Efficacy and safety of perioperative use of non-steroidal anti-inflammatory drugs for preemptive analgesia in lumbar spine surgery: a systematic review and meta-analysis.

OBJECTIVE: Lumbar spine disorders have become an increasingly common health problem in recent years. Modern clinical studies have shown that perioperative analgesia at certain doses can reduce postoperative pain by inhibiting the process of peripheral sensitization and central sensitization, which is also known as "preemptive analgesia," Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs that achieve antipyretic and analgesic effects by inhibiting cyclooxygenase (COX) and affecting the production of prostaglandins. Our meta-analysis aimed to assess the efficacy and safety of perioperative preemptive analgesia with non-steroidal anti-inflammatory drugs in patients with lumbar spine surgery. METHODS: We searched PubMed, ScienceDirect, the Cochrane Library, and the Web of Science for randomized controlled trials (RCTs) that met the inclusion criteria. A total of 12 clinical studies were included to assess the efficacy and safety of perioperative NSAIDs preemptive analgesia for lumbar spine surgery. RESULT: Twelve studies, including 845 patients, met the inclusion criteria. The results showed that perioperative receipt of NSAIDs for preemptive analgesia was effective and safe. Patient's postoperative morphine consumption (P < 0.05), visual analog scale (P < 0.05), and numerical rating scale (P < 0.05) were not statistically associated with postoperative complications (P > 0.05). CONCLUSION: Our findings suggest that NSAIDs are effective and safe for preemptive analgesia in the perioperative period of lumbar spine surgery and that more and better quality RCTs and more in-depth studies of pain mechanics are still needed.

[Neuroprotective effect and mechanism of cPLA2 inhibitor increases autophagic flux on spinal cord injury].

OBJECTIVE: To investigate the mechanism of cytosolic phospholipase A2(cPLA2) inhibitor to improve neurological function after spinal cord injury (SCI). METHODS: Thirty-six 3 months old female SD rats, with body mass (280±20) g, were divided into three groups (n=12):sham group, SCI group, and SCI+ arachidonyl trifluoromethyl ketone(AACOCF3) group. Balloon compression SCI model was established in all three groups. In the sham model group, the spinal cord compression model was created after the balloon was placed without pressure treatment, and the remaining two groups were pressurized with the balloon for 48 h. After successful modeling, rats in the SCI+AACOCF3 group were injected intraperitoneally with AACOCF3, a specific inhibitor of cPLA2. The remaining two groups of rats were injected intraperitoneally with saline. The animals were sacrificed in batches on 7 and 14 days after modeling, respectively. And the damaged spinal cord tissues were sampled for pathomorphological observation, to detect the expression of cPLA2 and various autophagic fluxPrelated molecules and test the recovery of motor function. RESULTS: Spinal cord histomorphometry examination showed that the spinal cord tissue in the sham group was structurally intact, with normal numbers and morphology of neurons and glial cells. In the SCI group, spinal cord tissue fractures with large and prominent spinal cord cavities were seen. In the SCI+AACOCF3 group, the spinal cord tissue was more intact than in the SCI group, with more fused spinal cord cavities, more surviving neurons, and less glial cell hyperplasia. Western blot showed that the sham group had the lowest protein expression of LC3-Ⅱ, Beclin 1, p62, and cPLA2 compared with the SCI and SCI+AACOCF3 groups (P<0.05) and the highest protein expression of LC3-Ⅰ (P<0.05). P62 and cPLA2 expression in the SCI group were higher than in the SCI+AACOCF3 group (P<0.05). Behavioral observations showed that the time corresponding to BBB exercise scores was significantly lower in both the SCI and SCI+AACOCF3 groups than in the sham group (P<0.05). Scores at 3, 7, and 14 days after pressurization were higher in the SCI+AACOCF3 group than in the SCI group (P<0.05). CONCLUSION: cPLA2 inhibitors can reduce neuronal damage secondary to SCI, promote neurological recovery and improve motor function by improving lysosomal membrane permeability and regulating autophagic flux.

Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.

Posterior hybrid surgery for atlantoaxial dislocation coexisting with multilevel cervical spondylotic myelopathy.

Background: To introduce a hybrid surgery of posterior craniovertebral fusion plus subaxial laminoplasty for atlantoaxial dislocation (AAD) coexisting with multilevel cervical spondylotic myelopathy (CSM). Methods: A retrospective study was performed by reviewing data from 23 patients with the coexistence of AAD and CSM who underwent the hybrid technique (n = 23). Clinical outcomes, including visual analogue scale (VAS), Japanese Orthopaedic Association (JOA), and neck disability index (NDI) score, and radiological cervical alignment parameters including C0-2 and C2-7 Cobb angle and range of motion (ROM) were analyzed. The operation time, blood loss, surgical levels, and complications were recorded. Results: The included patients were followed up with an average of 20.91 months (range, 12-36 months). Clinical outcomes including JOA, NDI, and VAS scores were significantly improved at different postoperative follow-up points. C0-2 Cobb angle, C2-7 Cobb angle, and ROM showed a stable tendency after 1-year follow-up. No major perioperative complications occurred. Conclusion: This study underlined the importance of pathologic condition of AAD coexisting with CSM and presented a novel hybrid approach of posterior craniovertebral fusion plus subaxial laminoplasty. This hybrid surgery was effective in achieving the desired clinical outcomes and better maintaining cervical alignment, proving its value and safety as an alternative technique.

Is coronal imbalance in degenerative lumbar scoliosis patients associated with the number of degenerated discs? A retrospective imaging cross-sectional study.

BACKGROUND: Degenerative lumbar scoliosis (DLS) is a common degenerative disease of the spine, that predominates in the elderly, and causes spinal deformities along with severe pain and reduced quality of life. The relationship between DLS and degenerated discs is now a new direction of research. Our study aimed to the relationship between the imaging parameters of coronal imbalance and the number of degenerated discs in patients with degenerative lumbar scoliosis and analyzed the segmental distribution of the degenerated discs in patients with DLS. METHODS: We performed a retrospective analysis of the imaging of 40 patients who met the inclusion criteria who attended our outpatient clinic between April 2021 and July 2021, measuring the intervertebral space height of the AV (high side and low side), Cobb angle, and AVT (Apical vertebral translation) from coronal X-ray. Degenerated discs were evaluated by the Pfirrmann score based on T2-weighted magnetic resonance images. We record the number of degenerated discs (Graded as Grade III, Grade IV or Grade V by the Pfirrmann score) and the segments in which they are located. Finally, we explore the relationship between the imaging parameters of coronal imbalance and the number of degenerated discs in patients with DLS. RESULT: Among the 40 patients with DLS in our study, all patients had degenerated discs in the lumbar spine, 95% of patients had degenerated discs(Pfirrmann score Grade III, Grade IV or Grade V) in 2 or more segments, with the L4-L5 segment being the most involved segment with the most degenerated discs, followed by the L3-L4 segment and the L5-S1 segment. There was no statistically significant relationship between the number of degenerated discs and the coronal imbalance in patients with DLS. CONCLUSION: Our results showed an association between DLS and degenerated discs, but there was no statistically significant relationship between imbalance in the coronal plane of the lumbar spine and the number of degenerated discs in patients with DLS. The distribution of degenerated disc segments in patients with DLS showed a higher likelihood of disc degeneration in 2 or more segments, and a higher frequency of disc degeneration in the inferior disc and in the adjacent segments of the AV.

Halo-pelvic traction in the treatment of severe scoliosis: a meta-analysis.

PURPOSE: To provide better evidence of the efficacy and safety of preoperative halo-pelvic traction on the improvements of deformity and pulmonary functions in patients with severe scoliosis. METHODS: Electronic database searches were conducted including the Cochrane Library, PubMed, Web of Science and Embase. All studies of halo-pelvic traction for the management of severe spinal deformity were included. We referred to a list of four criteria developed by the Agency for Healthcare Research and Quality (AHRQ) to assess the quality of included studies. The meta-analysis was performed using RevMan 5.4 software. RESULTS: Based on the study selection criteria, a total of eight articles consisting of a total of 210 patients were included. Statistically significant differences were found in coronal Cobb angle (P < 0.001), sagittal Cobb angle (P < 0.001) and height (P < 0.001) between pre- and post-traction. Sensitivity analysis was conducted, and there were substantial changes in heterogeneity with preoperative thoracoplasty subgroup in coronal Cobb angle (P < 0.001). Three trials including 74 subjects reported FVC and FEV1 predicted value between pre- and post-traction. There were statistically significant differences in FVC, FVC%, FEV1 and FEV1% (P < 0.001). The complication rate was 6.6-26.7%, and symptoms disappeared after reasonable traction strategy and intensive care. CONCLUSIONS: Preoperative halo-pelvic traction achieved significant improvements in spinal deformity and pulmonary functions, with minor and curable complications. Thus, it is an effective and safe solution before surgery and may be the optimal choice for severe scoliosis. In light of the heterogeneity and limitations, future researches are needed to better determine the long-term efficacy on comprehensive assessment and to explore the appropriate traction system.

Spinal Manual Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: We conducted this meta-analysis to provide better evidence of the efficacy of manual therapy (MT) on adolescent idiopathic scoliosis (AIS). Methods: All RCTs of MT for the management of patients with AIS were included in the present study. The treatment difference between the experimental and control group was mainly MT. The outcomes consisted of the total effective rate, the Cobb angle, and Scoliosis Research Society-22 (SRS-22) questionnaire score. Electronic database searches were conducted from database inception to July 2022, including the Cochrane Library, PubMed, Web of Science, Embase, Wanfang Data, CNKI, and VIP. The pooled data were analyzed using RevMan 5.4 software. Results: Four RCTs with 213 patients in the experimental group were finally included. There are 2 studies of standalone MT in the experimental group and 3 studies of MT with identical conservative treatments in the control group. Three trials reported total effective rate, and a statistically significant difference was found (P = 0.004). Three trials reported Cobb angle, and a statistical difference was found (P = 0.01). Then, sensitivity analysis showed that there was a significant difference in the additional MT subgroup (P < 0.00001) while not in the standalone MT subgroup (P = 0.41). Three trials reported SRS-22 scores (P = 0.55) without significant differences. Conclusion: There is insufficient data to determine the effectiveness of spinal manipulation limited by the very low quality of included studies. High-quality studies with appropriate design and follow-up periods are warranted to determine if MT may be beneficial as an adjunct therapy for AIS. Currently, there is no evidence to support spinal manipulation.

[Research progress of causes and strategies in revision surgery for atlantoaxial dislocation].

Atlantoaxial dislocation (AAD) is a kind of life-threatening atlantoaxial structural instability and a series of neurological dysfunction caused by common multidisciplinary diseases. The operation risk is extremely high because it is adjacent to the medulla oblongata and the location is deep. With the increase of the number of operations in the upper cervical region, postoperative complications such as failure of internal fixation, non fusion of bone graft and poor prognosis gradually increase.Incomplete primary operation, non fusion of bone graft, infection and congenital malformation are the potential causes. In addition, considering the objective factors such as previous graft, scar formation and anatomical marks changes, revision surgery is further difficult. However, there is currently no standard or single effective revision surgery method. Simple anterior surgery is an ideal choice in theory, but it has high risk and high empirical requirements for the operator;simple posterior surgery has some defects, such as insufficient reduction and decompression;anterior decompression combined with posterior fixation fusion is a more reasonable surgical procedure, but many problems such as posterior structural integrity and multilevel fusion need to be considered.This article reviews the causes and strategies of AAD revision surgery.

Occipitocervical Revision Surgery Using the Bicortical Screw and Plate System for Failed Craniovertebral Junction Stabilization.

BACKGROUND: To evaluate the clinical efficacy and safety of the modified technique utilizing the occipital bicortical screws and plate system in occipitocervical revision surgery. METHODS: Between October 2010 and May 2018, 12 consecutive patients were retrospectively evaluated. All patients had posterior occipitocervical resurgery utilizing modified technique of bicortical screws and occipital plate. The measurements of extracranial occiput on midline were conducted on computed tomography (CT) scans. The thickness of the occipital bone at the location of external occipital protuberance and below 15 mm were evaluated, respectively. For the procedure, the trajectory was drilled perpendicular to the external occipital protuberance for the specified depth with a depth-limited drilling, 2 mm away from the internal bone plate, then the trajectory was deepened at intervals of 1 mm each time until reaching the internal bone plate. Meanwhile, a probe was used to explore all the walls of the trajectory. Bicortical screws were inserted to the occipital plate and the depth of penetration was less than 2 mm from the internal bone plate. Clinical efficacy and radiographic evaluation were followed up. RESULTS: The thickest point was the external occipital protuberance, which was 15.49 ± 1.47 mm and decreased gradually on the midline to 13.41 ± 1.60 mm at below 15 mm. Twelve cases (mean age 41.17 years; range, 24-62 years), including five males and seven females, were followed up for 24.08 months (14-32 months). The interval time was 40.42 months (3-156 months) after the initial operation. At the final follow-up, JOA score increased from 8.58 ± 2.53 before surgery to 12.67 ± 1.84 (P < 0.05) and VAS score improved from 6.17 ± 1.21 to 2.08 ± 1.32 (P < 0.05). Besides, clinical symptoms were relieved in all patients after revision surgery. All patients had rigid internal fixations with bone fusion and no major complications occurred. CONCLUSIONS: Posterior occipitocervical plate-screw system with bicortical screws had the advantages of safety, simple and promising efficacy without excessive tissue release or intraspinal manipulation, proving that it's valuable as a modified technique for occipitocervical revision surgery.

The retropharyngeal steroid use during operation on the fusion rate and dysphagia after ACDF? A systematic review and meta-analysis.

PURPOSE: The aim of this meta-analysis was to investigate the effects of retropharyngeal steroid use during operation on bony fusion and dysphagia rate after ACDF. METHODS: We searched the electronic literature database of PubMed, Embase and the Cochrane Library published from January 1990 to February 2020. The size of each group, mean age, proportion of female patients, dysphagia events and fusion rate at one-year follow-up were extracted. RevMan 5.3 was used for the meta-analysis. RESULTS: A total of eight studies including six RCTs and two case-control studies met the inclusion criteria. This meta-analysis showed that retropharyngeal steroids could achieve significantly lower dysphagia rates (p < 0.001), higher fusion rates (p = 0.01), less moderate and severe events rates according to the Bazaz stratification (p < 0.001). However, there was no significant difference between two groups regarding operation time (p = 0.67), blood loss (p = 0.33), VAS scores at one day (p = 0.90) and VAS scores at two weeks (p = 0.80). CONCLUSIONS: Retropharyngeal steroid use is an effective method in reducing dysphagia rate, severe dysphagia rate and increasing fusion rate during ACDF surgery, without increasing operating time, blood loss or VAS scores at one day and two weeks. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Short-term posterior C1-C2 pedicle screw fixation without fusion to treat type II odontoid fracture among people under 60 years.

INTRODUCTION: Posterior C1-C2 pedicle screw fixation is a reliable technique used in treatment of type II odontoid fracture. However, the loss of cervical range of rotation motion (RORM) was inevitable. There were few studies focusing on the influence of short-term C1-C2 fixation with nonfusion technique to preserve cervical function in patients younger than 60 years. The purpose of this study was to compare cervical RORM which was measured by an improved goniometer, and the clinical outcomes between short-term and long-term C1-C2 fixation techniques in the treatment of Grauer type 2B and 2C odontoid fracture. MATERIALS AND METHODS: This study represents a retrospective analysis, including patients who underwent primary C1-C2 fixation surgery. These patients were divided into short-term and long-term groups based on whether underwent a fixation removal operation. The clinical results were collected and compared between the two groups. Independent T test and Chi-square analyses were used to identify significant differences between the two groups and dependent T test was used within each group. Statistical significance was set at p < .05. RESULTS: There were no severe postoperative complications, and all 60 patients achieved spinal stabilization after primary surgery. The mean rotation angle in the short-term group at last follow-up time was 138.39 ± 21.06°, which was better than 83.59 ± 13.06° in the long-term group (p < .05). The same statistical difference was observed in flexion-extension angle, which was 71.11 ± 18.73° in short-term group and 53.34 ± 18.23° in long-term group. The mean NDI score in short-term group at last follow-up time was 1.23 ± 0.86 and better than 8.24 ± 3.17 in long-term group. However, the VAS score in short-term group was 1.82 ± 0.54 which was worse compared to 0.64 ± 0.29 in long-term group. CONCLUSIONS: The results demonstrated that primary C1-C2 fixation with nonfusion technique could support satisfactory clinical effects. In addition, the removal of instruments after bony fusion could improve the function of cervical movement significantly in patients under 60 years.

[Function of NOD-like receptor protein 1 inflammasome in traumatic central nervous system injury].

NOD-like receptor protein 1 (NLRP1) inflammasome plays an important role in the innate immune response of human body. It can promote the activation of cysteinyl aspartate specific proteinases(Caspases), further activate interleukin-18 and interleukin-1 ß, and mediate pyroptosis. NlRP1 inflammasome plays a role in traumatic central nervous system injury. In this study, the structure of NLRP1 inflammasome, the activation of NLRP1 inflammasome in traumatic central nervous system injury and the treatment with NLRP1 inflammasome as a target are reviewed.

Phosphoglycerate kinase 1 silencing by a novel microRNA microRNA-4523 protects human osteoblasts from dexamethasone through activation of Nrf2 signaling cascade.

Nuclear-factor-E2-related factor 2 (Nrf2) cascade activation can ameliorate dexamethasone (DEX)-induced oxidative injury and death in human osteoblasts. Phosphoglycerate kinase 1 (PGK1) depletion is shown to efficiently activate Nrf2 signaling by inducing methylglyoxal modification of Kelch-like ECH-associated protein 1 (Keap1). We here identified a novel PGK1-targeting microRNA: microRNA-4523 (miR-4523). RNA fluorescent in situ hybridization, RNA pull-down, and Argonaute-2 RNA immunoprecipitation results confirmed a direct binding between miR-4523 and PGK1 mRNA in primary human osteoblasts and hFOB1.19 osteoblastic cells. Forced overexpression of miR-4523, using a lentiviral construct, robustly decreased PGK1 3'-UTR (untranslated region) luciferase activity and downregulated its expression in human osteoblasts and hFOB1.19 cells. Furthermore, miR-4523 overexpression activated the Nrf2 signaling cascade, causing Keap1-Nrf2 disassociation, Nrf2 protein stabilization, and its nuclear translocation as well as transcription activation of Nrf2-dependent genes (NQO1, GCLC, and HO1) in human osteoblasts. By expressing a UTR-null PGK1 construct, miR-4523 overexpression-induced Nrf2 cascade activation was however largely inhibited. Importantly, DEX-induced reactive oxygen species production, oxidative injury, and cell apoptosis were significantly attenuated by miR-4523 overexpression in human osteoblasts and hFOB1.19 cells. Such actions by miR-4523 were abolished by Nrf2 shRNA or knockout, but mimicked by PGK1 knockout (using CRISPR/Cas9 method). In PGK1 knockout human osteoblasts, miR-4523 overexpression failed to further increase Nrf2 cascade activation and offer osteoblast cytoprotection against DEX. Significantly, miR-4523 is downregulated in human necrotic femoral head tissues of DEX-taking patients. Together, PGK1 silencing by miR-4523 protected human osteoblasts from DEX through activation of the Nrf2 signaling cascade.

Comparative Effectiveness of Minimally Invasive Nonsurgical Treatments for Plantar Fasciitis: A Network Meta-analysis of 30 Randomized Controlled Trials.

BACKGROUND: Several minimally invasive nonsurgical treatments have been widely applied for plantar fasciitis (PF). To date, controversy still exists regarding the effectiveness of these approaches for treating PF. OBJECTIVE: The purpose of this study was to perform a comprehensive comparison of the currently available invasive nonsurgical treatments for PF regarding short- and mid-term reductions in pain using a network meta-analysis (NMA). STUDY DESIGN: NMA of randomized controlled trials (RCTs) for minimally invasive nonsurgical treatments of PF. METHODS: The EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible studies. Patients were adults age >= 18 years with PF. The outcome measures were the visual analog scale (VAS) scores at 3-6 weeks and 4-6 months. Pairwise meta-analysis and NMA based on a Bayesian analysis were performed, and all potential comparisons and rank of probabilities were calculated. RESULTS: Thirty RCTs were included in the NMA. The trials investigated 20 treatments or combined treatments, including autologous whole blood, botulinum toxin A (BTA), ultrasound-guided gastrocnemius injection of botulinum toxin (BTA in the gastrocnemius), corticosteroid (CS), miniscalpel-needle (MSN), placebo, platelet-rich plasma (PRP), and the ultrasound-guided technique and peppering technique (PEP). The MSN treatment may be the best choice. LIMITATIONS: Some treatments were investigated in only one study or at one follow-up period and were separated from the network at 4-6 months. Other limitations include the inconformity of the treatment schedule and dose. CONCLUSIONS: The MSN treatment should be recommended as the best therapy, followed by BTA in the gastrocnemius and BTA. CS and PRP are common medications that remain valuable in clinical practice. PEP can be performed after the injection of medication.

A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration.

PURPOSE: Revision surgery for adjacent segment degeneration (ASD) commonly requires exposing and removing the original fixation. To minimize trauma and to reduce the operation time and blood loss, we introduced a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional (3D)-printed navigation templates. METHODS: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All surgical data, including the operation time, blood loss, and incision length, were recorded. We evaluated the clinical efficacy using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and computed tomography (CT) scans were used to evaluate the stability of CBT screw fixation, the accuracy of screws, and the fusion rate. RESULTS: The mean follow-up was 22.4±4.7 months (12-31 months). The VAS, ODI, and JOA scores were analyzed by SPSS 21.0 and showed significant improvement at 2 weeks and the last follow-up compared with preoperative data (P<0.05). Seventy-six CBT screws were inserted with navigation templates; 2 screws were Grade B, and the other screws were Grade 0 or A. Changes in intervertebral height showed good stability of CBT screw fixation (P>0.05). All the patients exhibited satisfactory fusion results. CONCLUSION: Revision surgery for ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with the advantages of a short operation time, a small incision, and less blood loss.

The ratio of the posterior atlanto-occipital interval (PAOI): a novel radiographic ratio method evaluating the risk of cervical spondylotic myelopathy-a case-control study.

BACKGROUND: Our study aims to introduce a dynamic interval ratio method calculated using cervical hyperextension-flexion X-ray films. Secondarily, we aim to evaluate the relationship between the posterior atlanto-occipital interval ratio and cervical spondylotic myelopathy and explain the rationale. METHODS: We reviewed 83 cases with visible cervical dynamic X-ray films in our hospital from February 2015 to December 2018. Cases were divided into 2 groups according to their diagnosis (with or without spondylotic myelopathy). Radiographic measurements included the shortest distance between the posterior arch of the atlas and the occipital bone and cervical range of motion, and demographic data such as gender, age, and body mass index were also extracted. The posterior atlanto-occipital interval ratio (distance at hyperextension position/distance at hyperflexion position) was determined using logistic regression analysis models between the 2 groups. RESULTS: We included 40 cases in the disease group and 43 cases in the control group. The mean posterior atlanto-occipital interval ratio was 0.65±0.30 (mean ± standard deviation) in the disease group and 0.30±0.28 in the control group, with a significant difference (P<0.01). There was no correlation between the posterior atlanto-occipital interval ratio and gender or body mass index. However, the interval ratio had strong correlations with age, cervical spondylotic myelopathy, and Japanese Orthopaedic Association scores. Age, posterior atlanto-occipital interval ratio, and interval distance at hyperextension in the disease group were higher than those of the control group. Contrastingly, range of motion, Japanese Orthopaedic Association scores, and interval distance at the disease group's hyperflexion position were lower than in the control group. In all cases, the risk of cervical spondylotic myelopathy in the T2 group (cases with middle posterior atlanto-occipital interval ratio, according to the tertiles) was 6 times more than the T1 group (cases with lower ratio), and the T3 group (cases with higher ratio) had a 26.4 times greater risk than the T1 group. CONCLUSIONS: Our results suggest that the posterior atlanto-occipital interval ratio is a simple and meaningful parameter that could provide prognostic value for the risk of cervical spondylotic myelopathy through the imaging examinations of the selected cases. Higher posterior atlanto-occipital interval ratios indicate a greater risk for cervical spondylotic myelopathy and cervical musculoskeletal dysfunction. A higher posterior atlanto-occipital interval ratio may manifest undetected posterior atlanto-occipital stiffness, which needs more pathological evidence in future studies.

Prognostic Factors and a Nomogram Predicting Overall Survival in Patients with Limb Chondrosarcomas: A Population-Based Study.

INTRODUCTION: We aimed to develop and validate a nomogram for predicting the overall survival of patients with limb chondrosarcomas. METHODS: The Surveillance, Epidemiology, and End Results (SEER) program database was used to identify patients diagnosed with chondrosarcomas, from which data was extracted from 18 registries in the United States between 1973 and 2016. A total of 813 patients were selected from the database. Univariate and multivariate analyses were performed using Cox proportional hazards regression models on the training group to identify independent prognostic factors and construct a nomogram to predict the 3- and 5-year survival probability of patients with limb chondrosarcomas. The predictive values were compared using concordance indexes (C-indexes) and calibration plots. RESULTS: All 813 patients were randomly divided into a training group (n = 572) and a validation group (n = 241). After univariate and multivariate Cox regression, a nomogram was constructed based on a new model containing the predictive variables of age, site, grade, tumor size, histology, stage, and use of surgery, radiotherapy, or chemotherapy. The prediction model provided excellent C-indexes (0.86 and 0.77 in the training and validation groups, respectively). The good discrimination and calibration of the nomograms were demonstrated for both the training and validation groups. CONCLUSIONS: The nomograms precisely and individually predict the overall survival of patients with limb chondrosarcomas and could assist personalized prognostic evaluation and individualized clinical decision-making.

Clinical Efficacy and Safety of Zoledronic Acid Combined with PVP/PKP in the Treatment of Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: We conducted this meta-analysis to provide better evidence of the efficacy and safety of zoledronic acid (ZA) combined with percutaneous vertebroplasty/kyphoplasty (PVP/PKP) on osteoporotic vertebral compression fracture (OVCF) and proposed a protocol for its application in clinical practice. METHODS: All randomized controlled trials (RCTs) of ZA combined with PVP or PKP compared to individual PVP/PKP for the management of patients with OVCFs were included in this study. Electronic database searches were conducted from database inception to November 2020, including the Cochrane Library, PubMed, Web of Science, and Embase. The pooled data were analyzed using RevMan 5.3 software. RESULTS: Seven RCTs with 929 subjects were finally included. All included studies reported visual analog scores (VAS), and no statistically significant differences were identified at follow-ups of 3 d and 1 w (P > 0.05). In contrast, significant differences were observed at the 1 mo, 3 mo, 6 mo, and 12 mo follow-ups (P < 0.05). Two trials reported the Cobb angle and vertebral body height (VBH), including 182 subjects without significant differences at the 12 mo follow-up (P > 0.05). In addition, significant differences in the bone mineral density (BMD), ß-isomerized C-terminal telopeptide of type I collagen (ß-CTX), N-terminal propeptide of type I collagen (PINP), and N-terminal molecular fragment (N-MID) levels were observed between the two groups (P < 0.05). All trials reported side effects. Significant differences in recurrent fractures, fever, flu-like symptoms, and arthralgia or myalgia were identified (P < 0.05); however, no significant difference in postoperative leakage was detected (P > 0.05). CONCLUSION: Compared to PVP/PKP alone, an additional ZA injection had advantages of long-term analgesic effects with improved bone metabolism indexes. Moreover, combination therapy significantly prevented complications and drug reactions were well tolerated. Overall, this systematic review revealed that ZA combined with PVP/PKP was an effective, safe, and comprehensive therapy for patients with OVCFs.

Personality Traits Affect the Cost-Effectiveness of Total Knee Arthroplasty.

OBJECTIVE: To assess the clinical benefit and compare the cost-effectiveness of total knee arthroplasty (TKA) in patients with different personality traits. METHODS: The present study was retrospectively conducted from January 2017 to May 2018. A total of 232 patients between 46 and 71 years old who underwent unilateral, primary TKA with the diagnosis of knee osteoarthritis were interviewed. Three types of data were required to compare the cost-effectiveness differences among groups: personality traits, postoperative clinical outcomes about health-related quality of life, and costs associated with TKA. Personality was assessed using the Eysenck Personality Questionnaire, functional outcome was assessed through the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, and costs were evaluated. Besides, the marginal cost-effectiveness ratio (MCER) as the primary outcome, which relates the direct costs to the associated patient benefit as assessed by the clinical endpoint ($/quality-adjusted life years [QALY]), was compared among different personality traits. All information for this study was acquired by directly interviewing the patients and reviewing the medical computer records at our hospital. RESULTS: Two hundred and eleven patients completed the final analysis with an average of 24.6 months follow-up postoperatively. The choleric group, sanguine group, melancholic group, and phlegmatic group has 41, 70, 46, and 54 patients, respectively. A statistically significant difference in MECR, QALYs, and postoperative WOMAC existed among different personality traits (all P < 0.05). There was no significant difference in mean age (P = 0.588), body mass index (BMI) (P = 0.790), smoking (P = 0.934), heavy drinking (P = 0.994), chronic comorbidities (all P > 0.05), preoperative albumin <3.5 g/dL (P = 0.991), and American Society of Anaesthesiologists (ASA) score (P = 0.687) among personality traits. More women tend to be melancholic in comparison to other personality traits (P = 0.016). Melancholic patients attested inferiority of TKA compared with other personality traits, who would pay for the same QALYs at the highest costs (P < 0.05). By contrast, sanguine patients have a more cost-effective TKA than other personality traits, as they pay the least money for the same QALYs (P < 0.05). Although phlegmatic and choleric patients seemingly have moderate gains from TKA, in general, the extroversion (measured by the extroversion subscale) and stability (measured by the neuroticism subscale) displayed more pleasurable QALYs in comparison with introversion and instability (P < 0.05). Sensitivity analysis showed that the results mentioned above appeared not to be sensitive when varying key parameters (prosthesis survival and life expectancy) in a one-way sensitivity analysis. Sanguine and melancholic patients still have the lowest and highest MCER in comparison with choleric and phlegmatic traits (P < 0.05). The multivariate logistic regression showed that RA (adjusted OR = 1.3, 95% CI = 1.2-1.4, P < 0.01), ASA Class I-II (adjusted OR = 0.9, 95% CI = 0.8-1.0, P < 0.001), sanguine (adjusted OR = 0.8, 95% CI = 0.7-0.9, P < 0.001) and melancholic (adjusted OR = 1.2, 95% CI = 1.1-1.3, P < 0.001) were significantly associated with MCER. CONCLUSIONS: Before surgery, screening the melancholic patients would significantly reduce the economic burden, avoid unnecessary suffering, and shorten the recovery period.