinal deformity. METHODS: fifty four patients from a single center from February 2000 to February 2009 were included in this study. There were 23 males and 31 females with an average age of 28.3 years (range, 16-58 years). Patients were divided into 4 diagnostic categories: severe scoliosis (n = 9, mean Cobb angle, 91.7°), kyphoscoliosis (n = 22, mean scoliosis, 101.5°, and mean kyphosis, 69.4°), angular kyphosis (n = 21, mean kyphosis, 72.2°), global kyphosis (n = 2, mean kyphosis, 93.6°). All of the patients received one stage pVCR combined correction with pedicle screws and circumferential fusion. Radiographs and hospital charts were reviewed to analyze the outcomes of correction. RESULTS: a mean of 1.4 vertebral levels were resected, the mean operative time was 470 min, and the mean blood loss was 4180 ml. All the patients were followed-up for an average time of 26 months (range, 12 - 66 months). At the latest follow-up, the major curve correction averaged: severe scoliosis 61.4° (67%), kyphoscoliosis 59.7° (56%)/kyphosis 42.3° (59%), angular kyphosis 48.5° (71%), global kyphosis 62.7° (67%). A total of 21 complications (38.9%) occurred in 17 patients, including 5 (9.3%) neurological complications happened in early stage and one case of delayed complete paraplegic. There were 11 (20.4%) non-neurological complications happened in early stage and 5 (9.3%) cases in late stage. CONCLUSIONS: one stage posterior-only vertebral column resection can achieve satisfactory correction of severe deformities with limited flexibility. Given its technically demanding and exhausting features, its potential risk of significant complications should be paid more attention.

[The assessment of accuracy and safety of thoracic pedicle screws placement with interlaminar fenestration technique in severe kyphoscoliosis treatment].

OBJECTIVE: To analyze the accuracy and safety of thoracic pedicle screws placement with interlaminar fenestration technique in severe kyphoscoliosis treatment. METHODS: Twenty-three cases of severe kyphoscoliosis between June 1996 and December 2007 underwent pedicle screw placement of thoracic vertebrae by interlaminar fenestration technique. Postoperative CT scan was performed in all cases; there were 9 males and 14 females with the averaging age 17.8 years old. The preoperative Cobb angle of the main thoracic curve was 97.3 degrees in average. The average kyphotic angle in main curve was 67.4 degrees . Patients who underwent screw placement by closing technique and postoperative CT scan in the same stage with severe kyphoscoliosis were selected as control group (B): there were 22 patients with the averaging age 17.2 years old. The preoperative Cobb angle of the main thoracic curve was 96.6 degrees in average. The average kyphotic angle in main curve was 62.1 degrees . The screw-related complications were analyzed and online measure and analyze the degree of screw penetration according to CT by statistics. RESULTS: There were 209 thoracic pedicle screws being inserted in group A, no spinal cord and large blood vessel injury occurred, 5 patients occurred intraoperative pedicle fracture, dura lesion had 4 patients. Screws misplacement ratio was 8.6%, there were 11 screws located in the thoracic pedicle laterally, 6 screws located in medially, 1 screw presented a moderate anterior cortical perforation. The number of screws misplacement in upper and mild thoracic vertebrae were 15, occupied 83.3%; the number of screws misplacement in lower thoracic vertebrae were 3, occupied 16.7%. There was statistics difference (P < 0.05). Of the total 116 thoracic pedicle screws inserted on the convex side, the ratio of screw misplacement was 5.2%; 93 screws on the concave side, the ratio of screw misplacement was 12.9%, there was statistics difference (P < 0.05). There were 201 thoracic pedicle screws being inserted in group B, no spinal cord and large blood vessel injury occurred, 16 patients occurred intraoperative pedicle fracture, dura lesion had 7 patients. The ratio of screw misplacement was 22.4%, there were 24 screws located in the thoracic pedicle laterally, 11 screws located in medially, 10 screw presented a moderate anterior cortical perforation. The ratio of screw misplacement in Group B was higher than Group A (P < 0.05). All cases received 3.2 years and 3.4 years follow-up. There was no obvious loss of correction in coronal and sagittal plane at the latest follow-up. CONCLUSIONS: It is technically demanding for placement of thoracic screw in the severe kyphoscoliosis treatment. The interlaminar fenestration technique can increase the accuracy and safety of thoracic pedicle screw placement.

Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis.

OBJECTIVE: To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis (AS) and the effect of combined anterior and posterior operation. METHODS: Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel's score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach. RESULTS: There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a long-term complication in follow-up. CONCLUSIONS: The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.

[One stage posterior vertebral column resection for the treatment of thorciclumbar tuberculosis with kyphotic deformity].

OBJECTIVE: To evaluate the clinical outcome of one stage posterior vertebral column resection in patients with spinal tuberculosis combined with kyphotic deformity. METHODS: Thirty-six patients with spinal tuberculosis combined with kyphotic deformity underwent posterior one-stage vertebral column resection reducing tension on the spinal cord from 1998 to 2006. The patients were mobilized with a thoracolumbar orthosis for 3 months. All patients had a minimum of a 2-year follow-up, and clinical examinations and radiographs were obtained at 6-month intervals. RESULTS: No perioperative mortality occurred. The average duration of surgery was 208 (145 approximately 385) min. The kyphotic Cobb angle improved from the preoperative average of 57.2 degree(17 degree approximately 86 degree) to a postoperative average of 8.9 degree(-6 degree approximately 27 degree). The average horizontal distance between C(7) and S(1) was 13.6 (8 approximately 19) mm preoperatively and 3.6 (-11 approximately 9) mm postoperatively. Nineteen patients had preoperative neurological deficits. Of them, 89.5% (17/19) showed a postoperative neurologic improvement. Perioperative complications occurred in 3(8.5%) of the 36 patients with pneumonias and superficial infections. Twenty-five patients (69.4%) showed radiographic evidence of solid fusion in the follow-up examinations. In the follow-up, 25% (9/36) patients rated their results as excellent, 66.7% (24/36) as good, 2 as fair, and 1 as poor. CONCLUSION: One stage posterior vertebral column resection for the treatment of spinal tuberculosis with kyphotic deformity is safe and effective. Because this procedure is highly technical, the surgeon must be familiar with the pathoanatomy and the operation must be carefully done.

[Combined anterior and posterior approach for cervical fracture-dislocation with ankylosing spondylitis].

OBJECTIVE: To discuss the pathological characteristics of cervical spinal fracture of ankylosing spondylitis (AS), and surgical effect by combined anterior and posterior operation. METHODS: Eighteen AS patients with traumatic cervical fracture-dislocation were treated from January 2000 to January 2006. The symptom duration of AS was 14.5 years in average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D in Frankel's score. All patients underwent surgical procedures by combined anterior and posterior approach. RESULTS: There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage. There were some extent neurological improvement in 14 incompletely paraplegic patients, no improvement in 4 complete paraplegia patients. The follow-up period was 21.2 months in average and the bone fusion was 3.6 months. There were 4 complications during perioperative period and 1 in long term follow-up. CONCLUSIONS: The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is the reasonable surgical strategy in the treatment of cervical spinal fracture-dislocation with AS.