[Lateral position one-stage combined anteroposterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures].

OBJECTIVE: To compare the medium and long-term outcomes of lateral position one-stage plus anteroposterior versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures. METHODS: A total of 47 patients with thoracolumbar burst fractures were divided into 2 groups according to surgical approaches. Group A underwent lateral position one-stage plus anteroposterior approach while group B had posterior approach with subtotal corpectomy, decompression and reconstruction of spine. During a follow-up period of 36-68 months, their clinical and radiological outcomes were retrospectively evaluated. The perioperative volume of blood loss, operative duration, complications, pulmonary functions, Frankel scale and American Spinal Injury Association (ASIA) motor scores were recorded and analyzed. And the heights of anterior edge of vertebral body and Cobb angle were examined for radiological outcomes. RESULTS: At the latest follow-up, all patients achieved solid fusion with significant neurological improvements. The perioperative volumes of blood loss were less, operative duration was shorter and postoperative pulmonary functions were better in the group B (P < 0.05). The ASIA motor score and radiological outcomes were not significantly different at all timepoints between two groups (P < 0.05). But the neurological functions of two groups improved by approximately 1.4 Frankel grade (group A) versus 1.41 (group B) at the final follow-up. CONCLUSION: Lateral position one-stage plus anteroposterior and posterior approaches with subtotal corpectomy, decompression, and reconstruction of spine are adequate surgical treatments for thoracolumbar burst fractures. But the latter has the major advantages of less perioperative volume of blood loss, fewer complications, shorter operative duration and better pulmonary functions.

[Surgical options and clinical outcomes in patients of lumbar disc herniation with Modic changes].

OBJECTIVE: To retrospectively evaluate medium and long-term outcomes of conventional fenestration discectomy versus posterior lumbar interbody fusion in lumbar disc herniation with Modic changes. METHODS: From January 2002 to January 2007, a total of 486 patients of lumbar disc herniation with Modic changes were analyzed retrospectively. They were divided into fenestration group (n = 215) and fusion group (n = 271) according to the operative approaches. The scores of Oswestry disability index (ODI) and visual analog scale (VAS) pre-and post-operative 3, 6, 12 month and annually were recorded and analyzed. RESULTS: All of them had complete records during a mean follow-up period of 88.9 (60-120) months. At the end of the latest follow-up, all symptoms were relieved postoperatively. Significantly difference existed in the improvement rate of back pain VAS between two groups (77.9% vs 68.0%). In the fenestration group, the improvement rate of VAS (back pain) of Modic type I I was better than that of Modic type I (72.8% vs 64.9%). And the difference was statistically significant. For those with Modic type I changes, the improvement rate of ODI and VAS (back pain) of the fusion group were better than those of the fenestration group (78.3% vs 70.4% and 77.4% vs 64.9%). And the differences were statistically significant (P < 0.05). CONCLUSION: The patients with Modic I and II changes were recommended to undergo lumbar fusion and undergo fenestration discectomy respectively.

[Influences of clinical symptoms on the selection of surgical options for adult degenerative scoliosis].

OBJECTIVE: To retrospectively analyze the interactions between the clinical symptoms and surgical options and evaluate the surgical efficacies for adult degenerative scoliosis (DS). METHODS: A total of 35 adult DS patients underwent operations at Tianjin hospital from May 1996 to December 2008. There were 23 females and 12 males with a mean age of 59.1 years (range: 45 - 74). Clinical symptoms, physical examinations and radiological findings for all patients were recorded at different stages, at 1 week, 3 months, 6 months, 1 year post-operation and per year respectively. According to different surgical options, they were classified into 3 groups: A: limited decompression; B: selective decompression & short-segment fusion; C: selective decompression & long-segment correction & fusion. RESULTS: All patients had complete records with a mean follow-up period of 42.4 months (range: 24 - 168). Firstly, 9 patients in group A had no complaint of a low-back pain at pre-operation. The average coronal Cobb's angles were 15.6 ± 2.3° at pre-operation and 17.1 ± 3.3° at the latest follow-up. The radicular symptoms became greatly relieved at 1 year. Three cases complained of the aggravation of back pain. Secondly, 15 patients in group B mainly complained of a low-back pain at pre-operation. It was combined with lower-limb radiation pain in 6 patients and nerve claudication in 9 cases. The average coronal Cobb's angles were 14.1 ± 4.6° at pre-operation and 24.4 ± 6.7° at the latest follow-up. However, 12 patients experienced the progression of scoliosis. Thirdly, 11 patients in group C experienced a low-back pain at pre-operation while 5 cases with lower-limb radiation pain and 6 with claudication. The mean coronal Cobb's angles were 22.3 ± 9.2° at pre-operation and 12.2 ± 4.7° at the latest follow-up. Among 4 patients with residual pains, none required revision. CONCLUSIONS: For the DS patients, it is quite important for the surgical options to comprehensively analyze the neurological signs, imaging data and clinical symptoms. However, the fusion end vertebrae should always avoid the vicinity or apex of curve if the short-segment fusion is selected.

[Anterior cervical discectomy and fusion in the treatment of Hangman's fracture].

OBJECTIVE: To evaluate the efficacies and features of treating Hangman's fracture by anterior cervical discectomy and fusion (ACDF). METHODS: Since June 2005 to December 2008, 36 cases with Hangman's fracture were analyzed with their clinical data including history, symptoms, signs, radiological findings and treatments. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangman's fractures, they were subdivided into type I (n = 9) (conservative therapy), type II (n = 17) and type IIA (n = 10). Conservative therapy was offered to type I in 9 cases, while ACDF with cervical gear protection for 4 weeks after surgery was performed to type II in 17 cases and type IIA in 10 cases. A combination of operation time, days of hospitalization, complications, neurological improvement and fusion rate was assessed. RESULTS: An average follow-up of 15 months (range: 10 - 36) was achieved. No vertebral redisplacement and angulation deformity occurred. Axial pain was relieved in each case. The preoperative neurological deficits in all patients got improvements. No spinal cord injury, vertebral artery injury or cerebrospinal fluid leakage occurred. No complication related to internal fixator was found. Average operative time and hospitalization were similar to those of ACDF for lower cervical spine (98 minutes vs. 9 days). Fusion was achieved within 6 months in all cases. CONCLUSION: ACDF at C2-C3 may be an effective and safe way to treat Hangman's fracture.

[Surgical options and result analyses in adult degenerative lumbar scoliosis].

OBJECTIVE: To investigate the clinical and radiographic outcomes for varying degrees of degenerative lumbar scoliosis using different surgical options with a minimal 5-year follow-up. METHODS: From May 1998 to November 2002, 31 patients with degenerative lumbar scoliosis underwent operations at our hospital. The mean age of 19 females and 12 males was 55.8 years old (range: 45 to 71). All patients were divided into 4 groups: Group A, mild coronal deformity with obvious sagittal deformity, 13 cases; Group B, obvious coronal deformity with mild sagittal deformity; Group C, both significant coronal and sagittal deformities; Group D, both mild coronal and sagittal deformities. Posterior decompression, internal fixation and bone graft fusion were performed in Groups A, B and C. And posterior decompression was performed in Group D. All patients were followed up for at least 5 years. Patients answered the Oswestry low back pain disability questionnaire at pre-operation, and 1 year, 5 year post-operation. RESULTS: Thirty patients were followed up for the whole process. According to Cobb's angle methods, there was great post-operative improvement for patients with internal fixation (Groups A, B, C) while there was no significant difference for patients with posterior decompression at pre-and post-operation. After surgery, the average Oswestry Disability Index score in the patients with internal fixation (Groups A, B, C) was significantly lower than the preoperative score (25.8 vs 58.0; P < 0.001). However there was statistical difference for patients with internal fixation between 1 year and 5 year postoperatively. No perioperative death or major medical complications occurred. Ten patients had adjacent segment degeneration. CONCLUSIONS: The surgical aim for adults with a spinal deformity is to achieve a stable, balanced and pain-free spine. Surgical treatments should consist of decompression and fusion with segmental instrumentation to avoid instability and curb progression. Despite the complexity of adult lumbar degenerative scoliosis, it might improve the quality of life for patients by choosing an appropriate operation option on the basis of varying degrees of lumbar deformity.

miR-221 alleviates the inflammatory response and cell apoptosis of neuronal cell through targeting TNFAIP2 in spinal cord ischemia-reperfusion.

This study aimed to examine the role of miR-221 in inflammatory response and apoptosis of neuronal cells after spinal cord ischemia/reperfusion (I/R) injury. Blood samples were obtained from 20 I/R patients and that of 20 healthy individuals were used as a control. AGE1.HN and SY-SH-5Y neuronal cell lines subjected to oxygen-glucose deprivation (OGD) stress were used in cell experiments. Real-time PCR and western blot were used to evaluate the expression of miR-221, tumor necrosis factor-α, and TNFAIP2. TUNEL assay analyzed cell apoptosis. I/R patients had lower serum levels of miR-221 than healthy controls. In OGD-AGE1.HN and SY-SH-5Y cells, miR-221 was significantly downregulated and TNFAIP2 mRNA and protein were upregulated; meanwhile, both proinflammatory cytokine tumor necrosis factor-α and anti-inflammation cytokine interleukin-6 were elevated and the percentage of apoptotic cells was increased. This inflammatory response and cell apoptosis induced by OGD stress were attenuated by miR-221 overexpression and enhanced by miR-221 knockdown. TNFAIP2 is a target gene for miR-221 and could be regulated negatively by the miR-221 mimic or the miR-221 inhibitor with or without OGD stress. Accordingly, TNFAIP2 overexpression reversed the inflammatory response and cell apoptosis induced by miR-221 under OGD stress. Downregulation of miR-221 occurs in spinal cord I/R injury and in cell lines subjected to oxygen-glucose deprivation. miR-221 regulates the inflammatory response and apoptosis of neuronal cells through its impact on TNFAIP2.