One Approach Anterior Decompression and Fixation with Posterior Unilateral Pedicle Screw Fixation for Thoracolumbar Osteoporotic Vertebral Compression Fractures.

OBJECTIVE: The objective of the present paper was to explore the clinical effect of one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporosis vertebral compression fractures (OVCF). METHODS: This is a single-center retrospective analysis. A total of six thoracolumbar OVCF patients (four women and two men) with an average age of 65.2 years (58-72 years) who were treated between June 2016 and May 2018 were enrolled in the present study. The lesion segments included: 1 case at T11, 1 case at T12, 3 cases at L1, and 1 case at L2. The six thoracolumbar OVCF patients were treated with one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation. After general anesthesia, patients were placed in the right lateral decubitus position, an approximately 10-15-cm oblique incision was made along corresponding ribs, and the conventional left retroperitoneal and/or the extrapleural approach was performed for anterior lateral exposure. First, anterior decompression and fixation were performed, and then through the unilateral paraspinal muscle approach, posterior pedicle screw fixation was performed under the same incision. The back pain visual analogue scale (VAS), the Oswestry disability index (ODI), and the MacNab criteria were used to evaluate the clinical outcome. The radiographic analysis included the regional kyphosis angle and the fusion rate. Neurological status, operation time, intraoperative bleeding, the time of ambulation, hospital stay, and surgical complications were also assessed. RESULTS: Surgery was successful in all six patients, who were followed up for 31.6 months (range, 23-46 months). The operation time was 125-163 min, with a median of 135 min. The preoperative blood loss was 580-1230 mL, with a median of 760 mL. The time of ambulation was 3-5 days, with a median of 4.2 days. The hospital stay was 8-15 days, with the median of 10.5 days. According to the Frankel classification of neurological deficits, of two patients with grade C preoperatively, one had improved to grade D and one had improved to grade E at final follow up; among four patients with grade D preoperatively, at the final follow up one remained the same and three had improved to grade E. The postoperative back pain VAS score decreased significantly, from 6.17 ± 0.75 preoperatively to 0.83 ± 0.41 postoperatively (P < 0.05). The mean ODI score was 73.7 ± 5.86 preoperatively and reduced to 21.85 ± 3.27 postoperatively (P < 0.05). According to the MacNab criteria, at the final follow up, two patients rated their satisfaction as excellent, three patients as good, and one patient as fair. The mean regional kyphosis angle was 22.17° ± 6.01°before surgery, which improved to 9.33° ± 3.88° at the final follow up (P < 0.05). At the final follow up, there were two patients who had achieved a grade 2 bony fusion (33.3%), three patients grade 3 (50.0%), and one patient grade 4 (16.7%). No incision infections, internal fixation failures or other complications were found during the perioperative and the follow-up period. CONCLUSION: One approach anterior decompression and fixation with posterior unilateral pedicle screw fixation provides a novel method for thoracolumbar OVCF disease, with a satisfactory clinical outcome.

Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery.

Objective: Surgical site infection (SSI) following hip fractures represents an important complication. This study aimed to investigate the incidence rate after surgery of hip fractures in the elderly and to identify the associated risk factors. Patients: Patients' demographic, injury, and surgery-related data and biochemical indexes were retrospectively reviewed and recorded during their hospitalization, between July 2015 and June 2017. After their discharge from hospital, patients were prospectively followed up at postoperative 1, 3, 6, and 12 months. SSIs were identified by review of patients' medical records and post-discharge telephone follow-up. Univariate and multivariate analyses were performed to determine the independent risk factors associated with SSI. Results: A total of 611 patients undergoing surgery for hip fractures with complete data were included for analysis. During the postoperative one year, 27 SSIs (19 superficial and 8 deep SSIs) developed, indicating the cumulative incidence of 4.4% (95%CI, 2.8-6.0%). Of them, 21 (77.8%) SSIs were detected during patients' hospitalization, and the 6 (22.2%) cases were confirmed via telephone during the post-discharge follow-up. After adjustment of multiple variables, BMI, current smoking, surgical duration, preoperative hospital stay, ASA class of III-IV, ALB <35g/L, and FBG > 110mg/dL were identified as independent risk factors for SSI. Conclusions: Three modifiable factors as smoking, preoperative ALB <35g/L, and FBG > 110mg/dL should be optimized preoperatively to reduce the SSIs. Other factors, although not modifiable, could be used for screening of at-risk patients, patient risk stratification, or for counseling of patients.

Risk Factors of Secondary Vertebral Compression Fracture After Percutaneous Vertebroplasty or Kyphoplasty: A Retrospective Study of 650 Patients.

BACKGROUND In this study, we aimed to investigate the risk factors contributing to secondary vertebral compression fractures (SVCF) in patients undergoing percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) due to osteoporotic vertebral compression fracture (OVCF). MATERIAL AND METHODS Between January 2010 and December 2017, 650 patients with regular follow-up were identified and retrospectively analyzed in this study. Of these patients, 410 patients underwent PVP and 240 patients underwent PKP surgery. Patients were followed for 24 months on average, ranging from 6 months to 36 months follow-up. Possible risk factors screened for were age, gender, regional distribution, outdoor activity (ODA), bone mineral density (BMD), surgical methods (unilateral or bilateral), bone cement dose, bone cement leakage, chronic disease history, postoperative anti-osteoporosis treatment, and level of preoperative OVCF. Logistic regression analysis was applied to determine potential risk factors. RESULTS As a result, 102 patients (15.7%) suffered SVCF after PVP/PKP surgery at the last follow-up. Binary logistic regression model showed that older age increased the risk of developing SVCF [odds ratio (OR)=2.48, P=0.031] while high-level BMD (OR=0.31, P<0.001) and ODA (OR=0.38, P=0.001) decreased the risk. Binary logistic regression model showed the following: Logit (P)=1.03+0.91X1-1.18X2-0.97X3 (X1=age, OR=2.48, P=0.031; X2=BMD, OR=0.31, P<0.001; X3=ODA, OR=0.38, P=0.001). CONCLUSIONS In conclusion, older age and lower BMD were identified as risk factors of SVCF for OVCF patients following PVP/PKP surgery, whereas more ODA played a protective role in SVCF development.

Relationship between the incidence of de Quervain's disease among teenagers and mobile gaming.

OBJECTIVE: To assess the relationship between the incidence of de Quervain's disease (DD) and mobile gaming. METHODS: We conducted an experimental cross-sectional study and surveyed specialized students with different majors from Xingtai Technician Institute. We applied the stratified clustered sampling method to recruit 500 students aged 16 to 20 years as survey respondents. We diagnosed DD by conducting Finkelstein's test. Chi-square test or Fisher's exact test was used to determine the correlation between different variables and Finkelstein's test results. SPSS 20 statistical software was used to perform all the statistical analyses. RESULTS: Among the five hundred students providing the valid data, there were 302 males and 198 females, with a male-to-female ratio of 3:2. Of them, 216, 159, 77, and 48 reported they played mobile games for < two, two to four, four to six, and > six hours per day, respectively. A total of 246 students (49%) had a positive result in Finkelstein's test. Three hundred and five (61.0%) students played mobile games with their wrist in dorsiflexion position, and among them, 192 had a positive result in Finkelstein's test. The statistical analyses showed that more frequent play, prolonged mobile gaming time per day, and changes in wrist position were significantly correlated with the positive rate of Finkelstein's test (p < 0.05). DISCUSSION: Our results show that the incidence of DD in students in the school was 49.0%. More frequent play, prolonged duration of mobile gaming, and change in wrist position were associated with higher risk of DD. We advocate the restricted time to less than 2.25 hours per day and the frequency in mobile gaming to prevent or reduce DD.

Posterior atlantoaxial dislocation without fracture or neurological symptoms treated by transoral-posterior approach surgery: a case report and literature review.

BACKGROUND: Atlantoaxial dislocation usually results from hyperextension trauma and is almost always accompanied by odontoid fracture and neurological symptoms. In most cases, patients with atlantoaxial dislocation die instantly. This is a rare report of posterior atlantoaxial dislocation without fracture and neurological symptoms effectively treated by transoral-posterior approach surgery, and only eleven similar cases have been previously reported. OBJECTIVE: To describe the very rare case of an adult posterior atlantoaxial dislocation patient without fracture who was neurologically treated using transoral-posterior approach surgery and to review the relevant literature. METHOD: A 52-year-old man riding a motorcycle was rear-ended by a car. Using X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI), he was diagnosed with posterior atlantoaxial dislocation without a related fracture or a significant change in spinal cord signal. Transoral-posterior approach surgery with sustained skull traction was used after failed closed reduction. RESULT: During a 6-month follow-up observation, the lateral cervical spine radiography and sagittal reconstructions of CT scans demonstrated no instability of the atlantoaxial complex. Few patients experience posterior atlantoaxial dislocation without a related fracture or spinal cord deficit. For a patient who experiences trauma with hyperextension, such as in rear-end collisions, X-ray, CT scan and MRI should be performed to ensure that this injury is diagnosed. It is necessary to perform surgery to recover atlantoaxial stability, even in the absence of fracture or neurological symptoms. CONCLUSION: Transoral-posterior approach surgery is a safe and effective way to manage irreducible posterior atlantoaxial dislocation.

Protective role of 17ß-estradiol on tumor necrosis factor-α-induced apoptosis in human nucleus pulposus cells.

The molecular mechanisms underlying protection and pathogenesis in spinal degenerative diseases remain unclear. Tumor necrosis factor-α (TNF-α) has been demonstrated to induce apoptosis of inte rvertebral disc (IVD) cells during IVD degeneration, and 17ß­estradiol (17ß­E2) has a protective effect against IVD cell apoptosis. However, the underlying molecular mechanism by which 17ß­E2 protects nucleus pulposus (NP) cells remains to be investigated. The aim of the present study was to evaluate whether 17ß­E2 modulates apoptosis of human NP cells induced by TNF­α. In addition, the concentration­response effect of 17ß­E2 on human NP cells was investigated. Human NP cells were cultured in complete medium, which was replaced every three days until the culture was ~80% confluent. Cells were treated with 100 ng/ml TNF­α for 48 h, with or without pretreatment with various concentrations of 17ß­E2, and ICI 182,780, for 30 min. Morphologic alterations characteristic of apoptosis were observed by inverted phase­contrast microscopy and Hoechst 33258 staining; the apoptosis rate was analyzed by flow cytometry. A Cell Counting kit­8 assay was used to assess cell proliferation. Furthermore, caspase­3 activity was determined and proteins associated with apoptosis were analyzed by western blotting. The level of apoptosis and caspase­3 activity in human NP cells increased, whereas proliferation and the expression of poly ADP­ribose polymerase decreased following TNF­α treatment. These effects of TNF­α were abolished by pretreatment with 17ß­E2 in a concentration­dependent manner. The results of the present study indicated that 17ß­E2 serves a critical role in the survival of degenerative human NP cells.

Modified eggshell procedure via posterior approach for sclerosing thoracic disc herniation: a preliminary study.

BACKGROUND: Clinically, sclerosing thoracic disc herniation is a disease with high surgical risk and various complications. Eggshell procedure is a surgical method used by surgeons to treat sclerosing thoracic disc herniation. The aim of this study was to report a modified eggshell procedure to treat sclerosing thoracic disc herniation. METHODS: Medical records of 25 patients with sclerosing thoracic disc herniation were collected between 2007/01 and 2010/08, including 14 males and 11 females, with an average age of 51.7 years old. Modified eggshell procedure was performed to treat the patients with sclerosing thoracic disc herniation. All patients were followed up. Japanese Orthopaedic Association (JOA) score was used to evaluate the clinical outcomes. RESULTS: All operations were performed successfully with complication rate of 12 %. There were 2 cases of dural laceration and 1 subdural hematoma. All included patients were followed up for at least 5 years, with the median of 6 years. JOA score of preoperation was 5 (IQR = 1) while it was 8 (IQR = 2) at final follow-up, with significant difference (Mann-Whitney U test, Z = -4.891, P < 0.001). The improvement rate of neurological status was 51.5 ± 23.1 %. According to the classification of improvement rate, there were 15 cases at good level, 8 cases at moderate level, and 2 cases without any improvement. CONCLUSIONS: Modified eggshell procedure is a safe and effective surgical method when performed to treat sclerosing thoracic disc herniation in the clinical practice.

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture: A retrospective case-control study.

The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate.