Timosaponin A3 Induces Anti-Obesity and Anti-Diabetic Effects In Vitro and In Vivo.

Obesity is a serious global health challenge, closely associated with numerous chronic conditions including type 2 diabetes. Anemarrhena asphodeloides Bunge (AA) known as Jimo has been used to address conditions associated with pathogenic heat such as wasting-thirst in Korean Medicine. Timosaponin A3 (TA3), a natural compound extracted from AA, has demonstrated potential therapeutic effects in various disease models. However, its effects on diabetes and obesity remain largely unexplored. We investigated the anti-obesity and anti-diabetic properties of TA3 using in vitro and in vivo models. TA3 treatment in NCI-H716 cells stimulated the secretion of glucagon-like peptide 1 (GLP-1) through the activation of phosphorylation of protein kinase A catalytic subunit (PKAc) and 5'-AMP-activated protein kinase (AMPK). In 3T3-L1 adipocytes, TA3 effectively inhibited lipid accumulation by regulating adipogenesis and lipogenesis. In a high-fat diet (HFD)-induced mice model, TA3 administration significantly reduced body weight gain and food intake. Furthermore, TA3 improved glucose tolerance, lipid profiles, and mitigated hepatic steatosis in HFD-fed mice. Histological analysis revealed that TA3 reduced the size of white adipocytes and inhibited adipose tissue generation. Notably, TA3 downregulated the expression of lipogenic factor, including fatty-acid synthase (FAS) and sterol regulatory element-binding protein 1c (SREBP1c), emphasizing its potential as an anti-obesity agent. These findings revealed that TA3 may be efficiently used as a natural compound for tackling obesity, diabetes, and associated metabolic disorders, providing a novel approach for therapeutic intervention.

Acetylcorynoline Induces Apoptosis and G2/M Phase Arrest through the c-Myc Signaling Pathway in Colon Cancer Cells.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, and despite advances in treatment, survival rates are still low; therefore, the development of novel drugs is imperative. Acetylcorynoline (ACN) is derived from Corydalis ambigua Cham. et Schltdl tubers. The effect of ACN on colon cancer is still unknown. Therefore, we investigated its potential effects. Our data showed that ACN inhibited cell viability and proliferation. Moreover, ACN induced apoptosis and cell cycle arrest by inhibiting cell growth. In the present study, we hypothesized that ACN regulates c-Myc through CNOT2 or MID1IP1. ACN reduced the protein expression of oncogenic genes, decreased c-Myc half-life, and rapidly inhibited the serum stimulation response. Moreover, knockdown of CNOT2 and MID1IP1 with ACN increased apoptosis and further reduced the expression of oncogenes. In addition, ACN exhibited a synergistic effect with low-dose 5-fluorouracil (5-FU) and doxorubicin (Dox). Collectively, our data demonstrate that ACN inhibited c-Myc expression through CNOT2 and MID1IP1, and induced apoptosis. These findings indicate the potential of ACN as a therapeutic agent against colon cancer.

Diagnostic trends of preoperative venous thromboembolism and its clinical implications in patients who underwent surgery for degenerative spinal diseases.

BACKGROUND CONTEXT: Although the risk of postoperative venous thromboembolism (VTE) in patients who undergo surgery for degenerative spinal disease has received attention, patients experiencing prolonged pain and disability while awaiting or considering surgery have not received adequate attention regarding the risk of VTE. PURPOSE: To investigate the epidemiology of preoperative VTE in patients undergoing surgery for degenerative spinal disease. DESIGN: Retrospective cohort study using a nationwide database. PATIENT SAMPLE: Patients who underwent surgery for degenerative spinal disease. OUTCOME MEASURES: Preoperative occurrence of VTE. METHODS: Data from 2014 to 2018 were obtained from the Korean National Health Insurance claims database. The occurrence of preoperative VTE within a 1-year period divided into 12 time intervals of 30 days each was investigated. The patients were categorized into two groups based on the presence of preoperative VTE. Multivariable logistic regression analysis was conducted to identify the factors associated with preoperative VTE. To validate the relationship between degenerative spinal disease and preoperative VTE, the diagnostic trends of preoperative VTE were analyzed in accordance with the identified risk factors. RESULTS: The overall incidence of preoperative VTE was 50 per 10,000 individuals. Multivariable analysis revealed that VTE occurred more frequently in older patients with specific medical comorbidities, particularly in those with a lumbar spinal lesion accompanied by arthritis of the hip, knee, or shoulder. We also found that the incidence rates of preoperative VTE, as well as the gradient of their increase, began to rise approximately 2 to 3 months prior to the index surgery, peaking just before the index surgery. This diagnostic trend was consistently observed in all patients irrespective of the presence of other risk factors. CONCLUSIONS: The incidence of preoperative VTE in patients with degenerative spinal disease exhibited a sharp increase immediately before surgery, with similar rates to those of postoperative VTE. Clinicians managing patients with degenerative spinal disease should be vigilant for preoperative as well as postoperative VTE.

The Sagittal Balance of Cervical Spine : Comprehensive Review of Recent Update.

The cervical spine plays a critical role in supporting the skull, maintaining horizontal gaze, and facilitating walking. Its unique characteristics, including the widest range of motion among spinal segments, have led to extensive research on cervical sagittal alignment. Various parameters have been proposed to evaluate cervical alignment, with studies investigating their clinical significance, correlation with symptoms, and implications for surgical interventions. Recent findings suggest that cervical sagittal alignment not only impacts the cervical spine but also influences global spine-pelvic alignment through compensatory mechanisms. This comprehensive review examines classical and new parameters of cervical sagittal alignment and considers the dynamic and muscular factors associated with it.

Viscum album Induces Apoptosis by Regulating STAT3 Signaling Pathway in Breast Cancer Cells.

In this study, we investigated the potential anticancer effects of Viscum album, a parasitic plant that grows on Malus domestica (VaM) on breast cancer cells, and explored the underlying mechanisms. VaM significantly inhibited cell viability and proliferation and induced apoptosis in a dose-dependent manner. VaM also regulated cell cycle progression and effectively inhibited activation of the STAT3 signaling pathway through SHP-1. Combining VaM with low-dose doxorubicin produced a synergistic effect, highlighting its potential as a promising therapeutic. In vivo, VaM administration inhibited tumor growth and modulated key molecular markers associated with breast cancer progression. Overall, our findings provide strong evidence for the therapeutic potential of VaM in breast cancer treatment and support further studies exploring clinical applications.

Comparison of Midline Splitting versus Unilateral Open Door Laminoplasty and Its Impact on Patient Outcomes.

Background: Laminoplasty is a common and effective surgery for decompression of the spinal cord in multilevel cervical myelopathy. The midline splitting technique (MST) and the unilateral open door technique (UODT) are the two most commonly performed laminoplasty techniques with continuous debate on which is preferable. This study aimed to add light to the matter by comparing and exploring the possible causes of different outcomes. Methods: A total of 101 patients who underwent laminoplasty for degenerative cervical myelopathy were included in this study. Radiographic measurements including C2-7 Cobb angle, C2-7 range of motion (ROM), Pavlov ratio of the most compressed level, and canal area with diameter were compared. Modified Japanese Orthopedic Association (mJOA) score and complications including C5 palsy, axial neck pain, hinge fractures, and spacer displacement were also compared. Statistical analysis was performed using independent samples t-test, chi-square test, Fisher's exact test, and linear mixed model. Results: C2-7 ROM, canal diameter, Pavlov ratio, and mJOA score did not demonstrate differences between the two techniques. The UODT group had greater postoperative canal expansion but had more loss of C2-7 lordosis than did the MST group. Of the complications, hinge fractures were more common in the UODT group, with more loss of C2-7 lordosis in patients with hinge fractures. On the other hand, spacer displacement occurred only in the MST group, with lesser canal expansion in patients with spacer displacement. Conclusions: The two laminoplasty techniques both demonstrated effectiveness in treating patients with multilevel cervical myelopathy. However, care should be given to avoid hinge fractures and spacer displacement since both can possibly lead to unfavorable outcomes.

The epidemiology of concurrent infection in patients with pyogenic spine infection and its association with early mortality: A nationwide cohort study based on 10,695 patients.

BACKGROUND: Generally, a sufficient duration of relevant antibiotics based on an appropriate culture combined with proper surgical treatment guarantees a favorable clinical outcome in patients with pyogenic spine infections. However, a patient's condition often deteriorates as concurrent infections occur in other organs, leading to mortality. Therefore, this study aimed to investigate the epidemiology of concurrent infections in patients with a pyogenic spine infection and estimate the rates and risks of early mortality. METHODS: Patients with a pyogenic spine infection were identified using a national claims database that includes the entire population. The epidemiology of the six types of concurrent infections was investigated, and the corresponding early mortality rates and risks were estimated. The results were validated internally by bootstrapping and externally by defining two additional cohorts for sensitivity analysis. RESULTS: Among 10,695 patients with a pyogenic spine infection, the prevalence of the six types of concurrent infections was 11.3 % for urinary tract infections, 9.4 % for intra-abdominal infections, 8.5 % for pneumonia, 4.6 % for septic arthritis or osteomyelitis of the extremities, 0.7 % for central nervous system infections, and 0.5 % for cardiac infections. Patients with a concurrent infection had approximately 4-fold greater mortality than those without (3.3 % vs. 0.8 %). The early mortality rates were particularly higher in patients with multiple or specific types of concurrent infections, including central nervous system infections, cardiac infections, and pneumonia. In addition, the mortality trends differed significantly according to the number and type of concurrent infections. CONCLUSIONS: These data on six types of concurrent infection among patients with pyogenic spinal infection can be used as a source of reference by clinicians.

Utility of Diffusion and Magnetization Transfer MRI in Cervical Spondylotic Myelopathy: A Pilot Study.

Diffusion tensor imaging (DTI) and magnetization transfer (MT) magnetic resonance imaging (MRI) can help detect spinal cord pathology, and tract-specific analysis of their parameters, such as fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), radial diffusivity (RD) and MT ratio (MTR), can give microstructural information. We performed the tract-based acquisition of MR parameters of three major motor tracts: the lateral corticospinal (CS), rubrospinal (RuS) tract, and lateral reticulospinal (RS) tract as well as two major sensory tracts, i.e., the fasciculus cuneatus (FC) and spinal lemniscus, to detect pathologic change and find correlations with clinical items. MR parameters were extracted for each tract at three levels: the most compressed lesion level and above and below the lesion. We compared the MR parameters of eight cervical spondylotic myelopathy patients and 12 normal controls and analyzed the correlation between clinical evaluation items and MR parameters in patients. RuS and lateral RS showed worse DTI parameters at the lesion level in patients compared to the controls. Worse DTI parameters in those tracts were correlated with weaker power grasp at the lesion level. FC and lateral CS showed a correlation between higher RD and lower FA and MTR with a weaker lateral pinch below the lesion level.

Significance of Measuring Lumbar Spine 3-Dimensional Computed Tomography Hounsfield Units to Predict Screw Loosening.

BACKGROUND: Osteoporosis is a well-known risk factor of screw loosening. Classically, dual-energy x-ray absorptiometry (DEXA) scan is an easy and cost-effective method of detecting bone mineral density (BMD). However, T-score on DEXA scan can be overestimated in patients with degenerative changes of the spine. Our objective was to identify correlation between Hounsfield unit (HU) measured by 3-dimensional computed tomography (3D-CT) and screw loosening. METHODS: A total of 113 patients treated with lumbosacral spinal fusion were reviewed and categorized into a screw loosening group and a normal group to compare their average values of preoperative CT HU. Screw loosening was defined as radiolucent area around screw that was thicker than 1 mm with a "double halo sign". RESULTS: There were statistically significant differences in patient age and steroid use between screw loosening and non-loosening groups. There was no significant difference in BMD or T-score between the 2 groups. However, HU values measured in axial, coronal, and sagittal images were significantly different between the 2 groups. In the receiver operating characteristic for HU values measured in CT images, the greatest area under the curve was 0.774 and that was in case of Hounsfield unit measured by axial CT images from L1 to L4. CONCLUSIONS: Preoperative CT HU is associated with screw loosening. It can be a better predictor of screw loosening than DEXA scan. The best predictor of screw loosening in this study is the average value of HU from L1 to L4 in axial cut.

Analysis of the Incidence and Risk Factors of Postoperative Delirium in Patients With Degenerative Cervical Myelopathy.

OBJECTIVE: The purpose of this study is to analyze various risk factors that can cause postoperative delirium (POD) in degenerative cervical myelopathy (DCM) patients, which may affect normal recovery and outcomes after surgery, and to help deal with them in advance and to take a medical approach. METHODS: A total of 148 patients aged 60 years or older who underwent laminoplasty or anterior cervical discectomy and fusion (ACDF) for DCM from 2008 to 2015 were included in this study. Incidence and multiple risk factors for development of POD were analyzed. RESULTS: POD occurred in 24 patients (16.2%). Among the 148 patients, 78 received laminoplasty, of whom 19 patients (24%) experienced delirium; the other 70 patients underwent ACDF, of whom 5 patients (7.1%) experienced delirium. History of Parkinson disease (odds ratio [OR], 178.242; p = 0.015), potassium level (OR, 3.764; p = 0.031), and surgical approach of laminoplasty over ACDF (OR, 8.538; p = 0.008) were found to be significant risk factors in a multivariate analysis. Age (OR, 1.056; p = 0.04) and potassium level (OR, 3.217; p = 0.04) were significant risk factors in the laminoplasty group. CONCLUSION: The findings of this study suggest that the incidence and risk factors for POD may vary in patients with DCM. It is necessary to understand multiple factors that affect the development of POD.

Prediction of Recurrence in Pyogenic Vertebral Osteomyelitis by Artificial Neural Network Using Time-series Data of C-Reactive Protein: A Retrospective Cohort Study of 704 Patients.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The aim of this study was to develop recurrence-prediction models of pyogenic vertebral osteomyelitis (PVO). SUMMARY OF BACKGROUND DATA: Prediction of recurrence in PVO is crucial to avoid additional prolonged antibiotic therapy and aggressive spinal surgery and to reduce mortality. However, prediction of PVO recurrence by previously identified, initial risk factors is limited in PVO patients who exceptionally require prolonged antibiotic therapy and experience various clinical events during the treatment. We hypothesized that time-series analysis of sequential C-reactive protein (CRP) routinely measured to estimate the response to the antibiotics in PVO patients could reflect such long treatment process and increase the power of the recurrence-prediction model. METHODS: A retrospective study was performed to develop a PVO recurrence-prediction model, including initial risk factors and time-series data of CRP. Of 704 PVO patients, 493 and 211 were divided into training and test cohorts, respectively. Conventional stepwise logistic regression and artificial neural network (ANN) models were created from the training cohort, and the predictions of recurrence in the test cohort were compared. RESULTS: Prediction models using initial risk factors showed poor sensitivity (4.7%) in both conventional logistic model and ANN models. However, baseline ANN models using time-series CRP data showed remarkably increased sensitivity (55.8%-60.5%). Ensemble ANN model using both initial risk factors and time-series CRP data showed additional benefit in prediction power. CONCLUSION: The recurrence-prediction models for PVO created only using the initial risk factors showed low sensitivity, regardless of statistical method. However, ANN models using time-series data of CRP values and their ensemble model showed considerably increased prediction power. Therefore, clinicians treating PVO patients should pay attention to the treatment response including changes of CRP levels to identify high-risk patients for recurrence, and further studies to develop recurrence-prediction model for PVO should focus on the treatment response rather than initial risk factors.Level of Evidence: 4.

Changes in sleep disturbance in patients with cervical myelopathy: comparison between surgical treatment and conservative treatment.

BACKGROUND CONTEXT: The clinical symptoms of cervical myelopathy (CM) are closely associated with the risk factors of sleep disturbance, and its pathophysiological process is similar to that of spinal cord injury. Therefore, patients with CM are also expected to have sleep disturbance like patients with spinal cord injury, who typically have various types of sleep disorders. Fortunately, sleep disturbance in patients with CM is expected to respond well to treatment, and clinical studies are required to establish proper treatment strategies for CM patients with sleep disturbance. PURPOSE: To compare the effects of CM treatment on sleep quality between patients treated surgically and those managed conservatively and to identify predictors associated with sleep improvement. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Patients diagnosed as having CM. OUTCOME MEASURES: Pittsburgh Sleep Quality Index (PSQI). METHODS: The effect of CM treatment on sleep improvement at the 6-month follow-up was evaluated using a multivariate logistic regression analysis of propensity score-matched patients. To investigate factors associated with significant sleep improvement, a subgroup analysis was performed. RESULTS: A total of 131 patients with CM and sleep disturbance were enrolled. Among these patients, 31 received surgical treatment and 100 received conservative treatment. Sleep quality improved rapidly and consistently after surgery, and significant sleep improvement was observed in most of the patients in the surgical group (26/31 patients, 83.9%) at the 6-month follow-up. However, sleep improvement only occurred in 27 (27%) of the 100 patients in the conservative group at the 6-month follow-up. The subgroup analysis revealed that the degree of CM determined by mJOA scores >13 was a significant predictor of sleep improvement after conservative treatment. CONCLUSIONS: Clinicians should closely monitor patients with CM with sleep disturbance, and proper treatment strategies should be considered according to the severity of the conditions.

Risk factors for sleep disturbance in patients with cervical myelopathy and its clinical significance: a cross-sectional study.

BACKGROUND CONTEXT: Sleep disturbance is highly prevalent in patients with spinal cord injury and is one of the most important clinical issues affecting their quality of life. However, it has not been properly measured or treated in patients with cervical myelopathy (CM), although most typical or atypical symptoms of CM are known to be risk factors for sleep disturbance. In addition, previous studies identified that the presence of sleep disturbance is unintentionally missed under the current evaluation process for degenerative spinal disease without direct investigation using validated tools for sleep. Therefore, studies about sleep disturbances in patients with CM are essential. PURPOSE: The purpose of this study was to investigate the prevalence of sleep disturbance in patients with CM using validated tools and to understand its mechanism by identifying high-risk patients. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: Consecutive patients diagnosed with CM. OUTCOME MEASURES: Pittsburgh sleep quality index. METHODS: This study was performed on patients diagnosed with CM. Sleep disturbance was determined using the Pittsburgh sleep quality index. Variables associated with sleep disturbance including demographics, lifestyle, medical history, and radiologic parameters were investigated. Independent risk factors related to sleep disturbance were identified using multivariate logistic regression analysis. RESULTS: A total of 203 patients with CM were included in our study. Among them, 126 patients (62.1%) were men, and the mean age was 63.0 years. Despite male predominance, sleep disturbance was identified in 71.4% of patients (145 of 203). Multivariate analysis identified a worse depression scale score, a lower modified Japanese Orthopedic Association score, chronic shoulder joint pain, smaller spinal cord area, and decreased cervical range of motion as independent risk factors for sleep disturbance. CONCLUSIONS: In patients with CM, sleep disturbance was associated with a more severe type of myelopathy. Further studies including polysomnography and measurement of melatonin will be helpful to identify the mechanisms of the sleep disturbance in patients with CM and to improve their quality of life and clinical outcomes.

Cervical Sagittal Imbalance after Cervical Laminoplasty in Elderly Patients.

PURPOSE: To determine the effect of age on sagittal cervical alignment after cervical laminoplasty procedure so as to identify the group with the greatest degree of variation. Study Setting. Single-center retrospective chart review in a tertiary referral hospital. Outcome Measures. The sagittal vertical axis (SVA) (C2-7), T1 slope, and cervical lordosis. METHODS: We included patients who underwent cervical laminoplasty between 2014 and 2018 and divided 60 consecutive patients into two groups using the cut-off age of 65 years. The Paired t-test and Mann-Whitney U test were used to compare changes between preoperative radiographic cervical sagittal parameters and those 1 year after surgery. RESULTS: Mean patient ages in the older and younger groups were 71 years and 52 years, respectively. The difference of C2-7 SVA was greater in the older group. CONCLUSION: Postoperative cervical balance can be worse when laminoplasty is performed in elderly patients.

Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters After Laminoplasty in Patients with Degenerative Cervical Myelopathy.

For patients with kyphosis of the cervical spine, laminoplasty is usually incapable of improving neurological symptoms as it worsens kyphotic alignment. Thus, laminoplasty is not recommended in the presence of kyphotic alignment. Nevertheless, laminoplasty may be selected for myelopathy due to multiple-segment intervertebral disc herniation or ossification of posterior longitudinal ligament despite kyphotic alignment. This study examined whether cervical alignment influences surgical outcomes. Cervical alignment before the surgery was classified into lordosis and non-lordosis, and the non-lordosis group was subclassified into reducible and non-reducible groups to determine the change in cervical alignment before and after the surgery and to analyze its relationship with spinopelvic parameters. The lordosis group showed an increase in upper cervical motion (C0-2 Range of Motion (ROM), C0-2ROM/C0-7ROM) after surgery, while the non-lordosis group exhibited a decrease in C2-7ROM and C0-7ROM. The C0-2ROM was maintained without any reduction in the reducible group, while there was no significant change in cervical alignment and ROM of the non-reducible group. None of these changes showed significant association with the spinopelvic parameters of other sites. However, having a non-reducible type non-lordosis is not a proper indication for laminoplasty, as it does not change the alignment after surgery. Therefore, cervical alignment and reducibility should be identified before surgery.

Prevalence of sleep disturbance in patients with lumbar spinal stenosis and analysis of the risk factors.

BACKGROUND CONTEXT: Although sleep quality is indispensable for good quality of life, it has not been properly measured or treated in patients with lumbar spinal stenosis (LSS). Studies that investigate the prevalence of sleep disturbances and identify high-risk patients are essential to help understand mechanisms of sleep disturbance in patients with LSS, develop multimodal treatment strategies, and eventually improve the clinical outcome for LSS. PURPOSE: The purpose of the study was to investigate the prevalence and status of sleep disturbance in patients with LSS and understand its mechanism by identifying the risk factors. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: Patients diagnosed with LSS. OUTCOME MEASURES: Pittsburgh sleep quality index (PSQI). METHODS: A study was performed on patients diagnosed with LSS. Sleep disturbance was evaluated using the PSQI. Clinical and radiologic risk factors of sleep disturbance were investigated by comparing its presence and absence in patients with LSS. Multivariate logistic regression analysis was conducted to identify significant risk factors related to sleep disturbance. RESULTS: A total of 230 patients with LSS were analyzed in our study, 141 of whom (61.3%) were women, and the average age was 67.7 years. Sleep disturbance (PSQI score≥6) was identified in 66.1% of the patients (152 out of 230). After a multivariate analysis, sleep disturbance was consistently associated with the female sex, a negative score on the depression scale, and a severe foraminal-type stenosis. Oswestry disability index, visual analogue pain scale, and presence of nocturnal pain were not independently associated with sleep disturbance. CONCLUSIONS: This study identified potential high-risk groups for sleep disturbance among patients with LSS. Proper caution and evaluation for these patients, along with further studies about their treatment outcomes, are required.

Treatment outcomes in patients with pyogenic vertebral osteomyelitis who have cirrhosis.

Early diagnosis and proper treatment of pyogenic vertebral osteomyelitis (PVO) in patients with cirrhosis is challenging to clinicians, and the mortality rate is expected to be high. A retrospective study was conducted to investigate the treatment outcome in PVO patients with cirrhosis and to identify the predictors of their mortality. Mortality was divided into two categories, 30-day and 90-day mortality. A stepwise multivariate logistic regression model was used to identify predictors of mortality. Eighty-five patients were identified after initial exclusion. The patients' mean age was 60.5 years, and 50 patients were male. The early mortality rates within 30 and 90 days were 17.6% and 36.5%, respectively. Multivariate analysis revealed that increased age, CTP class C, and bacteremia at the time of PVO diagnosis were predictors of 30-day mortality, while higher MELD score, presence of combined infection, and multiple spinal lesions were predictors of 90-day mortality. Attention should be paid to the high mortality between 30 and 90 days after PVO diagnosis (18.8%), which was higher than the 30-day mortality. Liver function was consistently a strong predictor of mortality in PVO patients with cirrhosis. The high-risk patients should be targeted for an aggressive diagnostic approach, using spinal MRI and intensive monitoring and treatment strategies.

Cervical Cord Compression and Whole-Spine Sagittal Balance: Retrospective Study Using Whole-Spine Magnetic Resonance Imaging and Cervical Cord Compression Index.

OBJECTIVE: We sought to investigate the relationship between cervical cord compression and factors related to whole-spine sagittal balance. METHODS: This retrospective single-center study included patients who visited our clinic for the evaluation of lumbar pathology including trauma and degeneration. Patients aged 60-89 years who underwent whole-spine sagittal T2 scout magnetic resonance imaging and whole-spine radiograph between 2014 and 2018 were included in our study. We consecutively enrolled 100 patients for our study without any prejudice. We collected data on patient characteristics, diagnosis, cervical cord compression index (CCI), sagittal vertical axis (C7-S1, C2-7), and other parameters related to sagittal balance such as pelvic incidence minus lumbar lordosis. Pearson correlation coefficients were calculated to compare CCI with each whole-spine sagittal balance parameter. RESULTS: Of the 100 patients, 44 were men. The mean age was 74.21 years. On the basis of Pearson correlation coefficients, CCI showed the strongest positive linear correlation with C7-S1 sagittal vertical axis (r = 0.688; P < 0.01), followed by the C2-7 sagittal vertical axis (r = 0.563; P < 0.01). CONCLUSIONS: Cervical cord compression is more likely to develop in patients with sagittal imbalance. It is important to use whole-spine radiograph and whole-spine T2 scout magnetic resonance imaging to analyze CCI in these patients.

Outcomes of additional instrumentation in elderly patients with pyogenic vertebral osteomyelitis and previous spinal instrumentation.

BACKGROUND CONTEXT: In patients with pyogenic vertebral osteomyelitis (PVO) and previous instrumentation requiring surgical treatment, a decision must be made between a less-invasive noninstrumented surgery, including retaining the previous instrumentation, or a more invasive additional instrumented surgery involving the complete removal of the infected tissue and firm restabilization. PURPOSE: To evaluate the clinical outcomes of using additional instrumentation in patients with PVO and previous instrumentation and determine the significant risk factors related to recurrent infection. STUDY DESIGN/SETTING: Retrospective cohort study (case control study). PATIENT SAMPLE: PVO patients with previous instrumentation. OUTCOME MEASURES: Recurrence of PVO and mortality. METHODS: Patients were divided into two groups (instrumented or noninstrumented) according to the presence or absence of additional instrumentation. The baseline characteristics, infection profile, and treatment outcomes were compared between the two groups, and a multivariate logistic regression analysis was performed to identify the risk factors for infection recurrence. RESULTS: A total of 187 postoperative patients with PVO and previous spinal instrumentation were included. There were no significant differences in the baseline characteristics except the presence of a titanium cage. Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality compared with noninstrumented surgery despite a larger number of involved vertebral levels and greater incidence of epidural abscesses. However, instrumented patients with PVO and previous instrumentation who experienced infection recurrence had worse clinical outcomes than those of the noninstrumented patients with PVO. Severe medical comorbidities, the presence of a psoas abscess, and methicillin-resistant Staphylococcus aureus infection were associated with a higher risk of infection recurrence. CONCLUSIONS: Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality to those who underwent noninstrumented surgery despite a larger number of involved vertebral levels and an increased frequency of epidural abscesses.

Clinical effect of early bisphosphonate treatment for pyogenic vertebral osteomyelitis with osteoporosis: An analysis by the Cox proportional hazard model.

BACKGROUND CONTEXT: Patients with pyogenic vertebral osteomyelitis (PVO) are expected to have an increased risk of bone loss. Therefore, early bisphosphonate therapy would be clinically effective for PVO patients with osteoporosis. PURPOSE: This study aimed to investigate the effect of bisphosphonate on clinical outcomes of PVO patients with osteoporosis. STUDY DESIGN/SETTING: A retrospective comparative study. PATIENT SAMPLE: PVO patients with osteoporosis. OUTCOME MEASURES: Four events of interest for Cox proportional hazard model included surgical treatment, recurrence of infection, subsequent fracture of adjacent vertebral bodies, and death. METHODS: PVO patients were divided into three groups: group A (initiation of bisphosphonate within 6 weeks after PVO diagnosis), group B (initiation of bisphosphonate between 6 weeks and 3 months after PVO diagnosis), and group C (no treatment for osteoporosis). Cox proportional hazard model was used for the four events of interest. RESULTS: A total of 360 PVO patients with osteoporosis were investigated for the four events of interest. Group A had significantly lower hazard ratios for undergoing later (>6 weeks after diagnosis) surgery than group C (p = .014) despite similar occurrences of overall surgery. A significant difference was also observed in the occurrence of subsequent fractures at adjacent vertebral bodies (p = .001 for model 1 and p = .002 for model 2). Groups A and B had significantly lower hazard ratios for subsequent fracture than group C. No significant differences were observed in the hazard ratios of recurrence and death among the three groups. CONCLUSIONS: Early bisphosphonate treatment in PVO patients with osteoporosis was associated with a significantly lower occurrence of subsequent vertebral fracture at adjacent vertebral bodies and lower occurrence of subsequent surgery.