Comparative study on the efficacy of pregabalin versus limaprost in patients with lumbar spinal stenosis: A prospective, randomized controlled trial.

BACKGROUND: Patients with Lumbar Spinal Stenosis (LSS) typically complain of back pain and leg pain. These symptoms reduce the quality of life and also cause sleep disturbances. This study compares pregabalin and limaprost's efficacy in LSS for pain, disability, quality of life, and sleep, aiming to offer insights for medication selection. METHODS: This study was designed as a prospective, randomized, single-center, single-blinded, clinical superiority trial targeting patients with LSS. For 6 weeks, 111 patients per group were administered medication following a standard regimen, after which patient-reported outcomes were measured. The primary outcome was the Visual Analogue Scale (VAS) for back and leg pain, and the secondary outcomes included the Oswestry Disability Index (ODI), European Quality of Life 5 Dimensions (EQ-5D), and sleep quality. RESULTS: After 6 weeks of medication, there were significant improvements over time in the primary outcome, VAS for back pain and leg pain, in both groups, but no significant difference between the two groups. Similarly, for the secondary outcomes, ODI and EQ-5D, both groups showed significant improvements, yet there was no significant difference between them. In the subgroup analysis targeting poor sleepers (Pittsburgh sleep quality index, PSQI > 5), both groups also exhibited significant improvements in sleep quality, but again, there was no significant difference between the groups. CONCLUSIONS: Efficacy of pregabalin, limaprost in back and leg pain, ODI, EQ-5D, and sleep quality, but there was no significant difference between the two groups. Thus, it is advisable to prescribe based on individual drug responses and potential complications.

Surgeon Preference Regarding Wound Dressing Management in Lumbar Fusion Surgery: An AO Spine Global Cross-Sectional Study.

OBJECTIVE: To evaluate the global practice pattern of wound dressing use after lumbar fusion for degenerative conditions. METHODS: A survey issued by AO Spine Knowledge Forums Deformity and Degenerative was sent out to AO Spine members. The type of postoperative dressing employed, timing of initial dressing removal, and type of subsequent dressing applied were investigated. Differences in the type of surgery and regional distribution of surgeons' preferences were analyzed. RESULTS: Right following surgery, 60.6% utilized a dry dressing, 23.2% a plastic occlusive dressing, 5.7% glue, 6% a combination of glue and polyester mesh, 2.6% a wound vacuum, and 1.2% other dressings. The initial dressing was removed on postoperative day 1 (11.6%), 2 (39.2%), 3 (20.3%), 4 (1.7%), 5 (4.3%), 6 (0.4%), 7 or later (12.5%), or depending on drain removal (9.9%). Following initial dressing removal, 75.9% applied a dry dressing, 17.7% a plastic occlusive dressing, and 1.3% glue, while 12.1% used no dressing. The use of no additional coverage after initial dressing removal was significantly associated with a later dressing change (p < 0.001). Significant differences emerged after comparing dressing management among different AO Spine regions (p < 0.001). CONCLUSION: Most spine surgeons utilized a dry or plastic occlusive dressing initially applied after surgery. The first dressing was more frequently changed during the first 3 postoperative days and replaced with the same type of dressing. While dressing policies tended not to vary according to the type of surgery, regional differences suggest that actual practice may be based on personal experience rather than available evidence.

Triphenylphosphonium-functionalized dimeric BODIPY-based nanoparticles for mitochondria-targeting photodynamic therapy.

The dimerization of boron dipyrromethene (BODIPY) moieties is an appealing molecular design approach for developing heavy-atom-free triplet photosensitizers (PSs). However, BODIPY dimer-based PSs generally lack target specificity, which limits their clinical use for photodynamic therapy. This study reports the synthesis of two mitochondria-targeting triphenylphosphonium (TPP)-functionalized meso-ß directly linked BODIPY dimers (BTPP and BeTPP). Both BODIPY dimers exhibited solvent-polarity-dependent singlet oxygen (1O2) quantum yields, with maximum values of 0.84 and 0.55 for BTPP and BeTPP, respectively, in tetrahydrofuran. The compact orthogonal geometry of the BODIPY dimers facilitated the generation of triplet excited states via photoinduced charge separation (CS) and subsequent spin-orbit charge-transfer intersystem crossing (SOCT-ISC) processes and their rates were dependent on the energetic configuration between the frontier molecular orbitals of the two BODIPY subunits. The as-synthesized compounds were amphiphilic and hence formed stable nanoparticles (∼36 nm in diameter) in aqueous solutions, with a zeta potential of ∼33 mV beneficial for mitochondrial targeting. In vitro experiments with MCF-7 and HeLa cancer cells indicated the effective localization of BTPP and BeTPP within cancer-cell mitochondria. Under light irradiation, BTPP and BeTPP exhibited robust photo-induced therapeutic effects in both cell lines, with half-maximal inhibitory concentration (IC50) values of ∼30 and ∼55 nM, respectively.

Transpedicular injection of rhBMP-2 with ß-tricalcium phosphate to reduce the proximal junctional kyphosis after adult spinal deformity correction: preliminary study.

The aim of this preliminary study was to assess the impact of injecting recombinant human bone morphogenetic protein-2 (rhBMP-2) with ß-tricalcium phosphate (ß-TCP) carrier into the uppermost instrumented vertebra (UIV) during surgery to prevent the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). The 25 patients from study group had received 0.5 mg rhBMP-2 mixed with 1.5 g ß-TCP paste injection into the UIV during surgery. The control group consisted of 75 patients who underwent surgery immediately before the start of the study. The incidences of PJK and PJF were analyzed as primary outcomes. Spinopelvic parameters and patient-reported outcomes were analyzed as secondary outcomes. Hounsfield unit (HU) measurements were performed to confirm the effect of rhBMP-2 with ß-TCP on bone formation at preoperative and postoperative at computed tomography. PJK and PJF was more occurred in control group than study group (p = 0.02, 0.29, respectively). The HU of the UIV significantly increased 6 months after surgery. And the increment at the UIV was also significantly greater than that at the UIV-1 6 months after surgery. Injection of rhBMP-2 with ß-TCP into the UIV reduced PJK and PJF rates 6 months after surgery with new bone formation.

Red fluorescent BODIPY-based nanoparticles for targeted cancer imaging-guided photodynamic therapy.

Imaging-guided diagnosis and treatment of cancer hold potential to significantly improve therapeutic accuracies and efficacies. Central to this theragnostic approach has been the use of multicomponent-based multimodal nanoparticles (NPs). Apart from this conventional approach, here we propose a design strategy for the simple and straightforward formulation of NPs based on boron dipyrromethene (BODIPY) derivatives, LaB-X (X = H, Et, and Br). Specifically, the conjugation of lactose to the inherently hydrophobic BODIPY promoted the formation of LaB-X NPs in water. Furthermore, the BODIPY backbone was subjected to distyrylation, dibromination, and diethylation to tailor the optical window and the balance between fluorescence and singlet oxygen generation capabilities. We demonstrate that while the photoinduced anticancer activities of LaB-H and LaB-Et NPs were trivial, LaB-Br NPs effectively induced the apoptotic death of hepatocellular carcinoma cells under red light irradiation while allowing fluorescence cell imaging in the phototherapeutic window. This dual fluorescence photosensitizing activity of LaB-Br NPs could be switched off and on, so that both fluorescence and singlet oxygen generation were paused during NP formation in an aqueous solution, while both processes resumed after cellular uptake, likely due to NP disassembly.

Substitution Effect of a Single Nitrogen Atom on π-Electronic Systems of Linear Polycyclic Aromatic Hydrocarbons (PAHs): Theoretically Visualized Coexistence of Mono- and Polycyclic π-Electron Delocalization.

We theoretically investigated the nitrogen substitution effect on the molecular structure and π-electron delocalization in linear nitrogen-substituted polycyclic aromatic hydrocarbons (N-PAHs). Based on the optimized molecular structures and magnetic field-induced parameters of fused bi- and tricyclic linear N-PAHs, we found that the local π-electron delocalization of subcycles (e.g., mono- and bicyclic constituent moieties) in linear N-PAHs is preserved, despite deviation from ideal structures of parent monocycles. The introduction of a fused five-membered ring with a pyrrolic N atom (N-5MR) in linear N-PAHs significantly perturbs the π-electronic condition of the neighboring fused six-membered ring (6MR). Monocyclic pyrrole exhibits substantial bond length alternations, strongly influencing the π-electronic systems of both the fused N-5MR and 6MR in linear N-PAHs, depending on the location of shared covalent bonds. A fused six-membered ring with a graphitic N atom in an indolizine moiety cannot generate monocyclic π-electron delocalization but instead contributes to the formation of polycyclic π-electron delocalization. This is evidenced by bifurcated diatropic ring currents induced by an external magnetic field. In conclusion, the satisfaction of Hückel's 4n + 2 rule for both mono- and polycycles is crucial for understanding the overall π-electron delocalization. It is crucial to consider the unique characteristics of the three types of substituted N atoms and the spatial arrangement of 5MR and 6MR in N-PAHs.

Comparison of Fusion Rates among Various Demineralized Bone Matrices in Posterior Lumbar Interbody Fusion.

Background and Objectives: Posterior lumbar interbody fusion (PLIF) plays a crucial role in addressing various spinal disorders. The success of PLIF is contingent upon achieving bone fusion, as failure can lead to adverse clinical outcomes. Demineralized bone matrix (DBM) has emerged as a promising solution for promoting fusion due to its unique combination of osteoinductive and osteoconductive properties. This study aims to compare the effectiveness of three distinct DBMs (Exfuse®, Bongener®, and Bonfuse®) in achieving fusion rates in PLIF surgery. Materials and Methods: A retrospective review was conducted on 236 consecutive patients undergoing PLIF between September 2016 and February 2019. Patients over 50 years old with degenerative lumbar disease, receiving DBM, and following up for more than 12 months after surgery were included. Fusion was evaluated using the Bridwell grading system. Bridwell grades 1 and 2 were defined as 'fusion', while grades 3 and 4 were considered 'non-fusion.' Clinical outcomes were assessed using visual analog scale (VAS) scores for pain, the Oswestry disability index (ODI), and the European quality of life-5 (EQ-5D). Results: Fusion rates were 88.3% for Exfuse, 94.3% for Bongener, and 87.7% for Bonfuse, with no significant differences. All groups exhibited significant improvement in clinical outcomes at 12 months after surgery, but no significant differences were observed among the three groups. Conclusions: There were no significant differences in fusion rates and clinical outcomes among Exfuse, Bongener, and Bonfuse in PLIF surgery.

Assessing the predictive power of the GAP score on mechanical complications: a comprehensive systematic review and meta-analysis.

PURPOSE: The prevention of mechanical complications (MC) is a major concern in adult spinal deformity (ASD) correction surgery; thus, the global alignment and proportion (GAP) score was developed to assess MC risk. Numerous studies have clarified the validity of the GAP score, but their contradictory results have prevented researchers from reaching compelling conclusions. This study aimed to analyze the predictive power of the GAP score on MC via a meta-analysis. METHODS: A total of 1,617 patients were included in the meta-analysis. Studies relevant to the GAP score and MC were identified in PubMed, EMBASE, and Cochrane CENTRAL and screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The GAP score categories of the patients and their MC/revision surgery status were collected. The data collected for the meta-analysis of odds ratios (OR) included the number of patients in the GAP score subgroups and their MC/revision surgery status. To calculate the OR, three GAP score subgroups were combined into two groups; hence, the analysis was conducted twice (gap proportioned [GAP-P] and higher groups, and gap severely disproportioned [GAP-SD] and lower groups). RESULTS: Eleven studies were collected; of them, revision surgery data were available for seven. The proportion of MC in the studies was 27.7-60.6%, while that of revision surgery was 11.7-34.9%. In the meta-analysis of the GAP-P and higher score groups, the difference in MC ratio was significant (OR = 2.83; 95% confidence interval [CI] = 1.20-6.67; P = 0.02), whereas that for revision surgery was not. For the GAP-SD and lower score groups, the GAP-SD group had significantly higher proportions of both MC (OR = 2.65; 95% CI = 1.57-4.45; P < 0.001) and revision surgery (OR = 2.27; 95% CI = 1.33-3.88; P = 0.003). Publication bias was significant only in the latter MC analysis. CONCLUSION: The GAP score offers predictive value for the risk of mechanical complications.

Recent application of CRISPR-Cas12 and OMEGA system for genome editing.

In 2012, it was discovered that precise gene editing could be induced in target DNA using the reprogrammable characteristics of the CRISPR system. Since then, several studies have investigated the potential of the CRISPR system to edit various biological organisms. For the typical CRISPR system obtained from bacteria and archaea, many application studies have been conducted and have spread to various fields. To date, orthologs with various characteristics other than CRISPR-Cas9 have been discovered and are being intensively studied in the field of gene editing. CRISPR-Cas12 and its varied orthologs are representative examples of genome editing tools and have superior properties in terms of in vivo target gene editing compared with Cas9. Recently, TnpB and Fanzor of the OMEGA (obligate mobile element guided activity) system were identified to be the ancestor of CRISPR-Cas12 on the basis of phylogenetic analysis. Notably, the compact sizes of Cas12 and OMEGA endonucleases allow adeno-associated virus (AAV) delivery; hence, they are set to challenge Cas9 for in vivo gene therapy. This review is focused on these RNA-guided reprogrammable endonucleases: their structure, biochemistry, off-target effects, and applications in therapeutic gene editing.

Comparative Study of Post-Surgical Outcomes in Pain, Disability, and Health-Related Quality of Life for Adult Spinal Deformity in Patients Aged above and below 75 Years.

(1) Background: Adult spinal deformity (ASD) surgery is known to improve clinical and radiological parameters; however, it may also cause more complications in elderly patients. The purpose of this study was to compare the outcomes of ASD surgery, specifically regarding pain, disability, and health-related quality of life (HRQOL) in patients aged 75 years and over and patients aged under 75 years; (2) Methods: A total of 151 patients who underwent ASD surgery between August 2014 and September 2020 were included. Patients were divided into two groups based on whether they are 75 years and over or under. Radiological parameters measured included sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI)- lumbar lordosis (LL). Data were collected 3, 6, and 12 months after surgery; (3) Results: At 12 months postoperatively, visual analog scale (VAS) for low back pain (p = 0.342), Oswestry disability index (ODI) (p = 0.087), and EuroQol 5-Dimensions (EQ-5D) (p = 0.125) did not differ between patients under 75 years and those 75 and above 75 group. PT (p = 0.675), PI-LL (p = 0.948), and SVA (p = 0.108) did not differ significantly 12 months after surgery in the two groups. In the entire patient group, compared to preoperative data, significant improvements were demonstrated for clinical and radiological parameters 12 months after surgery (all p < 0.001). The rate of medical complications did not correlate with age, but the rates of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) did (p = 0.638, p < 0.001, and p = 0.001, respectively); (4) Conclusions: In terms of clinical and radiological improvements, ASD surgery should be considered for patients regardless of whether they are younger than or older than 75 years. The clinical and radiological improvements and the risk of complications and revision surgeries must be considered in ASD patients who are 75 years or older.

Herpes Zoster Oticus with Concurrent Hearing Loss: A Study on Clinical Characteristics and Prognosis.

This study aimed to analyze the clinical characteristics and treatment prognoses of patients with Herpes Zoster Oticus (HZO) and concurrent hearing loss (HL). Various clinical characteristics of 192 patients with HZO, with or without concurrent HL, from 2016 to 2020 were retrospectively analyzed through a chart review. All patients were followed-up until recovery or up to 12 months. Demographic and clinical findings were compared between the groups, and the recovery rates of facial palsy, hearing, and other clinical features were analyzed. Facial palsy recovery was analyzed using the House-Brackmann (HB) grading system, and hearing recovery rates were analyzed using the Siegel criteria. Of the 192 patients diagnosed with HZO, 142 had no hearing loss (HZO without HL), and 50 had hearing loss (HZO with HL). While both groups had similar ages, treatment timings, and underlying diseases, the HZO w HL group had a significantly higher rate of dizziness and tinnitus, but received more intratympanic steroid injections. In terms of facial palsy, there were no significant differences in the initial HB grade or recovery rates between the groups. Within the HZO w HL group, hearing loss severity varied, with 52% experiencing mild loss and only 16% achieving complete recovery. Descending-type audiograms were the most common at 66%. In patients with HZO, there was no statistically significant difference between the degree of initial facial paralysis and the degree of recovery of the final facial paralysis according to concurrent HL. However, among patients with concurrent HL, the hearing recovery rate in the HZO group was low.

A Randomized Controlled Trial of Vertebral Body Decompression Procedure Versus Conservative Treatment for Painful Vertebral Compression Fracture.

Background: Traditional treatment modalities for vertebral compression fractures (VCFs) include bed rest, pain medications, muscle relaxants, back braces, and physical therapy. In cases where conservative treatment proves ineffective, a new procedure called core decompression of the vertebral body is explored. Core decompression of the vertebral body has the potential to lower and stabilize the intraosseous pressure, resulting in enhanced blood circulation, which contributes to pain reduction. In this trial, we evaluated the efficacy of core decompression of the vertebral body in patients with painful VCFs compared with conventional conservative treatment. Methods: This prospective randomized controlled trial was conducted at a tertiary education hospital between June 2017 and May 2020. The participants were randomly assigned in a 1:1 ratio to one of two treatment groups: the core decompression group and the conservative treatment group. The primary outcome measure was the visual analog scale (VAS) pain score of the back 3 months after the procedure. Secondary outcome measures included the Oswestry Disability Index (ODI) for lumbar disabilities, the European Quality of Life-5 Dimensions (EQ-5D) score for quality of life, and radiographic outcomes such as changes in compression rate. Results: All patients underwent the assigned intervention (48 core decompression and 50 conservative treatments). At both 1 month and 3 months, there were no significant differences between the core decompression group and conservative treatment group in VAS pain score (adjusted treatment effect: -0.1 and 2.0; 95% confidence interval [CI]: -7.5 to 7.3 and -5.6 to 9.6; p = 0.970 and p = 0.601, respectively). In addition, there were no significant inter-group differences in ODI and EQ-5D scores throughout the follow-up period (p = 0.917 and 0.704, respectively). Conclusion: Core decompression of the vertebral body did not demonstrate any significant improvement in pain and disability compared to conventional conservative treatment.

Surgeon Preferences Worldwide in Wound Drain Utilization in Open Lumbar Fusion Surgery for Degenerative Pathologies.

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: Although literature does not recommend routine wound drain utilization, there is a disconnect between the evidence and clinical practice. This study aims to explore into this controversy and analyze the surgeon preferences related to drain utilization, and the factors influencing drain use and criterion for removal. METHODS: A survey was distributed to AO Spine members worldwide. Surgeon demographics and factors related to peri-operative drain use in 1 or 2-level open fusion surgery for lumbar degenerative pathologies were collected. Multivariate analyses by drain utilization, and criterion of removal were conducted. RESULTS: 231 surgeons participated, including 220 males (95.2%), orthopedics (178, 77.1%), and academic/university-affiliated (114, 49.4%). Most surgeons preferred drain use (186, 80.5%) and subfascial drains (169, 73.2%). Drains were removed based on duration by 52.87% of the surgeons, but 27.7% removed drains based on outputs. On multivariable analysis, significant predictors of drain use were surgeon's aged 35-44 (OR = 11.9, 95% CI = 1.2-117.2, P = .034), 45-54 (29.1, 3.1-269.6, P = .003), 55-64 (8.9, 1.4-56.5, .019), and wound closure using coaptive films (6.0, 1.2-29.0, P = .025). Additionally, surgeons from Asia Pacific (OR = 5.19, 95% CI = 1.65-16.38, P = .005), Europe (3.55, 1.22-10.31, P = .020), and Latin America (4.40, 1.09-17.83, .038) were more likely to remove drain based on time duration, but surgeons <5 years of experience (10.23, 1.75-59.71, P = .010) were more likely to remove drains based on outputs. CONCLUSIONS: Most spine surgeons worldwide prefer to place a subfascial wound drain for degenerative open lumbar surgery. The choice for drain placement is associated with the surgeon's age and use of coaptive films for wound closure, while the criterion for drain removal is associated with the surgeons' region of practice and experience.

Evaluating the Efficacy of Water-Soluble Bone Wax (Tableau Wax) in Reducing Blood Loss in Spinal Fusion Surgery: A Randomized, Controlled, Pilot Study.

Background and Objectives: Lumbar decompression with fusion surgery is an effective treatment for spinal stenosis, but critical postoperative hematoma is a concern. Bone wax has been widely used to control bone bleeding but it has some drawbacks. This study aimed to evaluate the efficacy of Tableau wax, a bioabsorbable hemostatic material, in patients undergoing spinal fusion surgery through a pilot study design. Materials and Methods: A total of 31 patients were enrolled in this single-surgeon, single-institution study. The participants underwent transforaminal lumbar interbody fusion surgery and were randomly assigned to the control group (Bone wax) or test group (Tableau wax). Demographic data, pre- and post-operative hemoglobin levels, blood loss volume, surgical time, Oswestry Disability Index, and EQ-5D scores were recorded. Results: The study showed no significant difference in preoperative and postoperative hemoglobin levels, Oswestry Disability Index, and EQ-5D scores between the groups. However, the Tableau wax group had a significantly lower reduction in hemoglobin levels (1.3 ± 1.0 g/dL) and blood loss (438.2 mL) compared to the Bone wax group (2.2 ± 0.9 g/dL and 663.1 mL, respectively; p = 0.018 and p = 0.022).

Biportal endoscopic discectomy versus tubular microscopic discectomy for treating single-level lumbar disc herniation in obese patients: a multicenter, retrospective analysis.

PURPOSE: In microscopic lumbar discectomy in obese patients, a correlation is found between the operation time and increase in estimated blood loss according to the increase in body mass index; however, no studies have investigated the outcomes of biportal endoscopic lumbar discectomy in obese patients. Therefore, this study aimed to compare the clinical and radiographic outcomes of microscopic and endoscopic discectomy in obese patients with lumbar herniated discs. METHODS: In this multicenter, retrospective study, clinical and radiological data were compared and analyzed in 73 obese patients with a body mass index of > 30 kg/m2 who underwent microscopic or biportal endoscopic lumbar discectomy. Clinical data on the visual analog scale (VAS), Oswestry disability index (ODI), and EuroQol-5D (EQ-5D) scores were measured, and radiological data were obtained using magnetic resonance imaging (MRI). RESULTS: This study enrolled 43 patients who underwent microscopic discectomy and 30 who underwent biportal endoscopic discectomy. The VAS, ODI, and EQ-5D scores in both groups improved after surgery compared with those before surgery, although there was no difference between the two groups. Although there was a difference in the incidence of recurrent disc herniation confirmed by MRI after surgery, no difference was found in the number of patients requiring surgery between the two groups. CONCLUSION: In obese patients with lumbar disc herniation that was not improved with conservative treatment, no significant clinical or radiological differences in outcomes were noted between microscopic and biportal endoscopic surgery methods. In contrast, minor complications were less common in the biportal group.

The Feasibility of Multiple Fixation Points in C2.

STUDY DESIGN: Analysis using three-dimensional simulation software for spinal screw placement and computed tomographic scan images. PURPOSE: To assess the feasibility of achieving multiple (three or four) screw fixation points in C2 vertebra by using a combination of pedicle and laminar screws. OVERVIEW OF LITERATURE: Secure C2 fixation using multiple screws is required or beneficial in some unique cases. However, to the best of our knowledge, there have been no reports analyzing the feasibility of multiple screw fixation in C2. METHODS: We used 1.0-mm interval computed tomographic scan images of 100 patients (50 men and 50 women) and screw trajectory simulation software. The diameter of all screws was set at 3.5 mm, considering its common usage in real surgery. The anatomical feasibility of placing both pedicle and laminar screws on the same side was evaluated. For all feasible sides, the three-dimensional distance between the screw entry points was measured. RESULTS: In 85% of cases, both pedicle and laminar screws could be placed on both sides, allowing for the insertion of 4 screws. In 11% of cases, 2 screws could be placed on one side, while only 1 screw was feasible on the other side, resulting in the placement of 3 screws. In all 181 sides where both types of screws could be inserted, the distance between their entry points exceeded 16.1 mm, which was sufficient to prevent the collision between the screw heads. CONCLUSIONS: C2 vertebra can accommodate three (11%) or four (85%) screws in 96% of cases.

Efficacy of Aceclofenac and Ilaprazole Combination Therapy versus Celecoxib Monotherapy for Treating NSAID-Induced Dyspepsia in Lumbar Spinal Stenosis Patients.

Background and Objectives: Dyspepsia is a common adverse event associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with lumbar spinal stenosis. Although proton pump and cyclooxygenase-2 inhibitors are potential treatment options, the optimal strategy remains unclear. This study aimed to compare the efficacy and safety of combination therapy with aceclofenac and ilaprazole versus celecoxib monotherapy for the treatment of dyspepsia caused by NSAID use in patients with lumbar spinal stenosis. Materials and Methods: This prospective, double-blind, randomized, actively controlled study was conducted at Seoul National University Bundang Hospital in South Korea from July 2020 to September 2021. The participants were randomized into one of two treatment groups: celecoxib monotherapy (control group) and combination therapy with aceclofenac and ilaprazole (test group). The primary efficacy endpoint was the mean change in the Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) scores from baseline to treatment week 8. The secondary efficacy endpoint was the mean change in Short-Form-12 (SF-12) scores from baseline (week 0) to treatment week 8. Results: The study enrolled 140 patients who were randomly assigned to receive combination therapy with aceclofenac and, ilaprazole or celecoxib. In the per protocol set, the mean change in SF-LDQ scores from week 0 to week 8 was -0.51 ± 4.78 and 1.85 ± 6.70 in the combination therapy and celecoxib group, respectively (p = 0.054). SF-12 scores did not differ significantly between the two groups. Adverse events were reported in both groups, but there was no significant difference in incidence. Conclusions: Combination therapy with aceclofenac and ilaprazole can be a treatment option for NSAID-induced dyspepsia in some situations.

Comparison of surgical outcomes between lumbar interbody fusions using expandable and static cages: a systematic review and meta-analysis.

BACKGROUND: The use of static cages for lumbar interbody fusion (LIF) can cause complications such as end plate violation, graft subsidence, and nerve injury. Therefore, expandable cages that allow for in-situ expansion have been developed to overcome these problems. However, it remains uncertain whether expandable cages have better surgical outcomes than static cages do. PURPOSE: We aimed to determine the effectiveness of expandable cages by analyzing studies that compared the surgical outcomes between the use of expandable cages and static cages. STUDY DESIGN: A systematic review and meta-analysis. METHODS: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to conduct this meta-analysis and systematic review. The primary outcomes of this study were anterior disc height, posterior disc height, segmental lordosis (SL), lumbar lordosis (LL), subsidence rate, numeric rating scale (NRS) scores for back and leg pain, and Oswestry Disability Index (ODI). RESULTS: Thirteen studies with 1,700 patients were included in the meta-analysis. Compared with static cages for LIFs, expandable cages significantly increased the anterior disc height (standardized mean difference 0.478, 95% confidence interval [CI] 0.088-0.867, p=.0162) and segmental lordosis (sMD 0.307, 95% CI 0.159-0.454, p<.0001). There were no significant differences in the posterior disc height, lumbar lordosis, subsidence rate, back pain, leg pain, or ODI between the two groups. CONCLUSION: Expandable cages show no clear clinical benefit over static cages.

Anterior Cervical Discectomy and Fusion Performed Using a CaO-SiO2-P2O5-B2O3 Bioactive Glass Ceramic or Polyetheretherketone Cage Filled with Hydroxyapatite/ß-Tricalcium Phosphate: A Prospective Randomized Controlled Trial.

A CaO-SiO2-P2O5-B2O3 bioactive glass-ceramic (BGS-7) spacer provides high mechanical stability, produces a chemical bond to the adjacent endplate, and facilitates fusion after spine surgery. This prospective, randomized, single-blind, non-inferiority trial aimed to evaluate the radiographic outcomes and clinical efficacy of anterior cervical discectomy and fusion (ACDF) using a BGS-7 spacer for treating cervical degenerative disorders. Thirty-six patients underwent ACDF using a BGS-7 spacer (Group N), and 40 patients underwent ACDF using polyetheretherketone (PEEK) cages filled with a mixture of hydroxyapatite (HA) and ß-tricalcium phosphate (ß-TCP) for the treatment of cervical degenerative disorders. The spinal fusion rate was assessed 12 months postoperatively using three-dimensional computed tomography (CT) and dynamic radiographs. Clinical outcomes included patient-reported outcome measures, visual analog scale scores for neck and arm pain, and scores from the neck disability index (NDI), European Quality of Life-5 Dimensions (EQ-5D), and 12-item Short Form Survey (SF-12v2). All participants were randomly assigned to undergo ACDF using either a BGS-7 spacer or PEEK cage filled with HA and ß-TCP. The primary outcome was the fusion rate on CT scan image at 12 months after ACDF surgery based on a per-protocol strategy. Clinical outcomes and adverse events were also assessed. The 12-month fusion rates for the BGS-7 and PEEK groups based on CT scans were 81.8% and 74.4%, respectively, while those based on dynamic radiographs were 78.1% and 73.7%, respectively, with no significant difference between the groups. There were no significant differences in the clinical outcomes between the two groups. Neck pain, arm pain, NDI, EQ-5D, and SF-12v2 scores significantly improved postoperatively, with no significant differences between the groups. No adverse events were observed in either group. In ACDF surgery, the BGS-7 spacer showed similar fusion rates and clinical outcomes as PEEK cages filled with HA and ß-TCP.

A Novel Trajectory of C7 Laminar Screws Determined Using Three-Dimensional Computed Tomography and Surgical Simulation Software: Comparison with a Pre-existing Trajectory.

STUDY DESIGN: Examination using three-dimensional screw trajectory software and computed tomographic scans. PURPOSE: To evaluate the feasibility of a novel trajectory for C7 laminar screws and to compare it with an old trajectory. OVERVIEW OF LITERATURE: The previously reported trajectory of C7 laminar screws has a horizontal direction without a fixed target point. Our new trajectory has a cephalad direction with a fixed target point. METHODS: Computed tomographic scans of a total of 50 male and 50 female patients were utilized. The placement of C7 laminar screws was activated employing the new and old trajectories. The success rate, the causes of failure, and the maximum allowable length of each trajectory were compared. RESULTS: Employing the new trajectory, the success rates of the unilaminar and bilaminar screws were 93% and 83%, respectively, which were significantly better than the old trajectory (80%, p<0.0001 and 70%, p=0.0003). The most prevalent cause of failure was laminar cortical breach followed by facet joint violation. The new trajectory also offered significantly longer maximum allowable screw length in unilaminar (32.5±4.3 mm vs. 26.5±2.6 mm, p<0.001), bilaminar cephalic (29.5±3.8 mm vs. 25.9±2.6 mm, p<0.0001) and bilaminar caudal (33.1±2.6 mm vs. 25.8±3.1 mm, p<0.001) screws than the old trajectory. With the new and old trajectories, 70% vs. 6% of unilaminar, 60% vs. 2% of bilaminar caudal, and 32% vs. 4% of bilaminar cephalic screws could be protracted perfectly into the corresponding lateral mass without any laminar cortical or facet joint violation (p<0.0001). CONCLUSIONS: The novel trajectory possesses a substantially higher success rate, longer maximum allowable screw length, and higher chance to be extended into the lateral mass (a condition known as a lamino-lateral mass screw) than the old trajectory.