Percutaneous short segmental fixation combined with bone cement augmentation for stage III Kümmell's disease without nerve deformity.

The objective of this study was to evaluate the safety and efficacy of percutaneous pedicle screw fixation combined with bone cement augmentation in the management of stage III Kümmell disease without nerve deformity. A retrospective analysis was conducted on 17 patients diagnosed with stage III Kümmell disease without nerve deformity, who underwent treatment with percutaneous pedicle screw fixation combined with bone cement augmentation between April 2019 and 2022. Preoperative, postoperative, and final follow-up clinical outcome measures were collected, including Visual Analog Scale scores and Oswestry Disability Index scores. Additionally, lateral radiography was used to measure the Cobb angle and height of the anterior border of the affected vertebral body. Operative time, volume of injected bone cement, intraoperative cement leakage, and other complications were recorded. All patients underwent successful surgery, resulting in significant reductions in Visual Analog Scale scores, Oswestry Disability Index scores, and Cobb angle postoperatively; meanwhile there was a significant increase in height of the anterior border of the affected vertebral body. No major complications occurred during the follow-up period. In conclusion, percutaneous pedicle screw short-segment fixation combined with bone cement augmentation appears to be an effective surgical option for treating stage III Kümmell disease without nerve deformities.

CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report.

Metastatic diseases of the spine are becoming increasingly common with an aging population and improvements in systemic cancer therapies. Microwave and vertebroplasty are the mainstay modalities for treating painful spine metastases. Most early spinal metastases predominantly attack the adnexa, but there are few reports on its treatment. This report presents a case of a 56-year-old female who had experienced severe thoracic back pain for several days and was diagnosed with a metastatic tumor of the right transverse process of T7. Percutaneous microwave ablation in combination with bone cement injection was used to treat the metastatic tumor under CT guidance. The postoperative pain on the Visual Analogue Scale was 1/10, without nerve or vessel damage and bone cement leakage during the operation.

A new tool in percutaneous anterior odontoid screw fixation.

BACKGROUND: Percutaneous anterior odontoid screw fixation for odontoid fractures remains challenging due to the complex anatomy of the craniocervical junction. We designed a new guide instrument to help with the placement of guide wire, which have achieved satisfying surgical results. The objective of this study is to evaluate the safety and efficacy of this new tool in percutaneous anterior odontoid screw fixation. METHODS: Twenty-nine patients with odontoid fracture were retrospectively evaluated. All patients underwent percutaneous anterior odontoid screw fixation with the traditional guide instrument (n = 13) or the new guide instrument we designed (n = 16). The following clinical outcomes were compared between the two groups: operation time, radiograph times, incision length, blood loss, postoperative hospitalization, postoperative complications, bony union, fixation failure, and reoperation. Radiographs or CT scans were performed at 3, 6 and 12 months after surgery. RESULTS: There were no significant differences in preoperative demographic data between the two groups. The operation time (56.62 ± 8.32 Vs 49.63 ± 7.47, P = 0.025) and radiograph times (26.54 ± 6.94 Vs 20.50 ± 5.02, P = 0.011) of the designed guide instrument group were significantly lower than those of the traditional guide instrument group. There were no significant differences in incision length (16.08 ± 3.07 Vs 15.69 ± 2.73, P = 0.720), blood loss (16.08 ± 4.96 Vs 17.88 ± 5.98, P = 0.393), postoperative hospitalization (7.15 ± 1.91 Vs 6.88 ± 2.36, P = 0.734), postoperative complications (7.7% Vs 12.5%, P = 1), and bony union (92.3% Vs 93.8%, P = 1) between the two groups. No fixation failure or reoperation occurred in either group. CONCLUSIONS: The top of our designed guide instrument is a wedge-shaped tip with 30° inclination, which has a large contact area with the anterior surface of the cervical vertebra. According to our retrospective study, the guide instrument can reduce the operation time and radiograph times. It has potential clinical value, which needs further testing with a higher level of research design.

Efficacy and Safety of Early Tracheotomy in Acute Cervical Spinal Cord Injury.

OBJECTIVE: To evaluate the clinical efficacy and safety of early tracheotomy versus delayed tracheotomy for patients with cervical spinal cord injury. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Orthopedic Surgery, The 80th Army Hospital of PLA, Weifang, Shandong, China, from January 2012 to June 2019. METHODOLOGY: Data of 45 patients with cervical spinal cord injury, who underwent tracheotomy and cervical spine internal fixation at the study place, were retrospectively analysed. Twenty-five patients underwent tracheotomy immediately after cervical spine internal fixation (early tracheotomy group) and 20 patients underwent tracheotomy 3-12 days after cervical spine internal fixation (delayed tracheotomy group). Clinical outcomes and tracheotomy complications were compared between the two groups. RESULTS: Compared with the delayed tracheotomy, the early tracheotomy significantly reduced the total duration of mechanical ventilation (p <0.01), duration of mechanical ventilation after tracheotomy (p <0.05), duration of indwelling tracheal tube (p <0.05), and hospital stay (p <0.01). There were no significant differences in pneumonia, mortality, and complications related to tracheotomy between the groups. No incision infection for tracheotomy and cervical spine internal fixation were found in all patients. CONCLUSION: Compared with delayed tracheotomy, early tracheotomy can significantly reduce the duration of mechanical ventilation, duration of indwelling tracheal tube, and hospital stay. Early tracheotomy did not increase the risk of infection of the cervical spine internal fixation. Therefore, early tracheotomy was beneficial and safe for patients. Key Words: Spinal cord injuries, Tracheotomy, Complications.

Progress and Applications of Polyphosphate in Bone and Cartilage Regeneration.

Patients with bone and cartilage defects due to infection, tumors, and trauma are quite common. Repairing bone and cartilage defects is thus a major problem for clinicians. Autologous and artificial bone transplantations are associated with many challenges, such as limited materials and immune rejection. Bone and cartilage regeneration has become a popular research topic. Inorganic polyphosphate (polyP) is a widely occurring biopolymer with high-energy phosphoanhydride bonds that exists in organisms from bacteria to mammals. Much data indicate that polyP acts as a regulator of gene expression in bone and cartilage tissues and exerts morphogenetic effects on cells involved in bone and cartilage formation. Exposure of these cells to polyP leads to the increase of cytokines that promote the differentiation of mesenchymal stem cells into osteoblasts, accelerates the osteoblast mineralization process, and inhibits the differentiation of osteoclast precursors to functionally active osteoclasts. PolyP-based materials have been widely reported in in vivo and in vitro studies. This paper reviews the current cellular mechanisms and material applications of polyP in bone and cartilage regeneration.

A Meta-Analysis of the Influencing Factors for Tracheostomy after Cervical Spinal Cord Injury.

BACKGROUND: Traumatic cervical spinal cord injury (CSCI) is a common disease that has high complication, disability, and mortality rates and a poor prognosis. Tracheostomy is an important supportive therapy for patients with CSCI. However, a consensus on the predictive factors for tracheostomy after CSCI has not been reached. OBJECTIVE: This meta-analysis study assessed the influencing factors for tracheostomy after CSCI. METHODS: We searched for relevant studies on the influencing factors for tracheostomy after CSCI. The extracted data were analyzed using RevMan 5.3 software. We calculated the odds ratio (OR) or mean difference (MD) and 95% confidence intervals (CIs). RESULTS: Sixteen eligible studies containing 9697 patients with CSCI were selected. The pooled OR (MD) and 95% CI of the influencing factors were as follows: age (mean ± SD): -0.98 (-4.00 to 2.03), advanced age: 1.93 (0.80 to 4.63), sex (male): 1.29 (1.12 to 1.49), American Spinal Injury Association Impairment Scale (AIS) A grade: 7.79 (5.28 to 11.50), AIS B grade: 1.15 (1.13 to 2.02), AIS C grade: 0.28 (0.20 to 0.41), AIS D grade: 0.04 (0.02 to 0.09), neurological level of injury (upper CSCI): 2.36 (1.51 to 3.68), injury severity score (ISS): 8.97 (8.11 to 9.82), Glasgow Coma Scale (GCS) score ≤8: 6.03 (2.19 to 16.61), thoracic injury: 1.78 (1.55 to 2.04), brain injury: 0.96 (0.55 to 1.69), respiratory complications: 5.97 (4.03 to 8.86), smoking history: 1.45 (0.99 to 2.13), traffic accident injury: 1.27 (0.92 to 1.74), and fall injury: 0.72 (0.52 to 1.01). CONCLUSIONS: The current evidence shows that male sex, AIS A grade, AIS B grade, neurological level of injury (upper CSCI), high ISS, GCS≤8, thoracic injury, and respiratory complications are risk factors for tracheostomy after CSCI, and AIS C grade and AIS D grade are protective factors. This study will allow us to use these factors for tracheostomy decisions and ultimately optimize airway management in patients with CSCI.

N-Cadherin Attenuates High Glucose-Induced Nucleus Pulposus Cell Senescence Through Regulation of the ROS/NF-κB Pathway.

BACKGROUND/AIMS: Diabetes mellitus (DM) is a potential etiology of disc degeneration. N-cadherin (N-CDH) helps maintain the cell viability, cell phenotype and matrix biosynthesis of nucleus pulposus (NP) cells. Here, we mainly aimed to investigate whether N-CDH can attenuate high glucose-induced NP cell senescence and its potential mechanism. METHODS: Rat NP cells were cultured in a base culture medium and base culture medium with a 0.2 M glucose concentration. Recombinant lentiviral vectors were used to enhance N-CDH expression in NP cells. Senescence-associated ß-galactosidase (SA-ß-Gal) activity was measured by SA-ß-Gal staining. NP cell proliferation was evaluated by CCK-8 assay. Telomerase activity and intracellular reactive oxygen species (ROS) content were tested by specific chemical kits according to the manufacturer's instructions. G0/G1 cell cycle arrest was evaluated by flow cytometry. Real-time PCR and Western blotting were used to analyze mRNA and protein expressions of senescence markers (p16 and p53) and matrix macromolecules (aggrecan and collagen II). Additionally, p-NF-κB expression was also analyzed by Western blotting to evaluate NF-κB pathway activity. RESULTS: High glucose significantly decreased N-CDH expression, increased ROS generation and NF-κB pathway activity, and promoted NP cell senescence, which was reflected in the increase in SA-ß-Gal activity and senescence marker (p16 and p53) expression, compared to the control group. High glucose decreased telomerase activity and cell proliferation potency. However, N-CDH overexpression partially attenuated NP cell senescence, decreased ROS content and inhibited the activation of the NF-κB pathway under the high glucose condition. CONCLUSION: High glucose decreases N-CDH expression and promotes NP cell senescence. N-CDH overexpression can attenuate high glucose-induced NP cell senescence through the regulation of the ROS/ NF-κB pathway. This study suggests that N-CDH is a potential therapeutic target to slow DM-mediated disc NP degeneration.

Dynamic Compression Promotes the Matrix Synthesis of Nucleus Pulposus Cells Through Up-Regulating N-CDH Expression in a Perfusion Bioreactor Culture.

BACKGROUND/AIMS: An adequate matrix production of nucleus pulposus (NP) cells is an important tissue engineering-based strategy to regenerate degenerative discs. Here, we mainly aimed to investigate the effects and mechanism of mechanical compression (i.e., static compression vs. dynamic compression) on the matrix synthesis of three-dimensional (3D) cultured NP cells in vitro. METHODS: Rat NP cells seeded on small intestinal submucosa (SIS) cryogel scaffolds were cultured in the chambers of a self-developed, mechanically active bioreactor for 10 days. Meanwhile, the NP cells were subjected to compression (static compression or dynamic compression at a 10% scaffold deformation) for 6 hours once per day. Unloaded NP cells were used as controls. The cellular phenotype and matrix biosynthesis of NP cells were investigated by real-time PCR and Western blotting assays. Lentivirus-mediated N-cadherin (N-CDH) knockdown and an inhibitor, LY294002, were used to further investigate the role of N-CDH and the PI3K/Akt pathway in this process. RESULTS: Dynamic compression better maintained the expression of cell-specific markers (keratin-19, FOXF1 and PAX1) and matrix macromolecules (aggrecan and collagen II), as well as N-CDH expression and the activity of the PI3K/Akt pathway, in the 3D-cultured NP cells compared with those expression levels and activity in the cells grown under static compression. Further analysis showed that the N-CDH knockdown significantly down-regulated the expression of NP cell-specific markers and matrix macromolecules and inhibited the activation of the PI3K/Akt pathway under dynamic compression. However, inhibition of the PI3K/Akt pathway had no effects on N-CDH expression but down-regulated the expression of NP cell-specific markers and matrix macromolecules under dynamic compression. CONCLUSION: Dynamic compression increases the matrix synthesis of 3D-cultured NP cells compared with that of the cells under static compression, and the N-CDH-PI3K/Akt pathway is involved in this regulatory process. This study provides a promising strategy to promote the matrix deposition of tissue-engineered NP tissue in vitro prior to clinical transplantation.

Osteogenic protein-1 attenuates apoptosis and enhances matrix synthesis of nucleus pulposus cells under high-magnitude compression though inhibiting the p38 MAPK pathway.

BACKGROUND: Disc degeneration is correlated with mechanical load. Osteogenic protein-1 (OP-1) is potential to regenerate degenerative disc. OBJECTIVE: To investigate whether OP-1 can protect against high magitude compression-induced nucleus pulposus (NP) cell apoptosis and NP matrix catabolism, and its potential mechanism. METHODS: Porcine discs were cultured in a bioreactor and compressed at a relatively high-magnitude mechanical compression (1.3 MPa at a frequency of 1.0 Hz for 2 hours once per day) for 7 days. OP-1 was added along with the culture medium to investigate the protective effects of OP-1. NP cell apoptosis and matrix biosynthesis were evaluated. Additionally, activity of the p38 MAPK pathway is also analyzed. RESULTS: Compared with the control group, high magnitude compression significantly promoted NP cell apoptosis and decreased NP matrix biosynthesis, reflected by the increase in the number of TUNEL-positive cells and caspase-3 activity, the up-regulated expression of Bax and caspase-3 mRNA and down-regulated expression of Bcl-2 mRNA, and the decreased alcian blue staining intensity and expression of matrix proteins (aggrecan and collagen II). However, OP-1 addition partly attenuated the effects of high magnitude compression on NP cell apoptosis and NP matrix biosynthesis. Further analysis showed that inhibition of the p38 MAPK pathway partly participated in this process. CONCLUSION: OP-1 can attenuate high magnitude compression-induced NP cell apoptosis and promoted NP matrix biosynthesis, and inhibition of the p38 MAPK pathway may participate in this regulatory process. This study provides that OP-1 may be efficacy in retarding mechanical overloading-exacerbated disc degeneration.

Resveratrol attenuates high glucose-induced nucleus pulposus cell apoptosis and senescence through activating the ROS-mediated PI3K/Akt pathway.

BACKGROUND: Diabetes mellitus is closely correlated with disc degeneration. Nucleus pulposus (NP) cell apoptosis and senescence are typical cellular features within the degenerative disc. Resveratrol is a newly identified phytoalexin that has protective effects on cartilaginous tissue. OBJECTIVE: To investigate the whether resveratrol can protect against high glucose-induced NP cell apoptosis and senescence, and the potential mechanism in this process. METHODS: Rat NP cells were cultured in either 10% FBS culture medium (control group) or 10% FBS with a high glucose concentration (0.2 M, experiment group) for 3 days. Resveratrol or the combination of resveratrol and LY294002 was added into the culture medium of experiment group to investigate the effects of resveratrol and the PI3K/Akt pathway. RESULTS: High glucose significantly promoted NP cell apoptosis and NP cell senescence compared with the control group. Resveratrol exhibited protective effects against high glucose-induced NP cell apoptosis and senescence. Further analysis showed that resveratrol suppressed reactive oxygen species (ROS) generation and increased the activity of the PI3K/Akt pathway under the high glucose condition. However, the LY294002 had no significant effects on ROS content in the resveratrol-treated high glucose group. CONCLUSION: Resveratrol can attenuate high glucose-induced NP cell apoptosis and senescence, and the activation of ROS-mediated PI3K/Akt pathway may be the potential mechanism in this process.

[Short-term effectiveness of quadrant retractor in treatment of recurrent lumbar disc protrusion].

OBJECTIVE: To investigate the effectiveness of Quadrant retractor for the treatment of recurrent lumbar disc protrusion. METHODS: Between July 2008 and March 2010, 18 cases of recurrent lumbar disc protrusion were treated with Quadrant. There were 13 males and 5 females with an average age of 43 years (range, 35-67 years). Involved segments included L4, 5 in 6 cases and L5, S1 in 12 cases. The time between first operation and recurrence was 12-120 months (mean, 42.8 months). Before operation, radiological evaluation including X-ray, CT, and MRI were performed. Visual analogue scale (VAS) score and modified MacNab criteria were used to evaluate the effectiveness. RESULTS: The operation time was 40-80 minutes (mean, 60 minutes), and the amount of blood loss was 80-120 mL (mean, 100 mL). All operations were performed successfully, and no complication of infection and nerve injury occurred. Incisions healed by first intention. Cerebrospinal fluid leakage occurred in 2 cases and was cured at 3 days after operation by removal of drainage. Eighteen patients were followed up 12-30 months (mean, 22 months). The VAS score of leg pain was decreased from 7.3 +/- 2.2 preoperatively to 2.0 +/- 1.3 at the final follow-up, showing significant difference (t = 11.08, P = 0.00). According to modified MacNab criteria, the results were excellent in 12 patients and good in 6 patients. No recurrence was found during follow-up. CONCLUSION: Discectomy via Quadrant retractor is a safe and effective minimally invasive surgical technique in treating recurrent lumbar disc protrusion.

[Research of single incision via MAST Quadrant retractor in management of lumbar spondylolisthesis].

OBJECTIVE: To evaluate the effect of posterior lumbar interbody fusion (PLIF) using single incision via MAST Quadrant retractor in the management of lumbar spondylolisthesis. METHODS: From July 2008 to June 2009, 20 cases of lumbar spondylolisthesis were treated with posterior lumbar interbody fusion via MAST Quadrant retractor using single incision, including 2 cases of degenerative spondylolisthesis and 18 cases of isthmic spondylolisthesis. There were 8 males and 12 females aged from 34 to 62 years (average 45.5 years). The disease course was 1 to 6 years (mean 34.5 months). The spondylolisthesis locations were L4, 5 in 8 cases and L5, S1 in 12 cases. According to Meyerding classification, all cases were classified as degree I. The Visual Analogue Scale (VAS) score was (6.6 +/- 1.2) points. The operative time, the blood loss, and the therapeutic effects were recorded. RESULTS: The operative time was (155 +/- 23) minutes and the amount of blood loss was (360 +/- 102) mL. The hospitalization time were (12.0 +/- 3.4) days. All incisions healed by first intention. X-ray films showed spondylolisthesis reduction immediately after operation. All patients were followed up 14.3 months on average (from 9 to 20 months). The VAS score decreased to (1.6 +/- 2.3) points at the last follow-up, showing significant difference when compared with that of preoperation (P < 0.05). The X-ray films showed that lumbar interbody fusion was achieved in all the patients. No loosening, breakage, and displacement of pedicle screw fixation was observed. According to Nakai standard, the results were excellent in 18 cases and good in 2 cases at the last follow-up. CONCLUSION: As long as the indication is strictly chosen, PLIF via MAST Quadrant retractor is a safe, effective, and minimally invasive surgical technique in treating lumbar spondylolisthesis.

[The clinical comparison of microendoscopic lumbar diskectomy with and without preservation of the ligamentum flavum].

OBJECTIVE: To discuss the surgical technique, indication and the clinical effects of the Microscope Endoscopic Tubular Retractor System (METRx) for microendoscopic lumbar diskectomy with the preservation of the ligamentum flavum. METHODS: Two hundred and eleven patients underwent single-segment METRx, with ligamentum flavum preservation in 65 patients (Group A), and without preservation in 146 patients (Group B). The two groups were compared clinically. All the patients suffered from low back pain and radicular syndrome to some extent, and the diagnosis was affirmed by CT and/or MRI. After exposed the interlaminar space regularly, the superior, inferior and lateral edge of the ligamentum flavum was released, the 3-sided dissociative ligament pacth was retracted medially during the spinal manipulation and restored anatomically after disc removal and the decompression of the nerve root. RESULTS: According to the results of two groups, ligamentum flavum preservation technique was feasible under endoscope and helpful in reducing the scar formation in the spinal canal. CONCLUSIONS: The ligamentum flavum preservation technique enable the surgeons to preserve the natural barrier. It is feasible to perform METRx, and it is helpful in reducing the epidural fibrosis.