Risk factor analysis of bone cement leakage for polymethylmethacrylate-augmented cannulated pedicle screw fixation in spinal disorders.

Objective: To investigate the risk factors of cement leakage (CL) for polymethylmethacrylate-augmented cannulated pedicle screw (CPS) in spinal degenerative diseases and provided technical guidance for clinical surgery. Methods: This study enrolled 276 patients with spinal degenerative disease and osteoporosis who were augmented using CPSs (835 screws in total) from May 2011 to June 2018 in our hospital. The patients' age, sex, bone mineral density (BMD), diagnosis, augmented positions, number of CPS implanted, and CL during surgery were recorded. CL was observed by postoperative computed tomography (CT) and was classified by Yeom typing. Results: A total of 74 (74/835, 8.9%) CPSs in 64 patients leaked (64/276, 23.2%). CL was significantly correlated with the number and position of screws (P < 0.05), but not with sex, age, and BMD (P > 0.05). The position, number of CPSs, fracture, degenerative scoliosis, ankylosing spondylitis, and revision surgery were risk factors for CL (P < 0.05). Augmentation of the thoracic vertebral body, fracture, and ankylosing spondylitis were independent risk factors for Type S. Augmentation of the lumbar vertebral body, lumbar disc herniation, and lumbar spondylolisthesis were independent risk factors for Type B (P < 0.05). Conclusions: CL has a high incidence in clinical practice. High-risk factors for leakage should be addressed to avoid serious complications. Particularly, it is necessary to develop alternative solutions once CPSs can't be used in surgery caused by CL.

Reversed windshield-wiper effect leads to failure of cement-augmented pedicle screw: Biomechanical mechanism analysis by finite element experiment.

The failure mode of cement-augmented pedicle screw (CAPS) was different from common pedicle screw. No biomechanical study of this failure mode named as "reversed windshield-wiper effect" was reported. To investigate the mechanisms underlying this failure mode, a series of finite element models of CAPS and PS were modified on L4 osseous model. Nine models were created according to the cement volume at 0.5 mL interval (range: 1-5 mL). Pullout load and cranio-caudal loads were applied on the screws. Stress and instantaneous rotation center (IRC) of the vertebra were observed. Under cranio-caudal load, the stress concentrated on the screw tip and pedicle region. The maximal stress (MS) at the screw tip region was +2.143 MPa higher than pedicle region. With cement volume increasing, the maximal stress (MS) at the screw tip region decreased dramatically, while MS at pedicle region was not obviously affected. As dose increased to 1.5 mL, the MS at pedicle region became higher than screw tip region and the maximal stress difference was observed at 3.5 mL. IRC of the vertebra located at the facet joint region in PS model. While IRC in CAPS models shifted anteriorly closer to the vertebral body with the increasing of cement volume. Under axial pull-out load, the maximal stress (MS) of cancellous bone in CAPS models was 29.53-50.04% lower than that 2.228 MPa in PS model. MS in the screw-bone interface did not change significantly with cement volume increasing. Therefore, the possible mechanism is that anterior shift of IRC and the negative difference value of MS between screw tip and pedicle region due to cement augmentation, leading to the screw rotate around the cement-screw complex as the fulcrum point.

Mild Three-Step Consecutive C-H Activations.

Herein, the Rh-catalyzed consecutive C-H bond olefination/annulation/olefination cascade, tandemly directed by sulfonamide and ester groups, has been developed under mild conditions with the assistance of 1-adamantane carboxylic acid. A seven-membered metallacycle including an ester group was preferred to the five-membered one including a sulfonamide group for the third C-H activation. In this transformation, the Rh catalyst exhibits its high reactivity by catalyzing a triple C-H activation process with a low catalyst loading at 50 °C. This method can be applied in the construction of various pharmaceutical derivatives.

Fate of the intervertebral disc and analysis of its risk factors following high-energy traumatic thoracic and lumbar fractures: MRI results of minimum five years after injury.

OBJECTIVE: Disc degenerative disease is regarded as the primary cause of low back pain. The purpose of this study was to clarify the fate of Intervertebral disc (IVD) following the traumatic event through long-term follow-up and to identify the risk factors for irrevocable degeneration. METHODS: 78 non-operative patients who had traumatic fracture of the thoracic or lumbar at minimum 5 years before were enrolled. Disc degeneration was assessed by modified Pfirrmann grading system. The Acceleration of disc degeneration (ADD) was defined as the difference of grade between IVD adjacent to fractured vertebra and their neighbors with increasing grade from 0 to 7. A novel classification of Endplate injury (EPI) with increasing severity from type I to III was proposed based on the injured morphology. The long-term fate of IVD adjacent to fractured vertebra and risk factors for ADD were analyzed. RESULTS: The mean time of last follow-up was 15.4 ± 10.8 years (range 5-49 years) after injury. 138 (68.66%) IVDs were graded 0 of ADD, 44 (21.89%) were 1-3 and 19 (9.45%) were 4-7. Multivariate binary logistic regression analyses showed that injured posterior ligamentous complex (PLC) and EPI type III were independent risk factors for ADD. CONCLUSIONS: Injured PLC and EPI type III were independent risk factors for ADD in patients with traumatic thoracic or lumbar fracture. For such patients without risk factors for ADD, the non-intervertebral fusion should be given a priority if surgery is necessary.

Vancomycin-Functionalized Porphyrinic Metal-Organic Framework PCN-224 with Enhanced Antibacterial Activity against Staphylococcus Aureus.

A vancomycin (Van) modification strategy on a porphyrinic metal-organic framework (MOF) PCN-224 is presented. The obtained Van-PCN-224 gives the combined advantages of porphyrinic MOF and Van with high photosensitive activity and excellent targeted antibacterial activity against Staphylococcus aureus. The features make Van-PCN-224 promising for antimicrobial therapy.

Effect of Topology on Photodynamic Sterilization of Porphyrinic Metal-Organic Frameworks.

Porphyrinic metal-organic frameworks (MOFs) are promising photosensitizers due to the lack of self-aggregation of porphyrin in aqueous solution. However, how the topology of porphyrinic MOFs affects the generation of singlet oxygen (1 O2 ) is unclear. Here, the effect of the topology of porphyrinic MOFs on their photodynamic performance is reported. Four porphyrinic zirconium MOFs (MOF-525, MOF-545, PCN-223 and PCN-224 with different topologies: ftw, csq, shp and she, respectively) were selected to study the influence of topology on the photodynamic antibacterial performance. The 1 O2 generation and the photodynamic antibacterial performance followed an decreasing order of MOF-545>MOF-525>PCN-224>PCN-223. The results reveal that the pore size, the distance between porphyrin, and the number of porphyrin per Zr6 O8 cluster in MOFs greatly affected 1 O2 generation. This work provides guidance for designing new MOFs for efficient photodynamic sterilization.

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis.

BACKGROUND: Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease. METHODS: May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening. RESULTS: There were no significant differences in the baseline data of the two groups. The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disk height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group. CONCLUSIONS: Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.

Weeping candidate genes screened using comparative transcriptomic analysis of weeping and upright progeny in an F1 population of Prunus mume.

Weeping is a specific plant architecture with high ornamental value. Despite the considerable importance of the weeping habit to landscaping applications and knowledge of plant architecture biology, little is known regarding the underlying molecular mechanisms. In this study, growth and phytohormone content were analyzed among the progeny of different branch types in an F1 mapping population of Prunus mume with varying plant architecture. Bulked segregant RNA sequencing was conducted to compare differences among progeny at a transcriptional level. The weeping habit appears to be a complex process regulated by a series of metabolic pathways, with photosynthesis and flavonoid biosynthesis highly enriched in differentially expressed genes between weeping and upright progeny. Based on functional annotation and homologous analyses, we identified 30 candidate genes related to weeping that merit further analysis, including 10 genes related to IAA and GA3 biosynthesis, together with 6 genes related to secondary branch growth. The results of this study will facilitate further studies of the molecular mechanisms underlying the weeping habit in P. mume.

Macrophage membrane coated persistent luminescence nanoparticle@MOF-derived mesoporous carbon core-shell nanocomposites for autofluorescence-free imaging-guided chemotherapy.

Efficient drug nanocarriers with high drug loading capacity and luminescent ability are in high demand for biomedical applications. Here we show a facile and bio-friendly synthesis of macrophage membrane coated persistent luminescence nanoparticle (PLNP)@metal-organic framework (MOF)-derived mesoporous carbon (MC) core-shell nanocomposites (PLMCs) for autofluorescence-free imaging-guided chemotherapy. MOF UiO-66 is used as both the precursor and the template, and is controllably coated on the surface of the PLNP to form a PLNP@UiO-66 core-shell composite. Subsequent calcination enables the transformation of PLNP@UiO-66 to PLMC due to the pyrolysis of the UiO-66 shell. PLMC with a small particle size of 70 nm, a tunable large pore size from ∼4.8 to ∼16.2 nm in the shell and near-infrared persistent luminescence in the core was prepared by controlling the calcination conditions. The prepared PLMC showed an enhanced drug loading capacity for three model drugs (doxycycline hydrochloride, acetylsalicylic acid, and paclitaxel) compared with PLNP@UiO-66. Further coating of the macrophage membrane on the surface of PLMC results in MPLMC with enhanced cloaking ability for evading the mononuclear phagocyte system. The drug-loaded MPLMC is promising for autofluorescence-free persistent luminescence imaging-guided drug delivery and tumor therapy.

Effects of Tai Chi Yunshou on upper limb function and balance in stroke survivors: A protocol for systematic review and meta analysis.

BACKGROUND: Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors. METHODS: This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes. RESULTS: This systematic review results will be carried out after the completion of the protocol. CONCLUSIONS: This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training. PROSPERO REGISTRATION NUMBER: CRD42020169549.

Clinical efficacy of Bone Cement-injectable Cannulated Pedicle Screw Short Segment Fixation for Lumbar Spondylolisthesis with Osteoporosise.

Many clinical studies have shown a satisfactory clinical efficacy using bone cement-augmented pedicle screw in osteoporotic spine, however, few studies have involved the application of this type of screw in lumbar spondylolisthesis. This study aims to investigate the mid-term clinical outcome of bone cement-injectable cannulated pedicle screw (CICPS) in lumbar spondylolisthesis with osteoporosis. From 2011 to 2015, twenty-three patients with transforminal lumbar interbody fusion (TLIF) using CICPS for lumbar spondylolisthesis were enrolled in the study. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate faunctional recovery and physical pain; and operation time, blood loss and hospitalization time were recorded, respectively. Radiograph and computed tomography of lumbar spine was performed to assess loss of the intervertebral disc space height, fixation loosening, and the rate of bony fusion. The average follow-up time of 23 patients was 22.5 ± 10.2 months (range, 6-36 months). According to VAS and ODI scores, postoperative pain sensation and activity function were significantly improved (p < 0.05). The height of the intervertebral disc space was reduced by 0.4 ± 1.1 mm, and the bone graft fusion rate was 100%. No cases of internal fixation loosening or screw pullout was observed. CICPS using cement augmentation may suggest as a feasible surgical technique in osteoporotic patients with lumbar spondylolisthesis.

LRRFIP1 expression triggers platelet agglutination by enhancing αIIbß3 expression.

Platelets primarily participate in hemostasis and antimicrobial host defense. The present study aimed to investigate the effects of leucine-rich repeat flightless-interacting protein-1 (LRRFIP1) on platelet agglutination. The bacterial strain of LRRFIP1 was used to synthesize the recombinant protein and a mouse model of LRRFIP1 gene knockout was established. Platelets were isolated from the mice and divided into the different trial groups according to their treatment with collagen, thrombin receptor SFLLRN, anti-wild-type (w)LRRFIP1monoclonal antibodies and the model of LRRFIP1 gene knockout. The platelets were prepared and platelet agglutination was examined using platelet aggregation apparatus. The active αIIbß3 integrin was examined by flow cytometry. The results revealed that the combined wLRRFIP1 protein was successfully expressed. wLRRFIP1 treatment significantly triggered platelet agglutination of collagen, thrombin and monoclonal antibody treated platelets. wLRRFIP1 knockout significantly decreased αIIbß3 levels compared with the wild-type. Platelet agglutination was also significantly inhibited in the LRRFIP1-/-mouse model compared with the wild-type. LRRFIP1 knockout significantly decreased the αIIbß3 levels in platelets undergoing convulxin treatment. In conclusion, LRRFIP1 treatment triggered platelet agglutination and LRRFIP1 gene knockout inhibited platelet agglutination. In addition, LRRFIP1 gene knockout significantly decreased the levels of αIIbß3. This suggests that LRRFIP1 my be applied to patients in a clinical setting to trigger platelet agglutination in inflammatory diseases and atherothrombotic diseases.

Genome-wide analyses of the bHLH gene family reveals structural and functional characteristics in the aquatic plant Nelumbo nucifera.

Lotus (Nelumbo nucifera Gaertn.) is an economically important aquatic plant with multiple applications, but water salinity and cold stress seriously affect lotus yield and distribution. The basic helix-loop-helix (bHLH) transcription factors (TFs) play a vital role in plant growth and development, metabolic regulation processes and responses to environmental changes. However, systematic analyses of the bHLH TF family in lotus has not yet been reported. Here, we report the identification and description of bHLH genes in lotus (NnbHLHs) with a focus on functional prediction, particularly for those involved in stress resistance. In all, 115 NnbHLHs were identified in the lotus genome and classified into 19 subfamilies. The chromosomal distribution, physicochemical properties, bHLH domain, conserved motif compositions and evolution of these 115 NnbHLHs were further analyzed. To better understand the functions of the lotus bHLH family, gene ontology, cis-element, and phylogenetic analyses were conducted. NnbHLHs were predicted to be involved in plant development, metabolic regulation and responses to stress, in accordance with previous findings. Overall, 15 NnbHLHs were further investigated with functional prediction via quantitative real-time PCR analyses. Meanwhile, expression profiles of NnbHLHs in four tissues indicated that many NnbHLHs showed tissue preference in their expression. This study is supposed to provide a good foundation for further research into the functions and evolution of NnbHLHs, and identifies candidate genes for stress resistance in lotus.

Variation of soil bacterial diversity after the invasion of Phyllostachys edulis into Pinus massoniana forest.

To identify the variation in soil bacterial community diversity brought by the invasion of Phyllostachys edulis into Pinus massoniana forest, we collected mixed soil samples from three types of forests, including a pure Ph. edulis forest, a mixed Ph. edulis and conifers (P. massoniana) fore-st, and a mixed forest of evergreen broadleaves and conifers. Samples were analyzed by high-throughput sequencing for measuring the soil bacterial community diversity and structure. The results showed that the bacterial communities comprised of 511 genera, 160 families, 134 orders, 88 classes, and 39 phyla. The proportion of Acidobateria in the pure Ph. edulis forest was significantly lower and the proportions of Actinobacteria, Bacteroidetes, TM7, and Chlamydiae were significantly higher than that in other forests. Meanwhile, various genera showed significant differences in proportions in both the mixed forests when compared with their corresponding proportions in the pure Ph. edulis forest. There were 130 non-dominant genera presented alone in each of the two mixed forests, at proportions between 0.005% and 0.1%. The pure Ph. edulis forest had the lowest &Agr; diversity, while that of the mixed Ph. edulis and evergreen broadleaf forest was intermediate, and that of the mixed evergreen broadleaf and coniferous forest was the highest. The index of &Agr; diversity followed evergreen coniferous mixed forest > bamboo needle mixed forest > pure bamboo forest, and the diffe-rence between the mixed Ph. edulis and evergreen broadleaf forest and the mixed evergreen broadleaf and coniferous forest was insignificant. The PCoA results revealed that the invasion of Ph. edulis affected the population diversity and community structure of soil bacteria. There was a significant correlation between the percentage of non-dominant bacterial phyla in the soil (less than 0.1% of the proportion) and the soil environmental gradient such as water-soluble organic nitrogen and nitrate. Water-soluble organic nitrogen and nitrate had strong effects on the non-dominant bacterial population in the soil following the invasion of Ph. edulis into the P. massoniana forest. These findings would serve as important references for further related studies.

Fabrication of mesoporous La3Ga5GeO14:Cr3+,Zn2+ persistent luminescence nanocarriers with super-long afterglow for bioimaging-guided in vivo drug delivery to the gut.

Infection by pathogens has always been a major threat to human health, and various drugs have been explored and designed to kill pathogens in the past decades. However, pathogens are evolving faster than the development of new antibiotics, and increasing doses are resulting in increasing side effects and toxicity; this has prompted us to exert effort toward the development of advanced drug carriers for precise delivery of antibiotics. In this study, with the involvement of persistent luminescence nanophosphors (PLNPs) as the emission core, we propose an antibiotic nanocarrier for in vivo delivery of vancomycin to intestinal bacteria via bioimaging guidance. The synthesized PLNPs were coated with mesoporous silica for vancomycin adsorption (NPs@SiO2@Van) and used as an efficient nanocarrier for direct vancomycin delivery and in vivo imaging with low cytotoxicity toward MC38 cell lines. Additionally, we detected the luminescence signals of NPs@SiO2@Van during their use as nanocarriers for vancomycin and accurately obtained the biodistribution of NPs@SiO2@Van in situ and in real time with neglectable auto-fluorescence from the animal body. For the first time, bioimaging-guided in vivo drug delivery to gut bacteria was realized in the present work. The outstanding luminescence features and excellent biocompatibility and structural stability of PLNPs may open new horizons in the development of nanocarriers for nano-diagnosis/therapy and in vivo studies of intestinal microorganisms.

Utilization of ring-shaped bone allograft for surgical treatment of adolescent post-tubercular kyphosis: A retrospective study.

This study aimed to investigate the mid-term outcome of ring-shaped bone allografts in the surgical treatment of adolescent post-tubercular kyphosis secondary to spinal tuberculosis.The records of adolescent patients diagnosed with spinal tuberculosis who received treatment in our department between 2009 and 2013 were retrospectively reviewed. The anterior approach was used in cases of cervical kyphosis and the posterior approach was used in cases of thoracic and lumbar kyphosis. During the surgery, the ring-shaped bone was used as a structural bone graft associated with the cancellous bone filing in the center portion of the ring shape. Cobb's angle, signs of spinal infusion on computed tomography, and complications were followed up.A total of 25 patients were included in our study. Among them, 3 involved the cervical region, 5 involved the thoracic region, 8 involved the thoracolumbar region, and 9 involved the lumbar region. The preoperative kyphosis deformity was a mean 65° Cobb's angle (40°-97°) compared to the postoperative 14° Cobb's angle (10°-21°) for an average correction of 51°. All wounds healed well without graft rejection. All patients achieved bone fusion 3 months postoperative for a 100% fusion rate.Our results show that the ring-shaped allograft bone is an effective option for the treatment of adolescent kyphosis. The ring-shaped allograft bone demonstrated satisfactory mechanical strength and vertebral fusion without mid-term metallic toxicity.

Synthesis of GdAlO3:Mn4+,Ge4+@Au Core-Shell Nanoprobes with Plasmon-Enhanced Near-Infrared Persistent Luminescence for in Vivo Trimodality Bioimaging.

The rise of multimodal nanoprobes has promoted the development of new methods to explore multiple molecular targets simultaneously or to combine various bioimaging tools in one assay to more clearly delineate localization and expression of biomarkers. Persistent luminescence nanophosphors (PLNPs) have been qualified as a promising contrast agent for in vivo imaging. The easy surface modification and proper nanostructure design strategy would favor the fabrication of PLNP-based multifunctional nanoprobes for biological application. In this paper, we have proposed novel multifunctional core-shell nanomaterials, applying the Mn4+ and Ge4+ co-doped gadolinium aluminate (GdAlO3:Mn4+,Ge4+) PLNPs as the near-infrared persistent luminescence emission center and introducing the gold nanoshell coated on the PLNPs to enhance the luminescence efficiency via plasmon resonance. Our developed core-shell nanoprobes have demonstrated the excellent features of ultrabrightness, superlong afterglow, good monodispersity, low toxicity, and excellent biocompatibility. The well-characterized nanoprobes have been utilized for trimodality in vivo imaging, with near-infrared persistent luminescence for optical imaging, Gd element for magnetic resonance imaging, and Au element for computed tomography imaging.

Posterior-only spinal fusion without rib head resection for treating type I neurofibromatosis with intra-canal rib head dislocation

OBJECTIVES: Patients with Type I neurofibromatosis scoliosis with intra-canal rib head protrusion are extremely rare. Current knowledge regarding the diagnosis and treatment for this situation are insufficient. The purpose of this study is to share our experience in the diagnosis and surgical treatments for such unique deformities. METHODS: Six patients with Type I neurofibromatosis scoliosis with rib head dislocation into the spinal canal were diagnosed at our institution. Posterior instrumentation and spinal fusion without intra-canal rib head resection via a posterior-only approach was performed for deformity correction and rib head extraction. The efficacy and outcomes of the surgery were evaluated by measurements before, immediately and 24 months after the surgery using the following parameters: coronal spinal Cobb angle, apex rotation and kyphosis of the spine and the intra-canal rib head position. Post-operative complications, surgery time and blood loss were also evaluated. RESULTS: Patients were followed up for at least 24 months post-operatively. The three dimensional spinal deformity was significantly improved and the intra-canal rib head was significantly extracted from the canal immediately after the surgery. At follow-up 24 months after surgery, solid fusions were achieved along the fusion segments, and the deformity corrections and rib head positions were well maintained. There were no surgery-related complications any time after the surgery. CONCLUSIONS: Systematic examinations are needed to identify patients with Type I neurofibromatosis scoliosis with rib head dislocation into the canal who can be treated by posterior-only spinal fusion without rib head resection. .

Posterior-only spinal fusion without rib head resection for treating type I neurofibromatosis with intra-canal rib head dislocation.

OBJECTIVES: Patients with Type I neurofibromatosis scoliosis with intra-canal rib head protrusion are extremely rare. Current knowledge regarding the diagnosis and treatment for this situation are insufficient. The purpose of this study is to share our experience in the diagnosis and surgical treatments for such unique deformities. METHODS: Six patients with Type I neurofibromatosis scoliosis with rib head dislocation into the spinal canal were diagnosed at our institution. Posterior instrumentation and spinal fusion without intra-canal rib head resection via a posterior-only approach was performed for deformity correction and rib head extraction. The efficacy and outcomes of the surgery were evaluated by measurements before, immediately and 24 months after the surgery using the following parameters: coronal spinal Cobb angle, apex rotation and kyphosis of the spine and the intra-canal rib head position. Post-operative complications, surgery time and blood loss were also evaluated. RESULTS: Patients were followed up for at least 24 months post-operatively. The three dimensional spinal deformity was significantly improved and the intra-canal rib head was significantly extracted from the canal immediately after the surgery. At follow-up 24 months after surgery, solid fusions were achieved along the fusion segments, and the deformity corrections and rib head positions were well maintained. There were no surgery-related complications any time after the surgery. CONCLUSIONS: Systematic examinations are needed to identify patients with Type I neurofibromatosis scoliosis with rib head dislocation into the canal who can be treated by posterior-only spinal fusion without rib head resection.