[Sagittal Profi le of the Spine in Patients after Lumbar Stabilisation Surgeries]. / Sagitální profi l pátere u pacientu po stabilizacních operacích bederní pátere.

PURPOSE OF THE STUDY: Spine stabilization surgery is nowadays one of the most common spinal surgical procedures. Spinopelvic alignment is considered to be an important factor impacting the patients' preoperative diffi culties as well as the outcome of surgery. In our study, the outcomes of stabilization surgeries in patients with lumbar spine disorders were evaluated - especially in those with stenosis and spondylolisthesis, in whom the importance of sagittal parameters were assessed with respect to the patients' clinical outcomes and diffi culties. MATERIAL AND METHODS: The study included 50 patients with lumbar spine disorders who had undergone a spine stabilization surgery for a degenerative disease - lumbar spinal stenosis, spondylolisthesis between 2015 and 2017. Spino-pelvic radiological parameters and clinical parameters were evaluated using the nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests. RESULTS: In 38 of 50 patients, who at the end of the follow-up period did not have the PI-LL (pelvic incidence-lumbar lordosis) mismatch, i.e. PI-LL was ≤10°, a statistically signifi cant difference in pelvic tilt (p=0.049) and sagittal vertical axis (p<0.001) was reported, which was not the case in the remaining patients of the study population. Claudication and OSWESTRY (ODI) showed no statistically signifi cant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A signifi cant change was seen in the claudication parameter at 12 and 24 months after surgery (p=0.007, p=0.005), with better outcomes achieved by 360° lumbar fusion compared to posterior lumbar fusion. The improvement of VAS and ODI scores in both the groups over time (from 6.1 to 3.6 or from 6.3 to 3.5 in VAS and from 62 to 32, or from 62 to 30 in ODI) was also statistically signifi cant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignifi cant. DISCUSSION: The authors confi rmed signifi cant improvement in the studied clinical parameters in all groups of patients (VAS, ODI, claudication), which is consistent with the results of recently published papers. The authors also established the correlation between different radiological parameters in the studied groups. The results do not confi rm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the fi ndings of other published manuscripts. The authors failed to confi rm a signifi cant change in clinical parameters in dependence on the matching relationship between the pelvic incidence and lumbar lordosis. CONCLUSIONS: Proper spinopelvic balance in patients after spinal surgery is a very important indicator of postoperative development and condition, but our cohort showed no statistically signifi cant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory. KEY WORDS: sagittal profi le, spine stabilization, pelvic tilt, pelvic incidence, sagittal vertical axis, SVA.

NiTi Alloys Exposure Alters miR-124 Expression in Physiological and Osteoarthritic Osteoblasts.

PURPOSE OF THE STUDY Nitinol (NiTi) is a biomaterial widely used in medicine based on super-elastic and shape memory properties. miR-124 has a key role in inflammatory process, osteoblasts differentiation, and mineralization. The aim of study was evaluating the differences in gene expression of miR-124 of human physiological osteoblasts (HOB) and human osteoarthritic osteoblasts (OSBA) as a response to NiTi alloy in different heat treatments. MATERIAL AND METHODS The cells were cultivated with NiTi discs with/without addition of bacterial lipopolysaccharide (LPS) for 72 hours. MicroRNAs were isolated, underwent reverse transcription and were analyzed by RT-PCR. RESULTS As a response to LPS, HOB overexpressed miR-124, while in OSBA expression change did not occur. Overexpression was also observed in both cell lines as a response to hydrogen and helium treated NiTi discs. HOB expressed significantly higher amount of miR-124 than OSBA as a response to hydrogen treatment of NiTi discs. In addition, hydrogen treatment caused significantly higher expression in HOB than LPS. The combination of NiTi disc and LPS treatment in HOB didn't cause any expression changes. Comparing to LPS-only treatment, the expression in HOB with combination of LPS and alloy was significantly lower. In OSBA, the expression was increased by the combination of LPS and hydrogen disc, in case of helium disc, the expression was decreased. CONCLUSIONS In conclusion, human physiological and osteoarthritic osteoblasts respond to NiTi alloy with both surface (hydrogen and helium atmosphere) treatment by overexpression of miR-124. The effect of LPS as inflammatory modulator suggests the presence of an "anti-inflammatory preconditioning" in osteoarthritic osteoblasts, as physiological osteoblasts overexpression was significantly higher. Key words: nitinol, osteoblast, miR-124, lipopolysaccharide.

[Long-term results of surgery for cervical spondylotic myelopathy using open-door laminoplasty]. / Dlouhodobé výsledky operacního resení cervikální spondylogenní myelopatie pomocí "open-door" laminoplastiky

PURPOSE OF THE STUDY Cervical spondylotic myelopathy (CSM) is a serious disease which, in its advanced form, can markedly disable the patient. The aim of the present work was a prospective evaluation of a group of CSM patients treated by open-door laminoplasty. MATERIAL AND METHODS We evaluated 89 patients (59 men and 30 women; average age, 62 years; range, 39 to 81 years) who underwent surgery in the years 2001 to 2011. The average follow-up was 76 months. The patients were examined neurologically, radiologically, by magnetic resonance imaging (MRI) or CT. All of them had quadruparetic disability and showed signs of myelopathy on MRI examination. We used a modified Hirabayashi technique of open-door laminoplasty. We evaluated the surgery time, intra-operative blood loss, neurological deficit on the modified Japanese Orthopaedic Society (mJOA) scale, intra- and postoperative complications, neck pain (NP) and extremity pain (EP) on the visual analogue scale (VAS) and a radiographic sagittal profile change after laminoplasty. RESULTS The average operative time was 117 minutes and the average intra-operative blood loss was 330 ml. The average mJOA score of 12.7 before surgery improved to 14.4. Two patients (2.25 %) showed persisting deterioration of neurological symptoms, conditions of six patients (6.75 %) were assessed as stable and the remaining 81 patients (91 %) showed varying degrees of both subjective and objective amelioration/improvement. Infection was recorded as the most frequent complication (7.8 %). C5 paresis reported in the literature did not occur in our group. One patient (1.1 %) had a moderate epidural haemorrhage. The pre-operative VAS NP score of 5.4 improved to 3.2 and the VAS EP score of 7.7 improved to 4.4. The average value for the radiographic sagittal profile changed from -18.2 pre-operatively to -16.5 post-operatively. CONCLUSIONS Laminoplasty remains the basic surgical option for CSM treatment, particularly in progressive cases of the disease, in multi-segmental disease, and in need to preserve or restore cervical spine alignment Key words: cervical spondylotic myelopathy, laminoplasty, Hirabayashi open-door technique, mJOA score, complications, VAS.

[Quality of life in the patients treated for degenerative lumbar spinal stenosis: a three-year follow-up study]. / Kvalita zivota u pacientu po operaci degenerativní spinální stenózy bederní pátere po 3 letech sledování.

PURPOSE OF THE STUDY: The aim of the study was to evaluate the quality of life in patients treated for degenerative lumbar spinal stenosis at 3 years of follow-up. MATERIAL AND METHODS: Between October 2005 and 2008, answers to Oswestry, quality-of-life (SF-36) and VAS questionnaires were obtained from 117 patients indicated for lumbar spine surgery due to spinal stenosis. There were 52 men and 65 women, with an average age of 62 years. For future evaluation, the patients were placed into three groups according to the surgical treatment used: simple decompression with posterolateral fusion using autograft (69 patients); decompression and instrumented posterior fusion completed with autograft (21 patients); decompression and posterior dynamic stabilisation using the Dynesys system (27 patients). The patients were asked to respond to the three questionnaires again at 6, 12, 24 and 36 months of follow-up and to rate their willingness to undergo the surgery again on a 1-to-5 scale (from definitely yes to definitely no). RESULTS: In all three groups, the Oswestry disability index (ODI) significantly improved from the average pre-operative value of 53 to 39 post-operatively. This remained constant at 12 months (ODI 38), 24 months (ODI 38) and 36 months (ODI 37) after surgery. The SF-36 questionnaire also showed significant improvements in both categories covering components of physical and mental health. The VAS-based assessment of satisfaction with life and back and leg pain, however, did not provide such convincing results. The marking of satisfaction with surgery outcome was 1-2 in 71 % of the patients, and "only" 9.5 % of them would have never undergone the surgery again (marked 5). The L4-L5 segment was the most frequently treated region, and monosegmental decompression with fusion was the technique used most often. DISCUSSION: Our results are in agreement with the data reported in the national and international literature, including the number of patients studied and the results obtained from the Oswestry and SF-36 questionnaires. The assessment of life satisfaction using the VAS score has not been found in the literature. Our VAS back pain and leg pain scores slightly differed from the literature data, since no significant improvement in them was recorded. In assessing the patient's quality of life after lumbar spinal surgery, it is necessary to take into consideration also co-morbidities and external factors. CONCLUSIONS The results presented here show that lumbar spine surgery results in a significant improvement of life quality and has an irreplaceable role in the treatment of patients with degenerative spinal disease. However, three-year results do not provide enough evidence of the real stabilisation of patients' health state and thus the follow-up study is to be continued.