Can paraspinal muscle degeneration be a reason for refractures after percutaneous kyphoplasty? A magnetic resonance imaging observation.

BACKGROUND: Vertebral augmentation (VA) techniques are used to treat acute osteoporotic vertebral compression fractures (OVCFs). However, the incidence of recurrent vertebral fractures after VA is controversial. Various factors have been discussed in the literature, but no convincing study on the quality of paraspinal muscles has been reported. The purposes of this study were to evaluate the changes in paraspinal muscles and discuss the relationship between paraspinal muscle degeneration and vertebral refractures after percutaneous kyphoplasty (PKP). METHODS: This retrospective study was conducted in patients who underwent PKP for an initial OVCF between July 2017 and August 2018. Patients were followed up and categorized in the refractured or non-refractured group. A final magnetic resonance imaging (MRI) scan and a preoperative MRI scan were used to determine the measurements. The paraspinal muscles at the mid-height level of the initial fractured vertebral body were measured using regions of interest (ROIs), including the cross-sectional area (CSA) and signal intensity (SI). The changes in the observed data were compared between the groups using rank-sum tests. RESULTS: Overall, 92 patients were enrolled in the study; 33 of them sustained vertebral refractures during the follow-up and the other 59 patients did not. There were no significant differences in terms of sex, age, preoperative bone mineral density, and body mass index between the groups (all, P > 0.05). The refractured group had a significantly higher decrease in the ROI-CSA and CSA/SI, and a higher increase in ROI-SI, compared with the preoperative data (all, P < 0.05). CONCLUSIONS: The quality of paraspinal muscles significantly decreased in patients with new OVCFs after PKP. This brings a new perspective to the study of postoperative recurrent fractures; patients and physicians need to pay more attention to the efficacy of bed rest and bracing.

Piperine protects against pyroptosis in myocardial ischaemia/reperfusion injury by regulating the miR-383/RP105/AKT signalling pathway.

miRNA-mediated pyroptosis play crucial effects in the development of myocardial ischaemia/reperfusion (I/R) injury (MIRI). Piperine (PIP) possesses multiple pharmacological effects especially in I/R condition. This study focuses on whether PIP protects MIRI from pyroptosis via miR-383-dependent pathway. Rat MIRI model was established by 30 minutes of LAD ligation and 4 hours of reperfusion. Myocardial enzymes, histomorphology, structure and function were detected to evaluate MIRI. Recombinant adenoviral vectors for miR-383 overexpression or miR-383 silencing or RP105 knockdown were constructed, respectively. Luciferase reporter analysis was used to confirm RP105 as a target of miR-383. Pyroptosis-related markers were measured by Western blotting assay. The results showed that I/R provoked myocardial injury, as shown by the increases of LDH/CK releases, infarcted areas and apoptosis as well as worsened function and structure. Pyroptosis-related mediators including NLRP3, cleaved caspase-1, cleaved IL-1ß and IL-18 were also reinforced after MIRI. However, PIP treatment greatly ameliorated MIRI in parallel with pyroptotic repression. In mechanistic studies, MIRI-caused elevation of miR-383 and decrease of RP105/PI3K/AKT pathway were reverted by PIP treatment. Luciferase reporter assay confirmed RP105 as a miR-383 target. miR-383 knockdown ameliorated but miR-383 overexpression facilitated pyroptosis and MIRI. Moreover, the anti-pyroptotic effect from miR-383 silencing was verified to be relied on the RP105/PI3K/AKT signalling pathway. Additionally, our present study further indicated the miR-383/RP105/AKT-dependent approach resulting from PIP administration against pyroptosis in MIRI. Therefore, PIP treatment attenuates MIRI and pyroptosis by regulating miR-383/RP105/AKT pathway, and it may provide a therapeutic manner for the treatment of MIRI.

Can Posterior Ligament Structure Be Functionally Healed After Anterior Reduction and Fusion Surgery in Patients with Traumatic Subaxial Cervical Fracture-Dislocations?

BACKGROUND: Selection of approach for subaxial cervical fracture-dislocation (SCFD) is controversial. The questions of whether a posterior ligamentous structure (PLS) can be functionally healed in patients with SCFD and how long this healing process takes are critical in these patients. METHODS: This study retrospectively enrolled 394 patients with SCFD who underwent anterior decompression, reduction, and fusion between January 2002 and December 2017. The definition of functional healing of PLS was based on evaluations of clinical function and radiographic stability of PLS. RESULTS: Follow-up was available for 354 patients (89.8%). The PLS of 339 cases was functionally healed at the first follow-up interval without any posterior surgical intervention. No hardware failure or progressive cervical kyphosis was observed at further follow-up. At 12 months postoperatively, interbody fusion was satisfactory. However, the other 15 patients experienced nonhealing PLS at 8 weeks postoperatively and developed cervical deformity at further follow-up. Five patients refused revision surgery; the other 10 patients obtained solid fusion after revision surgeries. CONCLUSIONS: Among 354 patients with SCFD and treated by single anterior reduction and fixation, simple PLS injury without any bony instability at the posterior column of the cervical spine can be functionally healed in 95.8% of patients by external fixation for 8 weeks. Whether this finding is applicable to various types of SCFD should be verified in further prospective studies with larger samples.

Alternative technique to save ischemic bowel segment in management of neonatal short bowel syndrome: A case report.

BACKGROUND: Congenital short bowel syndrome (SBS) associated with malrotation, gut volvulus and jejuno-ileal atresia is a very rare condition. It is a severe challenge for surgeons to preserve residual ischemic bowel segment in the management of short bowel syndrome,especially in neonates. CASE SUMMARY: We report a newborn baby with gut malrotation associated with jejuno-ileal atresia, congenital SBS and jejunal volvulus. Hematemesis and abdominal distention were noted. At laparotomy, malrotation associated with jejuno-ileal atresia, congenital SBS and jenunal volvulus was confirmed. The total length of the small bowel was 63 cm with proximal jejunal bowel segment measuring 38 cm, including 18 cm necrotic segment below the Treitz's ligament and 20 cm severe ischemic segment. The distal part of the small bowel was 25 cm in length and only about 0.8 cm in diameter. Ladd's procedure, necrotic segment resection and end-to-back duodeno-ileal anastomosis were performed. The residual severe ischemic jejunum was preserved with single proximal stoma and distal end closure. Three months later, to restore the continuity of the isolated gut segment, end-to-end duodeno-jejunal and jejuno-ileal anastomosis was performed. The entire functional small bowel length increased to 80 cm. Intravenous fluid therapy and parenteral nutrition were discontinued on the 10th day postoperatively. Twelve months later, her body weight was 9.5 kg. CONCLUSION: Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infants with SBS are safe and feasible.

Causes of Residual Back Pain at Early Stage After Percutaneous Vertebroplasty: A Retrospective Analysis of 1,316 Cases.

BACKGROUND: Percutaneous vertebroplasty (PVP) is now well accepted in the treatment of painful osteopathic vertebral compression fractures (OVCF), providing early pain relief and strengthening of the bone of the vertebrae. However, some patients still experienced severe back pain after PVP. OBJECTIVES: To analyze the possible reason for unsatisfactory back pain relief (UBPR) after PVP at early stage. STUDY DESIGN: Retrospective analysis. SETTING: Hong-Hui Hospital in Xi'an. METHODS: Between March 2013 and January 2015, a total of 1,316 patients with OVCF were treated by PVP at our Hospital. Demographics, clinical data, and surgical data were collected to analyze the factors associated with UBPR after PVP. RESULTS: Sixty cases complained of UBPR, and the prevalence was 4.6%. Univariate analyses showed that preoperative bone mineral density (BMD), number of fractures, cement distribution and volume injected per level, lumbodorsal fascia contusion, and depression were associated with UBPR after PVP (P < 0.001). Multivariate analysis revealed that preoperative BMD (odds ratio [OR], 3.577; P = 0.029), lumbodorsal fascia contusion (OR, 3.805; P = 0.002), number of fractures (OR, 3.440; P < 0.001), cement volume injected per level (OR, 0.079; P < 0.001), cement distribution (OR, 3.009; P = 0.013), and depression (OR, 3.426; P = 0.028) were independently associated with UBPR after PVP at the early postoperative stage. LIMITATIONS: A further prospective controlled study is needed to explore the association between the different degrees of the aforementioned factors and UBPR after PVP. CONCLUSIONS: Preoperative low BMD, lumbodorsal fascial injury, multiple segment PVP, insufficient cement injected volume, unsatisfactory cement distribution, and depression were strong risk factors associated with UBPR after PVP in patients with OVCF. KEY WORDS: Unsatisfactory back pain relief, residual back pain, percutaneous vertebroplasty.

Dual pitch titanium-coated pedicle screws improve initial and early fixation in a polyetheretherketone rod semi-rigid fixation system in sheep.

BACKGROUND: Reports on the efficacy of modifications to the thread design of pedicle screws are scarce. The aim of the study was to investigate initial and early fixation of pedicle screws with a plasma-sprayed titanium coating and dual pitch in the pedicle region (dual pitch titanium-coated pedicle screw [DPTCPS]) in a polyetheretherketone (PEEK) rod semi-rigid fixation system. METHODS: Fifty-four sheep spine specimens and 64 sheep were used to investigate initial ("0-week" controls) and early (post-operative 6 months) fixation, respectively. Sheep were divided into dual pitch pedicle screw (DPPS), standard pitch pedicle screw (SPPS), DPTCPS, and standard pitch titanium-coated pedicle screw (SPTCPS) groups. Specimens/sheep were instrumented with four screws and two rods. Biomechanical evaluations were performed, and histology at the implant-bone interface was investigated. RESULTS: At 0-week, mean axial pull-out strength was significantly higher for the DPTCPS and SPTCPS than the SPPS (557.0 ±â€Š25.2 vs. 459.1 ±â€Š19.1 N, t = 3.61, P < 0.05; 622.6 ±â€Š25.2 vs. 459.1 ±â€Š19.1 N, t = 3.43, P < 0.05). On toggle-testing, the DPTCPS was significantly more resistant than the SPPS and SPTCPS (343.4 ±â€Š16.5 vs. 237.5 ±â€Š12.9 N, t = 3.52, P < 0.05; 343.4 ±â€Š16.5 vs. 289.9 ±â€Š12.8 N, t = 3.12, P < 0.05; 124.7 ±â€Š13.5 vs. 41.9 ±â€Š4.3 cycles, t = 2.18, P < 0.05; 124.7 ±â€Š13.5 vs.79.5 ±â€Š11.8 cycles, t = 2.76, P < 0.05). On cyclic loading, maximum displacement was significantly lower for the DPTCPS than the SPPS and SPTCPS (1.8 ±â€Š0.13 vs. 3.76 ±â€Š0.19 mm, t = 2.29, P < 0.05; 1.8 ±â€Š0.13 vs. 2.46 ±â€Š10.20 mm, t = 2.69, P < 0.05). At post-operative 6 months, mean axial pull-out strength was significantly higher for the DPTCPS and SPTCPS than the SPPS (908.4 ±â€Š33.6 vs. 646.5 ±â€Š59.4 N, t = 3.34, P < 0.05; 925.9 ±â€Š53.9 vs. 646.5 ±â€Š59.4 N, t = 3.37, P < 0.05). On toggle-testing, the DPTCPS was significantly more resistant than the SPPS and SPTCPS (496.9 ±â€Š17.9 vs. 370.3 ±â€Š16.4 N, t = 2.86, P < 0.05; 496.9 ±â€Š17.9 vs. 414.1 ±â€Š12.8 N, t = 2.74, P < 0.05; 249.1 ±â€Š11.0 vs.149.9 ±â€Š11.1 cycles, t = 2.54, P < 0.05; 249.1 ±â€Š11.0 vs.199.8 ±â€Š7.2 cycles, t = 2.61, P < 0.05). On cyclic loading, maximum displacement was significantly lower for the DPTCPS than the SPPS and SPTCPS (0.96 ±â€Š0.11 vs. 2.39 ±â€Š0.14 mm, t = 2.57, P < 0.05; 0.96 ±â€Š0.11 vs. 1.82 ±â€Š0.12 mm, t = 2.73, P < 0.05). Resistance to toggle testing (370.3 ±â€Š16.4 vs. 414.1 ±â€Š12.8 N, t = 3.29, P < 0.05; 149.9 ±â€Š11.1 vs.199.8 ±â€Š7.2 cycles, t = 2.97, P < 0.05) was significantly lower and maximum displacement in cyclic loading (2.39 ±â€Š0.14 vs.1.82 ±â€Š0.12 mm; t = 3.06, P < 0.05) was significantly higher for the SPTCPS than the DPTCPS. Bone-to-implant contact was significantly increased for the DPTCPS compared to the SPPS (58.3% ±â€Š7.0% vs. 36.5% ±â€Š4.4%, t = 2.74, P < 0.05); there was no inflammatory reaction or degradation of coated particles. CONCLUSION: DPTCPSs might have stronger initial and early fixation in a PEEK rod semi-rigid fixation system.

Alteration of the esophageal microbiota in Barrett's esophagus and esophageal adenocarcinoma.

The incidence of esophageal adenocarcinoma (EAC) has increased in recent decades, and its 5-year survival rate is less than 20%. As a well-established precursor, patients with Barrett's esophagus (BE) have a persistent risk of progression to EAC. Many researchers have already identified some factors that may contribute to the development of BE and EAC, and the identified risks include gastroesophageal reflux (GER), male sex, older age, central obesity, tobacco smoking, Helicobacter pylori (H. pylori) eradication, and the administration of proton pump inhibitors (PPIs) and antibiotics. The human gut harbors trillions of microorganisms, the majority of which are bacteria. These microorganisms benefit the human host in many ways, such as helping in digestion, assisting in the synthesis of certain vitamins, promoting the development of the gastrointestinal immune system, regulating metabolism and preventing invasion by specific pathogens. In contrast, microbial dysbiosis may play important roles in various diseases, such as inflammation and cancers. The composition of the microbiota located in the normal esophagus is relatively conserved without distinct microbial preferences in the upper, middle and lower esophagus. Six major phyla constitute the esophageal microbiota, including Firmicutes, Bacteroides, Actinobacteria, Proteobacteria, Fusobacteria and TM7, similar to the oral microbiota. Streptococcus dominates the esophageal microbiota. However, the microbiota varies in different esophageal diseases compared to that in the healthy esophagus. The type I microbiota, which is primarily composed of gram-positive bacteria, is closely associated with the normal esophagus, while type II microbiota has enriched gram-negative bacteria and is mainly associated with the abnormal esophagus. These increased gram-negative anaerobes/microaerophiles include Veillonella, Prevotella, Haemophilus, Neisseria, Granulicatella and Fusobacterium, many of which are associated with BE. The microbial diversity in the esophagus is decreased in EAC patients, and Lactobacillus fermentum is enriched compared to that in controls and BE patients. Furthermore, the microbiota may be associated with BE and EAC by interacting with their risk factors, including central obesity, GER, H. pylori, administration of PPIs and antibiotics. Therefore, a large gap in research must be bridged to elucidate the associations among these factors. Some studies have already proposed several potential mechanisms by which the microbiota participates in human carcinogenesis by complicated interactions with the human host immune system and signaling pathways. The activation of the LPS-TLR4-NF-κB pathway may contribute to inflammation and malignant transformation. This exciting field of gastrointestinal microbiota allows us to unravel the mystery of carcinogenesis from another perspective. Further studies are needed to explore whether the microbiota changes before or after disease onset, to improve our understanding of the pathogenesis, and to find novel targets for prevention, diagnosis and therapy, which could offer more cost-effective and relatively safe choices.

Early versus delayed decompression for traumatic cervical spinal cord injury: application of the AOSpine subaxial cervical spinal injury classification system to guide surgical timing.

PURPOSE: Application of AOSpine subaxial cervical spine injury classification system to explore the optimal surgical decompression timing for different types of traumatic cervical spinal cord injury (CSCI). METHODS: A single-center prospective cohort study was conducted that included patients with traumatic CSCIs (C3-C7) between February 2015 and October 2016. After enrollment, patients underwent either early (< 72 h after injury) or late (≥ 72 h after injury) decompressive surgery of the cervical spinal cord. Each group was divided into A0, A1-4, B, C/F4 and F1-3 subgroups. The primary outcomes were ordinal changes in the ASIA Impairment Scale (AIS) and the Spinal Cord Independence Measure III (SCIM version 3) at a 12-month follow-up. The secondary outcomes included length of hospital stay, postoperative neurological deterioration, other complications and mortality. RESULTS: A total of 402 patients were included. Of these, 187 patients underwent early decompression surgery, and 215 patients underwent delayed decompression surgery. Statistical results included the following comparisons of the early vs late groups: AIS improvement ≥ 1 grade (combined groups: P < 0.0001; A0: P = 0.554; A1-4: P = 0.084; B: P = 0.013; C/F4: P = 0.040; F1-3: P = 0.742); AIS improvement ≥ 2 grades, P = 0.003 for all groups; SCIM version 3 (combined groups: P < 0.0001; A0: P = 0.126; A1-4: P = 0.912; B: P = 0.006; C/F4: P = 0.111; F1-3: P = 0.875). CONCLUSION: Type A and F1-3 fractures are not required to undergo aggressive early decompression. Type B and type C/F4 fractures should receive early surgical treatment for better clinical outcomes. These slides can be retrieved under Electronic Supplementary Material.

Bioinformatics analyses of differentially expressed genes associated with spinal cord injury: A microarray-based analysis in a mouse model.

Gene spectrum analysis has shown that gene expression and signaling pathways change dramatically after spinal cord injury, which may affect the microenvironment of the damaged site. Microarray analysis provides a new opportunity for investigating diagnosis, treatment, and prognosis of spinal cord injury. However, differentially expressed genes are not consistent among studies, and many key genes and signaling pathways have not yet been accurately studied. GSE5296 was retrieved from the Gene Expression Omnibus DataSet. Differentially expressed genes were obtained using R/Bioconductor software (expression changed at least two-fold; P < 0.05). Database for Annotation, Visualization and Integrated Discovery was used for functional annotation of differentially expressed genes and Animal Transcription Factor Database for predicting potential transcription factors. The resulting transcription regulatory protein interaction network was mapped to screen representative genes and investigate their diagnostic and therapeutic value for disease. In total, this study identified 109 genes that were upregulated and 30 that were downregulated at 0.5, 4, and 24 hours, and 3, 7, and 28 days after spinal cord injury. The number of downregulated genes was smaller than the number of upregulated genes at each time point. Database for Annotation, Visualization and Integrated Discovery analysis found that many inflammation-related pathways were upregulated in injured spinal cord. Additionally, expression levels of these inflammation-related genes were maintained for at least 28 days. Moreover, 399 regulation modes and 77 nodes were shown in the protein-protein interaction network of upregulated differentially expressed genes. Among the 10 upregulated differentially expressed genes with the highest degrees of distribution, six genes were transcription factors. Among these transcription factors, ATF3 showed the greatest change. ATF3 was upregulated within 30 minutes, and its expression levels remained high at 28 days after spinal cord injury. These key genes screened by bioinformatics tools can be used as biological markers to diagnose diseases and provide a reference for identifying therapeutic targets.

Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: An updated meta-analysis.

BACKGROUND: A miniature spine-mounted robot has recently been introduced to further improve the accuracy of pedicle screw placement in spine surgery. However, the differences in accuracy between the robotic-assisted (RA) technique and the free-hand with fluoroscopy-guided (FH) method for pedicle screw placement are controversial. A meta-analysis was conducted to focus on this problem. METHODS: Several randomized controlled trials (RCTs) and cohort studies involving RA and FH and published before January 2017 were searched for using the Cochrane Library, Ovid, Web of Science, PubMed, and EMBASE databases. A total of 55 papers were selected. After the full-text assessment, 45 clinical trials were excluded. The final meta-analysis included 10 articles. RESULTS: The accuracy of pedicle screw placement within the RA group was significantly greater than the accuracy within the FH group (odds ratio 95%, "perfect accuracy" confidence interval: 1.38-2.07, P < .01; odds ratio 95% "clinically acceptable" Confidence Interval: 1.17-2.08, P < .01). CONCLUSIONS: There are significant differences in accuracy between RA surgery and FH surgery. It was demonstrated that the RA technique is superior to the conventional method in terms of the accuracy of pedicle screw placement.

Decompression for Traumatic Thoracic/Thoracolumbar Incomplete Spinal Cord Injury: Application of AO Spine Injury Classification System to Identify the Timing of Operation.

OBJECTIVE: Application of AO spine injury classification system (AOSICS) to identify the timing of operation for different types of traumatic thoracic/thoracolumbar incomplete spinal cord injury (SCI). METHODS: A single-center prospective cohort study was conducted to enroll patients with thoracic/thoracolumbar incomplete SCI from April 2013 to November 2016; they were divided into an early group (<24 hours after SCI) and a late group (24-72 hours after SCI). Each group was divided into A, B, C subgroups according to AOSICS. The primary outcomes were ordinal changes in ASIA Impairment Scale at 12-month follow-up. The secondary outcomes included the Medical outcomes study 36-term short form health survey physical component summary (PCS), complications, mortality, and hospital length of stay (LOS). RESULTS: Seven hundred twenty-one patients with thoracic/thoracolumbar incomplete SCI were included; 335 patients underwent early surgery, and 386 patients underwent delayed surgery. Statistical results included the following comparisons of the early versus late groups: AIS improvement of 1 grade or more (combined groups: P = 0.009, odds ratio [OR] = 1.487; A: P = 0.777, OR = 1.072; B: P = 0.029, OR = 1.701; C: P = 0.007, OR = 1.762), AIS improvement 2 grades or more (combined groups: P = 0.002, OR = 2.471; A: P = 0.189, OR = 3.939; B: P = 0.011, OR = 2.550; C: P = 0.035, OR = 3.964) and PCS (combined groups: P = 0.327; A: P = 0.776; B: P = 0.019; C: P = 0.562). LOS (combined groups: P < 0.0001; A, B and C: P < 0.0001). Complications (combined groups: P = 0.267; A: P = 0.830; B: P = 0.111; C: P = 0.757). CONCLUSIONS: Patients with type-A injuries with incomplete SCI do not have to undergo aggressive early operations. Patients with type-B and type-C injuries should undergo an operation early to achieve better clinical results.

The analysis of MSTMOVCF (Multi-segment thoracolumbar mild osteoporotic fractures surgery or conservative treatment) based on ASTLOF (the assessment system of thoracolumbar osteoporotic fracture).

To investigate the issue that conservative or surgical treatment for multi-segmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF) by applying the assessment system of thoracolumbar osteoporotic fracture (ASTLOF). A single-center prospective cohort study was designed to enroll elderly patients with MSTMOVCF from June 2013 to June 2016, which were divided into conservative and surgery group. The primary outcomes were Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score, with secondary outcomes including SF-36 and imaging measures such as height of anterior and middle column, Beck value, complications. A total of 470 patients with MSTMOVCF were enrolled. 193 patients underwent surgery of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and 277 patients underwent conservative treatment. The VAS score of operation group was significantly lower than that of conservative group (P < 0.0001, for all). The ODI score of the operation group was significantly lower than that of conservative group (P < 0.0001, for all). The SF-36 score, height of anterior and middle column, Beck value in the operation group were higher than those in conservative group (P < 0.0001, for all) at 1-year follow-up. MSTMOVCF underwent surgery can achieve great short-term clinical results. The patient with the sum of revised ASTLOF scores of multiple injured vertebrae ≥ 5 was recommended for surgery.

Surgery for Multisegment Thoracolumbar Mild Osteoporotic Fractures: Revised Assessment System of Thoracolumbar Osteoporotic Fracture.

OBJECTIVE: To examine the Assessment System of Thoracolumbar Osteoporotic Fracture (ASTLOF), which can effectively guide the treatment of single-segmental thoracolumbar osteoporotic vertebral compression fractures but fails to guide the treatment of multisegmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF). METHODS: A prospective case series study was designed to enroll elderly patients with MSTMOVCF who had been treated with percutaneous kyphoplasty/percutaneous vertebroplasty (PKP/PVP) from June 2013 to June 2016. Surgery indication was based on revised ASTLOF. Visual analog scale and Oswestry Disability Index (ODI) scores were used to evaluate the postoperative improvement of back pain, and clinical effects were assessed according to the 36-Item Short Form Health Survey. Some imaging measures, such as height of anterior and middle column and Beck value, were measured before the operation and 12 months after the operation. Complications also were collected. RESULTS: A total of 193 patients underwent PKP/PVP surgery. At postoperative 2 days, 3 months, and 1-year follow-up, whereas VAS and ODI scores decreased (P < 0.0001, for all) significantly as well as SF-36, the height of anterior and middle column increased (P < 0.0001, for all) compared with preoperation. Beck value at 1-year follow-up was greater than preoperation (P = 0.001). The improvement rate of ODI was 86.4 ± 8.3%. CONCLUSIONS: Patients with MSTMOVCF who undergo surgery with PKP/PVP can achieve great clinical results. Patients with the sum of revised ASTLOF scores of multiple injured vertebrae ≥5 should be recommended for surgery. The consistency and repeatability of the revised ASTLOF need further study.

Radiological and clinical differences among three assisted technologies in pedicle screw fixation of adult degenerative scoliosis.

The purpose of this study was to compare the clinical and radiological differences among three advanced guided technologies in adult degenerative scoliosis. A total of 1012 pedicle screws were inserted in 83 patients using a spine robot (group A), 886 screws were implanted in 75 patients using a drill guide template (group B), and 1276 screws were inserted in 109 patients using CT-based navigation (group C). Screw positions were evaluated using postoperative CT scans according to the Gertzbein and Robbins classification. Other relevant data were also collected. Perfect pedicle screw insertion (Grade A) accuracy in groups A, B, and C was 91.3%, 81.3%, and 84.1%, respectively. Clinically acceptable accuracy of screw implantation (Grades A + B) respectively was 96.0%, 90.6%, and 93.0%. Statistical analysis showed the perfect and clinically acceptable accuracy in group A was significant different compared with groups B and C. Group A exhibited the lowest intra-op radiation dose and group B showed the shortest surgical time compared with the other two groups. Robotic-assisted technology demonstrated significantly higher accuracy than the drill guide template or CT-based navigation systems for difficult screw implantations in adult degenerative scoliosis and reduced the intra-op radiation dose, although it failed to reduce surgery time.

Acute massive cerebellar infarction associated with craniocervical junction complex malformation: a case report and literature review.

We report a case of acute massive cerebellar infarction associated with craniocervical junction (CVJ) complex malformation in a 21-year-old male. Timely surgical intervention prevented the deterioration of his neurological status.

Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block Combined with Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery in the Treatment of Adult Degenerative Scoliosis: A Clinical Observation Including 96 Patients.

OBJECTIVE: Application of nerve root block is mainly for diagnosis with less application in intraoperative treatment. The aim of this study was to observe clinical and imaging outcomes of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in to treat adult degenerative lumbar scoliosis. METHODS: From January 2012 to November 2014, 108 patients with adult degenerative lumbar scoliosis were treated with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery combined with intraoperative gelatin sponge impregnated with a mixture of 3 drugs. Visual analog scale and Oswestry Disability Index scores were used to evaluate postoperative improvement of back and leg pain, and clinical effects were assessed according to the 36-Item Short-Form Health Survey. Imaging was obtained preoperatively, 1 week and 3 months postoperatively, and at the last follow-up. Fusion status, complications, and other outcomes were assessed. RESULTS: Follow-up was complete for 96 patients. Visual analog scale scores of leg and back pain on postoperative days 1-7 were decreased compared with preoperatively. At 1 week postoperatively, 3 months postoperatively, and last follow-up, visual analog scale score, Oswestry Disability Index score, coronal Cobb angle, and coronal and sagittal deviated distance decreased significantly (P = 0.000) and lumbar lordosis angle increased (P = 0.000) compared with preoperatively. Improvement rate of Oswestry Disability Index was 81.8% ± 7.4. Fusion rate between vertebral bodies was 92.7%. CONCLUSIONS: Application of gelatin sponge impregnated with 3 drugs combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion for treatment of adult degenerative lumbar scoliosis is safe and feasible with advantages of good short-term analgesia effect, minimal invasiveness, short length of stay, and good long-term clinical outcomes.

The in vitro and in vivo effects of microRNA-133a on intervertebral disc destruction by targeting MMP9 in spinal tuberculosis.

AIMS: We aim to investigate the role of microRNA-133a (miR-133a) in intervertebral disc destruction by targeting MMP9 in spinal tuberculosis (TB). MAIN METHODS: Rabbit models with spinal TB were established and assigned to the blank, miR-133a mimic, miR-133a inhibitor and negative control (NC) groups. Primary notochordal cells were extracted and separately transfected with miR-133a mimics, miR-133a inhibitor, miR-nonsense sequence control (NC), si-NC and si-MMP9. QRT-PCR and Western blot assay were used to detect the expression of MMP-9, Collagen I, Collagen II and Collagen-X. Gelatin Zymography was performed to detect MMP9 activity. Immunohistochemistry was used to detect the expression of Collagen I, Collagen II and Collagen-X proteins. Osteoclast morphology and the number of osteoclast cells were observed after Tartrate resistant acid phosphatase staining. KEY FINDINGS: MMP9, Collagen-X and Collagen I expression and MMP9 activity were higher while the expression of Collagen II was lower in the miR-133a mimic group than the miR-NC group. MMP9, Collagen-X Collagen I and MMP9 activities were lower and Collagen II expression was higher in the miR-133a inhibitor group than the miR-NC group. Compared with the si-NC group, the si-MMP9 group showed increased Collagen II expression but decreased expression of MMP9, Collagen-X and Collagen I and MMP9 activity. A reduced amount of osteoclast cells exhibited in the miR-133a mimic group while an increased number was seen in the miR-133a inhibitor group compared to the blank group. SIGNIFICANCE: MiR-133a could inhibit Collagen degradation by down-regulating MMP-9 expression to attenuate the destructive effects of spinal TB on intervertebral disc.

Development and clinical application of grading and classification criteria of lumbar disc herniation.

This study aimed to develop new grading and classification criteria for lumbar disc herniation (LDH). First, from January 1993 to January 2003, we collected the detailed information of 1127 patients with LDH and, based on that information, developed a new grading classification termed the 6-score-V-type criteria wherein conservative treatment is recommended for patients with type I, II, or IIIA, surgical treatment is recommended for type IIIC, IV, and V, and 3 months of conservative followed by surgery if no improvements are obtained during the conservative treatment period is recommended for type IIIBe. The distribution of types among the 1,127 patients was: type I (7.9%), type II (22.9%), type III (34.1%), type IV (22.2%), and type V (12.6%). Type III cases were subdivided into type IIIA (9.9%), type IIIB (13.3%), and IIIC (10.8%). Second, from February 2003 to December 2009, we treated a separate group of 1130 patients with LDH according to this 6-score-V-type classification rubric and monitored them for 24 months. Therapeutic efficacy was assessed in 1130 patients with a standard evaluation for leg pain. Overall, 85.3% of the patients in the first year and 84.1% in the second year had good or excellent response ratings. The inter-examiner reliability was 98%. Assignment of therapeutic protocols according to the 6-score-V-type classification yielded satisfactory outcomes, indicating that the 6-score-V-type criteria are straightforward and practical.