The Role of Immunocyte Infiltration Regulatory Network Based on hdWGCNA and Single-Cell Bioinformatics Analysis in Intervertebral Disc Degeneration.

Immune infiltration plays a crucial role in intervertebral disc degeneration (IDD). In this study, we explored the immune microenvironment of IDD through single-cell bioinformatics analysis. Three single-cell datasets were integrated into this study. Nucleus pulposus cells (NPCs) were divided into subgroups based on characteristic genes, and the role of each subgroup in the IDD process was analyzed through pseudo-time trajectory analysis. The hub genes were obtained using hdWGCNA, further identified by bulk datasets and pseudo-time sequence. The expression of the hub genes defined the NPCs related to immune infiltration, and the interaction between these NPCs and immunocytes was explored. The NPCs were divided into four subgroups: reserve NPCs, HCL-NPCs, response NPCs, and support NPCs, which, respectively, dominate the four processes of IDD: non, mild, moderate, and severe degeneration. SPP1 and ICAM1 were identified as the nucleus pulposus immune infiltration hub genes. Macrophages and myelocytes played pro-inflammatory roles in the SPP1-ICAM both-up NPC group through the SPP1-CD44 pathway and ICAM1-ITGB2 ligand-receptor pathway, respectively. At the same time, both-up NPCs sought self-help inflammation remission from neutrophils through the ANXA1-FPR1 pathway. The systematic analysis of the differentiation and immune infiltration landscapes helps to understand IDD's overall development process. Our data suggest that SPP1 and ICAM1 may be new targets for the treatment of inflammatory infiltration in IDD.

Comparison between percutaneous short-segment fixation and percutaneous vertebroplasty in treating Kummell's disease: A minimum 2-year follow-up retrospective study.

BACKGROUND: Percutaneous kyphoplasty (PKP) or percutaneous short-segment fixation (PSSF) is often used to treat Kummell's disease. However, it is not clear which treatment is better for patients. OBJECTIVE: To retrospectively compare the clinical efficacy of PVP and PSSF for the treatment of Kummell's disease. METHOD: 60 patients were involved in this research and the period of follow-up was at least 2 years. 27 of them were treated with PVP (Group I) and the rest who received PSSF (Group II). The visual analog scale (VAS) and radiographic indexes of each participant had been measured preoperatively as well as 1 week, 3 months, and 2 years postoperatively. Additionally, the Oswestry Disability Index (ODI) scores were assessed at the last time point. RESULTS: Comparing the two groups, no statistical significance was found among all parameters preoperatively. The time of operations and blood loss is less in Group I. At each time point after operation, the imaging indices in Group II are lower (P< 0.05). One week after treatments, the VAS scores are lower in Group I, and similarly, 3 months are the same (P< 0.05), while VAS are similar at the last time point. In the aspect of ODI scores, they are lower in Group II during long-term follow-up. CONCLUSION: For the treatment of Kummell's disease, both PVP and PSSF have been found to be effective. PVP can provide rapid pain relief with a shorter operation time. However, in cases with severe kyphosis deformity, PSSF should be given priority.

Comparison between gravity drainage group and suction drainage group after cervical laminoplasty: a retrospective STROBE-compliant cohort study.

OBJECTIVES: A retrospective study was conducted to compare gravity drainage and suction drainage after cervical laminoplasty. PATIENTS AND METHODS: A total of 375 patients who underwent laminoplasty between January 2011 and December 2015 were engaged in this analysis. We investigated the patients' basic characteristics, drainage characteristics and postoperative complications. RESULTS: During the initial 24 h after laminoplasty, the drainage volume in the suction drainage group was 177.31 ± 92.02 mL, and the drainage volume in the gravity drainage group was 133.33 ± 92.40 mL. The drainage volume showed significant difference (p < 0.01). The total drainage volume was 357.49 ± 195.16 mL and 250.16 ± 27.44 mL in the suction drainage group and gravity drainage group, respectively. The total drainage volume between the two groups was statistically different (p = 0.03). The postoperative Hb was significantly different between the gravity group and suction group on the first day after the operation (108.37 ± 23.92 mL vs. 87.32 ± 21.53 mL, p = 0.02). The number of patients required blood transfusion was significantly different between the two groups as well (p = 0.04). Two cases had symptomatic epidural hematomas (SEH) after laminoplaty. However, the occurrence of SEH among the two groups was not different significantly. Twelve patients had surgical site infection (SSI). Of these 12, nine had applied gravity drainage and three suction drainage. The rate of SSI was similar between the two groups (p = 0.71). CONCLUSION: The initial 24 h' drainage volume and the total drainage volume increased significantly in the suction drainage group. The postoperative Hb was lower in the suction group than the gravity drainage group the first postoperative day. More patients needed blood transfusion if suction drainage was performed. The application of suction drainage cannot decrease the incidence of SSI and SEH after laminoplasty. Gravity drainage is recommended for laminoplasty.

Modified axial computed tomography classification of cervical ossification of the posterior longitudinal ligament: selecting the optimal operating procedure and enhancing the accuracy of prognosis.

BACKGROUND: Cervical ossification of the posterior longitudinal ligament (OPLL) causes spinal cord compression, which can lead to myelopathy or radiculopathy. Non-surgical treatments have little effect on this condition. Current OPLL classification systems offer little guidance on the selection of an appropriate operating procedure. In this study, we developed a modified axial computed tomography classification (MACTC) scheme. We then examined the usefulness of the MACTC scheme and two other existing classification schemes in guiding OPLL operation choice. METHODS: Following screening in which a defined exclusion criteria was used, a total of 91 patients with OPLL participated in the study. Patients' follow-up data for at least 2 years were obtained. The recovery rate of the Japanese Orthopaedic Association (JOA) scores was compared to two other classification schemes. RESULTS: According to the MACTC, central-sharp-type OPLL had a lower recovery rate of the JOA score than that of central-gentle-type OPLL (36.05±32.38 vs. 83.90±23.52, P≤0.05). The recovery rate of the JOA scores in the ipsilateral open-door OPLL group was significantly lower than that in the contralateral group of the lateral-steep type (36.67±41.5 vs. 88.89±17.21, P=0.04), but not of that in the lateral-gentle type. There was no significant difference in the recovery rates of the JOA scores between groups when using either existing classification scheme (P>0.05). CONCLUSIONS: The MACTC scheme can assist surgeons to choose the most appropriate operating procedure, and provide an accurate prognosis. If operations on central-sharp-type OPLL are not performed using both the posterior and anterior approaches, prognosis will be poor. The contralateral side should be the first choice for door opening in laminoplasty, especially for patients with lateral-steep-type OPLL. Severe OPLL may not be an absolute contraindication for the posterior approach.

"Sandwich" wound dressing to reduce surgical site infections during sacrococcygeal surgery: A retrospective analysis.

OBJECTIVE: To explore whether the "sandwich" wound dressing method with a hydrocolloid dressing can effectively reduce surgical site infection rates in sacrococcygeal aseptic operations. METHODS: A retrospective cohort of patients with sacrococcygeal aseptic operations (class I incision category) from January 2017 to March 2018 were divided into intervention (sandwich dressing) and control groups (conventional dressing). The surgical site infections (SSI) rate, wound healing course, hospitalization time, and medical costs in the two groups were determined. To exclude the influence of other factors, operation time, blood loss, age, sex ratio, the distance of the incision from the distal edge to the anus, and initial defecation times were compared between the groups. RESULTS: The SSI rates and medical costs in the interventional group were significantly lower than the control group (0% vs 78.57%, P < 0.0001; 3.27 ±â€¯0.98 vs 5.83 ±â€¯1.66 ¥10,000, p < 0.0001). Hospitalization times were also lower in the intervention compared to the control group (17.05 ±â€¯4.77 vs 34.50 ±â€¯15.47 day, P = 0.001). CONCLUSIONS: The sandwich wound dressing method with a hydrocolloid dressing can effectively prevent SSI during sacrococcygeal aseptic surgery.

Predictor of Surgical Outcomes in Ankylosing Spondylitis Cervical Spinal Fracture: An At Least 2 Years Follow-Up Retrospective Study.

STUDY DESIGN: Retrospective study. OBJECTIVE: A retrospective study was conducted to clarify the prognostic factors of postoperative for cervical spine fractures patients with ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: Now the high probability of cervical fractures in patients with AS is unanimously recognized. Fractures mostly occur in the lower cervical spine and two-thirds of patients are accompanied by spinal cord injury. But there are few studies on treatment of AS patients with cervical fracture and it is unclear whether the surgical method, timing of surgery, basic treatment of AS, and different doses of steroids therapy have an impact on the prognosis. Thus, this study aims to evaluate the impact of perioperative factors on the prognosis of traumatic cervical fractures in surgical patients with AS. METHODS: Preoperative and postoperative spinal cord function were assessed according to the Japanese Orthopaedic Association (JOA) Scores and Improvement rate were calculated. The neck pain severity were rated using a visual analogue scale (VAS) score. The t test and v2-test were used for comparison of clinical data between the preoperative and postoperative groups. Logistic univariate and multivariate regression analysis were used to obtain adjusted odds ratios. Pearson correlation coefficients were used to evaluate the relationship between variables. RESULTS: The degree of fracture displacement in cervical spine fractures patients with AS was most common at the neck-chest junction (26.1%). Patients with degree of cervical fracture displacement less than 50% had significantly improved JOA scores after surgery (P = 0). The incidence of spinal cord injury (SCI) due to fracture was high (52.2%). Patients with combined anterior and posterior is helpful for neurological recovery (P = 0.01). Basic AS treating before injury would be benefit for neurological improvement (P = 0). CONCLUSION: Basic AS treatment, SCI, and surgical methods are independent factors that affect the prognosis of cervical spine fractures patients with AS. It is controversial to perform surgery and preoperative steroid application as soon as possible. LEVEL OF EVIDENCE: 3.

Transdural Approach to Resection of Intraspinal Extradural Ventral Cysts in the Lumbar Spine.

BACKGROUND: Intraspinal extradural ventral cysts in the lumbar spine can cause back pain and neurological deficits of the lower extremities. For the resection of this type of space-occupying lesion, the transdural approach has not been reported in the literature. CASE DESCRIPTION: A 66-year-old man presented, suffering from progressive radiation pain of his bilateral lower extremities. Imaging examination revealed a cystic lesion in ventral side of lumbar spinal canal. We conducted the excision of the cyst with the transdural approach. The symptoms of the patient disappeared immediately after the operation and recurrence of the symptoms has not been observed in the 3-month follow-up. CONCLUSIONS: This operation approach is safe and effective. Compared with the previous surgical approach reported in the literature, by this approach surgeons could achieve less injury, shorter operation time, and the same surgical outcomes in the short term. Therefore, we would like to present this approach to provide an alternative to deal with similar lesions.

Circular RNA LARP4 correlates with decreased Enneking stage, better histological response, and prolonged survival profiles, and it elevates chemosensitivity to cisplatin and doxorubicin via sponging microRNA-424 in osteosarcoma.

BACKGROUND: This study aimed to evaluate the association of circular RNA La-related RNA-binding protein 4 (circ-LARP4) with clinical features and prognosis in osteosarcoma patients, and further explore its effect on chemosensitivity in osteosarcoma cells. METHODS: Seventy-two osteosarcoma patients with Enneking stage IIA-IIB who underwent resection were consecutively enrolled, and then, tumor tissues and non-tumor tissues were obtained. Circ-LARP4 in tumor tissue/non-tumor tissue was detected by quantitative polymerase chain reaction. After circ-LARP4 overexpression and negative control overexpression plasmid transfection, relative cell viability (%) was evaluated by Cell Counting Kit-8 in MG63 cells treated by different concentrations of cisplatin, methotrexate, and doxorubicin, and IC50 was calculated. RESULTS: Circ-LARP4 was downregulated in tumor tissue compared with non-tumor tissue and had a good value in distinguishing tumor tissue from non-tumor tissue with an area under curve of 0.829 (95% CI: 0.762-0.859). Meanwhile, tumor circ-LARP4 was negatively correlated with the Enneking stage. After resection, circ-LARP4 high expression patients showed an increased tumor cell necrosis rate to adjuvant chemotherapy compared to circ-LARP4 low expression patients, and circ-LARP4 high expression correlated with prolonged disease-free survival and overall survival. In vitro experiments revealed that circ-LARP4 overexpression elevated the chemosensitivity of MG63 cells to cisplatin and doxorubicin but not methotrexate, with decreased cisplatin IC50 and doxorubicin IC50 concentrations than negative control. Besides, miR-424 overexpression attenuated the chemosensitivity in circ-LARP4 overexpression-treated MG63 cells. CONCLUSION: Circ-LARP4 high expression correlates with decreased Enneking stage and prolonged survival profiles, and it elevates chemosensitivity to cisplatin and doxorubicin via sponging miR-424 in osteosarcoma.

Risk factors of postoperative low back pain for low-grade isthmic spondylolisthesis: a retrospective study.

OBJECTIVE: To investigate the risk factors of postoperative low back pain (LBP) following posterior lumbar interbody fusion (PLIF) surgery for low-grade isthmic spondylolisthesis (IS). METHODS: This retrospective study enrolled patients with IS that underwent PLIF between January 2011 and January 2016. Demographic, clinical, surgical and radiological characteristics were analysed to determine associations between these characteristics and LBP as measured using a visual analogue scale (VAS) pain score. RESULTS: A total of 192 patients were enrolled in the study. The mean VAS pain score of LBP decreased significantly after surgery. The mean preoperative VAS pain score was significantly greater in patients with symptoms of ≤3 years duration compared with those with symptoms lasting >3 years. The postoperative VAS pain score was significantly lower in patients with grade 1 slippage compared with those with grade 2 slippage. There was a significant correlation between preoperative to postoperative change of VAS pain score and postoperative disc height (r = 0.99). CONCLUSION: PLIF significantly improved LBP in patients with low-grade IS, although patients still reported some postoperative LBP. The grade of slippage was a risk factor for postoperative LBP. Restoring the disc height appeared to improve LBP.

The long noncoding RNA HOTAIR serves as a microRNA-34a-5p sponge to reduce nucleus pulposus cell apoptosis via a NOTCH1-mediated mechanism.

Intervertebral disc degeneration (IDD) is a major cause of lower back pain, but the specific molecular mechanisms governing its development are poorly characterized. This study sought to assess to what extent HOTAIR, a long non-coding (Lnc) RNA is expressed in IDD and regulates the apoptotic death of nucleus pulposus (NP) cells. We therefore used real-time qPCR to measure HOTAIR and microRNA(miR)-34a-5p in degenerative NP cells, and then validated their functional relevance via overexpressing them in these NP cells. We further verified the targets of these RNA constructs in 293 T cells through the use of a dual luciferase reporter assay. We further measured NP cell apoptosis via flow cytometry and Notch1 expression via western blotting. Our results indicated that IDD was linked with decreased HOTAIR expression relative to regular NP cells, and overexpressing this lncRNA was linked to reduced apoptotic NP cell death, whereas overexpressing miR-34a-5p had the opposite effect. We found that HOTAIR served as a miR-34a-5p sponge, sequestering this miRNA and thereby down regulating genes linked to apoptosis through the Notch signaling pathway. Even in naturally degenerated NP cells, HOTAIR delayed the onset of apoptosis. Together these results reveal that a HOTAIR/miR-34a-5p/Notch1 signaling pathway may regulate the development of IDD, potentially making HOTAIR a viable target for treatment of this disease.

Diagnostic accuracy of dual-energy CT in gout: a systematic review and meta-analysis.

OBJECTIVE: Dual-energy CT (DECT) is being widely used in suspected gout patients in recent years. Many clinicians tend to use DECT instead of aspiration biopsy in the diagnosis of gout, but its accuracy has shown controversial results. In this systematic review and meta-analysis, we sought to evaluate the accuracy of DECT in the diagnosis of gout. MATERIALS AND METHODS: We performed a systematic review of the literature published in Medline, Embase, PubMed, and Cochrane databases. Studies included are all clinical trials of DECT in the diagnosis of gout. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). We recorded sensitivity and specificity of algorithms and calculated positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odd ratio (DOR), and respective confidence intervals (CI). The summary receiver operating characteristic curve (sROC) was drawn to get the Cochran Q-index and the area under the curve (AUC). RESULTS: Seven studies were included in this review and showed high homogeneity. The analysis results presented the pooled sensitivity was 88% (95% CI 84-90%) and specificity was 90% (95% CI 85-93%). Then, we figured out that the pooled PLR was 8.48 (95% CI 5.89-12.22) and NLR was 0.10 (95% CI 0.04-0.24) respectively. In addition, Cochran-Q was 0.90 and AUC was 0.9565 in sROC curve. CONCLUSIONS: DECT showed relatively high sensitivity and specificity in the diagnosis of gout. Synthetically considering these DECT abnormalities could improve the diagnostic sensitivity. More rigorous and standardized studies are still needed to support these findings.

MicroRNA-411 promoted the osteosarcoma progression by suppressing MTSS1 expression.

MicroRNAs (miRNAs) play crucial roles in the progression of different tumors. In our study, we investigated the expression and roles of miR-411 in human osteosarcoma. In this study, we first confirmed that the miR-411 expression was higher in the serum of patients with osteosarcoma than in the serum of healthy volunteers. In addition, we found that the miR-411 expression was upregulated in the osteosarcoma tissues compared to that in the matched normal bone tissues. We also demonstrated that the miR-411 expression was upregulated in the four osteosarcoma cell lines. Elevated expression of miR-411 promoted osteosarcoma cell proliferation and migration. Moreover, we identified that metastasis suppressor protein 1 (MTSS1) was a direct target gene of miR-411 in the osteosarcoma cell. We also demonstrated that the MTSS1 expression was downregulated in the osteosarcoma tissues compared to that in the matched normal bone tissues. In addition, MTSS1 expression level was inversely correlated with miR-411 expression in the osteosarcoma tissues. Furthermore, elevated expression of miR-411 enhanced the osteosarcoma cell proliferation and migration through inhibiting the MTSS1 expression. These data suggested that miR-411 played as oncogene in the osteosarcoma partly by inhibiting the MTSS1 expression.

Risk Factors of Postoperative Sacroiliac Joint Pain for Posterior Lumbar Surgery: ≥2-Year Follow-up Retrospective Study.

PURPOSE: A retrospective study was conducted to clarify the risk factors of postoperative sacroiliac joint pain (SIJP) for posterior open lumbar surgery. PATIENTS AND METHODS: A total of 472 patients who underwent posterior lumbar surgery between January 2011 and December 2014 were included in this analysis. We recorded basic characteristics, surgical characteristics, and SIJP information for each patient. RESULTS: The incidence of postoperative SIJP is 13.8% in our study. Comparison of the incidence of SIJP between diskectomy and posterior lumbar interbody fusion indicated that SIJP incidence tended to be higher in posterior lumbar interbody fusion patients (P = 0.029). Compared with the single-segment group, SIJP occurred more frequently in the multiple operative segments group (P = 0.025). Comparing the incidence of SIJP among different types of lumbar diseases, SIJP incidence is significantly higher in the lumbar stenosis group (P = 0035). CONCLUSION: Lumbar fusion surgery and multiple operative segments are interdependent risk factors for the postoperative SIJP. The incidence of postoperative SIJP also increases in patients with lumbar stenosis compared with lumbar disk herniation and lumbar spondylolisthesis.

The significance of uric acid in the diagnosis and treatment of Parkinson disease: An updated systemic review.

BACKGROUND: Parkinson disease (PD) is a neurodegenerative disease characterized by chronic and progressive loss of dopaminergic neurons in substansia nigra pars compacta. Oxidative stress is proposed to play a critical role in the pathogenesis of PD. Uric acid (UA), as an important physiological antioxidant, is identified a molecular predictor associated with a decreased risk and a slower disease progression for PD and potential neuroprotectant of PD by increasing epidemiological and clinical evidences. Within this review, we will present a comprehensive overview of the data linking UA to PD in recent years. METHODS: We searched PubMed, EMBASE, Web of Science databases for relevant studies. Any observational or experimental studies that evaluated UA and PD were our goal of searching the electric databases. RESULTS: Twelve studies that evaluated UA and PD were identified in this review. We reviewed the roles of UA in the pathogenesis of PD, the association of UA with morbidity, severity/progression, nonmotor symptoms, motor complications of PD, with an attempt to provide new ideas for diagnosis and treatment in PD. CONCLUSION: Our findings supported that lots of clinical and epidemiological data observed lower UA levels in PD patients. Manipulation of UA or its precursors' concentration could be effective to treat or prevent PD. However, it is still suspectable that higher UA levels are better enough to PD patients. Furthermore, for the complex nature of PD and its heterogeneous genetic and environmental influences, it is inadequate for just manipulating UA in treating the disease.

Risk Factors of Postoperative Low Back Pain for Low-Grade Degenerative Spondylolisthesis: An At Least 2-Year Follow-Up Retrospective Study.

OBJECTIVE: A retrospective study was conducted to clarify the risk factors of postoperative low back pain (LBP) for low-grade degenerative spondylolisthesis. PATIENTS AND METHODS: A total of 239 patients who underwent posterior lumbar fusion between January 2011 and January 2015 were included in this analysis. We investigated patient characteristics, surgical characteristics, and radiographic characteristics. RESULTS: The mean visual analog scale (VAS) score of LBP decreased dramatically after the operation. The mean preoperative VAS score was greater in patients with severe lumbar multifidus (LM) intramuscular adipose tissue (IMAT). The postoperative VAS score was dramatically lower in patients with shorter symptom duration. Postoperative LBP disappeared more often in patients with shorter symptom duration. LBP VAS changing showed significant differences in different symptom duration groups and LM IMAT groups. CONCLUSIONS: LM IMAT and symptom duration were risk factors for postoperative LBP. Patients with severe LM IMAT reported more severe LBP before the operation. Postoperative LBP disappeared more often in patients with shorter symptom duration.

Risk Factors of Postoperative Low Back Pain for Lumbar Spine Disease.

PURPOSE: A retrospective study was conducted to clarify the risk factors of postoperative low back pain (LBP) for lumbar spine disease. PATIENTS AND METHODS: A total of 401 patients who underwent lumbar operation between January 2011 and December 2011 were included in this analysis. We investigated patient characteristics and surgical approaches and also compared the radiographic characteristics. RESULTS: The mean visual analogue scale (VAS) score decreased dramatically after the operation. The mean preoperative VAS score was greater in patients underwent posterior lumbar interbody fusion (PLIF) with longer duration of symptoms, longer operation time, and severe lumbar multifidus (LM) intramuscular adipose tissue (IMAT). The preoperative VAS score was dramatically lower in patients with lumbar herniation. The postoperative VAS score was dramatically lower in patients who underwent PLIF with longer operation time and mild LM IMAT. Postoperative LBP disappeared more often in patients who underwent PLIF with longer operation times. The number of operative levels and type of lumbar spine disease also were associated with postoperative LBP. CONCLUSION: Type of surgery, operation time, number of operative level, and type of disease were risk factors for the postoperative LBP. Patients underwent PLIF with shorter symptom duration, longer operation time severe LM IMAT, and lumber spondylolisthesis reported more severe LBP before the operation. Patients underwent discectomy with shorter operation times.

Effects of Zusanli and Ashi Acupoint Electroacupuncture on Repair of Skeletal Muscle and Neuromuscular Junction in a Rabbit Gastrocnemius Contusion Model.

Objective. To explore the effects of electroacupuncture (EA) at ST36 (EA-ST36) and at Ashi acupoints (EA-Ashi) on skeletal muscle repair. Methods. Seventy-five rabbits were randomly divided into five groups: normal, contusion, EA-Ashi, EA-ST36, and EA at Ashi acupoints and ST36 (EA-AS). EA (0.4 mA, 2 Hz, 15 min) was applied after an acute gastrocnemius contusion. The morphology of myofibers and neuromuscular junctions (NMJs) and expressions of growth differentiation factor-8 (GDF-8), acetylcholinesterase (AChE), Neuregulin 1 (NGR1), and muscle-specific kinase (MuSK) were assessed 7, 14, and 28 days after contusion. Results. Compared with that in contusion group, there was an increase in the following respective parameters in treatment groups: the number and diameter of myofibers, the mean staining area, and continuities of NMJs. A comparison of EA-Ashi and EA-ST36 groups indicated that average myofiber diameter, mean staining area of NMJs, and expressions of AChE and NRG1 were higher in EA-Ashi group, whereas expression of GDF-8 decreased on day 7. However, increases in myofiber numbers, expressions of MuSK and AChE, as well as decreases in GDF-8 expression, and the discontinuities were observed in EA-ST36 group on the 28th day. Conclusion. Both EA-ST36 and EA-Ashi promoted myofiber regeneration and restoration of NMJs. EA-Ashi was more effective at earlier stages, whereas EA-ST36 played a more important role at later stages.

Prevalence and Consequences of the Proximal Junctional Kyphosis After Spinal Deformity Surgery: A Meta-Analysis.

The aim of this study was to estimate the prevalence and patient outcomes of proximal junctional kyphosis (PJK) in pediatric patients and adolescents who received surgical interventions for the treatment of a spinal deformity.Literature was searched in electronic databases, and studies were selected by following précised eligibility criteria. Percent prevalence values of the PJK in individual studies were pooled to achieve a weighted effect size under the random effects model. Subgroup and meta-regression analyses were performed to appraise the factors affecting PJK prevalence.Twenty-six studies (2024 patients) were included in this meta-analysis. Average age of the patients was 13.8 ±â€Š2.75 years of which 32 ±â€Š20 % were males. Average follow-up was 51.6 ±â€Š38.8 (range 17 ±â€Š13 to 218 ±â€Š60) months. Overall, the percent prevalence of PJK (95% confidence interval) was 11.02 (10.5, 11.5) %; P < 0.00001 which was inversely associated with age (meta-regression coefficient: -1.607 [-2.86, -0.36]; 0.014). Revision surgery rate in the patients with PJK was 10%. The prevalence of PJK was positively associated with the proximal junctional angle at last follow-up (coefficient: 2.248; P = 0.012) and the change in the proximal junctional angle from surgery to last follow-up (coefficient: 2.139; P = 0.014) but not with preoperative proximal junctional angle.The prevalence of PJK in the children and adolescent patients is 11%. About 10% of those affected require revision surgery.

Predictors of Surgical Outcome in Acute Spinal Cord Injury Patients with Cervical Ossification of the Posterior Longitudinal Ligament.

OBJECTIVE: A retrospective study was conducted to clarify the predictors of the operation results for ossification of the posterior longitudinal ligament (OPLL) patients with acute spinal cord injury (SCI). Detailed analyses of surgical outcomes of OPLL patients with SCI have been rare because most surveys have aimed to investigate OPLL or SCI, but not both. PATIENTS AND METHODS: A total of 36 patients who underwent operation for OPLL between January 2011 and December 2011 were included in this analysis. We investigated the patients' characteristics and surgical approaches and compared the radiographic characteristics of OPLL patients with SCI. RESULTS: The mean modified Japanese Orthopaedic Association (mJOA) score improved dramatically after operation (P = 0.006). The mean preoperative mJOA score was greater in patients with Nurick 3 than in patients with Nurick 4 and 5 (P = 0.041). The preoperative mJOA score was dramatically lower in patients caused by traffic accident and in patients with segmental OPLL lesion (P < 0.05). The postoperative mJOA score was dramatically lower in patients with continuous OPLL lesion than in the segmental OPLL lesion (P = 0.028). Changing in mJOA score was significantly different between the patients with high-intensity zone (HIZ) and without HIZ on magnetic resonance imaging. CONCLUSIONS: HIZ on magnetic resonance imaging was significantly related to the surgical outcomes, which should be highlighted in the preoperative communication with patients. Patients with lower Nirick grade and segmental OPLL would show better symptom before the operation. In addition, SCI caused by slipping or falling showed better symptoms before the operation. Patients with segmental OPLL should show better resolution of symptoms after the operation.

Predictors of surgical outcome in ossification of the posterior longitudinal ligament.

STUDY DESIGN: A retrospective study. OBJECTIVE: To clarify the predictors of the operation results for ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Detailed analyses of surgical outcomes of OPLL have been rare because most survey aimed to investigate cervical spondylotic myelopathy. METHODS: All patients who underwent cervical operation for OPLL between January 2011 and December 2011 were included in this analysis. We investigated the patients' characteristics and surgical approaches, and compared the radiographical characteristics of OPLL. RESULTS: The mean mJOA score improved from 8.312 ± 3.021 points preoperatively to 11.24 ± 3.43 points at 24 months after operation (P<0.001). The average change in mJOA score was significantly greater in patients with a higher Nirik score than in those with lower Nirik scores (P<0.0001). The average change in mJOA score was also significantly different in patients with trauma history (P<0.0001). The average recovery ratio was 42 ± 26.3% in young patients and 30 ± 31.6% in the group older than 50 years (P=0.012). The average recovery ratio in patients with acute and chronic symptoms was 48 ± 22.9% and 26 ± 33.9%, respectively. There was great difference between the two groups. CONCLUSION: OPLL patients with myelopathy would receive good result after the operation. Age and symptom duration are related to the surgical outcomes. Patients with lower Nirick grade and without trauma history would receive better results before and after the operation.