Effectiveness of lumbar braces after lumbar surgery: a systematic review and meta-analysis.

OBJECTIVE: To systematically analyze the effectiveness of lumbar braces in patients after lumbar spine surgery. METHODS: The databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), were searched to identify the randomized controlled trials (RCTs), case-series or case-control studies on the use of lumbar braces after lumbar spine surgery. The two authors independently assessed the quality of the included study and extracted the data. The statistical analysis was performed using Revman 5.4 software. RESULTS: 9 English papers and 1 Chinese paper were included in the present work, involving a total of 2646 patients (2181 in the experimental group and 465 in the control group). The differences in preoperative VAS, postoperative VAS, preoperative ODI, postoperative ODI, length of hospital stay, postoperative complications, and surgical comparison were not statistically significant (p > 0.05). However, postoperative surgical site infection incidence was lower in the lumbar brace group than those without lumbar brace (p < 0.05). CONCLUSION: Whether or not the use of lumbar braces after lumbar fixation has a negligible impact on clinical outcomes was studied. Subsequent studies could further demonstrate whether the use of lumbar braces after lumbar surgery could reduce the incidence of surgical site infections.

Do Modic changes contribute to lumbar instability or other way around? A retrospective study based on their types, extents, and affected lumbar segments.

BACKGROUND: Which types of Modic changes (MCs) and whether or how specific factors associated to MCs work on lumbar instability have yet to be well understood. The purpose of this study was to investigate the influences of the types of MCs, the extent of MCs lesion involvement, and different lumbar levels involved by MCs on lumbar instability. METHODS: This retrospective study included 263 adult subjects with MCs who underwent lumbar X-ray examinations in the neutral, flexion, and extension positions. All patients who met our inclusion criteria were examined with 1.5 Tesla magnetic resonance units. Two experienced authors with more than three-year clinical experience independently evaluated and measured the subjects' radiographic images. The subgroup analysis was performed to detect the differences in subjects' baseline characteristics and lumbar segmental motions among three types of MCs, the extent of MCs lesion involvement and different lumbar levels involved by MCs. RESULTS: There was a statistical difference in body mass index (BMI) between different involvement extent of MCs (p < 0.01), indicating that the subjects with high BMI are more likely to develop severe MCs. The subjects with Modic type 1 change (MC1) had a significant increase in lumbar angular motion than those with Modic type 2 change (MC2) and Modic type 3 change (MC3) (p < 0.01) and compared with MC3, a significant increase in lumbar translation motion was detected in subjects with MC1 and MC2 (p < 0.01). While, angular motion decreased, translation motion increased significantly as the extent of MCs lesion involvement aggravated (p < 0.01). However, there were no statistical differences in lumbar angular and translation motions between different lumbar levels involved by MCs (p > 0.05). CONCLUSIONS: Higher BMI might be a risk factor for the development of severe MCs. MC1 and MC2 significantly contribute to lumbar instability. The extents of MCs lesion involvement are strongly associated with lumbar instability. However, different lumbar levels involved by MCs have little effect on lumbar stability.

Artificial intelligence reveals dysregulation of osteosarcoma and cuproptosis-related biomarkers, PDHA1, CDKN2A and neutrophils.

At present, the impact of cuproptosis-related genes in the study of osteosarcoma is largely unknown. Genome-wide data of osteosarcoma and controls were downloaded from 3 different databases, and specific diagnostic models associated with cuproptosis in osteosarcoma were constructed by support vector machines with artificial intelligence, random forest trees and LASSO regression. Differential analysis of immune cell infiltration was examined using routine blood data from 25,665 cases. Differential expression was examined using immunohistochemistry and PCR. PDHA1 and CDKN2A were obtained as specific cuproptosis-related biomarkers for osteosarcoma after artificial intelligence analysis. PDHA1, CDKN2A and neutrophils were differentially expressed in OS and control groups. PDHA1 and CDKN2A are significantly dysregulated in OS and are able to serve as biomarkers of OS.

Non-surgical therapy for the treatment of chronic low back pain in patients with Modic changes: A systematic review of the literature.

Background: In absence of uniform therapeutic recommendations, knowledge of the available treatment options for Modic changes (MCs) patients and their safety and effectiveness would be crucial and significant for clinicians and such patients. Objectives: The aim of this study was to provide a systematic review of available studies on non-surgical treatments of MCs. Methods: We performed a systematic review of multiple electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure for the period until 31st August 2021 to search for studies on non-surgical treatments for MCs in accordance with the guidance of the Cochrane Handbook. Potential studies were screened by their titles and abstracts. The methodological quality of the included studies was independently evaluated by two authors. Final recommendations for the included interventions were developed based on grades of recommendations. The narrative format was adopted to synthesize the findings of the present work. Results: Fifth studies involving a total of 1147 patients were identified for this systematic review. The results of this review demonstrated that spinal manipulation has been suggested as an alternative option for patients with MCs. However, there was insufficient evidence to support that patients with MCs can benefit from the medication and wearing the rigid lumbar brace. Moreover, the rationale and safety for the use of antibiotics in such patients remain highly controversial. Low evidence revealed that exercise therapy might decrease pain intensity only for special subgroups of MCs patients. Conclusions: There is not yet enough evidence to suggest that non-surgical treatments are useful for patients with MCs. Further high-quality, multicenter trials are required to validate the effectiveness of these non-surgical treatments.

Comprehensive Network Analysis Identified SIRT7, NTRK2, and CHI3L1 as New Potential Markers for Intervertebral Disc Degeneration.

Intervertebral disc degeneration (IDD) is considered the basis of serious clinical symptoms, especially for low back pain (LBP). Therefore, it is essential to explore the regulatory role and diagnostic performance of dysregulated genes and potential drugs in IDD. Through WGCNA co-expression analysis, 36 co-expression modules were obtained. Among them, MidnightBlue and Red modules were the most related to IDD. Functional enrichment analysis showed that the Red module was mainly related to neutrophil activation and regulation of cytokine-mediated signaling pathway and apoptosis, whereas the MidnightBlue module was mainly related to extracellular matrix organization, bone development, extracellular matrix, extracellular matrix component, and other extracellular matrices. Furthermore, 356 genes highly related to the module were screened to construct a protein interaction network. Network degree distribution analysis showed that the known IDD-related genes had a higher degree of distribution. Enrichment analysis demonstrated that these genes were enriched in MAPK_SIGNALING_PATHWAY (FDR = 0.012), CHEMOKINE_SIGNALING_PATHWAY, and some other pathways. By constructing a disease-gene interaction network, three disease-specific genes were finally identified. Through combining with the drug-target gene interaction network, two potential therapeutic drugs, entrectinib and larotrectinib, were determined. Finally, based on these genes, the diagnostic model in the training dataset, test dataset, and verification dataset all showed a high diagnostic performance. The findings of this study contributed to the diagnosis of IDD and personalized treatment of IDD.

Upper and lower adjacent segment range of motion after fixation of different lumbar spine segments in the goat: an in vitro experiment.

OBJECTIVES: The purpose of this study was to examine the biomechanical effects of fixation on range of motion (ROM) in the upper and lower adjacent segments of different lumbar spine segments in a goat spine model. METHODS: Fifteen goat spine specimens (vertebrae T12-S1) were randomly divided into three groups: A (single-segment fixation), B (double-segment fixation), and C (triple-segment fixation). Motion in different directions was tested using a spinal motion simulation test system with five external loading forces. Transverse, forward-backward, and vertical displacement of the upper and lower adjacent segments were measured. RESULTS: As the external load increased, the upper and lower adjacent segment ROM increased. A significantly greater ROM in group C compared with group A was found when the applied external force was greater than 75 N. The upper adjacent segment showed a significantly greater ROM than the lower adjacent segment ROM within each group. CONCLUSIONS: Adjacent segment ROM increased with an increasing number of fixed lumbar segments. The upper adjacent segment ROM was greater than that of the lower adjacent segments. Adjacent segment stability after lumbar internal fixation worsened with an increasing number of fixed segments.

Long non-coding RNA H19 regulates proliferation of ovarian granulosa cells via STAT3 in polycystic ovarian syndrome.

INTRODUCTION: Studies have shown that long non-coding RNAs (lncRNA) are aberrantly expressed in polycystic ovarian syndrome (PCOS) ovaries and may have a role in PCOS development. In this study, the role and therapeutic implications of lncRNA H19 were investigated in PCOS ovaries and granulosa cells. MATERIAL AND METHODS: qRT-PCR was used for expression analysis. Cell Counting Kit 8 (CCK-8) assay was used for cell viability and acridine orange/ethidium bromide (AO/EB) and Annexin V/propidium iodide staining was used to detect apoptosis. All transfections were carried out with Lipofectamine 2000 reagent. Western blot analysis was used for protein expression analysis. RESULTS: The expression of lncRNA H19 was remarkably upregulated in the PCOS ovarian tissues as well as the granulosa cells. Suppression of lncRNA H19 expression caused the inhibition of KGN granulosa cell proliferation due to the triggering of apoptosis. Bioinformatic analysis revealed the presence of the GAS binding site for STAT3 in the promoter of lncRNA H19. Silencing of STAT3 suppressed the expression of lncRNA H19 in KGN cells and also halted their growth by triggering apoptosis. Co-transfect experiments revealed that STAT3 and lncRNA H19 silencing cause inhibition of KGN growth synergistically. CONCLUSIONS: lncRNA H19 regulates the growth of ovarian granulosa cells and might prove to be a therapeutic target for management of PCOS.

Comparison of extreme lateral approach with posterior approach in the treatment of lumbar degenerative diseases: A meta-analysis of clinical and imaging findings.

OBJECTIVE: To compare clinical and imaging findings between extreme lateral lumbar interbody fusion (XLIF) and posterior fusion (PF) via meta-analysis for the treatment of lumbar degenerative diseases. METHODS: English papers reporting clinical and imaging findings for the treatment of lumbar degenerative diseases with XLIF and PF published electronically in the PubMed, Embase, Cochrane Library, and Web of Science databases from January 2006 to August 2019 were retrieved. Two authors independently extracted data and evaluated the quality of the included literature. Meta-analysis of outcome measures was performed using Stata 14 and RevMan 5.3 software. RESULTS: This meta-analysis included 744 patients from nine studies, two of which were prospective studies, while the others were retrospective studies. The quality of each study was determined to be high. The meta-analysis showed no significant differences in the operative time, length of hospital stay, clinical effectiveness, and improvement in postoperative global sagittal alignment between two approaches (P > 0.05). However, XLIF was significantly better than PF in reducing intraoperative blood loss and recovery of local sagittal alignment (P < 0.05). Moreover, the high incidence of postoperative complications were detected in XLIF group (P < 0.05). CONCLUSIONS: Both surgical approaches have equally promising clinical effectiveness for the treatment of lumbar degenerative diseases. Although XLIF can reduce intraoperative blood loss and obtain better postoperative local sagittal alignment than PF, the high incidence of postoperative complications should prompt us to consider why XLIF procedure is still being offered to our patients and how we can reduce these complications. In addition, any conclusions should be taken with caution because of the mix of prospective and retrospective studies, and the high heterogeneity and bias.

Correlation of Modic Changes with Sagittal Lumbopelvic Parameters.

PURPOSE: The main aim of this retrospective study was to analyze lumbopelvic sagittal parameters among the three different types of Modic changes (MCs). Furthermore, correlations between the sizes of MCs and the number of involved lumbar levels with lumbopelvic parameters are investigated. METHODS: A total of 263 adult subjects with MCs at a single institution from September 2015 to October 2020 who underwent lumbar x-ray examinations and magnetic resonance imaging were included in this retrospective study. Types of MCs, sizes of MCs, lumbar levels involved by MCs as well as lumbopelvic sagittal parameters from each subject were evaluated by two authors. RESULTS: Lumbar lordosis (LL), sacral slope (SS), and pelvic incidence (PI) in subjects with MC grade 1 were significantly smaller than in those with MC grade 2 and grade 3 (p<0.05). Lumbopelvic sagittal parameters decreased significantly as the sizes aggravated (p<0.01). Triple lumbar levels with MCs showed a significant increase in PI-LL (p<0.05) and decrease in LL (p<0.01), SS (p<0.01), and PI (p<0.01) when compared to MCs at single and double lumbar levels. CONCLUSION: MC grade 1, severe MCs, and lumbar multi-segmental MCs were significantly linked to lumbar sagittal imbalance.

Role of AP-2α/TGF-ß1/Smad3 axis in rats with intervertebral disc degeneration.

OBJECTIVE: Studies have proposed the role of AP-2α in human disease. However, few have focused on its effects on intervertebral disc degeneration (IDD). This study intends to discuss the role of AP-2α in IDD by regulating TGF-ß1 and Smad3 expression. METHODS: The AP-2α and TGF-ß1 expression in IDD NP clinical samples was detected. Rat models of IDD were established by acupuncture. The rats were injected with AP-2α low expression adeno-associated virus or TGF-ß1 high expression adeno-associated virus to observe their effects on pathological damages, NP cell apoptosis, matrix metalloproteinase-2 (MMP-2), MMP-9, Smad3, Aggrecan and collagen (Col)-2 expression in NP tissues. The NP cells were isolated and transfected with silenced AP-2α or overexpressed TGF-ß1 vector to figure out their functions in growth, senescence and apoptosis. RESULTS: AP-2α and TGF-ß1 were upregulated in NP tissues of patients and rats with IDD. AP-2α silencing limited the activation of TGF-ß1 signaling pathway. Reduced AP-2α ameliorated pathological changes, declined MMP-2, MMP-9 and Smad3 expression and elevated Aggrecan and Col-2 expression in NP tissues of rats with IDD, and speeded up the growth and depressed senescence and apoptosis of NP cells of rats with IDD. Up-regulating TGF-ß1 weakened the effect of down-regulated AP-2α on NP tissues and cells in IDD. CONCLUSION: Collectively, our study demonstrates that knockdown of AP-2α restricts TGF-ß1 and Smad3 expression to promote proliferation and depress senescence and apoptosis of NP cells in rats with IDD.

Modic changes of the lumbar spine-their association with the lumbar sagittal parameters: A retrospective imaging study.

BACKGROUND: The Lumbar sagittal parameters might be related to modic changes (MCs). However, studies on this topic have rarely been reported. The aim of this study was to identify the relationships between the lumbar sagittal parameters and the development of MCs. METHODS: The lumbar sagittal parameters of 321 patients with chronic low back pain from May 2016 to August 2018 were measured on X-ray by using Surgimap surgical planning software. Univariable analyses were used to test the potential variables of interest. Logistic regression models were then performed for the significant parameters to identify the independent factors associated with the development of MCs. RESULTS: More patients in the MCs group were older with more number of female than in the disc degeneration group (p < 0.05). In the univariate analysis, significant differences were detected for the parameters of lumbar lordosis, sacral slope, intervertebral height index, endplate concave angle, and intervertebral angle only at the L5/S1 level between the two groups. The results of logistic regression analysis showed that a smaller intervertebral height index was positively associated with the development of MCs at the level of L3/4 (p < 0.05). However, the positive role of gender was only for MCs at the L5/S1 level (p < 0.05). CONCLUSIONS: The results of this study revealed that there were negative relationships between the lumbar sagittal parameters and MCs. Furthermore, being female and having a narrow intervertebral space were the independent risk factors for the development of MCs at the corresponding lumbar levels. Interestingly, body mass index might be not associated with MCs for the Chinese population.

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis.

BACKGROUND: Many surgeons believe that the use of a 3D-printed drill guide template shortens operative time and reduces intraoperative blood loss compared with those of the free-hand technique. In this study, we investigated the effects of a drill guide template on the accuracy of pedicle screw placement (the screw placed completely in the pedicle), operative time, and intraoperative blood loss. MATERIALS/METHODS: We systematically searched the major databases, such as Medline via PubMed, EMBASE, Ovid, Cochrane Library, and Google Scholar, regarding the accuracy of pedicle screw placement, operative time, and intraoperative blood loss. The χ2 test and I2 statistic were used to examine heterogeneity. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the accuracy rate of pedicle screw placement, and weighted mean differences (WMDs) with 95% CIs were utilized to express operative time and intraoperative blood loss. RESULTS: This meta-analysis included 13 studies (seven randomized controlled trials and six prospective cohort studies) involving 446 patients and 3375 screws. The risk of research bias was considered moderate. Operative time (WMD = - 20.75, 95% CI - 33.20 ~ - 8.29, P = 0.001) and intraoperative blood loss (WMD = - 106.16, 95% CI - 185.35 ~ - 26.97, P = 0.009) in the thoracolumbar vertebrae, evaluated by a subgroup analysis, were significantly different between groups. The 3D-printed drill guide template has advantages over the free-hand technique and improves the accuracy of pedicle screw placement (OR = 2.88; 95% CI, 2.39~3.47; P = 0.000). CONCLUSION: The 3D-printed drill guide template can improve the accuracy rate of pedicle screw placement, shorten operative time, and reduce intraoperative blood loss.

A meta-analysis of the safety and effectiveness of titanium mesh versus bone graft alone for the treatment of thoracolumbar tuberculosis.

PURPOSE: The aim of this study is to investigate, using a meta-analysis, differences in safety and effectiveness between a titanium mesh bone graft and bone graft alone for the treatment of thoracolumbar spinal tuberculosis. METHODS: PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang (Chinese) and other databases were searched up to April 2019 using predetermined terms. Published studies investigating the safety and effectiveness of a titanium mesh bone graft versus a bone graft alone for the treatment of thoracolumbar spinal tuberculosis were included. Two authors independently extracted the data and evaluated the quality of the included articles. A meta-analysis of relevant outcome indicators was performed using Stata 14 and RevMan 5.3 software. RESULTS: We retrieved 8 retrospective studies that met the inclusion criteria and enrolled a total of 401 patients, including 203 patients in the titanium mesh group and 198 in the bone graft only group. Each study was rated as high quality. The meta-analysis results showed no statistically significant differences between the 2 bone graft methods in terms of surgery-related indicators, clinical effectiveness, imaging and complications. CONCLUSIONS: Both titanium mesh and bone grafts alone are effective for the treatment of thoracolumbar spinal tuberculosis based on safety. However, the results of this study do not support the superiority of titanium mesh bone grafts reported in previous studies. Because of the high risk of bias of the conclusions of a meta-analysis of non-randomized studies and the small sample sizes for some of the most important outcomes, randomized controlled trials are expected to further examine the reliability of the present findings.

Early and short-segment anterior spinal fusion for cervical spinal cord injury without fracture and dislocation can achieve more significant neurological recovery: a retrospective study based on the current medical system in southern China.

OBJECTIVE: The purpose of this study was to investigate the effects of the number of fused segments, the timing of surgery and their interaction on the prognosis of patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD), and to determine the appropriate time restrictions for early surgery in CSCIWFD patients based on the current diagnosis and treatment system in southern China. METHODS: CSCIWFD patients who underwent anterior cervical decompression and internal fusion (ACDF) from January 2012 to June 2017 were selected. The patients were grouped according to the timing of surgery and the number of fused segments and evaluated based on their American Spinal Injury Association (ASIA) score, ASIA impairment scale, and Japanese Orthopaedic Association (JOA) score before and after surgery. SPSS22.0 software was used for the statistical analysis. RESULTS: The ASIA score, JOA score, and ASIA impairment scale in all follow-ups were significantly higher than before surgery (p < 0.05). The ASIA and JOA scores at 6, 12, and 24 months after surgery of the patients who underwent ACDF within 72 h were significantly better than those of the patients who underwent ACDF after 72 h (p < 0.05). There were significant differences in postoperative ASIA and JOA scores at 12 and 24 months between the short-segment and three-segment fusion groups (p < 0.05). The results of the interaction between the surgical timing and the number of the fused segments showed that the postoperative ASIA and JOA scores at 6, 12, and 24 months were significantly higher in the patients who underwent early short-segment fusion than in those who underwent delayed short-segment fusion (p < 0.05). However, no statistically significant difference was found between early and delayed surgery in the patients who underwent three-segment fusion (p > 0.05). CONCLUSION: ACDF is safe and effective for the treatment of CSCIWFD. For patients with single- or double-segment injury, early (within 72 h) ACDF is associated with a more satisfactory prognosis. Due to the limitation of the small sample size, we cautiously recommend that 72 h can be used as a time limit for early surgery for CSCIWFD patients in regions where earlier surgery cannot be provided by the current diagnosis and treatment system.

The short- to midterm effectiveness of stemless prostheses compared to stemmed prostheses for patients who underwent total shoulder arthroplasty: a meta-analysis.

BACKGROUND: To systematically compare the short- to midterm effectiveness of stemless prostheses to that of stemmed prostheses for patients who underwent total shoulder arthroplasty (TSA) and to provide a guideline for clinical decision-making. METHODS: PubMed, the Cochrane Library, and Web of Science were searched with the given search terms until July 2019 to identify published articles evaluating the clinical outcomes for stemless prostheses compared with stemmed prostheses for patients who underwent TSA. Data extraction and the quality assessment of the included studies were independently performed by two authors. Stata software 14.0 was used to analyze and synthesize the data. RESULTS: Two randomized controlled trials and six case-controlled studies with a total of 347 shoulders were included in this meta-analysis. The results of this meta-analysis showed that there were no significant differences between the stemless and stemmed prostheses in terms of the Constant score, pain score, strength, activities of daily living, postoperative range of motion (ROM), and postoperative maximum active ROM. CONCLUSIONS: This is the first meta-analysis reporting the clinical results of stemless TSA in the short- to midterm follow-up period. Both types of shoulder prostheses were similar in achieving satisfactory clinical outcomes.

Patients with Modic type 2 change have a severe radiographic representation in the process of lumbar degeneration: a retrospective imaging study.

BACKGROUND: There are few studies to investigate changes in imaging parameters of Modic changes (MCs). The imaging studies examining the distinctions in the lumbar sagittal parameters between MCs and lumbar disc degeneration (LDD) are still lacking. The purpose of this study was to identify the differences in the lumbar sagittal parameters among patients for LDD with/without Modic type 2 change (MII). METHODS: A total of 208 patients with lumbar degenerative disease from January 2017 to August 2018 volunteered for this study. Sixty-two patients with MII were used as the MC group. The other 146 patients served as the disc degeneration (DD) group. The DD scores and sagittal parameters were measured on magnetic resonance imaging (MRI) and X-ray by using Surgimap software. RESULTS: The prevalence of MII for patients with degenerative lumbar diseases in this study was 29.81%, primarily located at L5/S1. There were significant differences in lumbar lordosis (LL) and sacral slope (SS) between these two groups (P < 0.05). Similarly, the significant decrease in intervertebral height index (IHI) was found at L3-S1 in the MC group, compared with the DD group (P < 0.05). However, a significant difference in intervertebral angle (IVA) was observed only at L5/S1 (P < 0.05). The MC group had the smaller endplate concave angle (ECA) than the DD group from L3 caudal endplate to S1 cranial endplate (P < 0.05). CONCLUSIONS: MII has a severe radiographic representation in the process of lumbar degeneration than patients without MII, and the overconcentration of load caused by the smaller LL, SS, and IVA may be a reasonable explanation to answer why MCs are more common at the L5/S1.

Efficacy and Safety of Surgical Interventions for Treating Multilevel Cervical Spondylotic Myelopathy via Anterior Approach: A Network Meta-Analysis.

BACKGROUND: Anterior cervical discectomy, with or without interbody fusion, is a common technique to treat cervical spondylotic myelopathy (CSM). To date, controversy still exists among spine surgeons regarding the anterior surgical approach to be used for the treatment of multilevel CSM. OBJECTIVES: To evaluate the effectiveness and safety of anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), cervical total disc replacement (CTDR), and hybrid surgery (HS) in the treatment of multilevel CSM. STUDY DESIGN: Network meta-analysis (NMA) of randomized or nonrandomized controlled studies for the treatment of multilevel CSM. METHODS: The databases such as PubMed, CENTRAL, and EMBASE were used to search and identify the clinical trials involving the evaluations for the treatment of multilevel CSM. The Newcastle-Ottawa Scale was used for the assessment of methodological qualities, whereas the Cochrane Collaboration tool was used for assessing the risk of bias. Outcome assessments included duration of surgery, Neck Disability Index (NDI) scores, and complications. Odds ratio was used to express dichotomous outcomes, whereas mean difference with a 95% confidence interval was used to express continuous outcomes. RESULTS: Sixteen relevant studies were identified, and 1,639 patients were included in this analysis. CTDR demonstrated a prominently decreased NDI score and total incidence of complications compared with ACDF, ACCF, and HS. In addition, ACDF resulted in shorter operation times compared with ACCF, CTDR, and HS. The ranked order of NDI score improvement in decreasing order was: CTDR, HS, ACDF, followed by ACCF. The rank order for reduction in operation time increased progressively from ACDF, HS, ACCF to CTDR. The total incidence of complications also showed a decreasing trend in the decreasing order-CTDR, ACDF, HS, ACCF, and finally CTDR with the lowest complication rate. LIMITATIONS: The limitations of this NMA include inconformity of the follow-up times and surgical skill, and implants of different treatment centers vary. CONCLUSIONS: The analysis of this study has shown that the best method for improvement of functional outcome and reduction in total incidence of complications for multilevel CSM is CTDR. KEY WORDS: Multilevel cervical spondylotic myelopathy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, cervical total disc replacement, hybrid surgery, effectiveness, safety, network meta-analysis.

Biomechanical Effects of Fixation of Different Segments of Goat Lumbar Spine on Adjacent Segmental Motion and Intradiscal Pressure Change.

BACKGROUND The aim of this study was to investigate the biomechanical fixation effects of different segments of the goat spine on adjacent segmental motion and intradiscal pressure (IDP) change. MATERIAL AND METHODS Eighteen goat spine specimens were randomly divided into 3 groups: group A (single-segment fixation), group B (double-segment fixation), and group C (triple-segment fixation). The motion was tested on each specimen using a spinal motion simulation test system with rational pressure loading. The IDP was measured using a pinhole pressure sensor. RESULTS Range of motion (ROM) and IDP of adjacent segments increased with increased external load. In comparison of the 3 groups, significant differences in ROM were found when the external force was more than 100 N (P<0.05). The differences in IDP of the adjacent segment were statistically significant (P<0.05) when external pressure was greater than or equal to 60 N. However, in comparison of group A with group B, no significant differences in ROM and IDP of the adjacent segments were noted for the motions of anterior flexion, posterior extension, and lateral bending (P>0.05). Moreover, upper adjacent segments had greater ROM than the lower adjacent segments (P<0.05). We found significant differences between IDPs of the upper adjacent segments and lower adjacent segments (P<0.05). CONCLUSIONS As the number of fixated lumbar segments increases, ROM and IDP of the adjacent segments increase. Multisegment fixation is most likely the main factor contributing to the development of adjacent segmental lesions after lumbar fixation.

Intravenous Administration of Tranexamic Acid Significantly Reduces Visible and Hidden Blood Loss Compared with Its Topical Administration for Double-Segment Posterior Lumbar Interbody Fusion: A Single-Center, Placebo-Controlled, Randomized Trial.

OBJECTIVE: Tranexamic acid (TXA) significantly reduces the visible and hidden blood loss associated with joint replacement. At present, many studies have examined the safety and effectiveness of the intravenous or topical administration of TXA after posterior lumbar surgery. However, randomized and controlled trials examining the presence of differences in the effect of TXA on the visible and hidden blood loss between these 2 modes of administration are lacking. The current study investigated the effects of intravenous and topical administrations of TXA on the visible and hidden blood loss of patients undergoing posterior lumbar interbody fusion (PLIF). METHODS: In a single-center, placebo-controlled, randomized design, a total of 150 patients with lumbar degenerative disease who underwent PLIF between September 2015 and August 2017 volunteered for this study. Of these patients, 126 fulfilled the inclusion criteria and were randomly assigned to 1 of 3 groups: the intravenous administration group (n = 45, group A), the topical administration group (n = 39, group B), or the placebo group (n = 42, group C). SPSS, version 17.0, was used to analyze the patient data, their blood biochemical indices, blood loss, and the number of blood transfusions across the 3 groups during the perioperative period. RESULTS: The postoperative drainage volume, number of blood transfusions, length of hospital stay, and extubation time significantly differed between group C and both groups A and B (P < 0.05); however, no significant differences were noted between groups A and B (P > 0.05). Intraoperative blood loss and visible or hidden blood loss as well as the levels of postoperative hemoglobin and hematocrit significantly differed among the 3 groups (P < 0.01). The results of the visual analogue scale, prothrombin time, and fibrinogen content did not significantly differ among the 3 groups (P > 0.05). CONCLUSIONS: For patients undergoing double-segment PLIF, both administrations of TXA can reduce blood loss, extubation time, and the length of hospital stay. Moreover, intravenous administration can reduce both visible and hidden blood loss more efficiently.