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2.
Artigo em Inglês | MEDLINE | ID: mdl-33496534

RESUMO

STUDY DESIGN: A retrospective analysis (2015-2019) of data collected from patients who underwent posterior lumbar spinal surgery. OBJECTIVE: This study aims to identify the incidence, perioperative hematological characteristics, potential prognostic indicators, and risk factors of deep venous thrombosis (DVT) in the lower limbs after posterior lumbar spinal surgery. Eliminating risk factors or taking measures against patients at risk may reduce the incidence of DVT. SUMMARY OF BACKGROUND DATA: Deep venous thromboses have been extensively studied in other reconstructive surgeries. Present literatures provide limited evidence for determining the prognostic and risk factors for this complication after spinal surgery. METHODS: Patients who underwent posterior lumbar spinal surgery with internal fixation in the Spine Surgery Center of Peking Union Medical College Hospital (PUMCH) were evaluated. The patient demographics, the number of operative segments, the hematological and biochemical parameters on baseline and postoperative day one, and the presence of DVTs were obtained from all patients. The diagnosis of DVT was established by venous ultrasound when symptomatic. A multivariate logistic regression test was subsequently performed to determine the prognostic indicators and risk factors for DVT. RESULTS: A total of 2,053 patients who received lumbar spine procedures were qualified and included. Patients were followed up for 12 weeks. Early symptomatic DVT occurred in 58 individuals (2.39%; 95% confidence interval [CI], 0.4-0.7%). Advanced age, higher preoperative serum D-dimer level, and lower serum potassium level were recognised as independent risk factors for symptomatic DVT. CONCLUSION: Multiple independent risk factors were identified for early symptomatic DVT after posterior lumbar spine surgery. Postoperative prophylactic anti-coagulation treatment might be warranted for patients with high D-dimer or low potassium levels before the procedure.Level of Evidence: 4.

3.
BMC Microbiol ; 20(1): 152, 2020 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522175

RESUMO

BACKGROUND: Members of the genus Proteus are mostly opportunistic pathogens that cause a variety of infections in humans. The molecular evolutionary characteristics and genetic relationships among Proteus species have not been elucidated to date. In this study, we developed a multilocus sequence analysis (MLSA) approach based on five housekeeping genes (HKGs) to delineate phylogenetic relationships of species within the genus Proteus. RESULTS: Of all 223 Proteus strains collected in the current study, the phylogenetic tree of five concatenated HKGs (dnaJ, mdh, pyrC, recA and rpoD) divided 223 strains into eleven clusters, which were representative of 11 species of Proteus. Meanwhile, the phylogenetic trees of the five individual HKGs also corresponded to that of the concatenated tree, except for recA, which clustered four strains at an independent cluster. The evaluation of inter- and intraspecies distances of HKG concatenation indicated that all interspecies distances were significantly different from intraspecies distances, which revealed that these HKG concatenations can be used as gene markers to distinguish different Proteus species. Further web-based DNA-DNA hybridization estimated by genome of type strains confirmed the validity of the MLSA, and each of eleven clusters was congruent with the most abundant Proteus species. In addition, we used the established MLSA method to identify the randomly collected Proteus and found that P. mirabilis is the most abundant species. However, the second most abundant species is P. terrae but not P. vulgaris. Combined with the genetic, genomic and phenotypic characteristics, these findings indicate that three species, P. terrae, P. cibarius and Proteus genospecies 5, should be regarded as heterotypic synonyms, and the species should be renamed P. terrae, while Proteus genospecies 5 has not been named to date. CONCLUSIONS: This study suggested that MLSA is a powerful method for the discrimination and classification of Proteus at the species level. The MLSA scheme provides a rapid and inexpensive means of identifying Proteus strains. The identification of Proteus species determined by the MLSA approach plays an important role in the clinical diagnosis and treatment of Proteus infection.

4.
J Med Genet ; 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381727

RESUMO

BACKGROUND: Early-onset scoliosis (EOS), defined by an onset age of scoliosis less than 10 years, conveys significant health risk to affected children. Identification of the molecular aetiology underlying patients with EOS could provide valuable information for both clinical management and prenatal screening. METHODS: In this study, we consecutively recruited a cohort of 447 Chinese patients with operative EOS. We performed exome sequencing (ES) screening on these individuals and their available family members (totaling 670 subjects). Another cohort of 13 patients with idiopathic early-onset scoliosis (IEOS) from the USA who underwent ES was also recruited. RESULTS: After ES data processing and variant interpretation, we detected molecular diagnostic variants in 92 out of 447 (20.6%) Chinese patients with EOS, including 8 patients with molecular confirmation of their clinical diagnosis and 84 patients with molecular diagnoses of previously unrecognised diseases underlying scoliosis. One out of 13 patients with IEOS from the US cohort was molecularly diagnosed. The age at presentation, the number of organ systems involved and the Cobb angle were the three top features predictive of a molecular diagnosis. CONCLUSION: ES enabled the molecular diagnosis/classification of patients with EOS. Specific clinical features/feature pairs are able to indicate the likelihood of gaining a molecular diagnosis through ES.

5.
Microorganisms ; 8(4)2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32294952

RESUMO

The genus Vibrio is ubiquitous in marine environments and uses numerous evolutionary characteristics and survival strategies in order to occupy its niche. Here, a newly identified species, Vibrio fujianensis, was deeply explored to reveal a unique environmental adaptability. V. fujianensis type strain FJ201301T shared 817 core genes with the Vibrio species in the population genomic analysis, but possessed unique genes of its own. In addition, V. fujianensis FJ201301T was predicated to carry 106 virulence-related factors, several of which were mostly found in other pathogenic Vibrio species. Moreover, a comparative transcriptome analysis between the low-salt (1% NaCl) and high-salt (8% NaCl) condition was conducted to identify the genes involved in salt tolerance. A total of 913 unigenes were found to be differentially expressed. In a high-salt condition, 577 genes were significantly upregulated, whereas 336 unigenes were significantly downregulated. Notably, differentially expressed genes have a significant association with ribosome structural component and ribosome metabolism, which may play a role in salt tolerance. Transcriptional changes in ribosome genes indicate that V. fujianensis may have gained a predominant advantage in order to adapt to the changing environment. In conclusion, to survive in adversity, V. fujianensis has enhanced its environmental adaptability and developed various strategies to fill its niche.

6.
BMC Surg ; 20(1): 74, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295591

RESUMO

BACKGROUND: Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality. CASE PRESENTATION: We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3-5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up. CONCLUSIONS: We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas da Coluna Vertebral/cirurgia , Idoso de 80 Anos ou mais , Feminino , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Biomed Res Int ; 2020: 1852070, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32190653

RESUMO

Background: Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH. Methods: Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria. Results: The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (. Conclusions: PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.

8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(7): 831-836, 2019 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-31297999

RESUMO

Objective: To summarize the efficacy of percutaneous endoscopic transforaminal unilateral decompression for the treatment of lumbar spinal stenosis, and to investigate the incidence and possible reasons for lower extremity symptoms of non-surgical side after surgery. Methods: The clinical data of 46 patients who underwent percutaneous endoscopic transforaminal unilateral decompression for lumbar lateral recess stenosis between February 2016 and March 2018 were retrospectively analysed. There were 22 males and 24 females with an average age of 56.9 years (range, 21-90 years). The disease duration was 6 months to 12 years (mean, 4.8 years). There were 37 cases of single-segment lumbar lateral recess stenosis and 9 cases of multi-segment stenosis. All patients underwent single-segment surgery, including 2 cases of L 3, 4, 35 cases of L 4, 5, and 9 cases of L 5, S 1. For patients with multi-segment lumbar lateral recess stenosis, the single segment consistent with radicular symptom was selected for surgery. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up to evaluate the relief of symptoms. Postoperative symptoms on non-surgical side of lower extremity including new or aggravated radiation pain and numbness were recorded. The surgical effectiveness was evaluated according to modified MacNab score at last follow-up. Results: All the 46 patients underwent successful operations without postoperative complications such as wound infection, permanent nerve root injury, and deep vein thrombosis. The patients were followed up 12-37 months (mean, 23.8 months). Four patients suffered from radioactive pain and numbness for the non-surgical side of lower extremities at 1-3 months postoperatively, and the symptoms were improved after conservative treatment without revision surgery. VAS scores of low back pain and sciatica and the ODI scores were significantly improved at last follow-up when compared with preoperative ones ( P<0.01). According to the criteria of modified MacNab scores, 25 cases were excellent, 17 cases were good, 3 cases were fair, and 1 case was poor. The excellent and good rate was 91.3%. Conclusion: Percutaneous endoscopic transforaminal unilateral decompression for lumbar spinal stenosis would be able to relieve pain effectively and achieve good results. Lower extremity symptoms of non-surgical side may be observed postoperatively. Although the symptoms can be relieved by conservative treatment, further investigation should be carried out for the long-term result of those cases.


Assuntos
Descompressão Cirúrgica , Estenose Espinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Feminino , Humanos , Extremidade Inferior , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/cirurgia , Adulto Jovem
9.
Semin Arthritis Rheum ; 49(3): 446-452, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31155445

RESUMO

OBJECTIVE: We aimed to characterize the phenotypes and genotypes of Chinese adult patients with systemic autoinflammatory diseases (SAIDs). METHODS: We prospectively evaluated clinical and genetic features of 92 adult patients (≥16 years) suspected of SAIDs in the period from April 2015 to October 2017, at the adult SAIDs center, Peking Union Medical College Hospital. The definite diagnosis of each disease was deemed to be present if both clinical phenotypes and genetic confirmation were met. Clinical manifestations of these patients were compared with those from the pediatric populations and patients from other countries. RESULTS: A final diagnosis of SAIDs was reached in 50 patients, including 13 familial Mediterranean fever (FMF), 10 NLRP12-associated autoinflammtory disease (NLRP12-AID), 7 NLRP3-associated autoinflammatory disease (NLRP3-AID), 5 tumor necrosis factor receptor-associated periodic fever syndrome (TRAPS), 3 Blau syndrome, 3 Yao syndrome (YAOS) and 9 periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA). First disease onset during adulthood was observed in 30 patients, and the final diagnosis was delayed with a median time of 9 years. Adult monogenic SAIDs patients usually carried low-penetrance mutations and all gene variants were presented as heterozygosis or compound heterozygosis. Frequencies of clinical manifestations in Chinese adult SAIDs patients were similar with adult patients in other countries, but different from pediatric populations. CONCLUSIONS: FMF, NLRP3-AID, and NLRP12-AID are relatively common monogenic SAIDs in Chinese adults. Adult-onset SAIDs may be related to the presence of low-penetrance mutations, characterized by nonspecific, incomplete or atypical disease patterns compared with child-onset SAIDs, leading to a delay of diagnosis.


Assuntos
Autoimunidade/genética , Predisposição Genética para Doença , Doenças Hereditárias Autoinflamatórias/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , China/epidemiologia , Feminino , Seguimentos , Testes Genéticos , Genótipo , Doenças Hereditárias Autoinflamatórias/diagnóstico , Doenças Hereditárias Autoinflamatórias/genética , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Prospectivos , Adulto Jovem
10.
Pain Res Manag ; 2019: 9758273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30944687

RESUMO

Study design: Retrospective characterization of nonspecific low back pain (NSLBP) in young adult female patients with and without lumbar scoliosis. Background: There is no consensus as to whether NSLBP in scoliosis patients is related to scoliosis per se or is just a normal symptom that could happen in anyone. Objectives: The aim of this study was to compare the differences in NSLBP between young adult female patients with and without lumbar scoliosis and to provide a theoretical basis for differential treatment of NSLBP in patients with and without lumbar scoliosis. Methods: Ninety female young adults with NSLBP were divided into scoliosis and nonscoliosis groups. Characteristics of pain, lumbar mobility, muscle strength, Cobb angle, axial trunk rotation (ATR) angle, and surface electromyography (SEMG) signal were compared between the two groups. Results: The pain location in scoliotic patients was more concentrated on the left side of the lumbar spine (P ≤ 0.001). The area affected by pain (P=0.028) and the numerical pain rating scale (NPRS) scores (P=0.014) of scoliotic patients were less than those of nonscoliotic patients. The difference between side-bending in scoliotic patients was greater than that in nonscoliotic patients (P=0.001). Scoliotic patients exhibited a significantly better ability for flexion (P=0.001) and extension (P=0.017) than nonscoliotic patients. The posterior muscles in scoliotic patients were stronger than those in nonscoliotic patients (P=0.014). The ratio of root-mean-square (RMS) on paraspinal muscles in scoliotic patients was greater than that in nonscoliotic patients (P ≤ 0.001). Scoliotic patients exhibited greater relaxation time during the flexion-relaxation phenomenon (FRP) than nonscoliotic patients (P=0.024). Conclusions: The characteristics of NSLBP experienced by patients with lumbar scoliosis were distinct from those of NSLBP experienced by nonscoliotic patients. The treatment of NSLBP in scoliotic patients should be different from that in nonscoliotic patients.


Assuntos
Dor Lombar/epidemiologia , Dor Lombar/etiologia , Escoliose/complicações , Escoliose/fisiopatologia , Feminino , Humanos , Dor Lombar/fisiopatologia , Vértebras Lombares , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
11.
Comput Assist Surg (Abingdon) ; : 1-9, 2019 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-30712394

RESUMO

BACKGROUND: Minimally invasive procedures are rapidly growing in popularity thanks to advancements in medical robots, visual navigation and space registration techniques. This paper presents a precise and efficient targeting method for robot-assisted percutaneous needle placement under C-arm fluoroscopy. METHOD: A special end-effector was constructed to perform fluoroscopy calibration and robot to image-space registration simultaneously and automatically. In addition, formulations were given to compute the movement of robot targeting and evaluate targeting accuracy using only one X-ray image. RESULT: A pre-clinical experiment showed that the maximum angle error was 0.94° and the maximum position error of a target located 80 mm below the end-effector was 1.31 mm. And evaluation of the system in a robot-assisted pedicle screws placement surgery has justified the accuracy and reliability of proposed method in clinical applications. CONCLUSION: The positioning accuracy was increased by using present method. Moreover, radiation exposure and operation time were reduced significantly compared to other commonly used methods.

12.
Comput Assist Surg (Abingdon) ; 24(sup1): 44-52, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30689445

RESUMO

Minimally invasive procedures are rapidly growing in popularity thanks to advancements in medical robots, visual navigation and space registration techniques. This paper presents a precise and efficient targeting method for robot-assisted percutaneous needle placement under C-arm fluoroscopy. In this method, a special end-effector was constructed to perform fluoroscopy calibration and robot to image-space registration simultaneously. In addition, formulations were given to compute the movement of robot targeting and evaluate targeting accuracy using only one X-ray image. With these techniques, radiation exposure and operation time were reduced significantly compared to other commonly used methods. A pre-clinical experiment showed that the maximum angle error was 0.94° and the maximum position error of a target located 80mm below the end-effector was 1.31mm. And evaluation of the system in a robot-assisted pedicle screws placement surgery has justified the accuracy and reliability of proposed method in clinical applications.


Assuntos
Fluoroscopia , Agulhas , Procedimentos Cirúrgicos Robóticos , Humanos , Duração da Cirurgia , Parafusos Pediculares , Exposição à Radiação , Fusão Vertebral/métodos
13.
Genet Med ; 21(7): 1548-1558, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30636772

RESUMO

PURPOSE: To characterize clinically measurable endophenotypes, implicating the TBX6 compound inheritance model. METHODS: Patients with congenital scoliosis (CS) from China(N = 345, cohort 1), Japan (N = 142, cohort 2), and the United States (N = 10, cohort 3) were studied. Clinically measurable endophenotypes were compared according to the TBX6 genotypes. A mouse model for Tbx6 compound inheritance (N = 52) was investigated by micro computed tomography (micro-CT). A clinical diagnostic algorithm (TACScore) was developed to assist in clinical recognition of TBX6-associated CS (TACS). RESULTS: In cohort 1, TACS patients (N = 33) were significantly younger at onset than the remaining CS patients (P = 0.02), presented with one or more hemivertebrae/butterfly vertebrae (P = 4.9 × 10‒8), and exhibited vertebral malformations involving the lower part of the spine (T8-S5, P = 4.4 × 10‒3); observations were confirmed in two replication cohorts. Simple rib anomalies were prevalent in TACS patients (P = 3.1 × 10‒7), while intraspinal anomalies were uncommon (P = 7.0 × 10‒7). A clinically usable TACScore was developed with an area under the curve (AUC) of 0.9 (P = 1.6 × 10‒15). A Tbx6-/mh (mild-hypomorphic) mouse model supported that a gene dosage effect underlies the TACS phenotype. CONCLUSION: TACS is a clinically distinguishable entity with consistent clinically measurable endophenotypes. The type and distribution of vertebral column abnormalities in TBX6/Tbx6 compound inheritance implicate subtle perturbations in gene dosage as a cause of spine developmental birth defects responsible for about 10% of CS.


Assuntos
Dosagem de Genes , Padrões de Herança , Escoliose/congênito , Escoliose/genética , Proteínas com Domínio T/genética , Animais , Estudos de Coortes , Modelos Animais de Doenças , Humanos , Camundongos , Modelos Genéticos , Escoliose/classificação , Escoliose/patologia , Coluna Vertebral/patologia
14.
Chin Med J (Engl) ; 130(21): 2608-2615, 2017 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-28799527

RESUMO

OBJECTIVE: Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. DATA SOURCES: We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: "minimally invasive," "spine," "surgery," and "scoliosis." STUDY SELECTION: The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. RESULTS: The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3-7, operative time was 2.3-8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications. CONCLUSIONS: MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Feminino , Humanos , Masculino , Escoliose , Resultado do Tratamento
15.
Medicine (Baltimore) ; 96(12): e6425, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28328849

RESUMO

The objective of this article is to report an unusual case of a spinal rod that protruded into the spinal canal after lumbar spine surgery.Only 4 cases of spinal rod migration with protrusion into the spinal canal have been reported. This is the first report of a case involving the use of posterior low lumbar segmental instrumentation with a screw-rod system. The left side of the rod gradually migrated and finally protruded into the canal and compressed the cord.A 60-year-old woman presented with pain and numbness of the posterior aspect of the left leg after a long-distance walk. Intermittent claudication became worse, and she developed pain and numbness in the perineal region. An x-ray showed that the left side of a spinal rod among the segmental spinal instruments that had been placed 10 years previously had protruded into the spinal canal.We removed the rod and decompressed the canal at the level of L5-S1. The patient became totally asymptomatic.Rods used as spinal instrumentation have the possibility of protruding into the spinal canal and endangering the nervous system. Long-term follow-up with radiological examinations should be conducted upon completion of spinal operations conducting using instrumentation.


Assuntos
Fixadores Internos/efeitos adversos , Vértebras Lombares/cirurgia , Falha de Prótese/efeitos adversos , Canal Vertebral/lesões , Feminino , Humanos , Pessoa de Meia-Idade
16.
Spine (Phila Pa 1976) ; 42(15): 1125-1129, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28187071

RESUMO

STUDY DESIGN: A case-control association study was performed to investigate the relationship between ladybird homeobox (LBX1) and adolescent idiopathic scoliosis (AIS) in northern Chinese Han population. OBJECTIVE: To explore the prevalence and functional importance of LBX1 polymorphisms in patients with AIS within the northern Chinese Han population. SUMMARY OF BACKGROUND DATA: AIS is the most common subtype of idiopathic scoliosis. Genetic factors such as LBX1 polymorphisms have been recently proved to be associated with AIS in some populations. In this study we explored the prevalence and functional importance of the polymorphisms around LBX1 in patients with AIS within the northern Chinese Han population. METHODS: Five tag single nucleotide polymorphisms (SNPs) around or in LBX1 were genotyped in 180 patients with AIS and 182 controls. And the luciferase assay was performed to explore the functional importance of the most significant SNPs. RESULTS: We replicated that rs11190870, previously reported as the most significantly associated SNP, was enriched in our AIS cohort. In addition, we found that the T allele of rs1322331 was associated with a novel risk allele (odds ratio = 3.349, 95% confidence interval 1.742-6.436). In the following luciferase assay, the TT-type promoter showed significantly reduced transcription activity in vitro. CONCLUSION: Two SNPs around LBX1, rs11190870 and rs1322331 are associated with AIS in northern Chinese Han population. The T allele of rs1322331 is a novel risk allele. We hypothesize that rs1322331 might increase patients' susceptibility to AIS by reducing LBX1-AS1 transcription and thus upregulating the function of LBX1. LEVEL OF EVIDENCE: 3.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Estudos de Associação Genética/métodos , Proteínas de Homeodomínio/genética , Polimorfismo de Nucleotídeo Único/genética , Vigilância da População , Escoliose/genética , Fatores de Transcrição/genética , Adolescente , Grupo com Ancestrais do Continente Asiático/etnologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Vigilância da População/métodos , Escoliose/diagnóstico , Escoliose/etnologia
17.
J Bone Joint Surg Am ; 98(24): 2096-2102, 2016 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-28002373

RESUMO

BACKGROUND: The natural history of split spinal cord malformation (SCM) is still unclear. Knowledge of the characteristics of the osseous spur and its relationship with the spinal deformity may allow early identification of patients with a higher risk of a neurological deficit and enhance surgical decision-making. METHODS: Eighty-five consecutive patients with congenital scoliosis and type-I SCM who had undergone surgical treatment at our hospital from May 2000 to December 2013 were identified retrospectively. There were 22 male and 63 female patients with an average age of 13.9 years at the time of surgery. Preoperative clinical and radiographic data were collected to investigate the characteristics of the scoliosis and the osseous spur. Two groups were identified on the basis of whether the patients had intact neurological function (Group A) or a neurological deficit (Group B). RESULTS: There were 52 patients (61%) in Group A (intact neurological function) and 33 patients (39%) in Group B (neurological deficit). There were no significant differences in the demographic distribution, curve magnitude, or length and thickness of the osseous spur between the 2 groups. In Group A, the location of the osseous spur relative to the apex of the major curve was proximal in 13 patients (25%), distal in 28 (54%), and central in 11 (21%). In Group B, the osseous spur was proximal in 7 (21%), distal in 8 (24%), and central in 18 (55%). The 2 groups differed significantly with respect to the location of the osseous spur (chi square = 10.898, p = 0.004). Group-B patients had a higher proportion of patients with kyphotic deformity (42%) than Group A (10%). The ratio of the diameters of the hemicords (concave side divided by convex side) differed significantly between the 2 groups (0.98 for Group A versus 0.89 for Group B, p = 0.030). CONCLUSIONS: The neurological status in patients with congenital scoliosis and type-I SCM appears to be closely related to the location of the osseous spur relative to the congenital scoliosis. An osseous spur at the apex of the scoliosis may be related to a higher risk of developing a neurological deficit, especially in patients with kyphotic deformity. Asymmetric splitting of the spinal cord may contribute to neurological deficits. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Defeitos do Tubo Neural/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/cirurgia , Estudos Retrospectivos , Escoliose/complicações , Escoliose/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
18.
J Orthop Res ; 34(5): 860-4, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26495885

RESUMO

Low back pain (LBP) is a common health problem and many LBP are caused by lumbar disc degeneration (LDD). ADAMTS-4 (a disintegrin and metalloprotease with thrombospondin motifs-4), also known as aggrecanse-1, plays a core role in degeneration of extracellular matrix in LDD. To investigate the association between ADAMTS-4 genetic polymorphism and LDD, we genotyped SNPs in and around ADAMTS-4. We recruited 482 sporadic cases of LDD and 496 healthy controls from Chinese Han population. Five SNPs were selected and phenotyped by the Sequenom MassARRAY system. Allelic, genotypic, and haplotypic association was performed. Rs4233367 (c.1877 C>T), which located in exon of ADAMTS-4 showed significant association with LDD. The T allele conferred a lower risk of LDD with an OR of 0.69 and TT genotype is at nearly one-fifth of the risk compared to CC genotype. Other tested SNPs didn't show significant difference between the case and control groups. The SNP rs4233367 in the exon of ADAMTS-4 gene may be associated with lumbar disc degeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:860-864, 2016.


Assuntos
Proteína ADAMTS4/genética , Degeneração do Disco Intervertebral/genética , Deslocamento do Disco Intervertebral/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Med Case Rep ; 7: 268, 2013 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-24330652

RESUMO

INTRODUCTION: Pachydermoperiostosis is a rare, hereditary disease commonly presenting with digital clubbing, pachydermia and periosteal hypertrophy. Therapeutic options for pachydermoperiostosis are few because of the unknown pathogenesis. Here, we report the complicated case of a patient with pachydermoperiostosis combined with spondyloarthritides, who was refractory to steroids and tumor necrosis factor alpha antagonists. We treated this patient with zoledronic acid and performed an arthroscopic synovectomy, with a satisfactory outcome. To the best of our knowledge, this is the first report in English on the combination of zoledronic acid administration and synovectomy for the treatment of a patient with pachydermoperiostosis and spondyloarthritides. CASE PRESENTATION: An 18-year-old Han Chinese man was diagnosed with pachydermoperiostosis in the presence of digital clubbing, periostitis and swollen limbs. Combined spondyloarthritides was also considered based on his lower back pain, lower limbs synovitis, bilateral sacroiliac sclerosis and a positive test for human leukocyte antigen B27, as well as immunoglobulin A nephropathy. He was refractory to steroids and tumor necrosis factor alpha antagonists, but treated with intravenous zoledronic acid and an arthroscopic synovectomy, with a satisfactory outcome. CONCLUSION: This is a rare, complicated case of pachydermoperiostosis with spondyloarthritides. Combination therapy of zoledronic acid administration with synovectomy is a novel, convenient and effective option for patients with pachydermoperiostosis with remarkable synovitis.

20.
Surg Neurol Int ; 4: 125, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24255796

RESUMO

BACKGROUND: Minimally invasive lumbar spine fusion surgery has gained popularity in recent years. Routinely, this technique requires bilateral parasagittal incisions for decompression, interbody fusion, and posterior instrumentation. The following study is a description of a new minimally invasive technique for one-level transforaminal lumbar interbody fusion (TLIF) using a unilateral parasagittal incision (Wiltse approach), with placement of pedicle screws and then a percutaneous transpedicular facet screw insertion on the contralateral side. The biomechanical stability of this posterior construct will be discussed while the efficacy and complications of this technique have been examined. METHODS: Forty patients underwent this new technique of one-level TLIF with posterior instrumentation using unilateral pedicle screw fixation supplemented with contralateral percutaneous transpedicular facet screw construct. Data regarding surgical time, estimated blood loss (EBL), hospital length of stay (LOS), and complications related to the posterior instrumentation are recorded. RESULTS: The average surgical time of this new procedure was 124 minutes; average EBL was 140 cc; average hospital LOS was 3 days. Two patients developed new leg pain on the side where the facet screw had been placed. Both patients had the facet screw removed. CONCLUSION: This novel technique of unilateral pedicle screw fixation combined with contralateral percutaneous transpedicular facet screw construct has further reduced the amount of normal tissue injury while maintaining the same biomechanical advantages of bilateral pedicle screw fixation. However, caution is needed during the placement of the percutaneous facet screw in order to avoid nerve root injury.

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