Deep learning algorithm based on analyzing the effect of posterior cervical vertebral canal decompression angioplasty in the treatment of ossification of posterior longitudinal ligament of cervical spine by CT image.

OBJECTIVE: The paper uses the convolutional neural network algorithm in the deep learning algorithm to explore the therapeutic effect of surgical treatment of hyperextension injuries associated with ossification of the posterior longitudinal ligament of the cervical spine. METHODS: In this retrospectively analyzed study 27 patients with hyperextension injury of the posterior longitudinal ligament of the cervical spine were selected from our hospital between August 2018 to July 2020. It included 21 males and 6 females; aged 36-79 years, with an average of 55.9 years. RESULTS: Follow-up time of patients was 3-39 months, with an average of 17.4 months. The JOA score after surgery was significantly better than that before surgery (P<0.01), which was statistically significant; the improvement of JOA in patients undergoing anterior therapy was better than that in patients undergoing posterior therapy, which was statistically significant; the JOA improved in patients with minor violent injuries. The situation is significantly better than severe violent injuries, with statistical significance. The rate of postoperative JOA improvement was significantly correlated with the degree of nerve function retention of the injured spinal cord before surgery (P<0.01), and there was no significant correlation between the degree of spinal stenosis caused by ossification and the postoperative JOA improvement of patients. CONCLUSION: Convolutional neural network algorithm in the deep learning algorithm based on the cervical spine posterior longitudinal ligament ossification hyperextension injury was significantly improved after surgery. The less preoperative neurological damage, the postoperative neurological function, the degree of improvement, there was no significant correlation between the degree of spinal stenosis and the improvement of postoperative spinal cord function. For patients with ossification of the posterior longitudinal ligament, if there are neurological symptoms, early surgical treatment is recommended to relieve the compression, so as to prevent irreversible neurological damage caused by trauma.

Diagnostic agreement between 3.0-T MRI sequences of nerve root and surgery in patients with cervical radiculopathy: A retrospective study.

ABSTRACT: Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.

Minimally invasive injectable lumbar interbody fusion with mineralized collagen-modified PMMA bone cement: A new animal model.

This study was to develop a feasible and safe animal model for minimally invasive injectable lumbar interbody fusion using a novel biomaterial, mineralized collagen-polymethylmethacrylate bone cement (MC-PMMA), with unilateral pedicle screw fixation in an in vivo goat model. Eight goats (Capra aegagrus hircus) were divided into three groups: MC-PMMA, unmodified commercial-polymethylmethacrylate bone cement (UC-PMMA), and a control group (titanium cage filled with autogenous bone, TC-AB). Each group of goats was treated with minimally invasive lumbar interbody fusion at the L3/L4 and L5/L6 disc spaces (injected for MC-PMMA and UC-PMMA, implanted for TC-AB). The pedicle screws were inserted at the L3, L4, L5, and L6 vertebrae, respectively, and fixed on the left side. The characteristics of osteogenesis and bone growth were assessed at the third and the sixth month, respectively. The methods of evaluation included the survival of each animal, X-ray imaging, and 256-layer spiral computed tomography (256-CT) scanning, imaged with three-dimensional microfocus computed tomography (micro-CT), and histological analysis. The results showed that PMMA bone cement can be extruded smoothly after doping MC, the MC-PMMA integrates better with bone than the UC-PMMA, and all goats recovered after surgery without nerve damage. After 3 and 6 months, the implants were stable. New trabecular bone was observed in the TC-AB group. In the UC-PMMA group a thick fibrous capsule had formed around the implants. The MC-PMMA was observed to have perfect osteogenesis and bone ingrowth to adjacent bone surface. Minimally invasive injectable lumbar interbody fusion using MC-PMMA bone cement was shown to have profound clinical value, and the MC-PMMA showed potential application prospects.

Mineralized collagen-modified PMMA cement enhances bone integration and reduces fibrous encapsulation in the treatment of lumbar degenerative disc disease.

As a minimally invasive surgery, percutaneous cement discoplasty (PCD) is now contemplated to treat lumbar disc degeneration disease in elder population. Here, we investigated whether the osteogenic mineralized collagen (MC) modified polymethylmethacrylate (PMMA) cement could be a suitable material in PCD surgery. Injectability, hydrophilicity and mechanical properties of the MC-modified PMMA (PMMA-MC) was characterized. The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation. Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress. Then, PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA. Three months after implantation, micro-computed tomography analysis revealed a 36.4% higher circumferential contact index between PMMA-MC and bone, as compared to PMMA alone. Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone, while the PMMA was covered by fibrous tissue. The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation. Therefore, the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro. We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages. Moreover, expressions of fibroblast-stimulating growth factors, insulin-like growth factor, basic fibroblast growth factor and tumor necrosis factor-ß were significantly down-regulated in the macrophages cocultured with PMMA-MC. Together, the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.

Insertion/deletion polymorphism in the 3' untranslated region of COL1A2 disrupts its interaction with microRNA-382 and leads to decreased susceptibility to osteoporotic fracture.

A growing body of evidence has proved that the expression of COL1A2 is associated with a reduced risk of osteoporotic fracture. One single-nucleotide polymorphism (rs3917) located within the 3'-untranslated region of COL1A2 may "alter" binding site of miR-382 and thereby associated with the risk of osteoporotic fracture. Bioinformatic analysis, luciferase reporter assay, site-directed mutagenesis, Western blot and real-time PCR were performed in this study. In this study, we validated COL1A2 as a target of miR-382 in osteoblast. In addition, bone tissue samples were genotyped as wild-type rs3917, heterozygous rs3917, and homozygous rs3917. The expression of miR-382 was comparable between the genotype groups, whereas the expression of COL1A2 mRNA and protein was much higher in heterozygous rs3917 and homozygous rs3917 than the wild-type rs3917 group. Furthermore, we transfected the wild-type rs3917 and heterozygous rs3917 cells with miR-382 mimics or inhibitors and found that the transfection with miR-382 mimics significantly increased the level of the miR-382 in the cells of both genotypes, and the introduction of miR-382 inhibitors substantially suppressed the level of miR-382 in both cells. In wild-type rs3917 cells, transfection of miR-382 mimics and COL1A2 small interfering RNA (siRNA) similarly and substantially downregulated the expression of COL1A2, while in heterozygous rs3917 cells, only COL1A2 siRNA notably reduced the expression of COL1A2, whereas introduction of miR-382 mimics left expression of COL1A2 intact. The findings showed rs3917 polymorphism interfered with the interaction between COL1A2 mRNA and miR-382, and minor allele is associated with a reduced risk of osteoporotic fracture.

Effects of Percutaneous Kyphoplasty on Bone Metabolism and Oxidative Stress in Elderly Patients with Osteoporotic Spinal Fractures.

OBJECTIVE: To investigate the effects of percutaneous kyphoplasty on bone metabolism and oxidative stress in elderly patients with osteoporotic spinal fractures. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Orthopedics, ZhangYe People's Hospital Affiliated to HeXi University, from February 2016 to October 2017. METHODOLOGY: A total of 100 elderly patients with osteoporotic spinal fractures were randomly divided into the observation group treated with percutaneous kyphoplasty (PKP) and the control group treated with percutaneous vertebroplasty (PVP), with 50 cases in each group. One month after surgery, the content of serum bone metabolic markers bone gla protein (BGP), carboxyl-terminal collagen I crosslinks (- β), bone alkaline phosphatase (BALP) and tartrate-resistant acid phosphatase (TRACP), oxidative stress markers malondialdehyde (MDA), total antioxidant capacity (TAC) and superoxide dismutase (SOD) were compared between the two groups. Visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to evaluate the degree of pain and functional status of the two groups, and the Cobb angles were measured in both groups. RESULTS: One month after surgery, the level of the serum bone metabolic marker BGP in the observation group was higher than the control group (p<0.001), and the levels of -CTX, BALP and TRACP in the observation group were lower than the control group (all p<0.001). The level of the serum oxidative stress marker MDA in the observation group was lower than the control group (p<0.001), and the levels of TAC and SOD in the observation group were higher than the control group (all p<0.001). There were no significant differences in VAS scores and ODI values between the two groups (p=0.806 and 0.913, respectively). Cobb's angle of the injured vertebrae in the observation group was smaller than the control group (p<0.001). CONCLUSION: Compared with PVP, PKP is more effective in treating elderly patients with osteoporotic spinal fractures. It can effectively optimise bone metabolism, promote fracture healing, and reduce the oxidative stress reactions after surgery, with a relatively larger application value.