Imaging-Assisted Diagnosis and Characteristics of Suspected Spinal Brucellosis: A Retrospective Study of 72 Cases.

BACKGROUND We clarified the imaging features of Brucella spondylitis to enhance our understanding of the disease and to minimize misdiagnosis. MATERIAL AND METHODS Imaging data (X-ray, computed tomography [CT], and magnetic resonance imaging [MRI] data) of 72 Brucella spondylitis patients treated from 2010 to 2017 were retrospectively analyzed; diagnoses was made by evaluating laboratory and pathological data. RESULTS X-ray films revealed changes in intervertebral space heights, the number of lateral osteophytes, and bone destruction, which were more severe in the following order: lumbosacral vertebrae (56 cases, 77.8%), cervical spine (6 cases, 8.3%), thoracic spine (5 cases, 6.9%), and multi-segmental mixed vertebrae (5 cases, 6.9%). CT revealed osteolytic destruction attributable to early-stage Brucella spondylitis (endplate and vertebral lamellar osteolysis), usually associated with multiple vertebral involvement, with the middle and late disease stages being characterized by osteophytes in the vertebral margins and bony bridges, endplate sclerosis, and vertebral osteosynthesis. We encountered 54 cases (75%) with endplate lamellar osteolysis, 37 (51.4%) with vertebral lamellar osteolysis, 59 (81.9%) with marginal osteophytes, 10 (13.9%) with bony bridges, 25 (34.7%) with vertebral laminar sclerosis, and 17 (23.6%) with vertebral osteosynthesis. MRI revealed early, low-intensity, differential T1WI vertebral and intervertebral signals, with occasional iso-signals, T2WI iso-signals or high-intensity signals; and T2WI-FS vertebral and intervertebral high-intensity signals, commonly from vertebral soft tissues and rarely from paravertebral abscesses. CONCLUSIONS A better understanding of the X-ray, CT, and MRI features of Brucella spondylitis could aid in diagnosis when combined with epidemiological and laboratory data, thus minimizing misdiagnosis.

[Combined application of neural stem cell and self-assembly isoleucine-lysine-valine-alanine-valine nanofiber gel transplantation in the promotion of function recovery of spinal cord injury in rats].

OBJECTIVE: To observe the effects of neural stem cells (NSC) plus self-assembly isoleucine-lysine-valine-alanine-valine (IKVAV) nanofiber gel transplantation on the promotion of function recovery of spinal cord injury (SCI) in rats. METHODS: A total of 230 SD rats were randomized into gel, NSC, NSC plus self-assembly IKVAV nanofiber gel transplantation, normal saline and sham-operation groups. Function repair was evaluated by bundle branch block (BBB) score, immunofluorescence and Western blot respectively at Day 1, 3, 5, 7, 14, 28, 56 and 92 post-operation. RESULTS: There were statistically significant differences among bundle branch block (BBB) scores of different treatment groups (P < 0.01). Moreover, statistical significance existed between each treatment group and combined transplantation group (P = 0.000). The expression of glial fibrillary acidic protein in combined transplantation group (rats with spinal injury) was lower than that in other treatment groups (except for sham operation) and the expression of NF-200 in this group was higher than that in other treatment groups (except for sham operation). Significant differences existed in the expressions of brain-derived neurotrophic factor and nerve growth factor between combined transplantation and other treatment groups (P < 0.01). CONCLUSION: Transplantation with IKVAV nanofiber gel, NSC and NSC plus self-assembly IKVAV nanofiber gel may promote the repair of SCI in rats. But the method of NSC plus self-assembly IKVAV nanofiber gel is more effective.

A meta-analysis of the local application of vancomycin powder to prevent surgical site infection after spinal surgeries.

OBJECTIVE: This study aimed to systematically analyze the effectiveness and safety of the local application of vancomycin powder to prevent surgical site infection (SSI) after spinal surgeries and provide guidance for clinical practice. METHODS: Two researchers independently searched PubMed, Web of Science, Elsevier, and China National Knowledge Infrastructure using the MeSH terms "spinal surgery," "vancomycin," "local," "topical," "prophylactic," "surgical site infection," and "SSI" to identify studies published between January 2010 and January 2020 on the local application of vancomycin powder for preventing SSI after spinal surgeries. The outcome assessment indicators were analyzed using RevMan 5.3 software. RESULTS: Three randomized controlled trials, two prospective studies, and 26 retrospective studies were included in the current research. The results of the meta-analysis revealed significant differences between the vancomycin and control groups (non-vancomycin group) concerning the incidence of SSI (risk ratio = 0.39, 95% confidence interval = 0.28-0.55, Z = 5.46), indicating that local application of vancomycin powder can significantly reduce the incidence of SSI. CONCLUSION: Local application of vancomycin powder is an effective and safe method to prevent SSI after spinal surgeries.

Long noncoding RNA HOXD-AS1 aggravates osteosarcoma carcinogenesis through epigenetically inhibiting p57 via EZH2.

Osteosarcoma is the most common primary malignant bone tumor and long non-coding RNAs (lncRNAs) have been proved to epigenetically regulate the oncogenesis of osteosarcoma. In this research, we investigate the role of lncRNA HOXD-AS1 on the osteosarcoma oncogenesis. Results revealed that HOXD-AS1 expression level was significantly up-regulated in osteosarcoma tissue and cells, moreover, the aberrant overexpression predicted the poor prognosis of osteosarcoma patients. Loss-of-functional experiments indicated that HOXD-AS1 silencing inhibited the osteosarcoma cells proliferation and induced G1/G0 phase arrest in vitro, and repressed tumor cell growth in vivo. Mechanistic investigations showed that HOXD-AS1 epigenetically repressed p57 through recruiting enhancer of zeste homolog 2 (EZH2) to the promoter of p57. Rescue experiments revealed that p57 could recover the oncogenic role of HOXD-AS1 on osteosarcoma. In conclusion, our study confirmed that HOXD-AS1 could interact with EZH2, and then repress p57 expression, to aggravate osteosarcoma oncogenesis. which provide new idea for the osteosarcoma tumorigenesis.

Incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1764 instrumented spinal procedures.

BACKGROUND: Surgical site infection (SSI) is a common complication in spinal surgery, imposing a high burden on patients and society. However, information about its characteristics and related risk factors is limited. We designed this prospective, multicenter study to address this issue. METHODS: From January 2015 through February 2016, a total of 1764 patients who had spinal trauma or degenerative spinal diseases were treated with instrumented surgeries and followed up for 1 year with complete data. Data on all patients were abstracted from electronic medical records, and SSIs were prospectively inspected and diagnosed by surgeons in our department. Any disagreement among them was settled by the leader of this study. SPSS 19.0 was used to perform the analyses. RESULTS: A total of 58 patients (3.3%, 58 of 1764) developed SSI; 1.1% had deep SSI, and 2.2% had superficial SSI. Of these, 60.6% (21 of 33) had a polymicrobial cause. Most of them (51 of 58) occurred during hospitalization. The median occurrence time was 3 days after operation (range: 1-123 days). SSI significantly prolonged hospital stays, by 9.3 days on average. The univariate analysis revealed reason for surgery as the only significant risk factor. The multivariate analysis, however, revealed 8 significant risk factors, including higher BMI, surgical site (cervical), surgical approach (posterior), surgery performed in summer, reasons for surgery (degenerative disease), autograft for fusion and fixation, and higher preoperative platelet level. CONCLUSION: Identification of these risk factors aids in stratifying preoperative risk to reduce SSI incidence. In addition, the results could be used in counseling patients and their families during the consent process.

Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: A systematic review and meta-analysis.

BACKGROUND: To assess the safety and efficacy of percutaneous short-segment pedicle instrumentation compared with conventionally open short-segment pedicle instrumentation and provide recommendations for using these procedures to treat thoracolumbar fractures. METHODS: The Medline database, Cochrane database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched for articles published. The randomized controlled trials (RCTs) and non-RCTs that compared percutaneous short-segment pedicle instrumentation to open short-segment pedicle instrumentation and provided data on safety and clinical effects were included. Demographic characteristics, clinical outcomes, radiological outcomes, and adverse events were manually extracted from all of the selected studies. Methodological quality of included studies using Methodological Index for Non-Randomized Studies scale and Cochrane collaboration's tool for assessing the risk of bias by 2 reviewers independently. RESULTS: Nine studies encompassing 433 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. The pooled results showed there were significant differences between the 2 techniques in short- and long-term visual analog scale, intraoperative blood loss, operative time, postoperative draining loss, hospital stay, and incision size, although there were no significant differences in postoperative radiological outcomes, Oswestry Disability Index, hospitalization cost, intraoperative fluoroscopy time, and adverse events. CONCLUSION: Percutaneous short-segment pedicle instrumentation in cases with achieve satisfactory results, could replace in many cases extensive open surgery and not increased related complications. However, further high-quality RCTs are needed to assess the long-term outcome of patients between 2 techniques.

[Surgical treatment of lumbar pyogenic spondylitis].

OBJECTIVE: To investigate the diagnosis and effectiveness of surgical treatment for lumbar pyogenic spondylitis. METHODS: Between February 2005 and June 2010, 15 cases of lumbar pyogenic spondylitis were treated. There were 10 males and 5 females with an average age of 48.6 years (range, 26-72 years). Affected segments included L2, 3 in 3 cases, L(3, 4) in 3 cases, L(4, 5) in 8 cases, and L5, S1 in 1 case. All cases had clinical manifestations of moderate or severe fever, local pain of lesion, and limitation of the spinal movement; 10 patients had nerve root symptoms, and 8 patients had symptoms of lower limb paraplegia. Leukocyte, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) significantly increased in all cases. The preoperative X-ray and CT examinations showed no clear bone destruction; MRI showed decreased signal intensity on T1WI and increased signal intensity on T2WI, 7 cases had localized abscess formation. The patients underwent focal cleaning and bone grafting and fusion combined with internal fixation, including anterior operation in 13 cases, posterior operation in 1 case, and combined anterior and posterior operation in 1 case. The results of bacterial culture were positive in 10 cases. According to the results of intraoperative bacterial cultures, sensitive antibiotics were selected. RESULTS: Healing of incision by first intention was achieved in 14 cases, healing by second intention in 1 case. After 2 weeks, 1 case recurred and symptoms was reliefed after symptomatic treatment. Back pain and (or) lower limb pain were obviously improved in the other patients; body temperature recovered to normal after 3-4 days; leukocyte, ESR, and CRP significantly decreased. All the patients were followed up 12 to 70 months with an average of 35.4 months. The patients had no rejection, no fistula formation, no lumbar kyphosis, and no fixator loosening or breakage. The bony fusion time was 4-8 months. CONCLUSION: Combination of clinical manifestations, laboratory tests, and MRI can diagnose lumbar pyogenic spondylitis, of which CRP is an important indicator to determine progression of the disease, and MRI is important for diagnosis. Debridement combined with interbody fusion and internal fixation is a safe and effective treatment method.