Surgical strategy for the treatment of thoracolumbar metastatic tumor and its clinical outcomes / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate surgical strategy and clinical outcomes for the treatment of thoracolumbar metastatic tumor.</p><p><b>METHODS</b>From January 2009 to December 2010,42 patients with thoracolumbar metastatic tumor were treated surgically. Among the patients, 30 patients were male, and 12 patients were female, ranging in age from 28 to 76 years old, with an average age of 56.8 years old. Twenty-five patients had metastatic tumor in thoracic vertebraes, and 17 patients had metastatic tumor in lumbar vertebraes. Thirty-four patients had metastatic tumor in 1 segment, 6 patients had metastatic tumor in 2 segments and 2 patients had metastatic tumor in 3 segments. Two patients had no symptoms and 40 patients had back or leg pain. Eighteen patients had neurologic deficits, and 5 patients had injuries of A degree, 3 patients had injuries of B degree, 4 patients had injuries of C degree, 6 patients had injuries of D degree according to ASIA grading system. The operation goal was made according to Tomita evaluation. The surgical procedures included pallative decompression, tumor curettage and total vertebrectomy, which were decided based on Tomita classification. The pain, spinal cord function,part control of tumor,survival rate and conditions of internal fixation were evaluated at 1 week, 3 months, 6 months, 1 year and 2 years after operation.</p><p><b>RESULTS</b>One patient died in the operation. Pain relief was obtained in 38 patients after operation. Among 18 patients suffering from spinal cord compromise, 17 patients improved 1 to 4 grades after surgery according to the ASIA grading system. All the patients were followed up and the duration ranged from 24 to 48 months, with a mean time of 34.2 months. Five patients got recurrence. The postoperative survival rates at 3 months, 6 months, 1 year and 2 years were 95.2%, 85.7%, 58.2%, 37.6% respectively.</p><p><b>CONCLUSION</b>According to Tomita system, the different surgical treatments can be selected for patients with spinal metastatic tumors, which can relieve pain, improve the neurological status and spine stabilization, maintain local control, improve quality of life.</p>

Factors as predictors for thoracic and thoracolumbar/lumbar structural curves in adolescent idiopathic scoliosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recent studies have demonstrated that the Lenke system is relatively efficient and consistent in classifying scoliosis curves. Basically, fusion should include the main curve and the structural minor curve. The criteria for defining the structural minor curve were established to help guide these decision-making process. The present study was designed to investigate predictors of the structural curve, and see whether it was possible to prevent the formation of the structural curve by interfering with influencing factors to decrease the fusion level.</p><p><b>METHODS</b>Age, gender, Cobb angle, Perdriolle rotation, Risser sign and the number of vertebrae included in the curve, brace treatment, and curve location were recorded in 145 idiopathic scoliosis patients from July 2001 to January 2007. The patients were divided into two groups: structural and non-structural groups. Demographics and baseline characteristics were compared between the two groups as an initial screen. Logistic regression was used to analyze factors affecting the minor curve to become the structural curve.</p><p><b>RESULTS</b>Compared with the non-structural group, the structural group had a higher Cobb angle ((51.34 ± 13.61)° vs. (34.20 ± 7.21)°, P < 0.001), bending angle ((33.94 ± 9.92)° vs. (8.46 ± 5.56)°, P < 0.001) and curve rotation ((23.25 ± 12.86)° vs. (14.21 ± 8.55)°, P < 0.001), and lower flexibility ((33.48 ± 12.53)% vs. (75.50 ± 15.52)%, P < 0.001). There was no significant difference in other parameters between the two groups. The results of the Logistic regression analysis showed that the Cobb angle (OR: 9.921, P < 0.001) and curve location (OR: 4.119, P = 0.016) were significant predictors of structural curve in adolescent idiopathic scoliosis. Every 10° change of Cobb angle increased the possibility of turning the minor curve into the structural curve by 10-fold. And thoracic curve showed, on the average, the possibility of becoming the structural curve about 4-fold more often than did the thoracolumbar/lumbar curve.</p><p><b>CONCLUSIONS</b>Curve severity and curve location affect the minor curve's structural features in adolescent idiopathic scoliosis.</p>

Single nucleotide polymorphisms and ossification of posterior longitudinal ligament: Recent progress / 第二军医大学学报

Ossification of the posterior longitudinal ligament (OPLL) is common clinical spinal disorders often occurring in the cervical spine, with the main symptom being nerve compression. The specific mechanism of OPLL remains unclear, but genetic factors, single nucleotide polymorphisms (SNPs), mechanical stimulation, metabolism abnormality might be involved in the etiology of the disease. Multiple genetic and environmental factors may contribute to the development of OPLL. OPLL has prominent genetic characteristic, and it is associated with SNPs of several genes. Here we review the SNPs of several genes (COL11A2, BMP-2, TGF-β1, TGF-β3, NPPS, COL6A1 and Runx2) which contribute to the development of OPLL, hoping to lay a foundation for future study.