Deep learning-based automated scan plane positioning for brain magnetic resonance imaging.

Background: Manual planning of scans in clinical magnetic resonance imaging (MRI) exhibits poor accuracy, lacks consistency, and is time-consuming. Meanwhile, classical automated scan plane positioning methods that rely on certain assumptions are not accurate or stable enough, and are computationally inefficient for practical application scenarios. This study aims to develop and evaluate an effective, reliable, and accurate deep learning-based framework that incorporates prior physical knowledge for automatic head scan plane positioning in MRI. Methods: A deep learning-based end-to-end automated scan plane positioning framework has been developed for MRI head scans. Our model takes a three-dimensional (3D) pre-scan image input, utilizing a cascaded 3D convolutional neural network to detect anatomical landmarks from coarse to fine. And then, with the determined landmarks, accurate scan plane localization can be achieved. A multi-scale spatial information fusion module was employed to aggregate high- and low-resolution features, combined with physically meaningful point regression loss (PRL) function and direction regression loss (DRL) function. Meanwhile, we simulate complex clinical scenarios to design data augmentation strategies. Results: Our proposed approach shows good performance on a clinically wide range of 229 MRI head scans, with a point-to-point absolute error (PAE) of 0.872 mm, a point-to-point relative error (PRE) of 0.10%, and an average angular error (AAE) of 0.502°, 0.381°, and 0.675° for the sagittal, transverse, and coronal planes, respectively. Conclusions: The proposed deep learning-based automated scan plane positioning shows high efficiency, accuracy and robustness when evaluated on varied clinical head MRI scans with differences in positioning, contrast, noise levels and pathologies.

Separation Operation Followed by Stereotactic Radiotherapy in the Treatment of Spinal Metastasis From Hepatocellular Carcinoma: A Retrospective Cohort Study.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Spinal metastasis from hepatocellular carcinoma is rapidly progressive and predisposes to spinal disability, cord compression and further neural injury, leading to poor prognosis. Currently, it is still challenging to look for a treatment strategy that can improve the quality of life of patients and even directly prolong the survival time. This study attempts to evaluate the clinical efficacy of separation operation combined with postoperative stereotactic radiotherapy (SRT/SRS) in the treatment of hepatocellular carcinoma patients developing spinal metastasis and epidural spinal cord compression. METHODS: Patients with metastases spinal cord compression from hepatocellular carcinoma were studied retrospectively and divided into two groups, the SO group (who undergo separation operations combined with postoperative SRS, n = 32) and RT group (who received only SRS, n = 28). The visual Analogue Scale (VAS) pain score, Frankel grade, Karnofsky performance score, and Quality of Life (SF-36) score were comparatively analyzed between the two groups. RESULTS: Significantly higher VAS pain scores, Frankel grades, Karnofsky performance scores and Quality of Life (SF-36) scores were demonstrated in patients with combination treatment than in patients with SRS alone. CONCLUSIONS: Separation operations are effective surgical procedure for the treatment of spinal metastatic tumor from hepatocellular carcinoma with spinal cord compression. The combination with postoperative SRS can significantly improve the quality of life in this patient population via spinal canal decompression and spinal stability reconstruction.

Circular RNA profiles of osteoarthritic synovium.

PURPOSES: To identify the circular RNA (circRNA) expression profile in the synovium of patients with osteoarthritis (OA) and explore their potential regulatory mechanism. METHODS: Transcriptome high-throughput sequencing was used to detect the expression profiles of circRNA and mRNA. We performed real-time PCR for the validation of circRNAs and used bioinformatics analysis to predict their possible biological functions. The conservation of circRNAs was evaluated, a circRNA-miRNA-mRNA interaction network was constructed and the receiver operating characteristic (ROC) curves of target genes were also drawn. RESULTS: We found 136 differentially expressed circRNAs, 64 upregulated and 72 downregulated. We also found 2035 differentially expressed mRNAs, 1216 upregulated and 819 downregulated. It was verified by qRT-PCR that hsa_circ_0072697 was significantly upregulated. The GO analysis results showed that the parental genes were mainly enriched in organelle organization, cytosol and anion binding. The most enriched pathways for these circRNAs participated in cellular senescence. And hsa_circ_0072697 might act as a sponge of hsa-miR-6736-5p, which could therefore lead to increased LEP and ULK1 mRNA expression. CONCLUSIONS: CircRNAs are significantly expressed in the knee synovium of OA patients and may play an important role in the occurrence and development of OA. The potential mechanism could be sponging miRNAs to increase mRNA expression.

Attenuation of Activated eIF2α Signaling by ISRIB Treatment After Spinal Cord Injury Improves Locomotor Function.

Following spinal cord injury (SCI), multiple signaling cascades are activated instantaneously in the injured segments of the spinal cord to create a complex and pathogenic microenvironment, making it difficult to treat SCI. Nevertheless, the significance of the integrated stress response (ISR) to the series of physiological and pathological changes that occur after SCI remains unclear. Through western blotting (WB), we determined that the autophosphorylation of stress receptors (GCN2, PERK, PKR, and HRI) was enhanced after SCI, leading to increased phosphorylation of eIF2α at Ser51. Strikingly, we found that eIF2α was highly phosphorylated at 1 day post injury (dpi) and that this hypophosphorylation was maintained thereafter in the spinal cord, especially in neurons, which suggests that intervening with eIF2α phosphorylation may be a treatment strategy for SCI. Therefore, we employed the small molecule ISRIB, which inhibits eIF2α phosphorylation when the ISR is activated at moderate or low levels but not when the ISR is highly activated. Daily intraperitoneal injection of ISRIB significantly inhibited ISR signaling after SCI, reduced the cytosolic localization of RNA-binding proteins, and decreased neuronal apoptosis. Histological and functional experiments further demonstrated that treatment with ISRIB after SCI effectively curbed morphological deterioration and promoted the recovery of locomotor function. In summary, the ISR plays an important role in SCI, and ISRIB is a promising drug for the treatment of SCI.

DCAF1-targeting microRNA-3175 activates Nrf2 signaling and inhibits dexamethasone-induced oxidative injury in human osteoblasts.

Activation of nuclear-factor-E2-related factor 2 (Nrf2) signaling can protect human osteoblasts from dexamethasone-induced oxidative injury. DDB1 and CUL4 associated factor 1 (DCAF1) is a novel ubiquitin E3 ligase for Nrf2 protein degradation. We identified a novel DCAF1-targeting miRNA, miR-3175. RNA pull-down, Argonaute 2 RNA-immunoprecipitation, and RNA fluorescent in situ hybridization results confirmed a direct binding between miR-3175 and DCAF1 mRNA in primary human osteoblasts. DCAF1 3'-untranslated region luciferase activity and its expression were significantly decreased after miR-3175 overexpression but were augmented with miR-3175 inhibition in human osteoblasts and hFOB1.19 osteoblastic cells. miR-3175 overexpression activated Nrf2 signaling, causing Nrf2 protein stabilization, antioxidant response (ARE) activity increase, and transcription activation of Nrf2-dependent genes in human osteoblasts and hFOB1.19 cells. Furthermore, dexamethasone-induced oxidative injury and apoptosis were largely attenuated by miR-3175 overexpression in human osteoblasts and hFOB1.19 cells. Importantly, shRNA-induced silencing or CRISPR/Cas9-mediated Nrf2 knockout abolished miR-3175 overexpression-induced osteoblast cytoprotection against dexamethasone. Conversely, DFAC1 knockout, by the CRISPR/Cas9 method, activated the Nrf2 cascade and inhibited dexamethasone-induced cytotoxicity in hFOB1.19 cells. Importantly, miR-3175 expression was decreased in necrotic femoral head tissues of dexamethasone-taking patients, where DCAF1 mRNA was upregulated. Together, silencing DCAF1 by miR-3175 activated Nrf2 signaling to inhibit dexamethasone-induced oxidative injury and apoptosis in human osteoblasts.

The "slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement.

BACKGROUND: Cervical Pedicle Screw (CPS) placement is a challenging work due to the high risk of neurovascular complications. Although there have been several different free-hand or navigation assisted techniques for CPS placement, perforations may occur during screw insertion, especially lateral perforation. The objective of this manuscript is to describe a novel free-hand technique for subaxial CPS placement (C3-C7) and to evaluate if it decreases the chances of perforation. METHODS: Thirty-two patients undergoing surgery with CPS instrumentation (C3-C7) at our institute between June 2017 and December 2018 were included in this study. All the patients had cervical trauma, and pedicle screw insertion was performed according to the free-hand "slide technique". The lamina, lateral mass and facet joint of the target area were exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a slide to permit the safe insertion of the screw. If the pedicle screw pathway was intact, the screw of the appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification. RESULTS: Thirty-two patients who met the inclusion criteria were included in this study. A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs were in C3, 61 CPSs were in C4, 55 CPSs were in C5, 53 CPSs were in C6, and 47 CPSs were in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. Among perforated screws (26 screws), there were 16 lateral perforations, 5 medical perforations, and 4 inferior perforations. CONCLUSIONS: The initial usage result shows the "slide technique" is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such a technique, and further studies are needed.

Correlation Analysis of C-terminal telopeptide of collagen type II and Interleukin-1ß for Early Diagnosis of Knee Osteoarthritis.

OBJECTIVE: To analyze the correlation between the Kellgren-Lawrence (K-L) score of knee osteoarthritis (KOA) patients with different degrees and their urine concentration of C-terminal telopeptide of collagen type II (CTX-II) and interleukin-1ß (IL-1ß), and to further evaluate the diagnostic value of CTX-II and IL-1ß during the pathological process by producing an experimental osteoarthritis (OA) model in rabbits. METHODS: From 1 January 2017 to 31 December 2018, a total of 34 subjects (7 mild, 9 moderate, 9 severe arthritis patients, and 9 healthy individuals) comprising 16 men and 18 women were included in this study. Patients were diagnosed according to the American College of Rheumatology (ACR) criteria. The urine of all subjects was collected to detect the concentration of CTX-II and IL-1ß. The rabbits in the KOA group were subjected to protease (control group with saline) injection into the articular cavity of their right knees and immobilization with gypsum. We used radiological and histological examination to identify the KOA model. ELISA was applied to investigate the concentrations of CTX-II and IL-1ß in urine and serum, and Spearman's rank correlation analysis was used to analyze the correlation. RESULTS: There was no significant difference in the mean ages and body mass index (BMI) between groups. The mean ages of mild, moderate, and severe arthritis patients and healthy individuals were 54.29 ± 5.76, 58.44 ± 6.44, 59.89 ± 6.75, and 56.67 ± 4.18 years, respectively. The mean BMI of mild, moderate, and severe arthritis patients and healthy individuals were 23.59 ± 1.56, 23.57 ± 2.06, 24.46 ± 1.64, and 23.42 ± 1.35 kg/m2 , respectively. The Kellgren-Lawrence (K-L) score was higher with the aggravation of KOA. The K-L scores of mild, moderate, and severe KOA patients were 1.14 ± 0.38, 2.56 ± 0.53, and 3.63 ± 0.52, respectively. The KOA symptoms of patients became more severe, with not only increased K-L scores but also elevated concentrations of CTX-II and IL-1ß. Moreover, there was a positive correlation between CTX-II and IL-1ß of all subjects (r = 0.974, P < 0.001), between K-L score and urine concentration of CTX-II (r = 0.900, P < 0.001), and between K-L score and IL-1ß (r = 0.813, P < 0.001) of all subjects. Both were significantly increased in KOA group rabbits at all time points after surgery. The serum concentration of CTX-II and IL-1ß was elevated as early as in the 2nd week (3.69 and 4.25 times) and reached a peak (5.41 and 7.23 times) in the 4th week after surgery. Then, until 12 weeks after surgery, the CTX-II and IL-1ß concentrations in the KOA group were slightly reduced and remained around 4.5 and 6.3 times that in the control group. Moreover, there was a positive correlation between the serum concentration of IL-1ß and CTX-II (r = 0.967, P < 0.001). CONCLUSION: CTX-II and IL-1ß, which were significantly increased during the process of KOA, can be used as biomolecular markers to provide guidelines for early diagnosis and treatment of KOA.

Gene Expression Profiles of Peripheral Blood Monocytes in Osteoarthritis and Analysis of Differentially Expressed Genes.

BACKGROUND: There is little understanding of the molecular processes involved in the pathogenesis of osteoarthritis, limiting early diagnosis and effective treatment of OA. Use of genechips can provide insights into the molecular pathogenesis of diseases. In this study, determination of gene expression profiles of osteoarthritis peripheral blood mononuclear cells will allow exploration of the molecular pathogenesis of OA and find out more candidate biomarkers and potential drug targets of OA. RESULT: A total of 1231 DEGs were screened out including 791 upregulated DEGs and 440 downregulated DEGs. The most significant upregulated DEG was RPL38, which may inhibit chondrocyte differentiation and synthesis of the extracellular matrix. PIK3CA, PIK3CB, PIK3CD, PIK3R1, MAPK14, IL1A, JUND, FOSL2, and PPP3CA were the gene symbols of the osteoclast differentiation pathway which was the most significant pathway enriched by DEGs. However, the MAPK signaling pathway occupied the core position of all the pathways which can regulate apoptosis, cell cycle, wnt signaling pathway, p53 signaling pathway, and phosphatidylinositol signaling system. Furthermore, PI3Ks may regulate IL1A, JUND, FOSL2 and PPP3CA through the MAPK signaling pathway. CONCLUSION: These identified DEGs and pathways may be novel biomarkers to monitor the changes of OA and can be a potential drug target for the treatment of OA.

Clinical effect observation of intravenous application of zoledronic acid in patients with cervical spondylosis and osteoporosis after anterior cervical discectomy and fusion: A randomized controlled study.

OBJECTIVE: To observe the clinical effect of zoledronic acid (ZA) in patients with cervical spondylosis and osteoporosis after anterior cervical discectomy and fusion (ACDF) surgery. METHODS: All selected patients were divided into the study group and the control group according to the sequence of surgery time. In the study group, 5 mg (100 ml) of ZA was applied intravenously as intervention on the 5 day after ACDF surgery. Patients were followed up regularly after surgery. RESULTS: Forty-three cases completed the follow-ups (21/22), the neck disability index (NDI) score significantly decreased at the 3rd month after surgery in both groups, it came to a plateau at the 6th month after surgery, and it had some rise at the 12th month after surgery, but the NDI score was lower in the study group at the 12th month after surgery ( p < 0.05). C-telopeptide of type I collagen (CTX) and amino terminal propeptide of type I procollagen of bone turnover markers in the study group showed a downward trend after surgery, among which CTX decreased significantly and no significant changes in the control group. At the 12th month after surgery, the bone mineral density of lumbar spine area in the study group was significantly improved ( p < 0.05). During the 3rd and the 6th month follow-up after surgery, 1/2 osteogenesis rate of the study group was significantly higher ( p < 0.05). However, all patients in the two groups obtained stable fusion at the 12th month follow-up after surgery. CONCLUSIONS: For patients with cervical spondylosis and osteoporosis, intravenous application of ZA after ACDF surgery can shorten the time of cervical osteogenesis, promote local bone graft fusion, and improve the postoperative clinical effect to some extent.

Protective effect of estrogen against intervertebral disc degeneration is attenuated by miR-221 through targeting estrogen receptor α.

Dysfunction of cartilaginous endplates (CEP) is an important etiologic aspect of intervertebral disc degeneration (IDD) because the endplate has nutritional and biomechanical functions in maintaining proper disc health. In this study, we investigated the regulatory effects of estrogen on degenerated human CEP cells and the involvement of miR-221 in these effects. Normal and degenerated human CEP tissues were collected from patients with idiopathic scoliosis and IDD, respectively. CEP cells were isolated from these tissues. Polymerase chain reaction (PCR) and western blot analysis were performed to detect the expression of specific genes and proteins, respectively. Apoptosis and cell cycle were analyzed by flow cytometry. The results showed that the levels of aggrecan, collagen II, TGF-ß and estrogen receptor α (ERα) were decreased in degenerated CEP tissues, while the levels of MMP-3, adamts-5, IL-1ß, TNF-α, IL-6, and miR-221 were increased. Treatment of degenerated CEP cells with 17beta-estradiol (E2) increased the expressions of aggrecan and collagen II, as well as the secretion of TGF-ß, but decreased IL-6 secretion. Moreover, E2 inhibited the apoptosis, resumed cell-cycle progression in G0/G1 phase, and improved the cell viability. These data indicate that estrogen has protective effect against degeneration of CEP cells. Furthermore, ERα was confirmed to be a target of miR-221 by the luciferase assay. The synthetic miR-221 mimics or knockdown of ERα attenuated the protective effects of E2, but miR-221 inhibitors promoted the protective effects of E2. These results suggest that miR-221 may impair the protective effect of estrogen in degenerated CEP cells through targeting ERα. This study reveals an important mechanism underlying the degeneration of CEP cells.

Osteopontin, Bone Morphogenetic Protein-4, and Vitamin D Receptor Gene Polymorphisms in the Susceptibility and Clinical Severity of Spinal Tuberculosis.

BACKGROUND/AIMS: Spinal tuberculosis (TB) is a common and dangerous form of extrapulmonary TB with unclear mechanisms in its occurrence and progression. This study investigated the clinical significances of bone morphogenetic protein-4 (BMP-4), osteopontin (OPN), and vitamin D receptor (VDR) gene polymorphism, mRNA and protein expression in spinal TB patients. METHODS: BMP-4 and OPN gene polymorphisms were detected by direct DNA sequencing, while VDR-FokI polymorphisms were analyzed using PCR-RFLP. mRNA and protein expression was measured using real-time PCR and Western blot, respectively. RESULTS: A significant lower frequency of TT genotype and T allele at 6007C>T polymorphism in BMP-4 gene; higher frequency of GG genotype and G allele at -66T>G polymorphism in OPN gene, and higher frequency of the ff genotype and f allele at the VDR-FokI polymorphism were observed in patients with spinal TB compared to controls. TT genotype of 6007C>T polymorphism correlated with a lower BMP-4 mRNA and protein expression, -66GG genotype correlated with a high OPN mRNA and protein expression, and ff genotype correlated with the lower VDR mRNA and protein levels in the intervertebral disc tissues. The TT genotype and low BMP-4 gene expression; the -66GG genotype and high OPN gene expression; and the ff genotype and low VDR gene expression significantly correlated with the clinical severity of spinal TB. CONCLUSION: The 6007C>T polymorphism of BMP-4, -66T>G polymorphism of OPN, and VDR-FokI polymorphism are the susceptible factors of spinal TB and indicators of the clinical severity. These three genes may collaborate in the development of spinal TB.

The role of single-stage posterior debridement, interbody fusion with titanium mesh cages and short-segment instrumentation in thoracic and lumbar spinal tuberculosis.

BACKGROUND: The aim of this paper was to retrospectively analyze the clinical efficacy and feasibility of thoracic and lumbar spinal tuberculosis treated by single-stage posterior debridement, interbody fusion with titanium mesh cages (TMC), and combined short-segment instrumentation. METHODS: Fifteen patients with no more than two vertebral bodies involving thoracic and lumbar tuberculosis were collected from January 2006 to January 2010, performed by single-stage posterior debridement, interbody fusion with TMC and posterior short-segment fixation. The clinical efficacy was evaluated based on the data of the 10-point Visual Analogue Scale (VAS), neurological status, kyphosis angle, erythrocyte sedimentation rate, and C-reactive protein, which were collected at a certain time. RESULTS: The average duration of surgery was 135 minutes. All the patients were followed up for a period ranging from 18 to 48 months (mean 28.9±6.44 months). The VAS score was improved from 8.47±1.13 (range 7-10) before surgery to 2.1±1.7 (range 0-2) after surgery. Correction of segmental kyphotic deformity was 24.2±6.59°. Neither the postoperative change of the position of titanium mesh cage nor any posterior instrumentation failure was recorded. The situation of 13 patients with incomplete neurologic lesions before surgery was improved after surgery. CONCLUSIONS: Patients with thoracic and lumbar spinal tuberculosis can be successfully treated by posterior debridement, interbody fusion with TMC combining short-segment instrumentation. The presence of the TMC anteriorly at the site of tubercular spondylitis has no negative influence on the course of infection healing, and additionally they stabilize the affected segment maintaining sufficient sagittal profile.

360-degree cervical spinal arthrodesis for treatment of pediatric cervical spinal tuberculosis with kyphosis.

BACKGROUND: There is limited evidence to guide treatment for pediatric cervical spinal tuberculosis with kyphosis (PCSTK). This study retrospectively evaluates the safety, feasibility and efficacy of 360-degree arthrodesis combined with anterior debridement and decompression for treating PCSTK, while simultaneously emphasizing the role of posterior fixation for the correction and maintenance of the kyphosis angle. METHODS: From May 2006 to December 2012, a total of 12 children with PCSTK underwent 360-degree cervical spinal arthrodesis followed by debridement of focus and decompression of the spinal cord. Data on the angle of kyphosis correction, visual analogue scale scores of pain, the American Spinal Injury Association scoring system of nerve function scores, erythrocyte sedimentation rate (ESR) and body weight were collected at certain periods. Clinical efficacy was evaluated by statistical analysis based on collected data. RESULTS: Average follow-up period was 34.3 ± 8.6 months. No postoperative complications related to the instrumentation occurred, and neurologic function improved in various degrees. Preoperative kyphosis angle was 41.4 ± 5.2°, and significantly decreased to -4.9 ± 4.9° after surgery. The correction of kyphosis and loss of correction were 47.1 ± 4.9° and 0.6 ± 1.4°, respectively. Average pretreatment ESR was 49.8 ± 13.2 mm/h, which normalized (8.5 ± 0.6 mm/h) within three months in all patients. Average preoperative visual analogue scale was 6.6 ± 1.6, which decreased to 2.3 ± 1.4 postoperatively and 0.3 ± 0.5 during the final follow-up. Mean preoperative body weight was 25.9 ± 5.1 kg, and body weight was 33.5 ± 4.8 kg at the third month of post-operation. Bone healing was achieved in all patients after a mean period of 5.4 months. CONCLUSIONS: 360-degree arthrodesis combined with anterior debridement and decompression is a safe and effective method for the treatment of PCSTK. For the correction and maintenance of the kyphosis angle, additional posterior fixation is recommended.

Single-stage posterior-only approach treating single-segment thoracic tubercular spondylitis.

There are quite a few controversies on surgical management of single-segment thoracic spinal tuberculosis (STB) with neurological deficits. The present study was to compare single-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of single-segment thoracic STB with neurological deficits and to determine the clinical feasibility and effectiveness of posterior-only surgical treatment. Sixty patients with single-segment thoracic STB with neurological deficits were treated with one of two surgical procedures in our center from January 2003 to January 2013. Thirty patients were treated with posterior-only surgery (Group A) and thirty were treated with combined posterior-anterior surgery (Group B). The American Spinal Injury Association (ASIA) score system to evaluate the neurological deficits, the visual analogue scale (VAS) to assess the degree of pain, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to judge the activity of tuberculosis (TB), surgery duration, intraoperative blood loss, length of hospitalization, bony fusion rates, and kyphosis correction of the two groups were compared. The average follow-up period was 36.5 ± 9.2 months for Group A and 34.6 ± 10.2 months for Group B. Under the ASIA score system, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5-11 months in all patients. There were no persistent or recurrent infections or obvious differences in radiological results between the groups. The kyphosis deformity was significantly corrected after surgical management. The average operative duration, blood loss, length of hospital stay, and postoperative complication rate of Group A were lower than those of Group B. In conclusions, posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.

Halo traction, single-segment circumferential fixation treating cervical tubercular spondylitis with kyphosis.

OBJECTIVE: To evaluate the clinical efficacy and feasibility of twenty patients with cervical tubercular spondylitis with kyphosis (CTSK) treated by halo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and bone grafting. METHODS: Retrospective review of data on twenty patients who suffered from CTSK admitted to our hospital between January 2007 and December 2012. All of them were performed by halo traction, single-segment circumferential instrumented fusion (anterior titanium plate and posterior pedicle or lateral mass fixation) combined anterior debridement, decompression and titanium mesh cage (TMC) filled with allograft bone particles. X-ray and computed tomographic (CT) images were used to determined sagittal balance and bone fusion. The clinical efficacy was evaluated using statistical analysis about the visual analogue scale (VAS) scores of pain, neurological status according to the Frankel classification and erythrocyte sedimentation rate (ESR), which were collected at certain time. RESULTS: The average follow-up period was 34.1 ± 7.0 months (24-48 months). In the 20 cases, no obvious postoperative complications related to instrumentation and bone grafting and neurologic function was improved in various degrees. The average pretreatment ESR was 46.4 ± 21.7 mm/h, which got normal within 3 months in all patients. The average VAS on admission was 6.7 ± 1.7, which decreased to 1.6 ± 1.1 postoperatively. All patients got bony fusion within 3.4-5.5 months after surgery. The Cobb angle of 30.8 ± 10.5° on admission reduced to 2.9 ± 3.9° performed by preoperative halo traction, became to -5.1 ± 4.0° after operation and remained at -4.3 ± 3.8°, with 0.9 ± 0.7° of correction loss. CONCLUSIONS: Halo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and TMC can be an effective and safe treatment method for the treatment of cervical tubercular spondylitis with kyphosis and the preoperative halo traction should be laid on much emphasis.

One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: a retrospective study of 34 cases.

BACKGROUND: There are quite a few controversies on the surgical management of single-segment thoracic spinal tuberculosis with neurological deficits (STSTND). In this study, the clinical efficacy and feasibility of one-stage posterior-only transpedicular debridement, interbody fusion, and posterior instrumentation for treating STSTND in adults were retrospectively evaluated. METHODS: Thirty-four cases with STSTND underwent one-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation at the same institution from January 2003 to January 2013. Follow-up time was 34.4 ± 10.2 months (range, 18-48 months), and kyphosis angle was 34.1 ± 12.3°. The American Spinal Injury Association (ASIA) classification of spinal cord injury was employed to evaluate neurological deficits, while visual analogue scale (VAS) was employed to assess the degree of pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the activity of tuberculosis (TB). RESULTS: All 34 patients with spinal tuberculosis (ST) were completely cured, and there was no recurrence of TB. Postoperative kyphosis angle was 8.2 ± 1.8°, and there was no significant loss of correction during the final follow-up. Solid fusion was achieved and pain was relieved in all cases. Neurological condition in all patients improved after surgery. CONCLUSIONS: One-stage posterior-only transpedicular debridement, interbody fusion, and posterior fixation followed by chemotherapy seems to be adequate for obtaining satisfactory healing of single-segment thoracic spinal tuberculosis with neurological deficits. Careful patient selection is critical to the successful outcome with this technique.

Comparison of three surgical approaches for cervicothoracic spinal tuberculosis: a retrospective case-control study.

STUDY DESIGN: This is a retrospective case-control study. OBJECTIVES: The surgical approaches to cervicothoracic spinal tuberculosis (CTSTB) were controversial. The aim of this research is to retrospectively compare the efficacy and feasibility of anterior-only (AO) approach, combined anterior and posterior (AP) surgeries, and posterior-only (PO) approach for the treatment of CTSTB. METHODS: AO approach was undertaken in 20 patients (group A), AP fusion was carried out in 18 patients (group B), and PO surgery was performed in 21 patients (group C). Surgery duration, intraoperative blood loss, length of hospitalization, neurological status, kyphosis angle correction, loss of correction, and complications of the three groups were compared. RESULTS: Three surgical approaches all improved the kyphosis deformity and neurological function significantly (P < 0.05). The mean loss of correction in group A in the final follow-up was higher than in groups B and C (P < 0.05), and the difference between groups B and C was not significant (P > 0.05). The mean operation time, blood loss, and hospitalization days in group B were greater than in groups A and C. Complications were most prevalent in group A, more in group B, and the least in group C. CONCLUSION: The AO approach surgery should be limitedly used for severe CTSTB. The AP approach had got satisfactory clinical and radiographic outcomes, but with larger trauma and more complications, which should be reservedly performed for mild CTSTB. Compared to traditional surgery, PO surgery can significantly improve clinical results and obviously relieve postoperative complications.

Two one-stage posterior approaches for treating thoracic and lumbar spinal tuberculosis: A retrospective case-control study.

The aim of this retrospective study was to analyze the results of two surgical treatments for thoracic and lumbar spinal tuberculosis. A total of 73 patients with monosegmental thoracic or lumbar spinal tuberculosis were enrolled from January 2006 to April 2011. The patients were divided into two groups. Patients in group A (n=34) underwent one-stage posterior debridement, limited decompression, bone grafting and internal fixation combined with lamina reconstruction, while those in group B (n=39) underwent one-stage posterior debridement, decompression, bone grafting and posterior instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Patients were followed for a mean 31.3 months (range, 21-42 months). Fusion occurred at 4-12 months (mean, 7.7 months). Surgical complications affected one and five patients in groups A and B, respectively. There was extraction of internal fixation in two group B patients. Postoperatively, there was significant Cobb angle correction in the two groups. By the last follow-up, the Cobb angle and correction loss in group A were significantly better than that in group B; the group A Oswestry Disability Index and Frankel grade were better than that in group B. In conclusion, one-stage posterior limited decompression, bone grafting and internal fixation combined with lamina reconstruction enables rapid management of monosegmental thoracic and lumbar spinal tuberculosis with fewer complications and minimal invasion.

One-stage lumbopelvic fixation in the treatment of lumbosacral junction tuberculosis.

PURPOSE: To investigate the clinical efficacy and feasibility of surgical treatment for lumbosacral junction tuberculosis by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage. METHODS: A total of 15 cases with lumbosacral junction tuberculosis treated by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage in our center from January 2005 to October 2011 were studied. Lumbosacral angle, visual analog scale (VAS), and neurological performance were assessed before and after surgery. RESULTS: All patients were followed for 28-56 months post-operation (average, 40.7 ± 7.7 months). No severe complications occurred. Bone fusion occurred in all patients at a mean of 8.4 months (range 6-12 months) after surgery. The mean lumbosacral angle was significantly increased from the mean preoperative angle (20.9° ± 1.8°) both post-operatively (26.5° ± 1.6°) and at final follow-up (25.3° ± 1.4°) (both P < 0.05). All patients had significant post-operative improvement in neurological performance and VAS scores. CONCLUSIONS: Our results suggest that one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage can be an effective and feasible treatment option for lumbosacral junction tuberculosis, offering fewer complications and a better quality of life.