Surgical management of lower limb radiculopathy following acute singe-level osteoporotic vertebral fracture of lower lumbar spine in geriatric patient: a retrospective study.

BACKGROUND: Radiculopathy of the lower limb after acute osteoporotic vertebral fractures (OVFs) in the lower lumbar spine is uncommon in geriatric patients. Moreover, surgical intervention is generally recommended in patients who are irresponsive to conservative treatment. Determining an optimum surgical strategy is challenging considering the poor general condition of this population. Thus, herein, we established an algorithm for surgically managing this clinical scenario, hoping to provide a reference for making a surgical decision. METHODS: We retrospectively studied patients who suffered from new-onset radiculopathy of the lower limb after acute single-level OVFs in the lower lumbar spine and eventually underwent surgical intervention at our department. Information on the demographics, bone quality, AO spine classification of the vertebral fracture, pre-existing degenerative changes, including foraminal stenosis and lumbar disc herniation, and surgical intervention type was collected. Additionally, clinical outcomes, including preoperative and postoperative visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), and MacNab criterion for response to surgery, were evaluated. RESULTS: From September 2019 to December 2021, a total of 22 patients with a mean age of 68.59 ± 9.74 years were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Among the 22 patients, 15 (68.2%) were diagnosed with the A1 type fracture of AO classification, and among them, 11 (73.3%) were characterized by the collapse of the inferior end plate (IEP). Three patients (13.6%) suffered from A2-type fractures, whereas four patients (18.2%) suffered from A3-type fractures. Pre-existing degenerative changes were observed in 12 patients (54.5%) of the patients. A total of 16 patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Additionally, three patients underwent posterior instrumentation and fusion, two patients underwent a secondary endoscopic foraminoplasty, and one patient underwent a secondary radiofrequency ablation. The mean follow-up period was 17.42 ± 9.62 months. The mean VAS scores for leg and back pain and ODI decreased significantly after the surgery (P < 0.05). The total satisfaction rate at the last follow-up was 90.9% per the Macnab criterion. CONCLUSION: Patients with OVFs in the IEP are predisposed to suffer from radiculopathy of the lower limb. PKP alone or in combination with other minimally invasive surgical strategies is safe and effective in treating stable fractures. Additionally, aggressive surgical intervention should be considered in patients with unstable fractures or severe foraminal encroachment.

Modified unilateral iliac screw fixation with partial reduction in the treatment of high-grade spondylolisthesis at L5/S1 in adult patients: introduction of key technique, report of clinical outcomes and analysis of spinopelvic parameters.

BACKGROUND: Management of high-grade spondylolisthesis (HGS) remains challenging. Spinopelvic fixation such as iliac screw (IS) was developed to deal with HGS. However concerns regarding constructs prominence and increased infection-related revision surgery have complicated it's use. We aim to introduce the modified iliac screw (IS) technique in treating high-grade L5/S1 spondylolisthesis and it's clinical and radiological outcomes. METHODS: Patients with L5/S1 HGS who underwent modified IS fixation were enrolled. Pre- and postsurgical upright full spine radiographs were obtained to analyze sagittal imbalance, spinopelvic parameters, pelvic incidence-lumbar lordosis mismatch (PI-LL), slip percentage, slip angle (SA), and lumbosacral angle (LSA). Visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated pre- and postoperatively for clinical outcomes assessment. Estimated blood loss, operating time, perioperative complications and revision surgery were documented. RESULTS: From Jan 2018 to March 2020, 32 patients (15 males) with mean age of 58.66 ± 7.77 years were included. The mean follow-up period was 49 months. The mean operation duration was 171.67 ± 36.66 min. At the last follow-up: (1) the VAS and ODI score were significantly improved (p < 0.05), (2) PI increased by an average of 4.3°, the slip percent, SA and LSA were significantly improved (p < 0.05), (3) four patients (16.7%) with global sagittal imbalance recovered a good sagittal alignment, PI-LL within ± 10° was observed in all patients. One patient experienced wound infection. One patient underwent a revision surgery due to pseudoarthrosis at L5/S1. CONCLUSION: The modified IS technique is safe and effective in treating L5/S1 HGS. Sparing use of offset connector could reduce hardware prominence, leading to lower wound infection rate and less revision surgery. The long-term clinical affection of increased PI value is unknown.

Effects of tracer position on screw placement technique in robot-assisted posterior spine surgery: a case-control study.

INTRODUCTION: Robot-assisted spine surgery is increasingly used in clinical work, and the installation of tracers as a key step in robotic surgery has rarely been studied. OBJECTIVE: To explore the potential effects of tracers on surgical outcomes in robot-assisted posterior spine surgery. METHODS: We reviewed all patients who underwent robotic-assisted posterior spine surgery at Beijing Shijitan Hospital over a 2-year period from September 2020 to September 2022. Patients were divided into two groups based on the location of the tracer (iliac spine or vertebral spinous process) during robotic surgery and a case-control study was conducted to determine the potential impact of tracer location on the surgical procedure. Data analysis was performed using SPSS.25 statistical software (SPSS Inc., Chicago, Illinois). RESULTS: A total of 525 pedicle screws placed in 92 robot-assisted surgeries were analyzed. The rate of perfect screw positioning was 94.9% in all patients who underwent robot-assisted spine surgery (498/525). After grouping studies based on the location of tracers, we found there was no significant difference in age, sex, height and body weight between the two groups. The screw accuracy (p < 0.01)was significantly higher in the spinous process group compared to the iliac group (97.5% versus 92.6%), but the operation time (p = 0.09) was longer in comparison. CONCLUSION: Placing the tracer on the spinous process as opposed to the iliac spine may result in longer procedure duration or increased bleeding, but enhanced satisfaction of screw placement.

Comparison of clinical outcomes of modified laminoplasty with preservation of muscle group inserted into C2 and C7 spinous processes versus conventional C3-C7 laminoplasty: a prospective, randomized, controlled, noninferiority trial.

BACKGROUND: The efficacy and noninferior of performing modified double-door laminoplasty (MDDL) (C4-C6 laminoplasty plus C3 laminectomy, alongside a dome-like resection of the inferior part of the C2 lamina and the superior part of the C7 lamina) in patients with multilevel cervical spondylotic myelopathy (MCSM) is equivocal. A randomized, controlled trial is warranted. OBJECTIVE: The objective was to evaluate the clinical efficacy and noninferior of MDDL compared with traditional C3-C7 double-door laminoplasty. STUDY DESIGN: A single-blind, randomized, controlled trial. METHODS: A single-blind, randomized, controlled trial was conducted in which patients who with MCSM with greater than or equal to 3 levels of spinal cord compression from the C3 to the C7 vertebral levels were enrolled and assigned to undergo either MDDL group or conventional double-door laminoplasty (CDDL) group in a 1:1 ratio. The primary outcome was the change in the Japanese Orthopedic Association score from baseline to 2-year follow-up. The secondary outcomes included changes in the Neck Disability Index (NDI) score, the Visual Analog Scale (VAS) for neck pain, and imaging parameters. Operative complications were also collected and reported. The outcome measures were compared between the groups at 3 months, 1 year, or 2 years after surgery. RESULTS: A total of 96 patients (mean age 67 years, 39.8% women) underwent randomization. Of these patients, 93 completed 3-month follow-up, 79 completed 1-year follow-up, and 66 completed 2-year follow-up. The changes in the Japanese Orthopedic Association score did not differ significantly between the study groups at the three time points after surgery. With respect to amelioration of neck pain and disability related to neck pain, patients in the MDDL group had a significantly greater decrease in the VAS and NDI component summary score than did those in the CDDL group at 1-year (VAS: -2.5 vs. -3.2, difference -0.7, 95% CI -1.1 to -0.2, P =0.0035; NDI: -13.6 vs. -19.3, difference -5.7, 95% CI -10.3 to -1.1, P =0.0159) and 2-years (VAS: -2.1 vs. -2.9, difference -0.8, 95% CI -1.4 to -0.2, P =0.0109; NDI: -9.3 vs. -16.0, difference -6.7, 95% CI -11.9 to -1.5, P =0.0127). The changes in the range of motion (ROM), the C2-C7 Cobb angle, and the cervical sagittal vertical axis in the MDDL group were significantly less than those in the CDDL group (ROM: -9.2±6.4 vs. -5.0±6.0, P =0.0079; C2-C7 Cobb angle: -7.9±7.8 vs. -4.1±6.2, P =0.0345; cervical sagittal vertical axis: 0.6±0.9 vs. 0.2±0.6, P =0.0233). The MDDL group had less blood loss (428.1 vs. 349.1, P =0.0175) and a lower rate of axial symptoms (27.3 vs. 6.1%, P =0.0475) than the CDDL group. CONCLUSIONS: Among patients with MCSM, the MDDL produced similar cervical cord decompression compared with the conventional C3-C7 double-door laminoplasty. The modified laminoplasty was associated with meaningful improvement in amelioration of neck discomfort, maintaining a better cervical ROM and sagittal alignment, decreasing blood loss, and reducing the incidence of axial symptoms.

Towards carbon neutrality: A study on China's long-term low-carbon transition pathways and strategies.

As the world's biggest carbon dioxide (CO2) emitter and the largest developing country, China faces daunting challenges to peak its emissions before 2030 and achieve carbon neutrality within 40 years. This study fully considered the carbon-neutrality goal and the temperature rise constraints required by the Paris Agreement, by developing six long-term development scenarios, and conducting a quantitative evaluation on the carbon emissions pathways, energy transformation, technology, policy and investment demand for each scenario. This study combined both bottom-up and top-down methodologies, including simulations and analyses of energy consumption of end-use and power sectors (bottom-up), as well as scenario analysis, investment demand and technology evaluation at the macro level (top-down). This study demonstrates that achieving carbon neutrality before 2060 translates to significant efforts and overwhelming challenges for China. To comply with the target, a high rate of an average annual reduction of CO2 emissions by 9.3% from 2030 to 2050 is a necessity, which requires a huge investment demand. For example, in the 1.5 °C scenario, an investment in energy infrastructure alone equivalent to 2.6% of that year's GDP will be necessary. The technological pathway towards carbon neutrality will rely highly on both conventional emission reduction technologies and breakthrough technologies. China needs to balance a long-term development strategy of lower greenhouse gas emissions that meets both the Paris Agreement and the long-term goals for domestic economic and social development, with a phased implementation for both its five-year and long-term plans.

Rosai-Dorfman disease with spine involvement: A case report.

RATIONALE: Rosai-Dorfman disease (RDD) is a rare, benign, self-limiting disease, also known as sinus histiocytosis with giant lymphadenopathy. Skeletal involvement is rare, and this isolated bone lesion usually occurs in adults with no other symptoms. It is estimated that 0.6% to 1% of RDD cases have isolated or complicated spinal lesions, which may occur in the bone, dura, and spinal parenchyma, but spinal RDD has no pathologic clinical or imaging features. PATIENT CONCERNS: A 25-year-old woman presented with complaints of low back pain without obvious causes for a month. DIAGNOSIS: RDD with spinal involvement. INTERVENTIONS: Resection of the spinous process of the third lumbar spine was performed under epidural anesthesia. OUTCOMES: At the time of discharge, the patient had no problems with autonomous activities and reported no discomfort. We also followed up the patient at 12 and 36 months after surgery, and the patient reported no discomfort, inconvenience, and no recurrence of symptoms. Imaging examination 1 year after surgery showed no recurrence. LESSON: This case suggests that surgery for RDD with spinal involvement may not require internal fixation.

The reallocation effect of China's provincial power transmission and trade on regional heavy metal emissions.

Coal-fired power plants (CFPPs) are key point sources to atmospheric heavy metal (HM) emissions in China. Unevenly distributed CFPPs lead to large-scale interregional power transmission, as well as corresponding environmental emissions transfer. However, the effect of power transmission on HM reallocation remains poorly understood. Here, we traced HM (including Hg, As, Se, Pb, Cd, and Cr) emission flows through electricity transmission and regional trade and calculated China's multi-perspective electricity-related HM emissions from 2010 to 2015. Results show that in 2015, power transmission and regional trade caused 226.5 t (14% of total emissions) and 453.6 t (28%) of HM emission flows, respectively, leading to great differences in provincial HM emissions under different perspectives (e.g., Beijing's consumption-based emission was 15.5 times higher than the city's production-based emission in 2015). Our study provides valuable insights for fairly allocating provincial HM emission reduction responsibility and formulating synergistic emission mitigation strategies among regions.

Study of the emissions and spatial distributions of various power-generation technologies in China.

The power sector is the main contributor to climate change and atmospheric pollution, and reducing the emissions from the power sector is essential for achieving sustainable development. However, few studies have accounted for the emissions from various power-generation technologies. In this paper, a high-resolution inventory of power plants with more than 6 MW accounting for 93% of the national power generation in China is established for the first time. Based on this inventory, the CO2, NOx and SO2 emissions of China's hard coal power, natural gas power, hydropower, wind power, photovoltaic power, biomass power and nuclear power are calculated by using the life cycle assessment method, and their spatial distributions in 2014 are further analyzed. The results show that China's power plants emitted 3.44 E+09 t CO2, 8.56 E+06 t NOx, and 1.19 E+07 t SO2, and the uncertainties were (-18.66%, +19.14%), (-67.10%, +66.41%) and (-88.69%, +87.61%) in 2014, respectively. Renewable-energy power plants accounted for approximately 15% of the national power generation but only contributed less than 1% of the total emissions. Meanwhile, in China's eastern cities, renewable-energy power accounts for the lowest proportion of the total installed capacity. In addition, both the emission amount and intensity were significantly higher in eastern cities than central and western cities. This study will help improve research on the emissions of all power-generation technologies in China and help achieve a comprehensive and systematic emissions reduction strategy.

Unbalanced economic benefits and the electricity-related carbon emissions embodied in China's interprovincial trade.

Quantifying the economic benefits and environmental costs brought about by trade can help reveal the environmental inequalities behind regional trade. There have been many studies on the accounting of greenhouse gas emissions and pollutants embodied in regional trade, but there are insufficient studies analyzing the imbalance between the economic benefits and environmental costs embodied in trade. Electricity-related carbon emissions are the main contributor to global warming, explaining more than 40% of carbon emissions both globally and in China. This study uses the network approach and multiregional input-output (MRIO) model to quantify the electricity-related carbon emissions and value added embodied in China's interprovincial trade from 2007 to 2012 and also applies the regional environmental inequality (REI) index to measure the imbalance of electricity-related carbon emissions and economic benefits embodied in such trade. The results show that 20-80% of the electricity-related carbon emissions and 15-70% of the value added of a province's final demand are outsourced to other provinces. The major directions of the net value added and electricity-related carbon emissions embodied in China's interprovincial trade were from north to south and from the center to the east. Unequal bilateral interprovincial trade mainly occurred between inland provinces and developed provinces, and western provinces (such as Guizhou, Gansu, and Ningxia) suffered economic and environmental losses from interprovincial trade. This study can promote understanding of the distribution impacts of domestic trade on environmental costs and economic benefits and provide a reference for China's cross-provincial carbon emission mitigation policies.