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1.
J Orthop Surg (Hong Kong) ; 28(3): 2309499020975213, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33355038

RESUMO

PURPOSE: The study aimed to develop an evidence-based expert consensus statement on diagnosis and treatment of cervical ossification posterior longitudinal ligament (OPLL). METHOD: Delphi method was used to perform such survey, and the panel members from Asia Pacific Spine Society (APSS) 2020 were invited to answer the open-ended questions in rounds 1 and 2. Then the results were summarized and developed into a Likert-style questionnaire for voting in round 3, and the level of agreement was defined as 80%. In the whole process, we conducted a systematic literature search on evidence for each statement. RESULTS: Cervical OPLL can cause various degrees of neurological symptoms, an it's thought to be more common in Asia population. CT reconstruction is an important imaging examination to assist diagnosis and guide surgical choice. Segmental, continuous, mixed, and focal type is the most widely used classification system. The non-surgical treatment is recommended for patients with no or mild clinical symptoms, or irreversible neurological damage, or failed surgical decompression, or condition cannot tolerant surgery, or refusing surgery. As OPLL may continue to develop gradually, surgical treatment would be considered in their course inevitably. The surgical choice should depend on various conditions, such as involved levels, thickness, and type of OPLL, skill-experiences of surgeons, which are listed and discussed in the article. CONCLUSION: In this statement, we describe the clinical features, classifications, and diagnostic criteria of cervical OPLL, and review various surgical methods (such as their indications, complications), and provide a guideline on their choice strategy.

2.
Macromol Biosci ; : e2000336, 2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33346401

RESUMO

Bone defects remains a challenge for surgeons. Bone graft scaffold can fill the defect and enhance the bone regeneration. Demineralized bone matrix (DBM) is an allogeneic bone graft substitute, which can only be used as a filling material rather than a structural bone graft. Coating of the scaffolds with nanoscale DBM may enhance the osteoinductivity or osteoconductivity. Herein the lyophilization method is presented to coat the nano-DBM on surface of the porous polycaprolactone (PCL)/ß-tricalcium phosphate (ß-TCP) scaffolds fabricated by 3D printing technology. The morphology, elastic modulus, in vitro cell biocompatibility, and in vivo performance are investigated. Scanning electron microscope (SEM) shows DBM particle clusters with size of 200-500 nm are observed on scaffolds fibers after coating. MC3T3-E1 cells on nano-DBM coated PCL/ß-TCP scaffold show better activity than on PCL/ß-TCP scaffold. In vivo tests show better infiltration of new bone tissue in nano-DBM coated PCL/ß-TCP scaffold than PCL/ß-TCP scaffold via the interface. These results show the presence of nano-DBM coating on PCL/ß-TCP scaffold could enhance the attachment, proliferation, and viability of cells and benefit for the new bone formation surrounding and deep inside the scaffolds. Nano-DBM could potentially be used as a new kind of biomaterial for bone defect treatment.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32776174

RESUMO

PURPOSE: To systematically review the clinical manifestations and treatment outcomes of patients with subaxial cervical spinal tuberculosis (SCS-TB) and evaluate the current evidence for surgical or nonsurgical treatment. METHOD: A systematic review was performed using the PubMed, ScienceDirect, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies published in English from January 2000 to December 2018 were included in the search. A reference lists search of relevant articles was also conducted for other potential references. The risk of bias was assessed with the 13-item criteria recommended by the Cochrane Back and Neck Group and the Methodological Index for Non-Randomized Studies. RESULTS: Fifteen articles were included with a total of 456 patients, of which only 1 study was randomized and fourteen were nonrandomized. The most common symptom reported was neck pain and stiffness, and the most common segment involved was C5. Of the 456 patients, 329 (72.1%) were treated surgically. Most experienced neurologic recovery after surgery. Instrumentation resulted in maintenance of the correction of alignment throughout the follow-up period. The use of radical debridement is still in debate. CONCLUSIONS: Anti-TB therapy is necessary for all SCS-TB patients, including those underwent surgical management. For patients with neurological dysfunction, the surgical method with decompression and instrumentation could provide better cervical spinal alignment and stability. For adult, the radical debridement remains in debate, while for children, radical debridement may cause the development of progressive kyphosis during growth. Larger randomized comparative studies with longer follow-up times are needed.

4.
Mol Med Rep ; 22(2): 1119-1128, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32626952

RESUMO

The Indian hedgehog (IHH) signaling pathway is an important pathway for bone growth and development. The aim of the present study was to examine the role of the IHH signaling pathway in the development of the ossification of ligamentum flavum (OLF) at the cellular and tissue levels. The expression levels and localization of the osteogenic genes Runt-related transcription factor 2 (RUNX2), Osterix, alkaline phosphatase (ALP), osteocalcin (OCN) and IHH were evaluated in OLF tissues by reverse transcription-quantitative PCR (RT-qPCR) and immunohistochemistry. Non-ossified ligamentum flavum (LF) sections were used as control samples. The tissue explant method was used to obtain cultured LF cells. In addition, OLF cells were subjected to cyclic stretch application for 0, 6, 12 or 24 h. The expression levels of osteogenic genes, and the IHH signaling pathway genes IHH, Smoothened (SMO), GLI family zinc finger 1 (GLI1), GLI2 and GLI3 were evaluated with RT-qPCR and western blotting. Osteogenic differentiation was further evaluated by assessing ALP activity and staining. Moreover, the effect of cyclopamine (Cpn), an IHH signaling inhibitor, on osteogenic differentiation was examined. The RT-qPCR and immunohistochemical results indicated that the mRNA and protein expression levels of RUNX2, Osterix, ALP, OCN and IHH were significantly higher in the OLF group compared with the LF group. Furthermore, application of cyclic stretch to OLF cells resulted in greater ALP activity, and significant increases in mRNA and protein expression levels of RUNX2, Osterix, ALP and OCN in a time-d00ependent manner. Cyclic stretch application also led to significant increases in IHH signaling pathway genes, including IHH, SMO, GLI1 and GLI2, while no significant effect was found on GLI3 expression level. In addition, it was found that Cpn significantly reversed the effect of cyclic stretch on the ALP activity, and the expression levels of RUNX2, Osterix, ALP, OCN, GLI1 and GLI2. Collectively, the present results suggested that the IHH signaling pathway may mediate the effect of cyclic stretch on the OLF cells.

5.
Spine (Phila Pa 1976) ; 45(19): 1320-1328, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32355140

RESUMO

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study was to investigate the prevalence of ossification of posterior longitudinal ligament (OPLL) in patients with degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: OPLL of the cervical spine is one of the main entities of DCM in Asian populations. However, few studies have reported the prevalence of cervical OPLL in DCM patients. METHODS: A total of 7210 DCM patients (4546 males and 2664 females; mean age: 54 years) who underwent cervical spine three-dimensional computed tomography (3D-CT) at the Shanghai Changzheng Hospital between January 2012 and December 2016 were included in this study. Demographic data including age, sex, height, body weight, body mass index (BMI), concomitant diabetes mellitus (DM), and hypertension were recorded. The imaging diagnosis criterion for OPLL was thickness >2 mm on axial imaging. RESULTS: The overall prevalence of OPLL in the 7210 DCM patients was 18.22%, including 19.73% in males and 15.65% in females, with a significant difference between the two groups (P < 0.001). The prevalence of OPLL in DM and hypertensive patients was significantly higher than that in non-DM and normotensive patients (24.16% vs. 18.76% and 22.26% vs. 17.91%, both P < 0.001). Comparison by age and BMI showed that the prevalence of OPLL was the highest in the 70- to 79-year age group (21.91%) and obesity group (26.51%), respectively. CONCLUSION: This CT-based study revealed that the overall prevalence of OPLL in DCM patients was 18.22%. Furthermore, old age, male sex, comorbid hypertension or DM, and high BMI were risk factors for cervical OPLL. Given its high prevalence, CT examination is suggested to identify possible OPLL in DCM patients. LEVEL OF EVIDENCE: 2.

6.
Theranostics ; 10(9): 4042-4055, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226538

RESUMO

Rationale: Bone is the most frequent site for breast cancer metastasis, which accounts for the leading cause of death in advanced breast cancer patients. Serious skeletal-related events (SREs) caused by bone metastasis have a decisive impact on the life expectancy of breast cancer patients, making breast cancer almost incurable. Metastatic breast cancer cell induced pathological osteoclastogenesis is a key driver of bone metastasis and osteolytic bone lesions. We previously reported that gold clusters can prevent inflammation induced osteoclastogenesis and osteolysis in vivo. In this study, we investigated the effects of a BSA-coated gold cluster on metastatic breast cancer-induced osteoclastogenesis in vitro and tumor-induced osteolysis in vivo, and elucidated its possible mechanism. Methods: Breast cancer cell line MDA-MB-231 was used to evaluate the regulatory effects of gold clusters on breast cancer metastasis and tumor induced osteoclastogenesis in vitro. Cell counting kit-8, transwell, wound-healing and colony formation assays were performed to evaluate the effect of gold clusters on proliferation and metastasis of MDA-MB-231 cells. Tartrate-resistant acid phosphatase (TRAP) staining and filamentous-actin rings analysis were used to detect the regulatory effects of gold clusters on MDA-MB-231 cell-conditioned medium (MDA-MB-231 CM) triggered and receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis in mouse bone marrow-derived mononuclear cells (BMMs). A mouse model of breast cancer bone metastasis was used to evaluate the in vivo activity of the gold cluster on the tumor induced osteolysis. Results: The gold clusters suppressed the migration, invasion and colony formation of MDA-MB-231 cells in a dose-dependent manner in vitro. The gold clusters strongly inhibited both MDA-MB-231 CM triggered and RANKL-induced osteoclast formation from BMMs in vitro. Cell studies indicated that the gold clusters suppressed the expression of osteolysis-related factors in MDA-MB-231 cells and inhibited the subsequent activation of NF-κB pathway in BMMs. Treatment with the clusters at a dose of 10 mg Au/kg.bw significantly reduces the breast cancer cell induced osteolysis in vivo. Conclusion: Therefore, the gold clusters may offer new therapeutic agents for preventing breast cancer bone metastasis and secondary osteolysis to improve patient outcomes.

7.
Spine (Phila Pa 1976) ; 45(11): 741-746, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31923132

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To determine the optimal open side in unilateral open-door laminoplasty (UODL) for lateral cervical ossification of posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: No literature has reported which side of the vertebral arch should be chosen as the open side in UODL for lateral cervical OPLL. METHODS: Patients with lateral cervical OPLL who were treated with UODL between 2013 and 2018 were retrospectively analyzed in two groups: Group A, where the open side was contralateral to the ectopic bone, and Group B, where the open side was ipsilateral to the ectopic bone. The Japanese Orthopaedic Association (JOA) Score, JOA recovery rate, spinal canal enlargement rate, cervical range of motion (ROM), and spinal cord area (SCA) were measured to evaluate and compare the clinical outcomes between the two groups. Statistical analysis was performed by t test and Hotelling T2 test. RESULTS: There was no significant difference in patient demographics and major complications between the two groups. The postoperative JOA Score and JOA recovery rate in Group A were significantly higher than those in Group B. There was no significant difference in cervical ROM within or between the two groups during the 2-year follow-up period, nor was there significant difference in spinal canal enlargement between the two groups. However, both postoperative SCA and increased SCA in Group A were significantly higher than those in Group B. CONCLUSION: The contralateral open side approach is preferable to the ipsilateral open side approach in UODL for lateral cervical OPLL. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
Calcif Tissue Int ; 105(6): 670-680, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31511959

RESUMO

Long non-coding RNAs (lncRNAs) play an important role in the development of bone-related diseases. This study was conducted to investigate the role and mechanism of lncRNA X inactive specific transcript (XIST) in the occurrence of cervical ossification of the posterior longitudinal ligament (OPLL). Here, primary human ligament fibroblasts cells (LFCs) were isolated from 30 cases of OPLL and 30 normal cervical posterior longitudinal ligament (non-OPLL) tissues to perform the qPCR and Western blot assay. We found that the mRNA level of lncRNA XIST was significantly increased in OPLL LFCs compared to non-OPLL LFCs. By bioinformatics analysis, we found that lncRNA XIST has four binding sites for miR-17-5p and found that the mRNA level of miR-17-5p was also significantly decreased in OPLL LFCs compared to non-OPLL LFCs. Since AHNAK is the target gene of miR-17-5p, we further found that the expression of AHNAK was significantly reduced in non-OPLL LFCs after being transfected with miR-17-5p mimic. The qPCR results showed that the mRNA expressions of BMP2 and Runx2 were significantly decreased. After being transfected with lncRNA XIST siRNA in the non-OPLL LFCs, the mRNA levels of lncRNA XIST, AHNAK, BMP2, and Runx2 were significantly decreased and the phosphorylated protein of Smad1/5/8 was reduced. After being cultured by mechanical vibration, the mRNA levels of lncRNA XIST, AHNAK, BMP2, Runx2, COL1, OC, OPN, and Phospho1 were significantly increased, but the mRNA expression of miR-17-5p was significantly decreased. The expression of phosphorylated Smad1/5/8 protein was also significantly increased. Together, this study was the first to determine that XIST gene inhibition plays an important role in the occurrence of cervical OPLL, through the mechanism of regulation of miR-17-5P/AHNAK/BMP2 signaling pathway. Thus, XIST may be a potential target that could be modulated for the treatment of cervical OPLL.


Assuntos
Ligamentos Longitudinais , MicroRNAs/genética , Osteogênese/genética , RNA Longo não Codificante/genética , Adulto , Proteína Morfogenética Óssea 2/genética , Proliferação de Células/genética , Feminino , Fibroblastos/metabolismo , Humanos , Masculino , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Proteínas de Neoplasias/genética , Ossificação do Ligamento Longitudinal Posterior/genética , Proteínas Recombinantes/genética , Transdução de Sinais/genética , Transdução de Sinais/fisiologia , Fator de Crescimento Transformador beta/genética
9.
World Neurosurg ; 119: e686-e693, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30092465

RESUMO

OBJECTIVES: Dizziness often happens in patients with chronic neck pain with only cervical disc degeneration but without cervical radiculopathy or myelopathy. We prospectively selected a series of patients who showed cervical disc degeneration with concomitant chronic neck pain and intractable dizziness who did not respond to conservative treatment to test a new diagnostic method for this dizziness, to analyze the results of anterior cervical discectomy and fusion (ACDF) surgery based on the test, and to explore its pathogenesis. METHODS: Seventy-seven patients who had a transient neck pain and dizziness relief after injection of bupivacaine into a suspected disc were included in the study. In total, 52 underwent ACDF as surgery group, and 25 refused surgery and accepted conservative treatments as conservative group from June, 2015 to October, 2016 with subsequent follow-up to 1 year. The outcomes were visual analogue scale for neck pain, Neck Disability Index, and intensity and frequency of dizziness. During ACDF, the 72 specimens of degenerative cervical discs were collected to determine the innervation in degenerative cervical discs immunohistochemically. RESULTS: After surgery, the patients experienced a significant reduction in neck pain and dizziness. Symptomatic relief in surgery group was obviously better than conservative group at each time point of follow-up (P = 0.001). Ruffini corpuscles and substance P-positive free nerve fibers were obviously increased in the number and deeply ingrown into the inner degenerative cervical discs. CONCLUSIONS: Current clinical and immunohistochemical studies strongly suggest that chronic neck pain and intractable dizziness in this series of patients stem from the degenerative cervical discs.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Tontura/etiologia , Degeneração do Disco Intervertebral/complicações , Cervicalgia/etiologia , Fusão Vertebral/métodos , Adolescente , Adulto , Idoso , Avaliação da Deficiência , Tontura/patologia , Tontura/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Degeneração do Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/patologia , Cervicalgia/cirurgia , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento , Adulto Jovem
10.
J Orthop Surg Res ; 13(1): 215, 2018 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-30157879

RESUMO

BACKGROUND: Cervical ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. Posterior decompression surgery is reported to be an effective and comparatively safe procedure with few complications for treatment of patients with myelopathy caused by OPLL. However, some patients require revision surgery because of late neurological deterioration due to OPLL progression or kyphotic changes in cervical alignment. This study reports preliminary clinical results of anterior controllable antidisplacement and fusion (ACAF), a novel revision surgery after initial posterior surgery for OPLL. METHODS: From January 2017 to June 2018, ten patients with cervical OPLL who underwent ACAF revision surgery after initial posterior surgery were included in this study. The mean age was 62.1 ± 8.0 years (52-78), and the mean interval between initial posterior surgery and revision was 78.0 ± 48.2 months (5-180). The Japanese Orthopaedic Association (JOA) scales, Neck Disability Index (NDI), visual analog scale (VAS), and surgical complications were recorded. RESULTS: The mean surgery time was 179.3 ± 41.8 min (120-240), and the mean blood loss was 432.5 ± 198.3 ml (225-850). The patients were followed up for at least 12 months. The JOA scores improved from 8.7 ± 2.8 to 13.4 ± 2.4; the mean improvement rate was 59.9% ± 16.1%. Postoperative NDI and VAS scores were 13.3 ± 3.7 and 2.0 ± 1.6, respectively, and were significantly improved compared to those before the procedure (P < 0.05). Cervical lordosis improved from 3.8 ± 4.3° to 17 ± 4.6° after revision surgery. There was only one instance of cerebrospinal fluid (CSF) leakage; no instances of postoperative hematoma, C5 root palsy, or hoarseness occurred. CONCLUSIONS: The present study demonstrates that excellent postoperative outcomes can be achieved with the ACAF technique for revision treatment of OPLL. Though further study is required to confirm the conclusion, this novel technique has the potential to serve as an alternative surgical technique for revision treatment of OPLL.


Assuntos
Ossificação do Ligamento Longitudinal Posterior , Reoperação , Idoso , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Estudos Retrospectivos , Resultado do Tratamento
11.
Am J Transl Res ; 10(5): 1457-1468, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29887959

RESUMO

Osteoporosis is a common disease associated with age and menopausal status. Postmenopausal osteoporosis is the most common type of primary osteoporosis and is accompanied by increased risk of osteoporotic fracture. Natural and herbal compounds have long been used to prevent and treat many human diseases. Here, we demonstrated that tanshinone IIA prevented ovariectomy-induced bone loss in an in vivo mouse model that closely mimics osteoporosis. In addition, we found that tanshinone IIA inhibited the receptor activator of nuclear factor NF-κB ligand (RANKL)-induced osteoclast differentiation and osteoclastogenesis in vitro. Tanshinone IIA treatment also abrogated RANKL-induced activation of the NF-κB pathway, PI3-kinase/Akt signaling, and the mitogen-activated protein kinase (MAPK) pathways, including nuclear translocation of NF-κB p65 and phosphorylation of IκB, extracellular signal-regulated kinase (ERK), p38, and Akt. Inactivation of these pathways resulted in deceased expression of osteoclastogenesis-related markers. These results suggest that tanshinone IIA, a natural drug, has the potential to treat and prevent bone loss diseases, including postmenopausal osteoporosis.

12.
World Neurosurg ; 116: e929-e933, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29852300

RESUMO

OBJECTIVE: To investigate the incidence, distribution characteristics, and radiographic features of the ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the nuchal ligament (ONL) and to analyze the correlation between the location of ONL and degree of ossification in patients with cervical OPLL. METHODS: From January 2010 to December 2016, the clinical data of 217 patients with cervical OPLL were reviewed retrospectively. Type and location of OPLL and ONL were determined on computed tomography images and lateral radiograph films. For patients with the local type of ONL, the segment with the largest spinal canal occupation ratio (COR) of OPLL was determined on cross-sectional computed tomography slices. The correlation between the location of ONL and segment with the largest COR of OPLL was evaluated. RESULTS: Of the 217 patients with cervical OPLL, 118 patients (54.4%) had OPLL combined with ONL (92 male and 26 female patients). The incidence of ONL was almost 1.4 times greater in males than in female patients (P = 0.03). C5-C6 (49.5%) was the segment at which ONL occurred most. Of 60 patients with the local type of ONL, 34 patients' ONL was located at the segment with largest COR of OPLL. The matching ratio was the largest (77.8%) when the type of OPLL was locally circumscribed (P = 0.003). CONCLUSIONS: The incidence of ONL was 54.4% in patients with cervical OPLL, and male patients were affected more than female patients. ONL occurred most in segment C5-C6. The location of local-type ONL commonly corresponded to the segment with the largest COR of OPLL when type of OPLL was circumscribed.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Imagem por Ressonância Magnética/métodos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Ligamentos Longitudinais/diagnóstico por imagem , Ligamentos Longitudinais/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
World Neurosurg ; 115: e172-e177, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29649650

RESUMO

BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) is a 3-dimensional (3D) disease that causes cervical myelopathy. The conventional 2-dimensional (2D) measurement of OPLL has limitations in estimating cord compression and myelopathy. In this study, we attempted to use 3D computed tomography (CT) and magnetic resonance imaging (MRI) to measure the 3D occupying ratio of OPLL and investigate its significance in the assessment of spinal cord myelopathy. METHODS: Three-dimensional CT and MRI were performed in 50 patients with cervical OPLL at a neutral position before surgery. MRI was done to determine the extent of spinal cord compression. The CT data were saved in DICOM format and analyzed using Mimics 17.0. Then a 3D model of OPLL was semiautomatically segmented at a specific threshold. The following data were measured: diameter of the spinal canal, thickness of the OPLL, and 3D volume of the OPLL and spinal canal. The Japanese Orthopedic Association (JOA) score was used to assess the cervical spinal cord function. RESULTS: Pearson correlation analysis showed that both the occupying ratio and the 3D occupying ratio were significantly and negatively correlated with the JOA score. Multiple linear regression analysis indicated that only the 3D occupying ratio showed a significantly negative correlation with the JOA score, whereas age, sex, and the occupying ratio were insignificantly associated with the JOA score. CONCLUSIONS: The 3D occupying ratio of OPLL is a reliable indicator for assessing the severity of spinal cord myelopathy. MRI provides more details about cord compression, making the measurement more accurate and objective.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Imageamento Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Vértebras Cervicais/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Medula Espinal/cirurgia
14.
Int J Surg ; 54(Pt A): 124-128, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29409935

RESUMO

BACKGROUND: Cervical radiculopathy is a common disease that affects millions of people. Patients usually are managed by conservative therapy and surgical treatments. OBJECTIVE: To compare the clinical outcomes between cervical disc arthroplasty (CDA) and conservative management for patients with single level cervical radiculopathy at C5/6. METHODS: Seventy-two patients with cervical radiculopathy that only affect C5/6 joints were included and thirty-two of them received CDA surgery, and forty patients were treated with conservative management. All the patients were followed up around 4 years. Cervical curvature, cervical range of motion (CROM), horizontal displacement of cervical spine, and intervertebral gap were measured by radiological examination. RESULTS: All the patients have comparable disease severity based on pre-surgical radiological assessments. At the 4-year follow-up examination, patients with CDA surgery had less CROM at C5/6 level, while greater CROM at C4/5 level, than control group. Similarly, the horizontal displacement in CDA group decreased at C5/6 vertebrae, and increased at C4/5 level at the 4-year follow-up examination. The intervertebral gaps of patients in CDA group were larger than control group at one-year and last follow-up examination. CONCLUSION: CDA surgery stabilized C5/6 vertebrae and increased the CROM and horizontal displacement of upper adjacent C4/5 vertebrae.


Assuntos
Artroplastia/estatística & dados numéricos , Vértebras Cervicais/cirurgia , Tratamento Conservador/estatística & dados numéricos , Radiculopatia/cirurgia , Adulto , Artroplastia/métodos , Vértebras Cervicais/diagnóstico por imagem , Tratamento Conservador/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Radiculopatia/diagnóstico por imagem , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
15.
World Neurosurg ; 110: e1025-e1030, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29229351

RESUMO

OBJECTIVE: The degree of hypertrophy of thoracic ossification of ligamentum flavum (TOLF) is related to the severity of the myelopathy. There is no uniform measuring method to calculate the spinal canal occupation ratio (COR) of TOLF simply and effectively. The study was to determine an appropriate measuring method to calculate the COR of TOLF. METHODS: A total of 37 computed tomography cross-sectional imaging scans (bone window) from 22 patients were analyzed retrospectively in this study. The ventral side of the lamina or superior facet was selected as bottom in Method 1, and a line perpendicular to the anteroposterior diameter and on the dorsal side of the spinal canal was selected as bottom in Method 2. The maximum thickness of the bilateral ossified mass to the bottom is d1 and d2. The maximum distance from the anterior wall of the spinal canal to the bottom is d. COR of Method 1 or 2 was (d1 + d2)/2d × 100%. Standard COR values calculated by software served as controls. RESULTS: The standard COR values were <50% in 10 images, 51%-60% in 9 images, 61%-70% in 10 images, and >71% in 8 images. There was no significant difference between COR1 and COR in every range. There were significant differences between COR2 and COR in the ≤50%, 51%-60%, and 61%-70% groups but they were not statistically significant in the >70% group. CONCLUSIONS: Method 1 is a convenient and practical method to measure the COR of ossification in patients with TOLF.


Assuntos
Ligamento Amarelo/patologia , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Canal Vertebral/diagnóstico por imagem , Vértebras Torácicas/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Pesos e Medidas
16.
Oncotarget ; 8(52): 90176-90184, 2017 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-29163819

RESUMO

Aims: To explicit cell apoptosis trend in PC12 oxygen-glucose-serum deprivation/restoration (OGSD/R) model and provide experimental bases for neural cell simulation in ischemia reperfusion injury in vitro. Methods: OGSD/R model was constructed using the passage PC12 cells in vitro. The profile of cell apoptosis was estimated by DAPI staining, Annexin V-FITC and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay, as well as the levels of apoptosis-related proteins, including procaspase-3 and caspase-12. Results: PC12 apoptosis was induced by OGSD and aggravated after restoration. CCK8 assay indicated that cell activity reached minimum after 1h of oxygen-glucose-serum restoration (OGR). DAPI staining suggested that apoptosis was the most serious after 1h of OGR, causing apoptotic cell nucleus pyknosis, particle spot formation, and fracture of cells with serious apoptosis forming pieces, and nucleus disintegration. The percentage of apoptotic cells exhibited increased trend after restoration, and reached the highest at 1h of OGR. Moreover, the expression of procaspase-3 and caspase-12 were extremely enhanced after OGD, especially 1h after OGR. Conclusions: PC12 apoptosis is induced by OGSD and aggravated after restoration. The apoptosis of PC12 reaches the highest at 1h after OGR, which may provide experimental bases for spinal cord ischemia reperfusion injury treatment.

17.
Medicine (Baltimore) ; 96(27): e7432, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28682906

RESUMO

The aim of the article is to investigate the efficacy and safety of 1-stage surgical therapy via combined anterior-posterior approach on cervical spine fracture in patients with ankylosing spondylitis (AS).We retrospectively analyzed profiles of 12 AS patients with severe fracture-dislocation of cervical spine received 1-stage combined anterior-posterior surgery in our hospital from October, 2013, to October, 2015, including clinical characteristics, follow-up data, and imaging records. We compared the parameters before and after surgery on the basis of neurological function, bone fusion, Cobb angles of operation segment, Barthel index (BI) score, and incidence rate of complications.A total of 12 patients received 1-stage surgery via combined anterior-posterior approach within 3 days after injury. No severe complications and death occurred. All patients received the successfully anatomical reduction of fracture-dislocation, in which 9 achieved function restoration. The latest follow-up showed the neurological function status of patients was improved. The Cobb angles of operation segments were recovered; the rate of bone fusion was 66.7% at 3 months and 100% at 6 months post-operation. The BI score was improved, 4 cases of moderate dependence and 8 of slight dependence at the latest follow-up compared to 10 of severe dependence and 2 of moderate dependence preoperation. In no cases did severe complications from implanted instrumentation occur.It was high efficacy and safety that the surgical therapy was performed on cervical fracture-dislocation in AS patients by the 1-stage combined anterior-posterior approach. The key of the surgery is the robust stabilization and full decompression of fracture spine at early stage. In addition, if spinal anatomical reduction of fracture segments is difficult to be achieved, the functional restoration should be adopted during the surgery.


Assuntos
Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Procedimentos Ortopédicos , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Resultado do Tratamento
18.
J Orthop Surg Res ; 12(1): 105, 2017 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-28693540

RESUMO

BACKGROUND: The objectives of this study are to investigate the clinical curative effect of Gallie technique and atlantoaxial screw-rod constructs (SRC) on atlantoaxial sagittal instability and determine the indication of Gallie technique. METHODS: Data of 49 patients with atlantoaxial sagittal instability from February 2008 to May 2015 were analyzed retrospectively. The visual analog scale (VAS) score and the neck disability index (NDI) were used to evaluate the curative effect. Postoperative radiological outcomes were used to evaluate the stability of atlantoaxial joint and bone fusion. Perioperative parameters such as blood loss, operation time, radiographic exposure times, and hospital expense were also recorded and analyzed. RESULTS: Forty-nine patients (36 men and 13 women) were included in this study. The mean age was 41.4 ± 8.9 (range from 19 to 64). All patients were followed up for 24-67 months. Among these patients, 25 of these patients underwent Gallie surgery and 24 underwent SRC surgery. The pain in the occipitocervical area of all the patients has been relieved. NDI scores and VAS scores were lower in Gallie group than in SRC group in early postoperative period. The proportion of the patients who achieved good bone fusion within 3 months after operation was 88.0% (22/25) in the Gallie group and 100% (24/24) in the SRC group. The Gallie group is lower than the SRC group in blood loss, operation time, radiographic exposure times, and hospital expense. Statistical difference was observed between the two groups. CONCLUSIONS: For patients with atlantoaxial instability who has (1) the atlantodental interval (ADI) which is bigger than 5 mm on lateral flexion-extension X-ray, or Anderson-D'Alonzo type II odontoid fracture, (2) no asymmetry between odontoid process and lateral mass on open-mouth anterior-posterior X-ray, and (3) no dislocation of lateral mass joint on the CT 3D reconstruction, Gallie technique can be chosen as a safe and effective method if atlantoaxial reduction can be achieved preoperatively. Compared with SRC, Gallie technique can relieve the pain in the occipitocervical area earlier and it can shorten operation time and reduce intraoperative bleeding, radiographic exposure times, and hospital expense effectively. However, for patients with irreducible atlantoaxial dislocation, the Gallie technique should be used with caution.


Assuntos
Articulação Atlantoaxial/cirurgia , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Adolescente , Adulto , Articulação Atlantoaxial/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Sci Rep ; 7(1): 2983, 2017 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-28592849

RESUMO

Thoracic ossification of the ligamentum flavum (TOLF) complicated with dural ossification (DO) is a severe clinical disease. The diagnosis of DO preoperatively remains challenging. The current study retrospectively analyzed imaging features of 102 segments with TOLF from 39 patients and proposed a grading system for evaluating DO risk. Logistic regression results showed that unilateral spinal canal occupational rate (UCOR), tram track signs, and C-signs were all risk factors for DO (odds ratios of 5.393, 19.734 and 72.594, respectively). In validation analyses for the TOLF-DO grading system, sensitivity was 76.0% (19/25), specificity was 91.0% (70/77), and Youden's index was 0.66. Thus, implementation of the TOLF-DO grading system has the potential to improve the diagnosis of DO.


Assuntos
Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/patologia , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/patologia , Feminino , Humanos , Masculino , Razão de Chances , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
20.
Sci Rep ; 7(1): 3440, 2017 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-28611362

RESUMO

Surface-modified metal implants incorporating different ions have been employed in the biomedical field as bioactive dental implants with good osseointegration properties. However, the molecular mechanism through which surface coatings exert the biological activity is not fully understood, and the effects have been difficult to achieve, especially in the osteopenic bone. In this study, We examined the effect of zinc-modified calcium silicate coatings with two different Zn contents to induce osteogenic differentiation of rat bone marrow-derived pericytes (BM-PCs) and osteogenetic efficiency in ovariectomised rabbits. Ti-6Al-4V with zinc-modified calcium silicate coatings not only enhanced proliferation but also promoted osteogenic differentiation and mineralized matrix deposition of rat BM-PCs as the zinc content and culture time increased in vitro. The associated molecular mechanisms were investigated by Q-PCR and Western blotting, revealing that TGF-ß/Smad signaling pathway plays a direct and significant role in regulating BM-PCs osteoblastic differentiation on Zn-modified coatings. Furthermore, in vivo results that revealed Zn-modified calcium silicate coatings significantly promoted new bone formation around the implant surface in osteopenic rabbits as the Zn content and exposure time increased. Therefore, Zn-modified calcium silicate coatings can improve implant osseointegration in the condition of osteopenia, which may be beneficial for patients suffering from osteoporosis-related fractures.


Assuntos
Doenças Ósseas Metabólicas/terapia , Materiais Revestidos Biocompatíveis/farmacologia , Osseointegração , Osteogênese , Animais , Compostos de Cálcio/química , Diferenciação Celular , Células Cultivadas , Materiais Revestidos Biocompatíveis/química , Materiais Revestidos Biocompatíveis/uso terapêutico , Feminino , Pericitos/citologia , Pericitos/efeitos dos fármacos , Pericitos/metabolismo , Coelhos , Transdução de Sinais , Silicatos/química , Proteínas Smad/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Zinco/química
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