Prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis curves of 40-50° using uniplanar radiographic measures of axial rotation.

PURPOSE: The management of adolescent idiopathic scoliosis (AIS) curves between 40 and 50° is controversial. Here, we investigated the prognostic significance of simple radiographic rotational parameters to identify curves of this magnitude with accelerated deterioration following skeletal maturity. METHODS: Seventy-three patients were identified with AIS and Cobb angles of the major curve between 40 and 50° at skeletal maturity. We defined fast progressive curves as those increasing by ≥ 2° per year after skeletal maturity. From the apical vertebra of the major curve upon presentation and skeletal maturity, we determined the modified Nash-Moe index (×100), and from thoracic major curves, the Rib Index. T tests were performed to compare fast-progressive curves with those that deteriorated by < 2° per year. Receiver operator characteristic (ROC) curves were plotted to establish optimal cutoffs, sensitivity, and specificity measures for rotational parameters. RESULTS: The average duration of follow-up post was 11.8 ± 7.3 years. Thirteen out of seventy-three patients were fast progressors. The modified Nash-Moe index was similar between groups at presentation (p = 0.477) but significantly higher in fast progressors than non-fast progressors at maturity for major thoracic curves (25.40 ± 6.60 vs. 19.20 ± 4.40, p < 0.001). Rib Index values were also higher among fast progressors at skeletal maturity (2.50 ± 0.90 vs. 1.80 ± 0.60, p = 0.026). An ROC curve for a modified Nash-Moe index of 0.235 for thoracic curves achieved an area under the curve (AUC) of 0.76 for discriminating fast progressors. A threshold of 1.915 for Rib Index at maturity achieved an AUC of 0.72 for discriminating fast progressors. In combining both rotational parameters, an AUC of 0.81 was achieved. CONCLUSION: These simple rotational parameters may be useful to predict fast progression in 40-50° AIS curves following skeletal maturity indicated for early fusion, but further validation upon larger cohorts and non-thoracic major curves is required.

Paired and matched analysis of neurological outcomes in revision surgery for cervical myelopathy following delayed neurological decline.

Background: Delayed neurological decline may be experienced following successful decompression surgery for cervical myelopathy. Our objective was to analyze neurological recovery upon revision surgery with relation to the index procedure and a matched control. Methods: Fourteen patients underwent both primary and revision decompression at a single academic center. Peri-operative clinical, radiological, and surgical details were retrieved. Neurological outcomes [change in modified Japanese Orthopedic Association (mJOA), recovery ratio] following the second surgery were compared to (I) the primary operation and (II) a control subject receiving primary decompression matched for gender, age, mJOA score, and surgical approach. The minimum clinically important difference (MCID) in mJOA score was set at 2.5. Results: Revision decompressions were performed 6.8±4.2 years following the index surgery, when patients were 61.4±11.0 years of age. An increase in mJOA score of 2.7±2.0 following revision surgery was similar to that achieved after the primary operation (2.2±2.1, P=0.616). A recovery ratio of 38.1%±25.4% upon revision compared favorably to that following the primary operation (35.0%±37.4%, P=0.867). Non-inferiority testing between revision surgery and the first operation (P=0.02) demonstrated a similar capacity to achieve the MCID as did comparison with matched subjects (P<0.01). Conclusions: Patients were able to make up for lost neurological gains following revision surgery. Careful selection of cases for revision likely facilitated recovery. Recovery trajectories should be consolidated upon larger sample sizes allowing for identification of prognostic factors.

An intelligent composite model incorporating global / regional X-rays and clinical parameters to predict progressive adolescent idiopathic scoliosis curvatures and facilitate population screening.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) affects up to 5% of the population. The efficacy of school-aged screening remains controversial since it is uncertain which curvatures will progress following diagnosis and require treatment. Patient demographics, vertebral morphology, skeletal maturity, and bone quality represent individual risk factors for progression but have yet to be integrated towards accurate prognostication. The objective of this work was to develop composite machine learning-based prediction model to accurately predict AIS curves at-risk of progression. METHODS: 1870 AIS patients with remaining growth potential were identified. Curve progression was defined by a Cobb angle increase in the major curve of ≥6° between first visit and skeletal maturity in curves that exceeded 25°. Separate prediction modules were developed for i) clinical data, ii) global/regional spine X-rays, and iii) hand X-rays. The hand X-ray module performed automated image classification and segmentation tasks towards estimation of skeletal maturity and bone mineral density. A late fusion strategy integrated these domains towards the prediction of progressive curves at first clinic visit. FINDINGS: Composite model performance was assessed on a validation cohort and achieved an accuracy of 83.2% (79.3-83.6%, 95% confidence interval), sensitivity of 80.9% (78.2-81.9%), specificity of 83.6% (78.8-84.1%) and an AUC of 0.84 (0.81-0.85), outperforming single modality prediction models (AUC 0.65-0.78). INTERPRETATION: The composite prediction model achieved a high degree of accuracy. Upon incorporation into school-aged screening programs, patients at-risk of progression may be prioritized to receive urgent specialist attention, more frequent follow-up, and pre-emptive treatment. FUNDING: Funding from The Society for the Relief of Disabled Children was awarded to GKHS.

Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy: A Longitudinal Study on 195 Patients.

BACKGROUND: Long-term data on postoperative neurological survivorship for patients with degenerative cervical myelopathy (DCM) undergoing decompressive surgery are limited. The purposes of this study were to assess neurological survivorship after primary decompressive surgery for DCM and to identify predictors for postoperative deterioration. METHODS: A longitudinal clinical data set containing surgical details, medical comorbidities, and radiographic features was assembled for 195 patients who underwent a surgical procedure for DCM between 1999 and 2020, with a mean period of observation of 75.9 months. Kaplan-Meier curves were plotted, and a log-rank test was performed for the univariate analysis of factors related to neurological failure. Lasso regression facilitated the variable selection in the Cox proportional hazards model for multivariate analysis. RESULTS: The overall neurological survivorship was 89.3% at 5 years and 77.3% at 10 years. Cox multivariate analysis following lasso regression identified elevated hazard ratios (HRs) for suture laminoplasty (HR, 4.76; p < 0.001), renal failure (HR, 4.43; p = 0.013), T2 hyperintensity (HR, 3.34; p = 0.05), and ossification of the posterior longitudinal ligament (OPLL) (HR, 2.32; p = 0.032). Subgroup analysis among subjects with OPLL demonstrated that the neurological failure rate was significantly higher in the absence of fusion (77.8% compared with 26.3%; p = 0.019). CONCLUSIONS: Overall, patients who underwent a surgical procedure for DCM exhibited an extended period with neurological improvement. Cervical fusion was indicated in OPLL to reduce neurological failure. Our findings on predictors for early deterioration facilitate case selection, prognostication, and counseling as the volume of primary cervical spine surgeries and reoperations increases globally. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Oral Zoledronic acid bisphosphonate for the treatment of chronic low back pain with associated Modic changes: A pilot randomized controlled trial.

To assess the safety and efficacy of oral 50 mg Zoledronic acid (ZA) bisphosphate once-a-week for 6-weeks to placebo among patients with chronic low back pain (cLBP) and Modic changes (MC) on MRI. A parallel, double-blinded randomized controlled study was performed at a single center, consisted of 25 subjects with cLBP and MC that received ZA (n = 13) or placebo (n = 12). Evaluation was at baseline, 2-weeks, 4-weeks, 3-months and 6-months for assessment of LBP/leg pain intensity, disability (Oswestry-Disability-Index: ODI), health-related quality-of-life (RAND-36), and mental component summary scores (MCS). Type 2 MC at baseline (56%) were prevalent. In the ZA group, LBP intensity was lower at 4-weeks in comparison to placebo (5.1 ± 1.9 vs. 6.9 ± 1.8, p = 0.038) (minimal clinically important difference [MCID] = 1.5). LBP intensity reduced at 4-weeks and 3-months in the ZA-treated group in comparison to baseline. Although there was no difference in ODI, subscale RAND-36 metrics for physical function (p = 0.038), energy/fatigue (p = 0.040) and pain (p = 0.003) were improved at 3-months compared to placebo, with moderate significant difference for pain at 6-months (p = 0.051). Correlated MCS scores to baseline also improved at 3-months (p = 0.035) and 6-months (p = 0.028) by 6.9 and 6.8, respectively, (MCID = 3.8). A reduction in MC endplate affected area at 6-month follow-up was noted in the ZA group (-0.67 ± 0.69 cm2 ), while in the placebo group no change in size was observed (0.0 ± 0.15; p = 0.041). Three subjects withdrew from the study and no long-lasting adverse events. Oral ZA was a safe and effective treatment that reduced MC volume, improved LBP symptoms and quality-of-life measures in cLBP subjects with MCs.

Length of Cervical Stenosis, Admission ASIA Motor Scores, and BASIC Scores Are Predictors of Recovery Rate Following Central Cord Syndrome.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: This study aims to determine whether quantitative magnetic resonance imaging (MRI) parameters and radiological scoring systems could be used as a reliable assessment tool for predicting neurological recovery trajectory following acute traumatic central cord injury syndrome (CCS). SUMMARY OF BACKGROUND DATA: Controversy remains in whether CCS should be managed conservatively or by early surgical decompression. It is essential to understand how clinical and radiological parameters correlate with neurological deficits and how they predict recovery trajectories. METHODS: We identified patients with CCS admitted between 2011 and 2018 with a minimum of 1-year follow-up. Cervical MRIs were analyzed for cord/canal dimensions, Brain and Spinal Injury Center (BASIC) scores and sagittal grading as ordinal scales of intraparenchymal cord injury. Japanese Orthopaedic Association (JOA) recovery rates (≥50% as good, < 50% as poor) were analyzed against these variables by logistic regression and receiver operator characteristic (ROC) curves. Additionally, we evaluated American Spinal Injury Association motor scale (AMS) scores/recovery rates. RESULTS: Sixty patients were included, of which 30 were managed conservatively and 30 via surgical decompression. The average follow-up duration for the entire cohort was (51.1 ±â€Š25.7) months. Upon admission, sagittal grading correlated with AMS and JOA scores (P < 0.01, ß = 0.48). Volume of the C2 to C7 canal and axial cord area over the site of maximal compression correlated with AMS and JOA scores respectively (P = 0.04, ß = 0.26; P = 0.01, ß = 0.28). We determined admission AMS more than 61 to be a clinical cutoff for good recovery (area under the receiver operating curve [AUC] = 0.74, 95% confidence interval [CI]: 0.61-0.85, sensitivity 80.9%, specificity 69.2%, P < 0.01). Radiological cutoffs to identify patients with poor recovery rates were length of cervical spinal stenosis more than 3.9 cm (AUC = 0.76, 95% CI: 0.63-0.87, specificity 91.7%, sensitivity 52.2%, P < 0.01), BASIC score of more than 1 (AUC = 0.69, 95% CI: 0.56-0.81, specificity 80.5%, sensitivity 51.1%, P = 0.02). Surgical decompression performed as a salvage procedure upon plateau of recovery did not improve neurological outcomes. CONCLUSION: Clinical and radiological parameters upon presentation were prognosticative of neurological recovery rates in CCS. Surgery performed beyond the acute post-injury period failed to improve outcomes.Level of Evidence: 3.

[Dynesys and posterior decompression and fusion internal fixation for the treatment of lumbar degenerative diseases: a systematic review].

OBJECTIVE: Meta analysis was used to evaluate the efficacy and safety of Dynesys and posterior decompression and fusion internal fixation for lumbar degenerative diseases. METHODS: The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion internal fixation were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software provided by Cochrane collaboration was used for systematic evaluation. RESULTS: A total of 9 clinical studies were included, including 3 prospective randomized controlled trials(RCT) and 6 retrospective controlled observational studies, which included 692 patients, with 336 cases in Dynesys group, and 356 cases in posterior decompression and fusion internal fixation (PLIF) group. The results showed that compared with PLIF, Dynesys system significantly decreased operation time(P<0.01), intraoperative blood loss (P<0.01). Both Dynesys and PLIF groups experienced improved ODI and back/leg pain VAS scores at final follow-up, and no statistically significant difference was noted according to the two surgical procedures(P>0.05). Dynesys could remain the range of motion (ROM) of surgical segments with less increased ROM of adjacent segments compared with that of PLIF group(P<0.01). Regarding the disc height of surgical segments, no statistically significant difference was noted according to the two groups(P>0.05), but postoperative complications incidence rate in PLIF group was higher than that in Dynesys group (P<0.05). CONCLUSIONS: Both Dynesys system and PLIF can improve clinical outcomes of lumbar degenerative diseases effectively. Compared with PLIF, Dynesys could remain the range of motion(ROM) of surgical segments with less increased ROM of adjacent segments and lower complication incidence rate. But the ability to prevent adjacent segments degeneration needs more RCTs with long-term follow-up to confirm.

Association of extracellular superoxide dismutase (EC-SOD) polymorphisms with risk of type 2 diabetes mellitus in a Chinese Han population.

We aimed to investigate whether the EC-SOD rs2536512, rs8192291 and rs1799895 polymorphisms and haplotypes are associated with T2DM in a Chinese Han population. A total of 540 Chinese Han patients with T2DM and 562 healthy subjects were enrolled in our study since October 2013, and all of them had no blood relationship. An iPlex GLOD SNP genotyping analysis of the EC-SOD rs2536512, rs8192291 and rs1799895 was carried out in a 384 well plate format using the Sequenom MassARRAY® System (Sequenom, Inc. San Diego, USA). We observed that the CT (OR=1.58, 95% CI=1.20-2.08) and TT (OR=15.27, 95% CI=4.34-53.75) genotypes of rs8192291 were associated with T2DM susceptibility compared with the CC genotype. In dominant and recessive models, rs8192291 was correlated with a moderate statistically increased susceptibility of T2DM compared with the reference genotype. The GTC, GCC and GCG haplotypes were associated with risk of T2DM. In summary, rs8192291 polymorphism and haplotypes may become a useful biomarker for prediction of the susceptibility of this disease. Further experiments are necessary to validate our results.

Complete mitochondrial genome sequence of the Rattus norvegicus SILN strain with central nervous system disorder.

The Rattus norvegicus SILN strain is a common used model for nervous system disorder disease study. We sequenced this R. norvegicus strain SILN mitochondrial genome for the first time (GenBank Accession No. KM114606). Its mitogenome was 16,311 bp and coding 13 protein-coding genes, 2 ribosomal RNA genes, 22 transfer RNA genes.

Honokiol downregulates Kruppel-like factor 4 expression, attenuates inflammation, and reduces histopathology after spinal cord injury in rats.

STUDY DESIGN: Randomized experimental study. OBJECTIVE: To investigate the neuroprotective effect of honokiol (HNK) on rats subjected to traumatic spinal cord injury (SCI) and the molecular mechanisms. SUMMARY OF BACKGROUND DATA: Inflammation contributes to the secondary injury to the spinal cord. Honokiol has been used as a neuroprotective agent because of its strong antioxidant and anti-inflammatory properties. Kruppel-like factor 4 (Klf4) is a newly identified critical target for the anti-inflammatory effect of HNK. Whether HNK can inhibit inflammatory response in rat model of SCI through mediating the expression of Klf4 has yet to be elucidated. METHODS: Eighty-four adult female Sprague-Dawley rats were randomly divided into 4 groups as sham, SCI, SCI + Vehicle (0.1% propylene glycol in saline, intraperitoneally), and SCI + HNK (20 mg/kg, intraperitoneally) groups. The influences of HNK on the proinflammatory cytokines, microglial activation, neutrophil infiltration, histological changes, and improvement in motor function were assessed. RESULTS: In the SCI group, proinflammatory cytokines, microglial activation, neutrophil infiltration, and Klf4 expression levels were increased compared with the sham group (P < 0.001). HNK intervention downregulated the expression of Klf4, reduced the production of proinflammatory cytokines, inhibited microglial activation, and neutrophil infiltration (P < 0.05). Furthermore, HNK also reduced histopathology and improved functional outcome after traumatic SCI. CONCLUSION: HNK reduces secondary tissue damage and improves locomotor function recovery after SCI through suppressing inflammatory response, and can be used as a potential therapeutic agent for SCI. LEVEL OF EVIDENCE: NA.

[Characteristics of coarse woody debris in Huzhong area of Great Xing' an Mountains].

An investigation was made on the coarse woody debris (CWD) in burned forestlands in Huzhong area of Great Xing' an Mountains. The loading capacity of CWD in the burned forestlands was 24.9-181.0 m3 x hm(-2), among which, snag and log occupied 24.3%-85.9% and 14.0%-75.7%, being 6.0-93.9 m3 x hm(-2) and 15.3-138.4 m3 x hm(-2), respectively. Significant differences were observed among burned forestlands and among years. The predominant DBH class of snag and log was 2.5-20 cm and 1.5-15 m, and the height of most snags and logs was 2.5-15 m and 5-20 cm, respectively. The loading capacity of CWD had no obvious change with the recovery of forest vegetation. The characteristics of CWD had a close relationship with pre-fire forest stand conditions and burn intensity.

[Spatial pattern of land surface dead combustible fuel load in Huzhong forest area in Great Xing'an Mountains].

By using geo-statistics and based on time-lag classification standard, a comparative study was made on the land surface dead combustible fuels in Huzhong forest area in Great Xing'an Mountains. The results indicated that the first level land surface dead combustible fuel, i. e., 1 h time-lag dead fuel, presented stronger spatial auto-correlation, with an average of 762.35 g x m(-2) and contributing to 55.54% of the total load. Its determining factors were species composition and stand age. The second and third levels land surface dead combustible fuel, i. e., 10 h and 100 h time-lag dead fuels, had a sum of 610.26 g x m(-2), and presented weaker spatial auto-correlation than 1 h time-lag dead fuel. Their determining factor was the disturbance history of forest stand. The complexity and heterogeneity of the factors determining the quality and quantity of forest land surface dead combustible fuels were the main reasons for the relatively inaccurate interpolation. However, the utilization of field survey data coupled with geo-statistics could easily and accurately interpolate the spatial pattern of forest land surface dead combustible fuel loads, and indirectly provide a practical basis for forest management.