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1.
Ann Palliat Med ; 10(10): 10450-10458, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763491

RESUMO

BACKGROUND: Cerebrospinal fluid leakage (CSFL) is one of the most common complications after posterior transarticular osteotomy and circumferential decompression (CD) for the ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Predicting CSFL preoperatively would be of great value to surgeons. The aim of this study was to discover the factors that can predict CSFL prior to CD and incorporate them into a predictive model. METHODS: Sixty-one patients with OPLL who underwent posterior transarticular osteotomy and CD at Peking University International Hospital were divided into a CSFL group and a non-CSFL group. Univariate analysis was used to identify possible predictors. A multivariate logistic regression model was developed to predict the probability of CSFL. Model validation was performed using a receiver operating characteristic (ROC) curve. RESULTS: CSFL occurred in 31.1% of patients. Univariate regression analysis showed statistical differences (P<0.05) in smoking history, segment of CD, whether OPLL was combined with the ossification of the ligamentum flavum (OLF), number of laminectomies, occupying ratio, and OPLL base ratio. Our multivariate regression model showed that CSFL predictors included smoking history [odds ratio (OR) =30.1; P=0.003], the upper thoracic segment (OR =188.0; P=0.002), the middle thoracic segment (OR =57.4; P=0.005), and the OPLL base ratio (OR =1.3; P=0.007). The ROC curve was in the upper left corner [area under the curve =0.955, 95% confidence interval (CI): 0.91-1.00; P<0.001], indicating the model had good predictability. CONCLUSIONS: The predictive model shows that if patients with thoracic OPLL have a history of smoking, or the segment of CD is in the upper or middle thoracic spine, or the OPLL has a wide base, The possibility for postoperative CSFL occurring is higher. Using these factors, a surgeon can preoperatively warn patients of the probability of CSFL occurring after posterior transarticular osteotomy and CD.


Assuntos
Ligamentos Longitudinais , Ossificação do Ligamento Longitudinal Posterior , Vazamento de Líquido Cefalorraquidiano , Descompressão Cirúrgica , Humanos , Ligamentos Longitudinais/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Osteogênese , Vértebras Torácicas/cirurgia , Resultado do Tratamento
2.
Front Surg ; 8: 750047, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34778362

RESUMO

Background: Emerging knowledge has highlighted the role of matrix metalloproteinase (MMP)-13 in osteoarthritis (OA); however, the suitability of MMP-13 as a biomarker for OA remains unclear. Therefore, this study aimed to assess the potential value of MMP-13 as a biomarker for OA. Methods: The study enrolled 51 patients, of which 33 had advanced varus OA and 18 did not have OA. Immunohistochemistry and western blotting analyses were performed to measure MMP-13 activity in the cartilage and subchondral bone of patients with OA. Enzyme-linked immunosorbent assay was used to measure serum MMP-13 levels in patients with or without OA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess the association between serum MMP-13 levels and clinical symptoms. Furthermore, the association between serum MMP-13 levels and radiological severity of OA was evaluated using the Kellgren-Lawrence (KL) grading system. Finally, we built the proportional odds logistic regression models to evaluate serum MMP-13 levels as a potential predictor for OA. Results: MMP-13 levels were significantly higher in the severe-worn cartilage of the medial tibial plateau than in the relatively intact portion of the lateral cartilage (p < 0.05). This was contrary to the findings for MMP-13 differential expression in the subchondral bone in knee OA (p < 0.05). Patients with OA had significantly higher serum MMP-13 levels compared with patients without OA. Additionally, remarkable associations among serum MMP-13 levels, WOMAC scores, and KL grading scores were found in the end-stage OA. Furthermore, the subsequent analysis suggested that serum MMP-13 level was a significant predictor for OA. Conclusion: MMP-13 is valuable for diagnosing, measuring disease severity, and predicting OA in the advanced period of the disease, suggesting that it has potential possibility as a biomarker for OA. However, the underlying mechanisms and clinical application of MMP-13 as a biomarker for OA require to be further investigated.

3.
Med Sci Monit ; 27: e930352, 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34424890

RESUMO

BACKGROUND Degenerative lumbar scoliosis (DLS) patients undergoing posterior long-segment spinal fusion surgery often require perioperative blood transfusions, and previous studies have reported that increased complications and additional costs accompany these transfusions. One method for decreasing transfusions is the administration of tranexamic acid (TXA). We sought to evaluate the costs and benefits of preoperative administration of 1 g of intravenous TXA, without maintenance, in DLS patients undergoing long-segment spinal fusion surgery. MATERIAL AND METHODS Patients who received TXA (TXA group) were compared with patients who did not receive TXA (NTXA group) with regard to blood loss, units of packed red blood cells (PRBC) transfused, hemostasis costs, and perioperative complications. The benefits and costs were estimated through analysis of the spending on NTXA and TXA patients, and were compared. The difference between the cost per patient in the 2 groups was designated as the net cost-benefit. Then, both groups were substratified into non-osteotomy and osteotomy subgroups for further analysis. RESULTS Of the 173 patients who met the inclusion criteria, 54 TXA patients had significantly reduced perioperative blood loss and total hemostasis costs compared with NTXA patients (n=119). In the group without osteotomy (n=72), TXA (n=13) reduced perioperative blood loss but did not significantly decrease PRBC units and hemostasis costs. However, in patients undergoing osteotomy (n=101), a remarkable net cost savings of ¥648.77 per patient was shown in the TXA group (n=41) (P<0.001). This was because patients undergoing osteotomy in the TXA group received fewer PRBC units (3.7 vs 5.7, P=0.001). CONCLUSIONS A single dose of TXA significantly decreased perioperative blood loss and total hemostasis costs for DLS patients undergoing osteotomy. Furthermore, TXA led to no additional net costs in patients without osteotomy.

4.
J Inflamm Res ; 14: 3665-3685, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34354364

RESUMO

Purpose: Ossification of the ligamentum flavum (OLF) is a multifactorial disease characterized by an insidious and debilitating process of abnormal bone formation in ligamentum tissues. However, its definite pathogenesis has not been fully elucidated. Potential links between the immune system and various forms of heterotopic ossification have been discussed for many years, whereas no research investigated the immune effects on the initiation and development of OLF. Therefore, we attempt to shed light on this issue. Methods: A series of bioinformatic algorithms were integrated to evaluate the immune score and the immunocyte infiltration patterns between OLF and normal samples, screen OLF-related and immune-related differentially expressed genes (OIDEGs), and analyze their biological functions. Correlation analysis inferred OIDEGs-related differentially expressed lncRNAs (OIDELs) and infiltrating immune cells (OIICs) to construct an immunoregulatory network. Results: Differential immune score and immune cell infiltration were determined between two groups, and 10 OIDEGs with diverse biological function annotations were identified and verified. A lncRNA-gene-immunocyte regulatory network further revealed 10 OIDEGs, 41 OIDELs and 7 OIICs that were highly correlated. Among them, CD1E and STAT3 were predicted as hub genes whether at the expression level or interaction level. cDCs emerged as having the most prominent differences and the highest degree of connectivity. FO393414.3, AC096734.1, LINC01137 and DLX6-AS1 with the greatest number of OIDEGs were thought to be more likely to participate in immunoregulation of OLF. Conclusion: This is the first research to preliminarily elucidate OLF-related immunocyte infiltration landscape and immune-associated transcriptome signatures based on bioinformatic strategies and real-world data, which may provide compelling insights into the pathogenesis and therapeutic targets of OLF.

5.
Clin Spine Surg ; 34(7): E382-E389, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397532

RESUMO

STUDY DESIGN: This was a cross-sectional study. OBJECTIVE: The objective of this study was to assess cervical paravertebral extensor degeneration in patients with cervical spondylotic myelopathy (CSM) and its impact on the sagittal parameters and functional status of the cervical spine. SUMMARY OF BACKGROUND DATA: Paravertebral extensor degeneration is well-studied in CSM; however, the effect of extensor degeneration on the sagittal balance and functional status of the cervical spine is unclear. MATERIALS AND METHODS: We enrolled 52 CSM patients (CSM group) and 52 age-matched and sex-matched healthy adults (control group). The C2-C7 and C0-C2 Cobb angles (CAs), C7 slope, T1 slope, cervical arc cord distance, cervical tilt (CERT), cranial tilt (CRAT), and C2-C7 sagittal vertical axis (SVA) were measured. The cross-sectional areas of the deep extensors (DEA), superficial extensors (SEA), and cervical vertebral body (VBA) of C4-C7 were measured. DEA/VBA and SEA/VBA were used to quantify the extensor volume. We analyzed the fatty infiltration ratio of the deep (DFIR) and superficial extensors (SFIR). The Visual Analog Scale, Neck Disability Index, and modified Japanese Orthopaedic Association Scale scores of the CSM group were calculated. RESULTS: The DEA/VBA was significantly lower and the DFIR and SFIR were significantly higher in the CSM group. The C4 DEA/VBA correlated with the C2-C7 SVA, C2-C7 CA, CERT, and the Neck Disability Index and modified Japanese Orthopaedic Association Scale scores (r=-0.608, 0.291, 0.335,-0.649, and 0.409, respectively). The DEA/VBA of C5 correlated with the cervical arc cord distance and CRAT (r=-0.350 and -0.356, respectively). The C4 DFIR correlated with the C2-C7 SVA, C2-C7 CA, and the Visual Analog Scale (r=0.286, -0.297, and 0.429, respectively). The SFIR of C7 correlated with the T1 slope and C7 slope (r=0.368 and 0.319, respectively). CONCLUSIONS: Paravertebral extensor degeneration negatively impacts the sagittal sequence and functional status of the cervical spine in CSM patients. Our study provides an insight into understanding the significance of cervical muscular degeneration in CSM patients. LEVEL OF EVIDENCE: Level III.


Assuntos
Lordose , Doenças da Medula Espinal , Adulto , Vértebras Cervicais/diagnóstico por imagem , Estudos Transversais , Estado Funcional , Humanos , Pescoço , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem
6.
Int Orthop ; 45(10): 2609-2618, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34398291

RESUMO

PURPOSE: Pseudomeningocele (PMC) is a rare complication following thoracic spinal decompression surgery. The aim of this study is to assess the clinical features and treatment of PMC and provide the technical notes with revision surgery. METHODS: Between January 2010 and December 2019, patients who developed PMC after posterior thoracic surgery were enrolled. An additional 25 patients who suffered cerebrospinal fluid leakage (CSFL) but did not develop PMC in the same period were randomly selected. General data, intra-operative factors, CSFL position, cost, modified Japanese Orthopaedic Association (mJOA) scores, patient satisfaction, and clinical features were recorded and compared between the two groups. RESULTS: Eighteen patients were diagnosed with PMC after thoracic spinal surgery. The average length, width, and depth were 16.25 ± 5.73 cm, 6.96 ± 3.61 cm and 4.39 ± 2.2 cm, respectively. The most common symptom was neurological deficits following incision problems and headache. Compared with the control group, the PMC group showed a longer duration of initial surgery, greater estimated blood loss, an increased rate of CSFL on the ventral side, reduced mJOA scores, and lower patient satisfaction at the final follow-up. CONCLUSION: PMC is a rare complication of thoracic surgery with an incidence of 1.12%. PMC typically occurs at the upper and lower thoracic spine, resulting in increased health care costs, poorer neurological recovery, and a lower rate of patient satisfaction. The management of PMC should be individualized depending on diagnosis time and symptoms.


Assuntos
Descompressão Cirúrgica , Vértebras Torácicas , Humanos , Incidência , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
7.
Aging (Albany NY) ; 13(13): 17302-17315, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226298

RESUMO

The molecular mechanism of bone metastasis in breast cancer is largely unknown. Herein, we aimed to identify the key genes and long non-coding RNAs (lncRNAs) related to the bone metastasis of breast cancer using a bioinformatics approach. We screened differentially expressed genes and lncRNAs between normal breast and breast cancer bone metastasis samples using the GSE66206 dataset from the Gene Expression Omnibus. We also constructed a differentially expressed lncRNA-mRNA interaction network and analyzed the node degrees to identify the driving genes. After finding potential pathogenic modules of breast cancer bone metastasis, we identified breast cancer bone metastasis-related modules and functional enrichment analysis of the genes and lncRNAs in the modules. Based on the above analysis, we constructed a differentially expressed lncRNA-mRNA network related to bone metastasis in breast cancer and identified core driver genes, including BNIP3 and the lncRNA RP11-317-J19.1. The role of core driver genes and lncRNAs in the network implies their biological functions in regulating bone development and remodeling. Thus, targeting the core driver genes and lncRNAs in the network may be a promising therapeutic strategy to manage bone metastasis.


Assuntos
Neoplasias Ósseas/genética , Neoplasias Ósseas/secundário , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Biologia Computacional , Regulação Neoplásica da Expressão Gênica/genética , Genes Neoplásicos/genética , RNA Longo não Codificante/genética , Desenvolvimento Ósseo/genética , Remodelação Óssea/genética , Bases de Dados Genéticas , Feminino , Perfilação da Expressão Gênica , Redes Reguladoras de Genes/genética , Humanos , Proteínas de Membrana/genética , Proteínas Proto-Oncogênicas/genética
8.
Geriatr Orthop Surg Rehabil ; 12: 21514593211029104, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34290899

RESUMO

Purpose: To analyze the relationships between coronal and sagittal spinopelvic parameters in degenerative lumbar kyphoscoliosis (DLKS). Methods: We enrolled 75 patients with DLKS for a radiographic study between January 2016 and September 2018. Correlations between coronal and sagittal spinopelvic radiographic parameters were analyzed. Then patients were divided into 2 groups: sagittal balanced group (SVA< = 5 cm, 30 patients) and sagittal imbalanced group (SVA >5 cm, 45 patients), and relevant parameters were compared. Results: The Cobb angle and lumbar lordosis of the DLKS patients were 24.87 ± 11.59° and 17.26 ± 12.24°, respectively. The average age was 68 years old (range: 42-82), and the sex ratio was 2.6:1 (female: 54 patients; male: 21 patients). 50 patients (66.7%) located convexity of the curve at left side, while 25 patients (33.3%) at right side. The Cobb angle correlated with LL-TK (r = -0.228, p = 0.049), LL (r = -0.255, p = 0.027) and SS (r = -0.232, p = 0.045). There were significant differences in PI-LL (t = -3.484, P = 0.001), LL-TK (t = 2.354, P = 0.023), PI (t = -3201, P = 0.002) and PT (t = -2.521, P = 0.014) between sagittal balanced and imbalanced group. Conclusions: In degenerative lumbar kyphoscoliosis, there are some correlations between coronal and sagittal spinopelvic parameters. Moreover, PI-LL, LL-TK, PI, PT were significantly different between sagittal balanced and imbalanced DLKS patients.

9.
World Neurosurg ; 154: e529-e535, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34314912

RESUMO

BACKGROUND: Discontinuous thoracic ossification of the ligamentum flavum (TOLF) is diagnosed according to the number and distribution of involved segments seen on magnetic resonance images. When TOLF causes thoracic myelopathy, surgical intervention for these lesions becomes unavoidable. However, there are few reports on the outcomes of surgery for discontinuous TOLF. METHODS: The study included 26 patients of mean age 55.0 years who underwent simultaneous (n = 16) or staged (n = 10) decompression of discontinuous TOLF between July 2006 and June 2016. Final neurologic status was evaluated using the modified Japanese Orthopaedic Association (JOA) score. The surgical data and incidence of complications were compared. The mean follow-up duration was 73.3 months. RESULTS: There was no between-group difference in number of levels decompressed or the amount of intraoperative blood loss. There was a significant improvement in the JOA score from 4.0 before surgery to 8.0 postoperatively, with an average recovery rate of 58.3%. The JOA recovery rate was significantly better in the staged group than simultaneous group (68.4% vs. 52.0%, P < 0.05). However, the incidence of complications was similar between the staged and simultaneous groups including for dural tear (1 vs. 6, P = 0.19), cerebrospinal fluid leak (4 vs. 6, P = 1.00), and transient neurologic deterioration (0 vs. 2, P = 0.51). CONCLUSIONS: The surgical outcome of staged decompression for discontinuous TOLF seems to be better than that of simultaneous decompression. The complication rates of these 2 strategies are similar.

10.
Eur Spine J ; 30(10): 2782-2790, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34287704

RESUMO

PURPOSE: Genetic factors play a crucial role in thoracic ossification of the ligamentum flavum (TOLF). This study aimed to better understand the association between single nucleotide polymorphisms (SNP) in functional regions of the collagen VI, alpha 1 gene (COL6A1) and TOLF, and to confirm COL6A1 as a TOLF susceptibility gene. METHODS: Ten tag SNPs in COL6A1 were genotyped using the SNaPshot assay, and allele and genotype frequencies were compared between TOLF patients and control individuals. The function of SNPs associated with disease was studied. For COL6A1 promoter SNPs, the transcriptional activity of each haplotype was determined by luciferase reporter assays. For COL6A1 exonic SNPs, the effect of nucleotide substitutions on COL6A1 expression was determined by western blotting. COL6A1 mRNA expression in ligamentum flavum tissues from TOLF patients with different genotypes was examined using reverse transcription real-time PCR. RESULTS: Four SNPs were associated or possibly associated with TOLF, with higher pathogenic allele and genotype frequencies seen in TOLF patients compared with controls. The rs17551710/rs7671-GG/GG genotype appeared to be related to disease severity. Nucleotide substitutions at rs17551710 and rs7671 increased COL6A1 transcriptional activity and nucleotide substitutions at rs1053312 and rs13051496 increased COL6A1 protein expression. COL6A1 mRNA expression was significantly up-regulated in individuals with rs17551710/rs7671-GG/GG and rs1053312/rs13051496-AA+AG/CC genotypes compared with other genotypes. CONCLUSION: SNPs in the COL6A1 promoter and exonic regions are associated with TOLF in the Chinese Han population, and lead to up-regulated COL6A1 expression. We confirmed COL6A1 as a TOLF susceptibility gene that may be involved in TOLF pathology.


Assuntos
Ligamento Amarelo , Ossificação do Ligamento Longitudinal Posterior , China , Colágeno Tipo VI/genética , Humanos , Osteogênese , Polimorfismo de Nucleotídeo Único/genética
11.
J Orthop Surg Res ; 16(1): 448, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253245

RESUMO

BACKGROUND: Paraspinal muscle is an important component to maintain spinal stability. But the relationship between the degeneration of paraspinal muscle and postoperative screw loosening in patients with adult degenerative scoliosis has not been studied. The objective of this study was to investigate risk factors for screw loosening in patients with adult degenerative scoliosis, including paraspinal muscle degeneration. METHODS: We investigated 93 patients with adult degenerative scoliosis who underwent spinal interbody fusion and pedicle screw fixation surgery. The lateral curvature was located in the lumbar spine and the follow-up time was ≥ 2 years. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a 1-mm or wider circumferential radiolucent line around the pedicle screw. We checked the cross-sectional area of paraspinal muscles, spinopelvic parameters, bone mineral density, number of fusion segment, and other factors. The potential risk factors for screw loosening were investigated by using binary logistical regression analysis. RESULTS: Fifty-seven patients showed screw loosening, which is 63.4% of total. Compared with patients in the non-loosening group, the cross-sectional area of erector spinae and psoas major muscle at L5 level were significantly smaller in patients with screw loosening (P < 0.05). Among these factors, the number of fused segments and relative erector spinae total cross-sectional area were independent risk factors for screw loosening. CONCLUSIONS: The degeneration of paraspinal muscle and the increase of fusion segment were independent factors for screw loosening in patients with adult degenerative scoliosis.


Assuntos
Atrofia Muscular/patologia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Escoliose/patologia , Fusão Vertebral/efeitos adversos , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/complicações , Músculos Paraespinais/patologia , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Escoliose/complicações , Escoliose/cirurgia , Fusão Vertebral/métodos
12.
Clin Interv Aging ; 16: 897-908, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34079239

RESUMO

Purpose: Cervical ossification of ligamentum flavum (COLF) is a rare clinical entity which can occasionally contribute to severe myeloradiculopathy. Many orthopedists are unfamiliar with or underestimate this pathology. Therefore, a comprehensive research is obligatory to reappraise the epidemiological, radiological, clinical and histopathological characteristics of COLF-myeloradiculopathy based on synthesis of individual patient data. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, EMBASE, Scopus and Web of Science databases were searched for studies discussing COLF-myeloradiculopathy from the inception to December 2020. Results: A total of 94 cases from 54 studies were identified. The annual publications demonstrated a steady increase, and most reports were from Japan and China. The mean age was 58.76±13.39 years and nearly 60% of cases occurred in the 55-64 and 65-74 years age group. The male-female ratio was 1.4:1. Most cases belonged to East Asian population (60.64%). COLF predominately appeared in the lower cervical and cervicothoracic spine (76.60%) and mainly affected C4-5 (23.29%) and C5-6 (21.23%). Single-segment type ossification accounted for 62.76 and 45.45% of ossification lesions distributed bilaterally. The majority of COLF (81.1%) were spontaneous, and motor disturbance (76.4%), spinal ataxia (62.5%) and sensory disturbance (58.9%) were the most common manifestations. Histopathologically, it's a metaplastic process of endochondral ossification with the formation of mature lamellar bone which was distinguished from calcification of ligamentum flavum. About 21.28% of concurrent COLF and COPLL cases were identified as a separated group, with unique characteristics. Conclusion: COLF is an underappreciated but potentially growing pathogeny of myeloradiculopathy in aging population, though its distinct epidemiological, radiological, clinical and histopathological features are not fully supported by current evidence. However, our findings will provide several referential data for future researches to shed light on COLF.


Assuntos
Calcinose/diagnóstico por imagem , Ligamento Amarelo/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Idoso , Envelhecimento , Calcinose/patologia , China , Feminino , Humanos , Japão , Ligamentos Articulares/diagnóstico por imagem , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/patologia , Compressão da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
13.
Spine J ; 21(11): 1881-1889, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34174436

RESUMO

BACKGROUND CONTEXT: Long-level spinal fusion for degenerative lumbar scoliosis (DLS)seeks to eliminate spinal motion in an attempt to alleviate pain, improve deformity, and reduce disability. However, this surgery considerably impairs the performance of activities of daily living (ADL) due to the resulting stiffness. The lumbar stiffness disability index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activity, but this index might not be fully applicable to the elderly Chinese population given several specific lifestyle characteristics. PURPOSE: To evaluate lumbar stiffness in patients with DLS after long-level fusion by Chinese-LSDI (C-LSDI). STUDY DESIGN: A retrospective study. PATIENT SAMPLE: A total of 129 DLS patients who underwent long-level (≧4 levels) fusion surgery with at least one-year follow-up from June 2009 to September 2017 were retrospectively included. OUTCOME MEASURES: The C-LSDI was designed by modifying LSDI and Korean-LSDI (K-LSDI) based on elderly Chinese lifestyles and the internal consistency and retest repeatability of the patient-reported outcome questionnaire in the measurement of the impact of lumbar stiffness on functional abilities was assessed. METHODS: The radiographic parameters including Cobb angle, apical vertebral translation (AVT), coronal vertical axis (CVA), sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and PI-LL, and clinical symptoms including visual analogue scale (VAS) for back and low extremity pain; Oswestry disability index (ODI), Japanese Orthopedic Association-29 (JOA-29), Scoliosis Research Society⁃22 (SRS-22), 36⁃Item short form survey (SF-36), physical component scores (PCS) and mental component scores (MCS) were measured preoperatively and at the last follow-up. RESULTS: Compared with LSDI and K-LSDI, the C-LSDI demonstrated higher internal consistency (Cronbach's alpha=0.902) and retest reliability (Internal consistency coefficients, ICC=0.904) in the elderly Chinese population. All patients showed increased lumbar stiffness and significant improvement in pain and deformity postoperatively. Regarding items, such as performing personal hygiene after toileting and getting out of a car, people reported more inconvenience with increasingly fixed levels. CONCLUSIONS: This study demonstrated that the C-LSDI questionnaire was a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among elderly Chinese patients with DLS after long-level fusion. Although the effects of stiffness did trend toward greater impacts among patients who underwent longer fusions, most patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.

14.
Global Spine J ; : 21925682211017477, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34018438

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate the incidence, risk factors, and outcomes of pedicle screw loosening in degenerative lumbar scoliosis (DLS) undergoing long-segment spinal fusion surgery. METHODS: One hundred and thirty DLS patients who underwent long-segment fusion surgery with at least a 12-month follow-up were studied. The incidence and risk factors of screw loosening were investigated. VAS, SRS-22, and ODI scores were obtained preoperatively and at follow-up. RESULTS: One hundred and sixty-eight of 1784 (9.4%) screws showed evidence of loosening in 71 (54.6%) patients. Three patients required revision surgery. Screw loosening rates according to vertebral insertion level were lowest instrumented vertebra (LIV): 45.4%; uppermost instrumented vertebra (UIV):17.7%; one vertebra above the LIV: 0.5%; 2 vertebrae above the LIV: 0.4%. Multiple logistic regression analysis of possible risk factors indicated that preoperative lateral subluxation ≥8 mm (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.16-6.20), osteopenia (OR: 5.52, 95% CI: 1.64-18.56), osteoporosis (OR: 8.19, 95% CI: 2.40-27.97), fusion to sacrum (OR: 2.55, 95% CI: 1.12-5.83), postoperative TLK greater than 10° (OR: 2.63, 95% CI: 1.14-6.04) and SVA imbalance (OR: 3.44, 95% CI: 1.17-10.14) were statistically significant. No difference was noted in preoperative, follow-up, and change of VAS, ODI, and SRS-22 scores. CONCLUSIONS: Screw loosening in DLS underwent long-segment surgery is common and tends to occur in the LIV or UIV. Lateral subluxation ≥8 mm, osteopenia, osteoporosis, fusion to the sacrum, postoperative TLK greater than 10°, and SVA imbalance were the independent influencing factors. Screw loosening can be asymptomatic, while longer-term follow-up is required.

15.
Front Genet ; 12: 641575, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912216

RESUMO

Pathological changes in the ligamentum flavum (LF) can be defined as a process of chronic progressive aberrations in the nature and structure of ligamentous tissues characterized by increased thickness, reduced elasticity, local calcification, or aggravated ossification, which may cause severe myelopathy, radiculopathy, or both. Hypertrophy of ligamentum flavum (HLF) and ossification of ligamentum flavum (OLF) are clinically common entities. Though accumulated evidence has indicated both genetic and environmental factors could contribute to the initiation and progression of HLF/OLF, the definite pathogenesis remains fully unclear. MicroRNAs (miRNAs), one of the important epigenetic modifications, are short single-stranded RNA molecules that regulate protein-coding gene expression at posttranscriptional level, which can disclose the mechanism underlying diseases, identify valuable biomarkers, and explore potential therapeutic targets. Considering that miRNAs play a central role in regulating gene expression, we summarized current studies from the point of view of miRNA-related molecular regulation networks in HLF/OLF. Exploratory studies revealed a variety of miRNA expression profiles and identified a battery of upregulated and downregulated miRNAs in OLF/HLF patients through microarray datasets or transcriptome sequencing. Experimental studies validated the roles of specific miRNAs (e.g., miR-132-3p, miR-199b-5p in OLF, miR-155, and miR-21 in HLF) in regulating fibrosis or osteogenesis differentiation of LF cells and related target genes or molecular signaling pathways. Finally, we discussed the perspectives and challenges of miRNA-based molecular mechanism, diagnostic biomarkers, and therapeutic targets of HLF/OLF.

16.
Int Orthop ; 45(6): 1539-1547, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33825002

RESUMO

PURPOSE: Post-operative neurological deterioration (ND) is a severe complication. However, limited literature exists on the ND in thoracic disc disorders with myelopathy (TDM). This study describes the risk factors of neurological deterioration in TDM with instrumentation and fusion. METHODS: A single-centre review of TDM with instrumentation and fusion during 2006-2019 was performed. Post-operative neurological deterioration was defined as the deterioration of pre-existing neurological function or the appearance of new neurological symptoms. Patients were then grouped into two groups depending on neurological deterioration (ND group) or not (non-ND group). Demographics, radiographic parameters, and surgical characteristics were compared between the two groups. RESULTS: A total of 257 cases were included, and neurological deterioration occurred in 16 (6.23%) cases. Multivariate analysis revealed spinal canal occupancy ratio > 75%, U-shaped compressed spinal cord in axial MRI, calcified herniated disc, anterior approach, and intra-operative blood loss > 1500 mL were associated with ND. Ten patients (62.5%) had complete neurological recovery within six months, and four patients (25%) had progressive neurological function improvement and equal or better than pre-operation within nine months. CONCLUSIONS: The rate of neurological deterioration is 6.23%, and a higher spinal canal occupancy ratio, U-shaped compressed spinal cord, calcified herniated disc, anterior approach, and massive intra-operative blood loss were associated with neurological deterioration. Long-term outcomes of neurological deterioration are favourable, and 62.5% of patients experienced complete neurological recovery within six months. Patients with TMD who undergo surgery should be properly informed of the potential risks of neurological deterioration, despite its usually transient nature in most patients.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Doenças da Medula Espinal , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Fatores de Risco , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
17.
Orthop Surg ; 13(3): 1055-1066, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33719181

RESUMO

OBJECTIVE: The aim of the present paper was to evaluate the strength and the magnitude of the association between ossification of the nuchal ligament (ONL) and the risk of cervical ossification of the posterior longitudinal ligament (COPLL) and to determine whether there is a direct association or whether COPLL is a consequence of shared risk factors. METHODS: Medline, Web of Science, Cochrane Library, and Embase databases were searched for studies evaluating the association of COPLL-ONL published before July 2020. Eligible studies were selected based on certain inclusion and exclusion criteria. Two investigators independently conducted the quality assessment and extracted the data, including study designs, countries, patients' age, gender, body mass index (BMI), and the risk of COPLL between individuals with and without ONL. A meta-analysis of homogenous data, a sensitivity analysis, a publication bias assessment, and a subgroup analysis were performed using Stata 12.0 software. RESULTS: A total of 10 cohort studies involving 8429 participants were incorporated into this analysis. Pooled results demonstrated a statistically significant association between the presence of ONL and the increased COPLL risk (odds ratio [OR] 3.84; 95% confidence interval [CI] 2.68-5.52, P < 0.001). Furthermore, subgroup analyses indicated that this association was independent of study design (6.36-fold in case-control studies vs 3.22-fold in cross-sectional studies), sex (6.33-fold in male-female ratio >2.5 vs 2.91-fold in male-female ratio <2.5), age (4.28-fold in age ≥55 years vs 3.45-fold in age <55 years), and BMI (3.88-fold in BMI ≥ 25 kg/m2 vs 2.43-fold in BMI < 25 kg/m2 ), which also indicated that obese, older male patients with ONL had a higher risk of OPLL. Moreover, combined two articles revealed that patients with larger-type ONL had a significantly higher risk of long-segment COPLL compared with controls (OR 1.86; 95% CI 1.41-2.47, P < 0.001). CONCLUSION: This is the first meta-analysis to demonstrate a strong and steady association between ONL and higher risk of COPLL. This association was independent of sex, age, and BMI. Considering that ONL is generally asymptomatic and easily detectable on X-ray, our findings implied that ONL might serve as an early warning sign of the onset of COPLL and provide clinicians an opportunity for early detection and early intervention.


Assuntos
Vértebras Cervicais/patologia , Ligamentos Articulares/patologia , Ossificação do Ligamento Longitudinal Posterior/patologia , Fatores Etários , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Sexuais
18.
Proc Biol Sci ; 288(1947): 20210148, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33726593

RESUMO

The Earth has been beset by many crises during its history, and yet comparing the ecological impacts of these mass extinctions has been difficult. Key questions concern the kinds of species that go extinct and survive, how communities rebuild in the post-extinction recovery phase, and especially how the scaling of events affects these processes. Here, we explore ecological impacts of terrestrial and freshwater ecosystems in three mass extinctions through the mid-Phanerozoic, a span of 121 million years (295-174 Ma). This critical duration encompasses the largest mass extinction of all time, the Permian-Triassic (P-Tr) and is flanked by two smaller crises, the Guadalupian-Lopingian (G-L) and Triassic-Jurassic (T-J) mass extinctions. Palaeocommunity dynamics modelling of 14 terrestrial and freshwater communities through a long sedimentary succession from the lower Permian to the lower Jurassic in northern Xinjiang, northwest China, shows that the P-Tr mass extinction differed from the other two in two ways: (i) ecological recovery from this extinction was prolonged and the three post-extinction communities in the Early Triassic showed low stability and highly variable and unpredictable responses to perturbation primarily following the huge losses of species, guilds and trophic space; and (ii) the G-L and T-J extinctions were each preceded by low-stability communities, but post-extinction recovery was rapid. Our results confirm the uniqueness of the P-Tr mass extinction and shed light on the trophic structure and ecological dynamics of terrestrial and freshwater ecosystems across the three mid-Phanerozoic extinctions, and how complex communities respond to environmental stress and how communities recovered after the crisis. Comparisons with the coeval communities from the Karoo Basin, South Africa show that geographically and compositionally different communities of terrestrial ecosystems were affected in much the same way by the P-Tr extinction.


Assuntos
Ecossistema , Extinção Biológica , Biodiversidade , China , Fósseis , Água Doce , África do Sul
19.
Global Spine J ; : 2192568220984129, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33541141

RESUMO

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are minimally invasive techniques widely used for the treatment of neurologically intact osteoporotic Kümmell's disease (KD), but which treatment is preferable remains controversial. Therefore, this study aimed to shed light on this issue. METHODS: Six databases were searched for all relevant studies based on the PRISMA guidelines. Two investigators independently conducted a quality assessment, extracted the data and performed all statistical analyses. RESULTS: Eight studies encompassing 438 neurologically intact osteoporotic KD patients met the inclusion criteria. Compared to PVP, PKP was associated with greater improvement in the short- and long-term Cobb angle [SMD = -0.37, P = 0.007; SMD = -0.34, P = 0.012], short-term anterior vertebral height [SMD = 0.43, P = 0.003] and long-term middle vertebral height [SMD = 0.57, P = 0.012] and a lower cement leakage rate [SMD = 0.50, P = 0.003] but produced more consumption (cement injection volume, operative time, fluoroscopy times, intraoperative blood loss and operation cost). However, there were no differences between the 2 procedures in the short- and long-term VAS and ODI scores, long-term anterior vertebral height, overall complications or new vertebral fractures. CONCLUSIONS: Both procedures are equally effective for neurologically intact KD in terms of the clinical outcomes, with the exception of a lower cement leakage risk and better radiographic improvement for PKP but greater resource consumption. Based on the evidence available, good clinical judgment should be exercised in the selection of patients for these procedures.

20.
Pain Med ; 22(7): 1539-1547, 2021 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-33527130

RESUMO

OBJECTIVE: In this study, we proposed a new radiographic parameter, the plateau attrition index (PAI), and the PAI grades (PAIs) to explore the relationship between subchondral attrition of the tibial plateau and symptoms of knee osteoarthritis (OA) in patients with late-stage knee osteoarthritis. METHOD: One hundred nineteen patients with late-stage knee osteoarthritis were enrolled. The Kellgren and Lawrence (K/L) grades and hip-knee-ankle (HKA) angle were used to characterize the radiographic features of knee OA. The bone attrition of the tibial plateau was determined by the PAI and PAIs. The symptoms of knee OA were assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which is composed of the WOMAC pain (WOMP), WOMAC stiffness (WOMS), and WOMAC function (WOMF) subscores. WOMAC pain scores were divided into non-weight-bearing pain (NWBP) and weight-bearing pain (WBP) subcategories. The Pearson correlation coefficient was used to determine the relationship between the PAI, HKA angle, and WOMAC scores. The Spearman rank correlation coefficient was used to evaluate the correlation between the WOMAC score and the PAIs and K/L grades. RESULTS: The distribution of the WOMAC scores according to the PAIs was significant (P < .01). A positive correlation was identified between the PAI and the WOMAC, WOMP, WOMF and WBP scores (r = 0.29, 0.34, 0.26 and 0.34, P < .01, respectively). In addition, the PAIs was also significantly correlated with the WOMAC, WOMP, WOMF, and WBP scores (r = 0.37, 0.38, 0.35 and 0.44, P < .01, respectively). CONCLUSIONS: The attrition of tibial subchondral bone determined by the new parameter, the plateau attrition index, was correlated with symptoms, especially weight-bearing pain in late-stage knee OA.


Assuntos
Osteoartrite do Joelho , Estudos Transversais , Humanos , Articulação do Joelho , Osteoartrite do Joelho/diagnóstico por imagem , Medição da Dor , Índice de Gravidade de Doença
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