Comparison of transoral anterior Jefferson-fracture reduction plate and posterior screw-rod fixation in C1-ring osteosynthesis for unstable atlas fractures.

Objective: To compare the clinical outcomes of transoral anterior Jefferson fracture reduction plate (JeRP) and posterior screw rod (PSR) surgery for unstable atlas fractures via C1-ring osteosynthesis. Methods: From June 2009 to June 2022, 49 consecutive patients with unstable atlas fractures were treated by transoral anterior JeRP fixation (JeRP group) or PSR fixation (PSR group) and followed up at our hospital; 30 males and 19 females were included. The visual analogue scale (VAS) score, neck disability index (NDI), distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMDs), Redlund-Johnell value, postoperative complications, and fracture healing rate were retrospectively collected and statistically analyzed. Results: Compared with that in the PSR group, the bleeding volume in the JeRP group was lower, and the length of hospital stay was longer. The VAS scores and NDIs of both groups were significantly improved after surgery. The postoperative DAAF and DPAF were significantly smaller after surgery in both groups. Compared with the significantly shorter DPAF in the PSR group, the JeRP group had a smaller DAAF, shorter LMDs and larger Redlund-Johnell value postoperatively and at the final follow-up. The fracture healing rate at 3 months after surgery was significantly greater in the JeRP group (P<0.05). Conclusion: Both C1-ring osteosynthesis procedures for treating unstable atlas fractures yield satisfactory clinical outcomes. Transoral anterior JeRP fixation is more effective than PSR fixation for holistic fracture reduction and short-term fracture healing, but the hospital stay is longer.

Swaying the Public? Impacts of Election Forecast Visualizations on Emotion, Trust, and Intention in the 2022 U.S. Midterms.

We conducted a longitudinal study during the 2022 U.S. midterm elections, investigating the real-world impacts of uncertainty visualizations. Using our forecast model of the governor elections in 33 states, we created a website and deployed four uncertainty visualizations for the election forecasts: single quantile dotplot (1-Dotplot), dual quantile dotplots (2-Dotplot), dual histogram intervals (2-Interval), and Plinko quantile dotplot (Plinko), an animated design with a physical and probabilistic analogy. Our online experiment ran from Oct. 18, 2022, to Nov. 23, 2022, involving 1,327 participants from 15 states. We use Bayesian multilevel modeling and post-stratification to produce demographically-representative estimates of people's emotions, trust in forecasts, and political participation intention. We find that election forecast visualizations can heighten emotions, increase trust, and slightly affect people's intentions to participate in elections. 2-Interval shows the strongest effects across all measures; 1-Dotplot increases trust the most after elections. Both visualizations create emotional and trust gaps between different partisan identities, especially when a Republican candidate is predicted to win. Our qualitative analysis uncovers the complex political and social contexts of election forecast visualizations, showcasing that visualizations may provoke polarization. This intriguing interplay between visualization types, partisanship, and trust exemplifies the fundamental challenge of disentangling visualization from its context, underscoring a need for deeper investigation into the real-world impacts of visualizations. Our preprint and supplements are available at https://doi.org/osf.io/ajq8f.

Superior Mesenteric Artery Syndrome Following Scoliosis Surgery: A Systematic Review of Case Reports.

BACKGROUND: Superior mesenteric artery (SMA) syndrome is a well-recognized, rare complication of undergoing surgical correction of a spinal deformity. The objective of this study was to summarize the best available evidence on SMA syndrome treatment after scoliosis surgery. To identify differences, special attention was paid to scoliosis pathology, intervention and SMA syndrome presentation. METHODS: A systematic review of the literature was performed on SMA syndrome following scoliosis surgery. The Web of Science, PubMed, Wanfang (Chinese) and EMBASE databases were systematically searched for articles from January 1971 to October 2020. The main subjects discussed are scoliosis pathology, intervention and SMA syndrome presentation. RESULTS: A total of 32 articles with 52 cases were included in our report. The mean age of patients with SMA syndrome following scoliosis surgery was 14.7 ± 2.9 years and the majority (n = 42, 80.8%) were girls. The most frequently reported scoliosis type was adolescent idiopathic scoliosis (n = 34, 65.4%). The mean postoperative days (POD) (interval between the surgical treatment and the onset of symptoms) was 9.6 ± 9.5 days. Different treatment methods were analyzed in 46 patients. We noted a trend toward a higher percentage of patients with POD < 48 hr in the group with surgical treatment than in the conservative treatment group (P = 0.002). CONCLUSION: In summary, in this systematic review, for the first time, we found that the time of onset of postoperative symptoms can be used as an important reference index for surgical intervention. We also believe that recommendations about the treatment of SMA syndrome following scoliosis surgery should include this finding. Given the lack of robust clinical evidence, these findings warrant verification in a prospective multicenter screening trial.

Obturator nerve impingement caused by an osteophyte in the sacroiliac joint: A case report.

BACKGROUND: Cases of obturator nerve impingement (ONI) caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported. This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve. CASE SUMMARY: A 65-year-old Asian man presented with severe pain and numbness in his left lower limb, which became aggravated during walking and showed intermittent claudication. The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive. Computed tomography (CT) and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint. The results of electrophysiological examination showed peripheral neuropathy. A CT-guided obturator nerve block significantly reduced the severity of pain in this patient. According to the above findings, ONI caused by the osteophyte in the sacroiliac joint was diagnosed. This patient underwent an operation to remove the bone spur and symptomatic treatment. After therapy, the patient's pain and numbness were significantly relieved. The last follow-up was performed 6 mo after the operation, and the patient recovered well without other complications, returned to work, and resumed his normal lifestyle. CONCLUSION: Osteophytes of the sacroiliac joint can cause ONI, which leads to symptoms including severe radiative pain in the lower limb in patients. The diagnosis and differentiation of this disease should attract the attention of clinicians. Surgical excision of osteophytes should be considered when conservative treatment is not effective.

Can C7 Slope Substitute the T1 Slope in Idiopathic Scoliosis Patients? A Radiographic Study.

BACKGROUND: The aim of this study was to investigate whether C7 slope can be used as a substitute for T1 slope in idiopathic scoliosis. METHODS: From January 2014 to October 2019, 101 patients who received posterior spinal internal fixation and fusion in our hospital were retrospectively analyzed. After analyzing the visibility of vertebral endplates, 46 cases of C7/T1 vertebral endplates were visible, including 14 males and 32 females, aged 9 to 18 years (mean 14.6±2.0 y). The upper C7 slope, lower C7 slope, T1 slope, cervical lordosis and C2 to 7 sagittal vertebral axis were measured before and after operation and at the last follow-up. Pearson correlation coefficient was used to evaluate the correlation strength between upper C7 slope and T1 slope, and lower C7 slope and T1 slope. Through simple linear regression analysis, linear regression equations were generated from the upper and lower C7 slopes to predict T1 slope. RESULTS: According to the 2 researchers' judgment, the visibility rate of the upper C7 endplate was 93.1% before operation, 93.1% after operation, and 91.1% at the last follow-up. The lower C7 endplate's visible rate was 72.3% before operation, 70.3% after operation and 68.3% at the last follow-up. The visible rate of T1 upper endplate was 52.5% before operation, 48.5% after operation and 50.5% at last follow-up. Linear regression analysis showed that the upper C7 slope and T1 slope in idiopathic scoliosis patients, regardless of preoperative (r=0.908, P<0.01), postoperative (r=0.0.886, P<0.01), follow-up (r=0.899, P<0.01), or overall (r=0.895, P<0.01), both have a close correlation; the lower C7 slope and the T1 slope are the same before surgery (r=0.882, P<0.01), after surgery (r=0.940, P<0.01), follow-up (r=0.952, P<0.01), or overall (r=0.929, P<0.01) all have statistical significance. CONCLUSION: When the upper endplate of T1 is not visible on standard radiographs, the upper or lower C7 slope can be used as a reliable alternative measurement parameter for sagittal balance assessment.

Distinction and Potential Prediction of Lung Metastasis in Patients with Malignant Primary Osseous Spinal Neoplasms.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: The aim of this study was to develop and validate a nomogram for the prediction of lung metastasis in patients with malignant primary spinal tumors. SUMMARY OF BACKGROUND DATA: In patients with malignant primary spinal tumors, lung metastasis is usually found by computed tomography (CT) and is considered to be an essential factor affecting the prognosis and survival. METHODS: We retrospectively collected 580 malignant primary osseous spinal neoplasms patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic analysis were used to identify independent factors. These prognostic factors were included in the nomograms. The nomograms were validated based on its calibration, discrimination, and clinical utility. The overall survival of the patients was analyzed using the Kaplan-Meier method and the survival differences were tested by the log-rank test. RESULTS: We randomly divided all these patients (n = 580) into a training cohort (n = 408) and a validation cohort (n = 172). The results showed that the risk of lung metastasis was independently influenced by histologic type, use of surgery, clinical T stage, clinical N stage, and tumor extension (all P < 0.05). The nomogram consisted of five clinical features and provided good calibration and discrimination in the training and validation cohort, with an area under the curve of 0.858 and 0.811, respectively. Decision curve analysis showed that the nomogram was clinically useful. The Kaplan-Meier curves showed a significant difference between the higher and lower risk of lung metastasis groups (P < 0.001). CONCLUSION: Nomograms were developed to predict the risk of lung metastasis in patients with malignant primary spinal tumors. The nomogram showed favorable discrimination and calibration values, which may help optimize treatment decision-making for patients. LEVEL OF EVIDENCE: 4.

The Correlation Between Postoperative Cervical Sagittal Alignment and Spine Sagittal Alignment in Adolescent Idiopathic Scoliosis: A Meta-Analysis.

OBJECTIVE: To perform a meta-analysis exploring the correlation between cervical lordosis (CL) and sagittal spine alignment in patients with adolescent idiopathic scoliosis (AIS) after surgery for determining a surgical strategy. METHODS: We searched 3 electronic databases for studies discussing the correlation between CL and spine sagittal alignment in patients with AIS. Studies reported from the inception of the database to June 2019 were retrieved without any language restrictions. Summary correlation coefficient (r) values were extracted from each study, and 95% confidence intervals (CIs) were calculated. In addition, we conducted subgroup analyses in different curve type subgroups with at least 2 studies. RESULTS: Ten relevant studies involving 539 patients were evaluated in this meta-analysis. The Pearson correlation (r) for CL and the T1 slope was -0.69; (95% CI, -0.79 to -0.54). The fixed-effects summary correlation between CL and thoracic kyphosis in patients was moderate (r = -0.40; 95% CI, -0.48 to -0.31). In addition, the fixed-effects summary correlations between CL and lumbar lordosis (r = 0.19; 95% CI, 0.07-0.30), pelvic incidence (r = -0.08; 95% CI, -0.20 to 0.04), pelvic tilt (r = -0.06; 95% CI, -0.18 to 0.06), and sacral slope (r = -0.06; 95% CI, -0.18 to 0.06) in patients were weak. CONCLUSIONS: There is a strong negative correlation between CL and the T1 slope in patients with AIS. Given the lack of robust clinical evidence, these findings warrant verification by large prospective registries and randomized trials with long follow-up periods.