Analysis of guide wire displacement in robot-assisted spinal pedicle screw implantation.

Robot-assisted pedicle screw placement is prone to guide wire migration, and the related influencing factors have not yet been discussed. Therefore, this study aimed to investigate and analyze the causes of robot-assisted spinal pedicle guide wire displacement and summarize the relevant treatment strategies. The surgical outcomes of 82 patients who underwent robotic-assisted pedicle screw spinal placement at our hospital between July 2022 and June 2023 were retrospectively analyzed. A total of 342 screws were placed in 82 patients; 47 guide wires were offset, 47 guide wires were replaced, and 295 guide wires were not significantly offset, with a first guide wire offset rate of 13.7% and a total guide wire offset rate of 12.1%. Univariate analysis showed that Screw placement level, whether respiration was controlled during guide wire placement, Hu value of CT, the position of needle insertion point, and operation time had a significant effect on guide wire deviation (P < 0.05). Multivariate logistic regression analysis showed that the inclusion of screw placement segments, whether breathing was controlled during guide wire placement, and Hu value of CT had a significant effect on guide wire offset (P < 0.05). Whether the guide wire was offset had no significant effect on the accuracy of subsequent pedicle screw implantation (P > 0.05). The level of screw placement, whether breathing was controlled during guide wire placement, and Hu value of CT were independent risk factors for guide wire deviation. When causing an excursion, screw orientation can be adjusted during intraoperative screw placement, and guide wire excursion has no significant impact on the accuracy of subsequent pedicle screw placement.

Reconstruction of complicated spinal tuberculosis with long-segment fibula transplantation: a case report.

BACKGROUND: Treating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB. CASE PRESENTATION: This report describes a case of tuberculosis affecting the vertebrae extending from thoracic 12 to lumbar 5 in a 60-year-old woman who suffered sudden paralysis in both lower extremities. The patient underwent emergency posterior paraspinal abscess clearance, laminectomy with spinal decompression. Partial correction of the kyphotic deformity via long-segment fixation from the T9 vertebral body to the ilium in a one-stage posterior procedure. The patient's neurological status was diagnosed as grade E on the American Spinal Injury Association (ASIA) scale after the one-stage operation. Following standardized 4-combination anti-tuberculosis drug therapy for three months in postoperative patients, the patient underwent two-stage transabdominal anterior abscess removal, partial debridement of the lesion and bilateral fibula graft support. One year after the two-stage operation, the patient's visual analog scale (VAS) score of back pain was 1 point, and the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels returned to normal. Five years after the second-stage operation, the Oswestry disability index (ODI) of patient quality of life was 14 points. There was a 4-degree change in the Cobb angle over five years. During the five-year follow-up period, the grafted fibula did not experience any subsidence. CONCLUSION: For patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral support, was an effective reconstruction method.

Specific microstructural changes of the cervical spinal cord in syringomyelia estimated by diffusion tensor imaging.

The microstructure of the spinal cord in syringomyelia has not been well studied. The aim of this study was to evaluate the microstructure of the cervical cord in patients with syringomyelia using diffusion tensor imaging (DTI) and to investigate the association between DTI parameters and the size of the syrinx cavity. Thirty patients with syringomyelia and 11 age-matched controls were included in this study. DTI and T1/T2-weighted MRI were used to estimate spinal microstructure. The patients were divided into a clinical symptom group (group A) and a non-clinical symptom group (group B) according to ASIA assessments. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values (mm2/s) were measured and compared between patients and controls. Correlation between FA/ADC and the size of the syrinx cavity was examined with a bivariate analysis. FA values were lower (P < 0.000) and ADC values were higher (P < 0.000) compared to the controls at the level of all syrinxes examined in patients with syringomyelia; both FA values and ADC values reached normal values either above or below the syrinx levels (all P > 0.05). FA values and ADC values at all cervical levels were not significantly different either in controls or outside of the syrinx (all P > 0.05). FA values of group A was significantly lower than those of group B (P < 0.000). There was a negative association between FA values and the size of syrinx cavity, and a positive association between ADC values and the size of syrinx cavity (FA: P < 0.05, ADC: P < 0.05). The microstructure of the cervical spinal cord is different across all patients with syringomyelia. DTI is a promising tool for estimating quantitative pathological characteristics that are not visible with general MRI.

Microstructural Changes in Compressed Cervical Spinal Cord Are Consistent With Clinical Symptoms and Symptom Duration.

STUDY DESIGN: A prospective study. OBJECTIVE: To investigate the association between microstructural changes measured by diffusion tensor imaging (DTI) and clinical symptoms and their duration in patients with cervical spondylotic myelopathy (CSM) affected by single level. SUMMARY OF BACKGROUND DATA: No report was reported regarding the association between the microstructural changes and the symptoms and their duration at single-level spinal cord compression. METHODS: Twenty-nine consecutive patients with CSM and 29 normal subjects were enrolled in this study. DTI with tractography was performed on the cervical spinal cord. Clinical symptoms were evaluated using modified Japanese Orthopaedic Association (mJOA) scores for each patient, and the duration of clinical symptoms was noted based on the earliest instance of limb pain or numbness or weakness or bladder dysfunction. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from tractography images. RESULTS: The mean FA value of the cervical compressed spinal cord was significantly lower than the FA of the normal population (P < 0.001). The mean ADC value in the cervical compressed spinal cord was obviously higher than those of normal cervical spinal cord (P < 0.001). In the CSM patients, a significant positive association was observed between FA values and mJOA scores (P < 0.001). However, there were a notable negative association between mJOA scores and ADC values (P < 0.001), and between mJOA scores and symptom duration (P < 0.001). CONCLUSION: These results illustrate DTI can measure the micostructural changes of cervical spinal cord and DTI parameters are potential biomarkers for spinal cord dysfunction in patients with CSM. LEVEL OF EVIDENCE: 3.

The Role of Gene Expression Changes in ceRNA Network Underlying Ossification of Ligamentum Flavum Development.

We aimed at exploring the role of gene expression changes regulated by non-coding RNAs in ossification of ligamentum flavum (OLF). Three microarray datasets, including long non-coding RNA (lncRNA)/mRNA expression profile (GSE106253), circular RNA (circRNA) expression profile (GSE106255), and microRNA (miRNA) expression profile (GSE106256), were downloaded from the public Gene Expression Omnibus repository. The differentially expressed (DE) mRNAs, lncRNAs, miRNAs, and circRNAs in OLF tissues were analyzed, compared with normal tissues. Two competing endogenous RNA (ceRNA) networks with lncRNA-miRNA-mRNA and circRNA-miRNA-mRNA interactions were constructed, separately. Random walk with the restart model was applied to calculate the correlations of mRNAs with the published OLF-related genes. The top 50 mRNAs were subjected to function enrichment analysis and active small-molecule prediction. Total 2323 DE mRNAs, 1168 lncRNAs, 336 circRNAs, and 29 miRNAs were identified based on the microarray datasets. The LncRNA-related ceRNA network was constructed with 614 lncRNA-miRNA, 494 miRNA-mRNA, and 2099 lncRNA-mRNA interaction pairs; the circRNA-related ceRNA network was constructed with 153 circRNA-miRNA, 190 miRNA-mRNA, and 210 circRNA-mRNA interaction pairs. There were 17 OLF-related genes retrieved from previous literature, such as NPPS, COL6A1, and COL11A2, among which COL6A1 was the overlapped gene with mRNAs in the ceRNA network. Subsequently, top 50 mRNAs that closely correlated with COL6A1 in the ceRNA network were captured and these genes were closely related with the collagen catabolic process, regulation of cell growth, and neuronal action potential. DRD1 and COL6A1 were predicted to be the targets by small active molecule drugs. The collagen catabolic process may be implicated in OLF development. COL6A1 and DRD1 may be the candidate targets for OLF. However, further validations were needed.

MiR-564 is down-regulated in osteosarcoma and inhibits the proliferation of osteosarcoma cells via targeting Akt.

Aberrant expression of miRNAs has been observed in a variety of human cancers. In this study, we reported that miR-564 was down-regulated in human osteosarcoma (OS) cell lines and patients. Overexpression of miR-564 in OS cells suppressed the cell proliferation and induced cell apoptosis. Mechanistically, we identified Akt as a direct target of miR-564. Highly expressed miR-564 decreased the expression of Akt at both mRNA and protein level and consequently, inhibited the essential role of Akt in the glycolysis of OS cells. Notably, restoring the expression of Akt in miR-564 overexpressing cells recovered the glucose metabolism and cell growth. These results suggested that miR-564 inhibited the glycolysis and cell proliferation through directly targeting Akt, which highlighted the potential application of miR-564-Akt axis in the treatment of osteosarcoma.

Daidzein ameliorates spinal cord ischemia/reperfusion injury-induced neurological function deficits in Sprague-Dawley rats through PI3K/Akt signaling pathway.

Daidzein (DZ) has a broad spectrum of biological activities, including antioxidant, anti-inflammatory and anticancer as well as cardio- and hepatoprotective properties. The present study was designed to elucidate the in-depth mechanism underlying the neuroprotective efficacy of DZ against spinal cord ischemic/reperfusion injury (SCII) in a rat model by comparison with the standard neuroprotective agent methylprednisolone (MP). A total of 48 rats were divided into four groups of twelve rats in each (n=12). In sham-operated group (Control) group, rats received only saline (Fogarty catheter was inserted without balloon inflation), whereas rats in the SCII induction group (SCII) were subjected to SCII insult by insertion of a Fogarty balloon catheter, which was inflated in the descending thoracic aorta to cause an occlusion. A proportion of rats was treated with DZ (20 mg/kg; DZ+SCII group) or MP (50 mg/kg; MP+SCII group) for seven days prior to and after SCII. The locomotor function (neurological activity) and antioxidant levels (superoxide dismutase and catalase) levels were significantly improved upon treatment with DZ and MP in comparison with those in the SCII group. A concomitant decline in edema, inflammatory markers (myeloperoxidase, tumor necrosis factor-α and nuclear factor κB p65), the apoptotic marker caspase-3 and the number of cells with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was also observed in the DZ and MP groups. The protein levels of phosphoinositide-3 kinase (PI3K), the phosphorylated Akt/Akt ratio and B-cell lymphoma 2 (Bcl-2) were substantially downregulated, while Bcl-2-associated X protein levels were upregulated SCII insult group, which was inhibited by treatment with DZ. To conclude, pre-treatment with DZ significantly improved the neurological function by upregulating PI3K/Akt signaling and thereby considerably attenuating the inflammatory response and apoptosis, thus maintaining the neuronal count in an SCII-induced rat model.

Entire syringomyelia associated with Chiari II malformation and severe scoliosis and hydrocephalus.

BACKGROUND: The syrinx can occur in any region of the spinal cord and is common in cervical and/or thoracic region, and distributing along spinal cord is unusual, especially association with Chiari II malformation and scoliosis. OBJECTIVE: To report a first case of entire syringomyelia associated with Chiari II malformation and severe scoliosis and hydrocephalus. CASE PRESENTATION: The patient began to experience symptoms of bilateral hand weakness in adulthood. In this patient, MR imaging of the brain and spine showed syrinx along entire spine and hydrocephalus, cerebellar tonsillar herniation, and expansion of the fourth ventricle and posterior cranial fossa. The patient underwent operative treatment to prevent the progression of her neurological deficit. At 12 months' follow-up, the patient's neurological deficit remains stable with the scoliosis left untreated. CONCLUSIONS: Foramen magnum decompression, duraplasty and syrinx-shunting are effective methods even to CM II and entire syrinx.

Comparison of medial versus lateral meniscus allograft transplantation. Literature review and meta-analysis.

OBJECTIVES: To perform a literature review and meta-analysis evaluating the effectiveness of medial and lateral meniscus allograft transplantation (MAT). METHODS: The literature review and meta-analysis were conducted between August and October 2015 in the People's Hospital of China Three Gorges University, Yi Chang, China. A systematic search was performed in the Medline and EMBASE databases, and the Cochrane Library for relevant literature published through October 2015. The outcomes of the included studies were analyzed in terms of the Lysholm Score, International Knee Documentation Committee (IKDC) Score, Knee Injury And Osteoarthritis Outcome Score (KOOS), Visual Analog Scale (VAS), Tegner Activity Score,  MRI results, and failure rates. An adapted version of the Newcastle-Ottawa Scale was used for the methodological quality assessment in the meta-analyses. RESULTS: The literature review identified 12 observational studies, including 7 retrospective studies, 4 prospective studies, and the nature of one study was not reported. Significant differences in the outcomes of the lateral MAT group and the medial MAT group were observed in the IKDC scores, KOOS pain values, KOOS activities of daily living (ADL) values, and the absolute and relative extrusions observed on MRI, which suggested that the lateral MAT patients experienced superior clinical benefits compared with the medial MAT patients. However, significant differences between the lateral MAT group and the medial MAT group were not observed with regards to the Lysholm Scores, KOOS symptom values, KOOS sports and recreations values, KOOS quality of life (QOL) values, Tegner Activity Scores, VAS for pain values, and failure rates. CONCLUSION: The analysis results indicated that lateral MAT provides superior clinical outcomes compared with medial MAT according to the KOOS and IKDC scores. In addition, greater graft extrusion was observed in the medial group on MRI. Although significant differences were not detected between the 2 groups, the medial MAT patients were more prone to failure compared with the lateral MAT patients.

Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature.

OBJECTIVE: The object of the present meta-analysis is to compare the effectiveness of transforaminal epidural steroid injection (TFESI) and interlaminar epidural steroid injection (ILESI) for treating patients with low back pain (LBP) secondary to lumbosacral radicular pain. METHODS: A systematic search was performed in the PubMed and Embase databases and the Cochrane Library for relevant literature published through January 2016. The randomized controlled trials (RCTs) and controlled observational studies were selected, which did not only compare TFESI with ILESI but also reported the available data. The Cochrane Collaboration's Handbook and Newcastle-Ottawa Scale (NOS) were used for the methodological quality assessments of the RCTs and observational studies respectively. The meta-analysis was performed using the Revman 5.2 software. RESULTS: A total of 931 patients from nine RCTs and four observational studies were subjected to meta-analysis. In primary outcomes, the TFESI patients experienced superior pain relief compared with the TFESI patients in RCTs (P = 0.01), but not in observational studies (p = 0.63). The pooled data of RCTs showed that the TFESI group presented superior clinical results in terms of visual analogue scale (VAS) than the ILESI group (p = 0.0005). Moreover, the numeric rating scale (NRS) specifically favored TFESI in the RCTs (p < 0000.1). Similar functional improvement and oswentry disability index (ODI) score were observed between TFESI and ILESI in RCTs (P = 0.62). In secondary outcomes, meta-analysis of RCTs and observational studies revealed that there were no statistically significant differences between both groups in regard to procedure frequency, surgery rate, and ventral epidural spread. CONCLUSIONS: According to the results of meta-analysis, TFESI to manage LBP provides superior short term pain relief and equal functional improvement when compared to ILESI. It has not shown a statistically significant difference between both groups with regard to procedure frequency, surgery rate, and ventral epidural spread.

SPRY4 Intronic Transcript 1 Promotes Epithelial-Mesenchymal Transition Through Association with Snail1 in Osteosarcoma.

Osteosarcoma is an aggressive tumor and the most common malignancy of the skeleton. Due to pulmonary metastasis, the 5-year survival rate is still unsatisfactory. It has been reported that SPRY4 intronic transcript 1 (SPRY4-IT1) promotes cell growth, invasion, and inhibits apoptosis in several cancers. However, the role of SPRY4-IT1 in osteosarcoma remains unclear. In the present study, we investigated the role of SPRY4-IT1 in osteosarcoma cells. Loss- and gain-of-function assays demonstrated that SPRY4-IT1 promoted cell proliferation, migration, and invasion in osteosarcoma. Moreover, SPRY4-IT1 induced epithelial-mesenchymal transition phenotype in osteosarcoma cells. Subsequent investigations revealed that SPRY4-IT1 promoted migration and invasion through association with Snail1 and regulating its stability. Based on these findings, the SPRY4-IT1/Snail1/E-cadherin pathway may play a crucial role in promoting osteosarcoma metastasis. Thus, SPRY4-IT1 may be a potential target for new therapies of osteosarcoma.

Microstructural Changes in Compressed Nerve Roots Are Consistent With Clinical Symptoms and Symptom Duration in Patients With Lumbar Disc Herniation.

STUDY DESIGN: A prospective study. OBJECTIVE: To investigate the association between microstructural nerve roots changes on diffusion tensor imaging (DTI) and clinical symptoms and their duration in patients with lumbar disc herniation. SUMMARY OF BACKGROUND DATA: The ability to identify microstructural properties of the nervous system with DTI has been demonstrated in many studies. However, there are no data regarding the association between microstructural changes evaluated using DTI and symptoms assessed with the Oswestry Disability Index (ODI) and their duration. METHODS: Forty consecutive patients with foraminal disc herniation affecting unilateral sacral 1 (S1) nerve roots were enrolled in this study. DTI with tractography was performed on the S1 nerve roots. Clinical symptoms were evaluated using an ODI questionnaire for each patient, and the duration of clinical symptoms was noted based on the earliest instance of leg pain and numbness. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from tractography images. RESULTS: The mean FA value of the compressed lumbar nerve roots was significantly lower than the FA of the contralateral nerve roots (P < 0.001). No notable difference in ADC was observed between compressed nerve roots and contralateral nerve roots (P = 0.517). In the compressed nerve roots, a significant negative association was observed between FA values and ODI and symptom duration. However, an obvious positive association was observed between ODI and ADC values and duration on the compressed side. CONCLUSION: Significant changes in diffusion parameters were found in the compressed sacral nerves in patients with lumbar disc herniation and leg pain, indicating that the microstructure of the nerve root has been damaged. LEVEL OF EVIDENCE: 3.

Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools.

BACKGROUND: Although many studies on reliability and reproducibility of measurement have been performed on coronal Cobb angle, few results about reliability and reproducibility are reported on sagittal alignment measurement including the pelvis. We usually use SurgimapSpine software to measure the Cobb angle in our studies; however, there are no reports till date on its reliability and reproducible measurements. METHODS: Sixty-eight standard standing posteroanterior whole-spine radiographs were reviewed. Three examiners carried out the measurements independently under the settings of manual measurement on X-ray radiographies and SurgimapSpine software on the computer. Parameters measured included pelvic incidence, sacral slope, pelvic tilt, Lumbar lordosis (LL), thoracic kyphosis, and coronal Cobb angle. SPSS 16.0 software was used for statistical analyses. The means, standard deviations, intraclass and interclass correlation coefficient (ICC), and 95% confidence intervals (CI) were calculated. RESULTS: There was no notable difference between the two tools (P = 0.21) for the coronal Cobb angle. In the sagittal plane parameters, the ICC of intraobserver reliability for the manual measures varied from 0.65 (T2-T5 angle) to 0.95 (LL angle). Further, for SurgimapSpine tool, the ICC ranged from 0.75 to 0.98. No significant difference in intraobserver reliability was found between the two measurements (P > 0.05). As for the interobserver reliability, measurements with SurgimapSpine tool had better ICC (0.71 to 0.98 vs 0.59 to 0.96) and Pearson's coefficient (0.76 to 0.99 vs 0.60 to 0.97). The reliability of SurgimapSpine measures was significantly higher in all parameters except for the coronal Cobb angle where the difference was not significant (P > 0.05). CONCLUSION: Although the differences between the two methods are very small, the results of this study indicate that the SurgimapSpine measurement is an equivalent measuring tool to the traditional manual in coronal Cobb angle, but is advantageous in spino-pelvic measurement in T2-T5, PT, PI, SS, and LL.

Score distribution of the scoliosis research society health-related quality of life in different subgroups of adolescent subjects unaffected by scoliosis in China.

STUDY DESIGN: A comparative study. OBJECTIVE: The aims of this study were to: (1) evaluate Scoliosis Research Society (SRS)-22 questionnaire performance in normal adolescents without scoliosis to establish a normative baseline useful for evaluating the discriminate validity of the SRS-22 in primary adolescent scoliosis; and (2) investigate impact of age and sex on SRS-22 in an adolescent population unaffected by scoliosis. SUMMARY OF BACKGROUND DATA: The SRS-22 questionnaire is widely used to measure health-related quality of life of patients with spinal disease including scoliosis and lumbar spondylolisthesis. However, normal data, which are very important, when comparing patients and nonpatients, are few, little, and there are few studies about factors that may affect SRS questionnaire performance. METHODS: The adolescent population was from 14 schools located in 7 provinces. A total of 2008 adolescents (961 females, 1026 males, 21 unknown; mean age, 14.3 yr; range, 11-20) completed the simplified Chinese version of SRS-22 questionnaire and demographic questions. Surveys were stratified into 8 age-sex groups for analysis: male/female; 12 to 13.4, 13.5 to 14.9, 15 to 15.9, and more than 16 years of age. Post hoc testing and the Tukey least significant difference were used to compare differences between any 2 of the 4 age groups. RESULTS: Self-image scores in males were higher than those in females (P < 0.01). Pain domain scores were significantly higher in males than those in females in the 13.5- to 14.9-year-old subgroup, whereas other subgroups showed no obvious differences. The function domain scores in males who were aged 15 to 15.9 years and those older than 16 years were significantly higher than those in females (P < 0.001). There were no statistically significant differences in mental health domain scores among age-sex subgroups, with the exception of the 13.5- to 14.9-year-old group. CONCLUSION: This is the first study to characterize the sex and age influence on the SRS-22 scores in normal population. Age and sex have an important effect on SRS-22 scores, so when using the instrument to assess health-related quality of life of patients with scoliosis or other spinal disease, we should consider the differences in patients with different age and sex. LEVEL OF EVIDENCE: 3.