Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures.

BACKGROUND: This study aimed to determine if the hybrid short-segment (HSS) technique is a good alternative to the intermediate-segment (IS) and long-segment (LS) techniques in pedicle screw fixations for acute thoracolumbar burst fractures (TLBFs). METHODS: In this retrospective evaluation, we examined 43 patients who underwent surgical treatments, including one- or two-level suprajacent (U) and infrajacent (L) pedicle screw fixations, for acute single-level TLBFs with neurological deficits between the T11 and L2 levels from July 2013 to December 2019. Among these patients, 15 individuals underwent HSS (U1L1), 12 received IS (U2L1), and 16 underwent LS (U2L2) fixations. Supplemental kyphoplasty of the fractured vertebral bodies was performed exclusively in the HSS group. Our analysis focused on assessing blood loss and surgical duration. Additionally, we compared postoperative thoracolumbar kyphotic degeneration using the data on Cobb angles on lateral radiographic images acquired at three time points (preoperatively, postoperative day 1, and follow-up). The end of follow-up was defined as the most recent postoperative radiographic image or implant complication occurrence. RESULTS: Blood loss and surgical duration were significantly lower in the HSS group than in the IS and LS groups. Additionally, the HSS group exhibited the lowest implant complication rate (2/15, 13.33%), followed by the LS (6/16, 37.5%) and IS (8/12, 66.7%) group. Implant complications occurred at a mean follow-up of 7.5 (range: 6-9), 9 (range: 5-23), and 7 (range: 1-21) months in the HSS, IS, and LS groups. Among these implant complications, revision surgeries were performed in two patients in the HSS group, two in the IS group, and one in the LS group. One patient treated by HSS with balloon kyphoplasty underwent reoperation because of symptomatic cement leakage. CONCLUSIONS: The HSS technique reduced intraoperative blood loss, surgical duration, and postoperative implant complications, indicating it is a good alternative to the IS and LS techniques for treating acute single-level TLBFs. This technique facilitates immediate kyphosis correction and successful maintenance of the corrected alignment within 1 year. Supplemental kyphoplasty with SpineJack® devices and high-viscosity bone cements for anterior reconstruction can potentially decrease the risk of cement leakage and related issues.

Increased hip adductor activation during sit-to-stand improves muscle activation timing and rising-up mechanics in individuals with hemiparesis.

Long sit-to-stand (STS) time has been identified as a feature of impaired functional mobility. The changes in biomechanics of STS performance with simultaneous hip adductor contraction have not been studied, which may limit indications for use of hip adductor activation during STS training. Ten individuals with hemiplegia (mean age 61.8 years, injury time 29.8 ± 15.2 months) performed the STS with and without squeezing a ball between two legs. The joint moments, ground reaction force (GRF), chair reaction force and movement durations and temporal index of electromyography were calculated from the control condition for comparison with those from the ball squeezing condition. Under the squeeze condition, reduced peak vertical GRF during the ascension phase with increased loading rate was observed in the nonparetic limb, and the peak knee extensor moment occurred earlier in the paretic. Earlier activation of tibialis anterior and gluteus maximus, and gluteus medius were found in squeeze STS. Squeezing a ball between limbs during STS increased the contraction timing of tibialis anterior, gluteus maximus, gluteus medius, and soleus as well as a more symmetric rising mechanics encourage the use of squeezing a ball between limbs during STS for individuals with hemiparesis.

Risk factors of postoperative hydrocephalus following decompressive craniectomy for spontaneous intracranial hemorrhages and intraventricular hemorrhage.

INTRODUCTION: Hydrocephalus is a complication of spontaneous intracerebral hemorrhage; however, its predictive relationship with hydrocephalus in this patient cohort is not understood. Here, we evaluated the incidence and risk factors of hydrocephalus after craniectomy. METHODS: Retrospectively studied data from 39 patients in the same hospital from 2016/01 to 2020/12 and analyzed risk factors for hydrocephalus. The clinical data recorded included patient age, sex, timing of surgery, initial Glasgow Coma Scale score, intracerebral hemorrhage (ICH) score, alcohol consumption, cigarette smoking, medical comorbidity, and blood data. Predictors of patient outcomes were determined using Student t test, chi-square test, and logistic regression. RESULTS: We recruited 39 patients with cerebral herniation who underwent craniectomy for spontaneous supratentorial hemorrhage. Persistent hydrocephalus was observed in 17 patients. The development of hydrocephalus was significantly associated with the timing of operation, cigarette smoking, and alcohol consumption according to the Student t test and chi-square test. Univariate and multivariate analyses suggested that postoperative hydrocephalus was significantly associated with the timing of surgery (P = .031) and cigarette smoking (P = .041). DISCUSSION: The incidence of hydrocephalus in patients who underwent delayed operation (more than 4 hours) was lower than that in patients who underwent an operation after less than 4 hours. nonsmoking groups also have lower incidence of hydrocephalus. Among patients who suffered from spontaneous supratentorial hemorrhage and need to receive emergent craniectomy, physicians should be reminded that postoperative hydrocephalus followed by ventriculoperitoneal shunting may be necessary in the future.

Assessing the Global Impact on the Mouse Kidney After Traumatic Brain Injury: A Transcriptomic Study.

Purpose: In this study, we use animal models combined with bioinformatics strategies to investigate the potential changes in overall renal transcriptional expression after traumatic brain injury. Methods: Microarray analysis was performed after kidney acquisition using unilateral controlled cortical impact as the primary mouse TBI model. Multi-oriented gene set enrichment analysis was performed for differentially expressed genes. Results: The results showed that TBI affected the gene set associated with mitochondria function in kidney cells, and a negative enrichment of gene sets associated with immune cell migration and epidermal development was also observed. Analysis of the disease phenotype gene set revealed that differential expression of mitochondria-related genes was associated with lactate metabolism. Alternatively, activation and adhesion of immune cells associated with the complement system may promote autoinflammation in kidney tissue. The simulated immune cell infiltration analysis showed an increase in the proportion of activated memory CD4 T cells and a decrease in the proportion of resting memory CD4 T cells, suggesting that activated memory CD4 T cell infiltration may be involved in the inflammation of renal tissue and cause damage to renal cells, such as principal cells, mesangial cells and loops of Henle cells. Conclusion: This study is the first to reveal the effects of brain trauma on the kidney. TBI may affect the expression of mitochondria function-related gene sets in renal cells by increasing lactate. It may also affect renal mesangial cells by inducing increased infiltration of immune cells through mechanisms related to complement system activation or autoimmune antibodies.

The Use of Wearable Sensors for the Movement Assessment on Muscle Contraction Sequences in Post-Stroke Patients during Sit-to-Stand.

Electromyography (EMG) sensors have been used to study the sequence of muscle contractions during sit-to-stand (STS) in post-stroke patients. However, the majority of the studies used wired sensors with a limited number of placements. Using the latest improved wearable technology with 16 sensors, the current study was a thorough investigation to evaluate the contraction sequences of eight key muscles on the trunk and bilateral limbs during STS in post-stroke patients, as it became feasible. Multiple wearable sensors for the detection of muscle contraction sequences showed that the post-stroke patients performed STS with abnormal firing sequences, not only in the primary mover on the sagittal plane during raising, but also in the tibialis anterior, which may affect anticipatory postural adjustment in the gluteus medius, which may affect balance control. The abnormal tibialis anterior contraction until the early ascending phase and the delayed firing of the gluteus muscles highlight the importance of whole-kinetic-chain monitoring of contraction sequences using wearable sensors. The findings can be helpful for the design of therapeutic exercises.

Multiple-Wearable-Sensor-Based Gait Classification and Analysis in Patients with Neurological Disorders.

The aim of this study was to conduct a comprehensive analysis of the placement of multiple wearable sensors for the purpose of analyzing and classifying the gaits of patients with neurological disorders. Seven inertial measurement unit (IMU) sensors were placed at seven locations: the lower back (L5) and both sides of the thigh, distal tibia (shank), and foot. The 20 subjects selected to participate in this study were separated into two groups: stroke patients (11) and patients with neurological disorders other than stroke (brain concussion, spinal injury, or brain hemorrhage) (9). The temporal parameters of gait were calculated using a wearable device, and various features and sensor configurations were examined to establish the ideal accuracy for classifying different groups. A comparison of the various methods and features for classifying the three groups revealed that a combination of time domain and gait temporal feature-based classification with the Multilayer Perceptron (MLP) algorithm outperformed the other methods of feature-based classification. The classification results of different sensor placements revealed that the sensor placed on the shank achieved higher accuracy than the other sensor placements (L5, foot, and thigh). The placement-based classification of the shank sensor achieved 89.13% testing accuracy with the Decision Tree (DT) classifier algorithm. The results of this study indicate that the wearable IMU device is capable of differentiating between the gait patterns of healthy patients, patients with stroke, and patients with other neurological disorders. Moreover, the most favorable results were reported for the classification that used the combination of time domain and gait temporal features as the model input and the shank location for sensor placement.

Biomechanical effects of cage positions and facet fixation on initial stability of the anterior lumbar interbody fusion motion segment.

STUDY DESIGN: An in vitro biomechanical study using porcine lumbar segments as specimens. OBJECTIVE: To evaluate the effects of interbody cage support and endplate strength on the stability of instrumented segments. SUMMARY OF BACKGROUND DATA: The anterior lumbar interbody fusion (ALIF) cage is widely used to restore disc height and support the anterior column. Transpedicle or posterior spinal fusion or facet screw fixation (FSF) can improve the stability of the vertebra-instrumented segments. The cage position can affect the anterior support and initial stability of the ALIF region, but there is no consistent data on its biomechanical effects on ALIF and ALIF/FSF segments. METHODS: Nine variations of 3 instrumentation modes (intact, ALIF, ALIF/FSF) and 3 cage positions (type I, anterolateral; type II, mediolateral; and type III, posteromedial) are tested under 5 lumbar motions. The range of motion and axial displacement are used as comparison indices for the different variations. RESULTS: The cage placement serves as support for the intervertebral loads while the posterior fixation behaves as lever to further enhance the anterior support. At the endplate-cage interfaces, the endplate strength directly affects the cage subsidence. Type III exhibits higher stability for standing due to the greater strength of the endplate in the posterior region. Otherwise, type I consistently has higher stability for all other types of motion. CONCLUSION: The initial stability of the ALIF region is affected by the moment arm and the mechanical strength of the engaged endplates. Type I has greater moment arm and provides more efficient support to the instrumented segments. Endplate strength provides an ability to withstand lumbar loads and suppress the cage subsidence. Bone quality at the endplate-cage interfaces must therefore be cautiously evaluated preoperatively. LEVEL OF EVIDENCE: N/A.

Temozolomide-related acute lymphoblastic leukemia with translocation (4;11)(q21;q23) in a glioblastoma patient.

Temozolomide (TMZ), an alkylating agent, is widely used for treating high-grade gliomas. TMZ has been reported to cause secondary myelodysplastic syndrome and acute myeloid leukemia. However, TMZ-related acute lymphoblastic leukemia is rare. Here we describe a 54-year-old woman with glioblastoma multiforme, who developed precursor-B acute lymphoblastic leukemia with translocation (4;11)(q21;q23) after 15 months of TMZ treatment.

Progressive kyphosis after vertebroplasty in osteoporotic vertebral compression fracture.

STUDY DESIGN: A single-center retrospective study. OBJECTIVE: To identify the relevant incidence and risk factors of delayed vertebral collapse and progressive kyphosis with spinal canal encroachment after percutaneous vertebroplasty (PVP) for vertebral compression fracture (VCF). SUMMARY OF BACKGROUND DATA: Delayed vertebral collapse and progressive kyphosis with spinal canal encroachment are complications after PVP for VCF. METHODS: Between December 2002 and February 2011, 843 patients underwent PVP for VCFs for at least 2 years of minimum follow-up term in a tertiary referral center. All imaging measurements were obtained digitally, with comparisons of the Cobb angle and spinal canal stenosis on fractured vertebral level at 3 different time points of pre- and postvertebroplasty, and before revision surgery. RESULTS: Thirteen patients (14 fractures) who underwent PVP had delayed vertebral collapse and progressive kyphosis on the level of the fractured vertebra, 3 were male and 10 female, with a median age of 75 years (range, 66-89 yr). One had 2-level VCFs. All were treated with revision surgery of decompressive laminectomy for spinal canal stenosis with neurological complications. Twelve patients had additional instrument fixation. The involved vertebras were concentrated at the thoracolumbar junction region (T11-L2). The mean Cobb angles were measured at 23.67° before PVP, 15.90° after PVP, and 30.92° before revision surgery. The ratio of spinal canal stenosis was 35.45% and 49.48% before PVP and revision surgery, respectively. The occurrence rate of delayed complications was about 1.5% (13/843). CONCLUSION: Conservative treatment and minimal invasive vertebral augmentation surgery can be selected from patients with stable VCFs. Close follow-up is warrant to monitor the occurrence of late collapse with neurological complications. LEVEL OF EVIDENCE: N/A.

Simple transpedicular vertebral biopsy for diagnosis of malignancy in vertebral compression fracture.

BACKGROUND: The transpedicular route in percutaneous vertebroplasty (PVP) is a well-established approach for the treatment of vertebral compression fractures (VCFs). However, the value of simple transpedicular biopsy in VCFs is less addressed. The purpose of this study is to evaluate the value of transpedicular biopsy during PVP for uncovering the malignancy in VCFs in a 10-year retrospective study. MATERIALS AND METHODS: During the study period of the 1019 patients who underwent PVP for VCFs, 450 patients comprising of 127 male and 323 female underwent transpedicular biopsy during PVP for 705 fractured vertebras. The medical records were analyzed for age, gender, imaging studies, operation notes, pre-operative and post-operative diagnoses, date of vertebroplasty and biopsy, vertebral level and pathological reports. RESULTS: Pathology of the specimens of the 450 patients confirmed non-malignant VCFs in 389 (86.44%) and malignancy in 61 (13.56%). The malignant pathology included: 52 (11.56%) distant metastases to vertebra, in 3 (0.67%) of the spinal metastases was unsuspected and in 49 (10.89%) of them the malignancy was suspected pre-operatively. There were 9 (2%) primary spinal malignancies, 2 (0.44%) unsuspected multiple myeloma and 7 (1.56%) pre-operatively suspected primary malignancies. The frequency of unsuspected malignancy was 1.11% (5/450) in this study. There was no complication associated with transpedicular biopsy during PVP. CONCLUSIONS: VCFs harbored 1.11% of unexpected malignancy. During the vertebroplasty, concomitant transpedicular vertebral biopsy is a safe and useful procedure for distinguishing non-malignant from malignant compression fractures, especially in diagnosing unsuspected malignancy.