Risk factors of revision operation and early revision for adjacent segment degeneration after lumbar fusion surgery: a case-control study.

BACKGROUND CONTEXT: Adjacent segment degeneration (ASD) following lumbar fusion operation is common and can occur at varying timepoints after index surgery. An early revision operation for ASD, however, signifies a short symptom-free period and might increase the risk of successive surgeries. PURPOSE: We aimed to elucidate the overall risk factors associated with revision surgeries for ASD with distinct attention to early revisions. STUDY DESIGN/SETTING: Retrospective, case-control study. PATIENT SAMPLE: The study included 86 patients who underwent revision operations for ASD after lumbar fusion in the revision group and 166 patients who did not for at least 5 years after index surgery. OUTCOME MEASURES: Sagittal parameters, Pfirrmann grading, facet degeneration grading, and disc space height (DSH) of adjacent segments were assessed. METHODS: Revision operations within 5 years postsurgery were defined as early revision. We compared the revision and no-revision groups as well as the early- and late-revision groups. RESULTS: The revision group demonstrated a significantly greater preoperative C7-S1 sagittal vertical axis (SVA) (p=.001), postoperative C7-S1 SVA (p<.001), and postoperative pelvic incidence (PI)-lumbar lordosis (LL) (p<.001) than those in the no-revision group. Preoperative DSH of the proximal adjunct segment (p=.001), postoperative PI-LL (p=.014), and postoperative C7-S1 SVA (p=.037) exhibited significant association with ASD in logistic regression analysis. The early-revision group had a significantly higher patient age (p=.001) and a greater number of levels fused (p=.030) than those in the late-revision group. Multivariate Cox regression analysis demonstrated that old age (p=.045), a significant number of levels fused (p=.047), and a narrow preoperative DSH of the proximal adjacent level (p=.011) were risk factors for early revision. CONCLUSIONS: Postoperative sagittal imbalance, including significant PI-LL and C7-S1 SVA were risk factors for revision operation for ASD but not for early revision. These factors are likely to affect the long-term risk of revision operation due to ASD and thus are not considered risk factors for early revision. Narrow DSH of the proximal adjacent level increased the risks of both revision and early revision surgeries. Moreover, old age and a significant number of levels fused further increased the risk for early revision for ASD.

Does Posterior Cord Compression From the Ligamentum Flavum Influence Clinical Outcomes After Anterior Cervical Discectomy and Fusion?

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To clarify whether outcomes of anterior cervical discectomy and fusion (ACDF) differ according to the presence of posterior cord compression from the ligamentum flavum (CCLF). SUMMARY OF BACKGROUND DATA: Although ACDF effectively addresses anterior cord compression from disc material and bone spurs, it cannot address posterior compression. Whether ACDF could result in favorable outcomes when CCLF is present remains unclear. PATIENTS AND METHODS: A total of 195 consecutive patients who underwent ACDF and were followed up for >2 years were included. CCLF was graded based on magnetic resonance imaging findings. Patients with CCLF grade 2 were classified as such, whereas patients with CCLF grades 0 to 1 were classified as the no-CCLF group. Patient characteristics, cervical sagittal parameters, neck pain visual analog scale, arm pain visual analog scale, and Japanese Orthopedic Association (JOA) score were assessed. Categorical variables were analyzed using a χ 2 test, whereas continuous variables were analyzed using the Student t test. Multivariable logistic regression analysis was performed to elucidate factors associated with JOA recovery rates of >50%. RESULTS: One hundred sixty-seven patients (85.6%) were included in the no-CCLF group, whereas the remaining 28 patients (14.4%) were included in the CCLF group. Among patients in the CCLF group, 14 patients (50.0%) achieved clinical improvement. JOA score significantly improved in the no-CCLF group after the operation ( P < 0.001), whereas improvement was not appreciated in the CCLF group ( P = 0.642). JOA scores at 3 months ( P = 0.037) and 2 years ( P = 0.001) postoperatively were significantly higher in the no-CCLF group. Furthermore, the JOA recovery rate at 2 years after surgery was significantly higher in the no-CCLF group ( P = 0.042). Logistic regression demonstrated that CCLF was significantly associated with a JOA recovery rate of >50% at 2 years after surgery (odds ratio: 2.719; 95% CI: 1.12, 6.60). CONCLUSION: ACDF performed for patients with CCLF grade 2 showed inferior JOA score improvement compared with those with CCLF grade 0 or 1. ACDF cannot remove posterior compressive structures, which limits its utility when ligamentum flavum significantly contributes to cord compression.

Mortality rates of hip fracture patients with non-operative treatment.

OBJECTIVES: In this study, we aimed to analyze patient mortality rate after non-operative treatment of hip fractures to determine the distribution of causes of death and to compare factors affecting mortality. PATIENTS AND METHODS: Between January 2013 and March 2019, a total of 93 patients (17 males, 76 females; mean age: 86.0±7.4 years; range, 64 to 98 years) who had hip fractures and were treated non-operatively were analyzed retrospectively. Survival, date of death, and cause of death were collected and analyzed. Baseline demographics, pre-trauma ambulation, pre- and post-trauma residence status, American Society of Anesthesiologists Physical Status (ASA PS) classification, and Parker's mobility score were compared with one-year mortality rates. RESULTS: The mean follow-up of survivors was 16.1±11.9 (range, 6.3 to 79.6) months. The mean survival of non-survivors was 4.9±6.1 (range, 0.007 to 27.3) months. The 3-, 6-, 12-, and 24-month mortality rates were 40.9%, 53.3%, 74.4%, and 87.5%, respectively. Respiratory diseases (33.3%) and cardiovascular diseases (13.6%) were the main causes of death among the patients. There was no statistically significant difference between the patients' age, sex, fracture site, pre-trauma ambulation, pre- and post-trauma residence status, ASA PS classification, Parker's mobility score, and one-year mortality. CONCLUSION: A significant number of patients are still treated non-operatively after hip fractures, and they have a high mortality rate. Efforts and research are needed to reduce mortality and improve the quality of life.

Dasatinib regulates LPS-induced microglial and astrocytic neuroinflammatory responses by inhibiting AKT/STAT3 signaling.

BACKGROUND: The FDA-approved small-molecule drug dasatinib is currently used as a treatment for chronic myeloid leukemia (CML). However, the effects of dasatinib on microglial and/or astrocytic neuroinflammatory responses and its mechanism of action have not been studied in detail. METHODS: BV2 microglial cells, primary astrocytes, or primary microglial cells were treated with dasatinib (100 or 250 nM) or vehicle (1% DMSO) for 30 min or 2 h followed by lipopolysaccharide (LPS; 200 ng/ml or 1 µg/ml) or PBS for 5.5 h. RT-PCR, real-time PCR; immunocytochemistry; subcellular fractionation; and immunohistochemistry were subsequently conducted to determine the effects of dasatinib on LPS-induced neuroinflammation. In addition, wild-type mice were injected with dasatinib (20 mg/kg, intraperitoneally (i.p.) daily for 4 days or 20 mg/kg, orally administered (p.o.) daily for 4 days or 2 weeks) or vehicle (4% DMSO + 30% polyethylene glycol (PEG) + 5% Tween 80), followed by injection with LPS (10 mg/kg, i.p.) or PBS. Then, immunohistochemistry was performed, and plasma IL-6, IL-1ß, and TNF-α levels were analyzed by ELISA. RESULTS: Dasatinib regulates LPS-induced proinflammatory cytokine and anti-inflammatory cytokine levels in BV2 microglial cells, primary microglial cells, and primary astrocytes. In BV2 microglial cells, dasatinib regulates LPS-induced proinflammatory cytokine levels by regulating TLR4/AKT and/or TLR4/ERK signaling. In addition, intraperitoneal injection and oral administration of dasatinib suppress LPS-induced microglial/astrocyte activation, proinflammatory cytokine levels (including brain and plasma levels), and neutrophil rolling in the brains of wild-type mice. CONCLUSIONS: Our results suggest that dasatinib modulates LPS-induced microglial and astrocytic activation, proinflammatory cytokine levels, and neutrophil rolling in the brain.

Enhanced ridge preservation by bone mineral bound with collagen-binding synthetic oligopeptide: a clinical and histologic study in humans.

BACKGROUND: The ridge-preservation technique has been applied with membrane alone or membrane plus graft. Synthetic peptides, mimicking bioactive growth factor or extracellular matrix protein, have been attempted to provide an active surface of the biomaterials in inducing bone formation while alleviating the limitations of whole protein such as short half-life, immunologic responses. The aim of the present clinical study is to examine the osteogenic effect of synthetic oligopeptide-coated bone mineral compared to bone graft without peptide when applied with collagen membrane in a ridge-preservation technique. METHODS: Synthetic oligopeptide from the collagen-binding domain of osteopontin was chemically synthesized and coated onto the surface of bone mineral particulates. Ridge preservations were performed at 44 extraction sites in 42 patients (20 males and 22 females). Analyses of clinical parameters and histomorphometric evaluations were conducted to compare the osteogenic effects of the grafts between baseline and 6 months. RESULTS: In the bone grafts of the control group treated without synthetic peptide, new bone formation was only seen around borders and basal areas. However, new bone was observed broadly in the defects of the test group treated with synthetic peptide-coated bone mineral, as seen not only at peripheries but also in the central and coronal parts of bone cores in the defects. The average percentage of new bone formation was significantly higher in the test group (5.3% ± 8.3% versus 10.4% ± 4.6%). The contact percentages between the graft particles and the new bone were 8.2% ± 11.3% for the control group and 20.4% ± 7.5% for the test group (P <0.05). CONCLUSIONS: The ridge-preservation approach using synthetic oligopeptide-coated bone mineral with collagen membrane effectively prevented the resorption of hard tissue with higher bone-to-graft contact, and the oligopeptide-coated bone may be a choice for ridge-preservation procedures while assuring new bone formation.

Follicular wave emergence, luteal function and synchrony of ovulation following GnRH or estradiol benzoate in a CIDR-treated, lactating Holstein cows.

This study evaluated the effect of GnRH or estradiol benzoate (EB) on follicular wave emergence and progesterone concentrations, and following a second injection of GnRH, synchrony of ovulation, and pregnancy rates in a controlled internal drug release (CIDR)-based timed AI (TAI) protocol in lactating Holstein cows. Cows received a CIDR device without hormone (controls), with an injection of 100 microg GnRH or with an injection of 4 mg EB. Thereafter, all received PGF(2 alpha) at the time of CIDR removal on Day 7, GnRH on Day 9, and TAI 16 h later. Follicular wave emergence occurred within 7 days in 19/20 GnRH-treated, 14/20 EB-treated and 5/20 control cows (P < 0.05). The interval to wave emergence was the shorter and less variable (P < 0.01) in the GnRH group (2.9 +/- 0.2 days) than in the EB (4.7 +/- 0.5 days) or control (4.8 +/- 1.0 days) groups. Serum progesterone concentrations from Days 4 to 7 were higher (P < 0.01) in the GnRH-treated cows that ovulated than in those that did not ovulate, or in control and EB-treated cows. The diameters of dominant follicle on Day 7 differed among groups (P < 0.01), and the diameters of the preovulatory follicle on Day 9 were larger (P < 0.01) in the control and GnRH groups than in the EB group. The proportion of cows with synchronized ovulations did not differ among groups, but pregnancy rate to TAI was higher (P < 0.05) in the GnRH group (65%; 13/20) than in the control (30%; 6/20) or EB (35%; 7/20) groups. Results suggest that GnRH treatment of CIDR-treated lactating Holstein cows will result in synchronous follicular wave emergence, large preovulatory follicles and synchronous ovulation, resulting in an acceptable pregnancy rates to TAI.