Early versus delayed decompression for traumatic cervical spinal cord injury: application of the AOSpine subaxial cervical spinal injury classification system to guide surgical timing.

PURPOSE: Application of AOSpine subaxial cervical spine injury classification system to explore the optimal surgical decompression timing for different types of traumatic cervical spinal cord injury (CSCI). METHODS: A single-center prospective cohort study was conducted that included patients with traumatic CSCIs (C3-C7) between February 2015 and October 2016. After enrollment, patients underwent either early (< 72 h after injury) or late (≥ 72 h after injury) decompressive surgery of the cervical spinal cord. Each group was divided into A0, A1-4, B, C/F4 and F1-3 subgroups. The primary outcomes were ordinal changes in the ASIA Impairment Scale (AIS) and the Spinal Cord Independence Measure III (SCIM version 3) at a 12-month follow-up. The secondary outcomes included length of hospital stay, postoperative neurological deterioration, other complications and mortality. RESULTS: A total of 402 patients were included. Of these, 187 patients underwent early decompression surgery, and 215 patients underwent delayed decompression surgery. Statistical results included the following comparisons of the early vs late groups: AIS improvement ≥ 1 grade (combined groups: P < 0.0001; A0: P = 0.554; A1-4: P = 0.084; B: P = 0.013; C/F4: P = 0.040; F1-3: P = 0.742); AIS improvement ≥ 2 grades, P = 0.003 for all groups; SCIM version 3 (combined groups: P < 0.0001; A0: P = 0.126; A1-4: P = 0.912; B: P = 0.006; C/F4: P = 0.111; F1-3: P = 0.875). CONCLUSION: Type A and F1-3 fractures are not required to undergo aggressive early decompression. Type B and type C/F4 fractures should receive early surgical treatment for better clinical outcomes. These slides can be retrieved under Electronic Supplementary Material.

Accuracy of a patient-specific template for pedicle screw placement compared with a conventional method: a meta-analysis.

INTRODUCTION: Accurate placement of pedicle screws in spine surgery is a challenge for surgeons. Patient-specific template techniques have the potential for improving the accuracy of screw placement. The target of this analysis was to investigate differences in terms of accuracy of pedicle screw insertion between patient-specific template assistance and the conventional free-hand method for reconstruction of spinal stability. MATERIALS: The Cochrane Library, Ovid, Web of Science, PubMed, EMBASE and CNKI database were searched until February 2017 for a systematic review, and several comparative studies were screened for comparisons of accuracies of pedicle screw insertion with patient-specific assistance and conventional methods. Primary outcomes extracted from papers that met the selection criterion were expressed as odds ratios for dichotomous outcomes with a 95% confidence interval. A χ 2 test and I 2 statistics were used to evaluate heterogeneity. RESULTS: A total of ten RCTs and two prospective cohort studies were finally chosen for the analysis of accuracy rates. Study quality was assessed using the Cochrane Collaboration's Tool and Newcastle-Ottawa Quality Assessment Scale. There were obvious differences between them, and the accuracy rate of screw implantation among a patient-specific template assistance set was statistically significantly higher than the conventional free-hand set (OR 95% CI 3.78-6.41, P < 0.01); in vitro: OR 95% CI 3.93-7.42, P < 0.01; in vivo: OR 95% CI 2.49-6.44, P < 0.01. CONCLUSIONS: The template-assisted technique is superior to the conventional method for the reduction of pedicle violation. The template-assisted technique is a promising technique that should be considered as another available navigation tool for surgeons to improve the accuracy of pedicle screw placement. As an available technique for emerging applications in spine surgeries, this technique will face challenges but ultimately prove successfully.

Sarcopenia predicts an adverse prognosis in patients with combined hepatocellular carcinoma and cholangiocarcinoma after surgery.

BACKGROUND: The prognostic value of sarcopenia in combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) patients after surgery has not been evaluated, while the efficacy of the available tumor stage for cHCC-CC remains controversial. METHODS: All consecutive cHCC-CC patients after surgery were retrieved. The patients were stratified by the sex-specific medians of the psoas muscle index into groups with or without sarcopenia. Prognosis was analyzed using the Kaplan-Meier (K-M) method, and the K-M curves were adjusted by inverse probability weighting (IPW). A nomogram based on Cox regression analysis was established and further compared with primary liver cancer (PLC) stages by internal validation based on bootstrap resampling and k-fold cross-validation. RESULTS: A total of 153 patients were stratified into sarcopenia and non-sarcopenia groups. The sarcopenia group revealed statistically worse overall survival (OS) and disease-free survival (DFS) using the K-M method and K-M curves adjusted by IPW. Multivariate Cox regression analyses suggested sarcopenia as an independent risk factor for OS (HR = 1.55; p = 0.040) and DFS (HR = 1.55; p = 0.019). Subgroup analysis based on baseline variables showed sarcopenia as a stable risk factor for the prognosis. Our nomogram outperformed PLC stages in prognostic prediction, as evidenced by the best c-index, area under the curve, and positive improvement of the net reclassification index and integrated discrimination improvement. A fivefold cross-validation revealed consistent results. Decision curve analysis revealed higher net benefits of the nomogram than PLC stages. CONCLUSIONS: Sarcopenia is an independent and stable risk factor for the prognosis of cHCC-CC patients after surgery. Our nomogram might aid high-risk patient identification and clinical decisions.

Surgical treatment of the lower cervical brucellosis with osteoporosis in the northwest region of China: review of 22 cases.

OBJECTIVE: To analyze the surgical treatment of patients with cervical brucellosis with osteoporosis over a 4-year period in Northwest China. METHODS: From 2013 to 2018, 22 patients (12 males and 10 females) with lower cervical spine brucellosis (C3-C7) underwent anterior lesion debridement, decompression, bone grafting and internal fixation combined with posterior bone graft fusion and internal fixation (ADDF+PIF). The follow-up period averaged 37.4 months (ranging from 24 to 57 months). RESULTS: Involvement of 1 vertebra was observed in 3 patients, involvement of 3 vertebrae was observed in 9 patients, and involvement of 3 vertebrae was observed in 10 patients. Before surgery, 1 patient had Frankel grade B, 2 had grade C, 9 had grade D, and 10 had grade E. In the final follow-up, 12 patients had neurological deficits, 10 patients improved by one grade, 6 patients improved by two grades, and the neurological status of 6 patients remained unchanged. In all cases, it was observed that bone fusion required 6.8 months on average. The kyphosis Cobb angle was enhanced from an average of 11.5° preoperatively (range 0°-24°) to 0.13° postoperatively (range 1°-5°), and there was no vital loss of correction in the follow-up. CONCLUSIONS: ADDF+PIF is an effective and safe treatment for patients with lower cervical brucellosis with osteoporosis.

Nomogram Models for Predicting Risk and Prognosis of Newly Diagnosed Ovarian Cancer Patients with Liver Metastases - A Large Population-Based Real-World Study.

Background: Previous studies about liver metastases (LM) in newly diagnosed ovarian cancer (NDOC) patients based on Surveillance, Epidemiology, and End Results (SEER) program disregarded selection bias of missing data. Methods: We identified Data of NDOC patients from SEER between 2010 and 2016, presented a comprehensive description of this dataset, and limited possible biases due to missing data by applying multiple imputation (MI). We determined predictive factors for underlying LM development in NDOC patients and evaluated prognostic factors in NDOC patients with LM (OCLM). We then established predictive nomograms, assessed by the concordance index, calibration curve, decision curve analysis (DCA), and clinical impact curves (CIC). Results: The amount of missing data for different variables in SEER dataset ranges from 0 to 36.11%. The results between complete dataset and MI datasets are similar. LM prevalence in NDOC patients was 7.18%, and median overall survival for OCLM patients was 11 months. The C-index of risk nomogram for LM development in the training cohort (TC) and validation cohort (VC) were 0.764 and 0.759, respectively. The C-index and integrated area under curve within five years of prognostic nomogram for OCLM patients in the TC and VC were 0.743 and 0.773, 0.714 and 0.733, respectively. For both nomograms, DCA revealed favorable clinical use and calibration curves suggested good consistency. Conclusion: The risk nomogram is expected to aid clinicians in identifying high-risk groups of LM development in NDOC patients for intensive screening. The prognostic nomogram could facilitate individualized prediction and stratification for clinical trials in OCLM patients.

Anterior Cervical Discectomy and Fusion Combined with Foraminotomy Assisted by High-Definition 3-Dimensional Exoscope in the Treatment of Cervical Spondylotic Radiculopathy Secondary to Bony Foraminal Stenosis.

OBJECTIVE: To evaluate the outcomes of cervical spondylotic radiculopathy secondary to bony foraminal stenosis treated with anterior cervical discectomy and fusion (ACDF) combined with anterior cervical foraminotomy (ACF) assisted by High-Definition 3-Dimensional Exoscope. METHODS: In this retrospective study, a total of 19 consecutive patients (12 males and seven females, with an average of 49.2 years, range from 40 to 59 years) with spondylotic radiculopathy caused by bony foraminal stenosis underwent ACDF combined with ACF assisted by High-Definition 3-Dimensional Exoscope in our hospital between January 2019 and December 2019 were included in this study. All patients signed the consent form before the surgery. The patient baseline information such as gender, age, body mass index (BMI), surgery time, blood loss, hospital stay, lesion segment, side, follow-up time and postoperative complications were recorded. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) were measured and compared before surgery, 1 months and final follow-up after surgery. The radiographic outcomes were evaluated using the C2 -C7 angel, disc height, foraminal height, superior diagonal distance, inferior diagonal distance, and foraminal area. RESULTS: The involved levels included C4 -C5 (six cases), C5 -C6 (10 cases), C6 -C7 (three cases). The mean duration of the surgery, mean blood loss, mean hospital stay, and mean follow-up were 100 ± 11.10 min, 19.4 ± 7.05 mL, 7.1 ± 0.99 days, and 12.1 ± 2.25 months, respectively. The average preoperative JOA score was 11.9 ± 1.31, then improved to 15.7 ± 0.73 (t = -13.45, P < 0.001) and 16.2 ± 0.74 (t = -14.39, P < 0.001) at 1 month after operation and at last follow-up, respectively. The average preoperative NDI score was 27.3 ± 3.36, then decreased to 5.1 ± 1.79 (t = 20.63, P < 0.001) and 4.5 ± 1.21 (t = 25.53, P < 0.001) 1 month after operation and at last follow-up, respectively. The average preoperative VAS score was 6.7 ± 0.93, then decreased to 2.4 ± 0.69 (t = 15.05, P < 0.001) and 1.9 ± 0.78 (t = 16.40, P < 0.001) 1 month after operation and at last follow-up, respectively. As compared with the condition before surgery, there was a significant improvement in the C2 -C7 angel, disc height, foraminal height, and foraminal area (P < 0.05). None of the patients developed postoperative vascular injury, nerve injury, loosening and rupture of the internal fixation, displacement of interbody fusion cage, and pseudarthrosis. CONCLUSION: ACDF combined with ACF assisted by High-Definition 3-Dimensional Exoscope is effective and safe for the treatment of CSR caused by secondary to bony foraminal stenosis.

Safety and Efficacy of Minimally Invasive Transforaminal Lumbar Interbody Fusion Combined with Gelatin Sponge Impregnated with Dexamethasone and No Drainage Tube after Surgery in the Treatment of Lumbar Degenerative Disease.

OBJECTIVE: The aim of the present study was to use a gelatin sponge impregnated with dexamethasone, combined with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and no drainage tube after the operation for early postoperative recurrence of root pain caused by edema. METHODS: A prospective case series study was designed. From September 2015 to January 2018, eligible patients diagnosed with lumbar degenerative disease underwent MIS-TLIF combined with a gelatin sponge impregnated with dexamethasone and no drainage tube after surgery. The short-term clinical data were collected, such as visual analog scale (VAS) scores for low back pain and leg pain preoperatively and on postoperative days (POD) 1-10, time bedridden postoperatively, and length of hospital stay postoperatively. Long-term indicators include the Japanese Orthopaedic Association (JOA) score, the Oswestry Disability Index (ODI) score, and the 36-Item Short-Form Health Survey (SF-36) score, evaluated preoperatively and 1 week, 3 months, and more than 1 year postoperatively. RESULTS: Complete clinical data was obtained for 139 patients. All patients were followed up for more than 12 months (13.7 ± 3.3 months). The average bedridden period was 1.5 ± 0.4 days and hospital stays were 2.7 ± 0.9 days. The VAS score of leg and back pain on POD 1-10 were all decreased compared with preoperation (all P < 0.0001). At the last follow up, the VAS scores for back pain and leg pain (0.69 ± 0.47; 1.02 ± 0.55) and the ODI score (11.1 ± 3.5) decreased (all P < 0.0001), and the JOA score (27.1 ± 3.2) and the SF-36 (physical component summary, 50.5 ± 7.3; mental component summary, 49.4 ± 8.9) increased (all P < 0.0001) compared with preoperative values. Patients' early and long-term levels of satisfaction postoperatively were 92.8% and 97.8%, respectively. At POD 7 and the last follow-up, the improvement rate of the JOA score, respectively, was 41.8% ± 10.6% and 87.7% ± 8.2%, and clinical effects assessed as significantly effective according to the improvement rate of the JOA score was 16.5% and 66.9%, respectively. There were 2 (1.4%) cases with complications, including 1 (0.7%) case of wound infection and 1 (0.7%) case of deep vein thrombosis. There were no device-related complications or neurological injuries. CONCLUSION: Use of a gelatin sponge impregnated with dexamethasone combined with MIS-TLIF and no drainage tube after the operation, compared with previous studies, appears to be safe and feasible to reduce recurrent back pain and leg pain after decompression in the treatment of lumbar degenerative disease.

The CT Image Changes in Ankylosing Spondylitis from Fracture to Andersson Lesions: A Case Report and Literature Review.

BACKGROUND: Ankylosing spondylitis with Andersson lesions is not rare, but its potential pathogenesis and natural course remain unclear. CASE DESCRIPTION: We describe a case of CT image changes in ankylosing spondylitis from fracture to Andersson lesions. A 40-year-old man with a 23-year history of ankylosing spondylitis presented with acute back pain after a slight fall, and the CT showed a T12 fracture; the patient refused surgery for 12 months. The process from fracture to Andersson lesions was characterized by CT, including the subsequent interbody bone graft with internal fixation and successful bone fusion at the last follow-up. Histopathologic analysis showed degenerative fibrocartilage tissue calcification, necrotic intervertebral disc tissue, fibrovascular hyperplasia, and focal accumulation of inflammatory cells. CONCLUSION: Aseptic inflammation and persistent instability caused by a fracture contributed in the course from fracture to Andersson lesions in ankylosing spondylitis. CT can accurately track the pathological process, and interbody fusion via the posterior pedicle lateral approach can achieve satisfactory effectiveness, good fusion and kyphosis correction.

Reliability and application of the new morphological classification system for chronic symptomatic osteoporotic thoracolumbar fracture.

BACKGROUND: We propose a new classification system for chronic symptomatic osteoporotic thoracolumbar fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years; however, the lack of a standard classification system has resulted in inconvenient communication, research, and treatment. Previous CSOTF classification studies exhibit different symptoms, with none being widely accepted. METHODS: Imaging data of 368 patients with CSOTF treated at our hospital from January 2010 to June 2017 were systematically analyzed to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans, and magnetic resonance imaging. Ten investigators methodically studied the classification system grading in 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability. Based on the radiographic characteristics, the patients were divided into 5 types, and different treatments were suggested for each type. Clinical outcome evaluation included using the visual analog score (VAS), the Oswestry disability index (ODI), and the American Spinal Injury Association (ASIA) impairment scale. RESULTS: The new classification system for CSOTF was divided into types I-V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively). The VAS score and ODI of each type were significantly improved at the final follow-up compared with those before surgery. In all patients with neurological impairment, the ASIA grading after surgery was significantly improved compared with that before surgery (P < 0.001). CONCLUSIONS: The new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The treatment algorithm based on the classification can result in satisfactory improvement of clinical efficacy for the patients of CSOFT.

Incidence and Outcomes of C5 Palsy and Axial Pain After Open-Door Laminoplasty or Laminectomy and Fusion: A Meta-Analysis.

OBJECTIVE: C5 palsy and axial pain are significant factors affecting the quality of life after posterior cervical surgery; however, there has been no clear and supportive conclusion on which method is more suitable in a certain case. As a result, we compare the clinical outcomes, complication rates, and anatomical changes between open-door laminoplasty (ODL) and laminectomy and fusion (LF) for cervical spondylotic myelopathy. This is a systematic literature review and meta-analysis. METHODS: A comprehensive literature search was conducted using PubMed, Embase, and the Cochrane library. The following outcomes were extracted and analyzed: the cases of C5 palsy and axial pain patients, Japanese Orthopaedic Association, range of motion (ROM), and cervical curvature. Data analysis was conducted with RevMan 5.3. The I2 statistics were used to evaluate heterogeneity. RESULTS: A total of 9 studies were included in the final analysis, all of which were prospective or retrospective cohort studies. The pooled data showed that the incidences of C5 palsy and axial pain in LF were higher than those in ODL. The study indicated that there was no significant difference in pre- and postoperative Japanese Orthopaedic Association scores, preoperative cervical ROM, pre- and postoperative cervical curvature between the 2 groups, but there was significant difference in ROM after operation. These results indicate that ODL was superior to LF in maintaining cervical ROM. CONCLUSIONS: Our results demonstrate that the lower incidence of C5 palsy and axial pain can be achieved by using ODL compared with LF. However, current data only provide weak support, if any, favoring ODL over for clinical improvement in reduce these 2 complications.

Rare Hereditary Abnormal Bone Hyperplasia and Ossification of the Yellow Ligament Complicated by Thoracic Spinal Stenosis.

We report a rare case of familial inherited abnormal bone hyperplasia and ossification of the yellow ligament complicated by spinal stenosis. Complete reconstruction of stability and spinal cord decompression were achieved by posterior total laminectomy, fusion, and internal fixation. We cannot clearly describe the inheritance characteristics of the disease. Although the risk of surgical treatment is high, it is still necessary to perform surgery, and the effect of the operation is substantial.

Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: Systematic Review and Meta-Analysis.

BACKGROUND: Many retrospective studies of pedicle screw placement have revealed that intraoperative navigation systems provide higher accuracy rates and safety than do free-hand techniques. The accuracy of various image-guided navigation systems has been studied; however, differences have not been well defined due to the lack of adequate evidence-based comparative studies. OBJECTIVE: A meta-analysis was conducted to focus on the variation in pedicle screw insertion among 3 navigation systems: a 3-dimensional fluoroscopy-based navigation system (3D FluoroNav), a 2-dimensional fluoroscopy-based navigation system (2D FluoroNav), and a conventional computed tomography navigation system (CT Nav). METHODS: We screened for comparative studies on different pedicle screw insertion navigation systems published through January 2017 using the Cochrane Library, Ovid, Web of Science, PubMed, and EMBASE databases. RESULTS: From 125 papers that were identified, 10 articles were finally chosen. The present comparative study included 8 retrospective clinical studies, 1 prospective clinical trial, and 1 randomized controlled cadaveric study. The prevalence rate of pedicle violation in the 3D FluoroNav group was significantly lower than the rates of the 2D FluoroNav group (relative risk [RR] 95%, confidence interval [CI]: 0.16-0.61, P < 0.01) and the CT Nav group (RR 95%, CI: 0.42-0.90, P = 0.01), and the rate of the CT Nav group was significantly lower than that of the 2D FluoroNav group (RR 95%, CI: 0.29-0.81, P < 0.01). CONCLUSION: Significant differences exist among CT Nav, 3D FluoroNav, and 2D FluoroNav. Our review suggests that 3D FluoroNav may be superior to the other 2 methods in reducing pedicle violation and that clinicians should consider 3D FluoroNav as a better choice.

Surgery for Multisegment Thoracolumbar Mild Osteoporotic Fractures: Revised Assessment System of Thoracolumbar Osteoporotic Fracture.

OBJECTIVE: To examine the Assessment System of Thoracolumbar Osteoporotic Fracture (ASTLOF), which can effectively guide the treatment of single-segmental thoracolumbar osteoporotic vertebral compression fractures but fails to guide the treatment of multisegmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF). METHODS: A prospective case series study was designed to enroll elderly patients with MSTMOVCF who had been treated with percutaneous kyphoplasty/percutaneous vertebroplasty (PKP/PVP) from June 2013 to June 2016. Surgery indication was based on revised ASTLOF. Visual analog scale and Oswestry Disability Index (ODI) scores were used to evaluate the postoperative improvement of back pain, and clinical effects were assessed according to the 36-Item Short Form Health Survey. Some imaging measures, such as height of anterior and middle column and Beck value, were measured before the operation and 12 months after the operation. Complications also were collected. RESULTS: A total of 193 patients underwent PKP/PVP surgery. At postoperative 2 days, 3 months, and 1-year follow-up, whereas VAS and ODI scores decreased (P < 0.0001, for all) significantly as well as SF-36, the height of anterior and middle column increased (P < 0.0001, for all) compared with preoperation. Beck value at 1-year follow-up was greater than preoperation (P = 0.001). The improvement rate of ODI was 86.4 ± 8.3%. CONCLUSIONS: Patients with MSTMOVCF who undergo surgery with PKP/PVP can achieve great clinical results. Patients with the sum of revised ASTLOF scores of multiple injured vertebrae ≥5 should be recommended for surgery. The consistency and repeatability of the revised ASTLOF need further study.

The analysis of MSTMOVCF (Multi-segment thoracolumbar mild osteoporotic fractures surgery or conservative treatment) based on ASTLOF (the assessment system of thoracolumbar osteoporotic fracture).

To investigate the issue that conservative or surgical treatment for multi-segmental thoracolumbar mild osteoporotic vertebral compression fracture (MSTMOVCF) by applying the assessment system of thoracolumbar osteoporotic fracture (ASTLOF). A single-center prospective cohort study was designed to enroll elderly patients with MSTMOVCF from June 2013 to June 2016, which were divided into conservative and surgery group. The primary outcomes were Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score, with secondary outcomes including SF-36 and imaging measures such as height of anterior and middle column, Beck value, complications. A total of 470 patients with MSTMOVCF were enrolled. 193 patients underwent surgery of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and 277 patients underwent conservative treatment. The VAS score of operation group was significantly lower than that of conservative group (P < 0.0001, for all). The ODI score of the operation group was significantly lower than that of conservative group (P < 0.0001, for all). The SF-36 score, height of anterior and middle column, Beck value in the operation group were higher than those in conservative group (P < 0.0001, for all) at 1-year follow-up. MSTMOVCF underwent surgery can achieve great short-term clinical results. The patient with the sum of revised ASTLOF scores of multiple injured vertebrae ≥ 5 was recommended for surgery.

Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block to Promote Early Postoperative Recovery of Lumbar Disc Herniation.

OBJECTIVE: To observe effect of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block to promote early postoperative recovery of lumbar disc herniation. METHODS: Retrospective analysis was performed of 265 patients with single-level lumbar disc herniation from January 2013 to October 2017. Patients were divided into intervention and control groups based on intraoperative application of gelatin sponge impregnated with a mixture of 3 drugs. All patients underwent unilateral minimally invasive surgical transforaminal lumbar interbody fusion. Clinical data, including bedridden period, postoperative hospital stay, visual analog scale scores for low back pain and leg pain, Japanese Orthopaedic Association score, postoperative satisfaction questionnaire results, and therapeutic effect, were collected. RESULTS: There were 136 cases in the intervention group and 129 cases in the control group. The intervention group had significantly shorter bedridden period and postoperative hospital stay than control group (P < 0.05). Visual analog scale scores for low back pain and leg pain at postoperative days 1-10 were significantly lower in the intervention group compared with control group (P < 0.05). The Japanese Orthopaedic Association score at postoperative day 6 and satisfaction at 72 hours postoperatively were significantly higher in the intervention group than in control group (P < 0.05). Clinical effect at postoperative day 6 was significantly better in the intervention group than control group (P < 0.05). CONCLUSIONS: Application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block can significantly promote early postoperative recovery of lumbar disc herniation and has great short-term clinical efficacy.

Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: An updated meta-analysis.

BACKGROUND: A miniature spine-mounted robot has recently been introduced to further improve the accuracy of pedicle screw placement in spine surgery. However, the differences in accuracy between the robotic-assisted (RA) technique and the free-hand with fluoroscopy-guided (FH) method for pedicle screw placement are controversial. A meta-analysis was conducted to focus on this problem. METHODS: Several randomized controlled trials (RCTs) and cohort studies involving RA and FH and published before January 2017 were searched for using the Cochrane Library, Ovid, Web of Science, PubMed, and EMBASE databases. A total of 55 papers were selected. After the full-text assessment, 45 clinical trials were excluded. The final meta-analysis included 10 articles. RESULTS: The accuracy of pedicle screw placement within the RA group was significantly greater than the accuracy within the FH group (odds ratio 95%, "perfect accuracy" confidence interval: 1.38-2.07, P < .01; odds ratio 95% "clinically acceptable" Confidence Interval: 1.17-2.08, P < .01). CONCLUSIONS: There are significant differences in accuracy between RA surgery and FH surgery. It was demonstrated that the RA technique is superior to the conventional method in terms of the accuracy of pedicle screw placement.

Long-Segment or Bone Cement-Augmented Short-Segment Fixation for Kummell Disease with Neurologic Deficits? A Comparative Cohort Study.

BACKGROUND: The standard treatment for Kummell disease with neurologic deficit remains controversial. Traditional posterior long-segment fixation (LSF) has been widely used, but the procedure results in significant trauma and carries the risk of multiple complications. Therefore, bone cement-augmented short-segment fixation (BCASSF) has been recommended for this condition. METHODS: The study included 36 patients treated with LSF or BCASSF between January 2012 and June 2015. The visual analog scale (VAS), Oswestry Disability Index (ODI) score, anterior height of fractured vertebrae, kyphotic Cobb angle, and neurologic function by the Frankel classification were evaluated and compared, and duration of operation, blood loss, length of hospital stay, and complications were recorded. RESULTS: Significant differences were observed in the VAS, ODI, anterior height of affected vertebrae, and kyphotic Cobb angle between preoperatively and 7 days postoperatively and between preoperatively and at the final follow-up, whereas no significant differences were observed between 7 days postoperatively and at final follow-up. No significant differences in the aforementioned parameters were observed between the groups at 7 days postoperatively and at the final follow-up. Neurologic function was improved in both groups; however, no significant differences were observed between the 2 groups either preoperatively or postoperatively. Blood loss and length of hospital stay were significantly lower in the BCASSF group compared with the LSF group, but no significant between-group differences were observed in operation time and complications. CONCLUSIONS: Lower blood loss and shorter hospital stay were associated with BCASSF compared with LSF; the 2 techniques had similar clinical outcomes and radiographic findings. Therefore, we recommend BCASSF for treating patients with Kummell disease with neurologic deficits.

Decompression for Traumatic Thoracic/Thoracolumbar Incomplete Spinal Cord Injury: Application of AO Spine Injury Classification System to Identify the Timing of Operation.

OBJECTIVE: Application of AO spine injury classification system (AOSICS) to identify the timing of operation for different types of traumatic thoracic/thoracolumbar incomplete spinal cord injury (SCI). METHODS: A single-center prospective cohort study was conducted to enroll patients with thoracic/thoracolumbar incomplete SCI from April 2013 to November 2016; they were divided into an early group (<24 hours after SCI) and a late group (24-72 hours after SCI). Each group was divided into A, B, C subgroups according to AOSICS. The primary outcomes were ordinal changes in ASIA Impairment Scale at 12-month follow-up. The secondary outcomes included the Medical outcomes study 36-term short form health survey physical component summary (PCS), complications, mortality, and hospital length of stay (LOS). RESULTS: Seven hundred twenty-one patients with thoracic/thoracolumbar incomplete SCI were included; 335 patients underwent early surgery, and 386 patients underwent delayed surgery. Statistical results included the following comparisons of the early versus late groups: AIS improvement of 1 grade or more (combined groups: P = 0.009, odds ratio [OR] = 1.487; A: P = 0.777, OR = 1.072; B: P = 0.029, OR = 1.701; C: P = 0.007, OR = 1.762), AIS improvement 2 grades or more (combined groups: P = 0.002, OR = 2.471; A: P = 0.189, OR = 3.939; B: P = 0.011, OR = 2.550; C: P = 0.035, OR = 3.964) and PCS (combined groups: P = 0.327; A: P = 0.776; B: P = 0.019; C: P = 0.562). LOS (combined groups: P < 0.0001; A, B and C: P < 0.0001). Complications (combined groups: P = 0.267; A: P = 0.830; B: P = 0.111; C: P = 0.757). CONCLUSIONS: Patients with type-A injuries with incomplete SCI do not have to undergo aggressive early operations. Patients with type-B and type-C injuries should undergo an operation early to achieve better clinical results.

Application of Gelatin Sponge Impregnated with a Mixture of 3 Drugs to Intraoperative Nerve Root Block Combined with Robot-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery in the Treatment of Adult Degenerative Scoliosis: A Clinical Observation Including 96 Patients.

OBJECTIVE: Application of nerve root block is mainly for diagnosis with less application in intraoperative treatment. The aim of this study was to observe clinical and imaging outcomes of application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in to treat adult degenerative lumbar scoliosis. METHODS: From January 2012 to November 2014, 108 patients with adult degenerative lumbar scoliosis were treated with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery combined with intraoperative gelatin sponge impregnated with a mixture of 3 drugs. Visual analog scale and Oswestry Disability Index scores were used to evaluate postoperative improvement of back and leg pain, and clinical effects were assessed according to the 36-Item Short-Form Health Survey. Imaging was obtained preoperatively, 1 week and 3 months postoperatively, and at the last follow-up. Fusion status, complications, and other outcomes were assessed. RESULTS: Follow-up was complete for 96 patients. Visual analog scale scores of leg and back pain on postoperative days 1-7 were decreased compared with preoperatively. At 1 week postoperatively, 3 months postoperatively, and last follow-up, visual analog scale score, Oswestry Disability Index score, coronal Cobb angle, and coronal and sagittal deviated distance decreased significantly (P = 0.000) and lumbar lordosis angle increased (P = 0.000) compared with preoperatively. Improvement rate of Oswestry Disability Index was 81.8% ± 7.4. Fusion rate between vertebral bodies was 92.7%. CONCLUSIONS: Application of gelatin sponge impregnated with 3 drugs combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion for treatment of adult degenerative lumbar scoliosis is safe and feasible with advantages of good short-term analgesia effect, minimal invasiveness, short length of stay, and good long-term clinical outcomes.

IFN-γ secretion in gut of Ob/Ob mice after vertical sleeve gastrectomy and its function in weight loss mechanism.

Vertical sleeve gastrectomy (VSG) is becoming more and more popular among the world. Despite its dramatic efficacy, however, the mechanism of VSG remains largely undetermined. This study aimed to test interferon (IFN)-γ secretion n of mesenteric lymph nodes in obese mice (ob/ob mice), a model of VSG, and its relationship with farnesoid X receptor (FXR) expression in the liver and small intestine, and to investigate the weight loss mechanism of VSG. The wild type (WT) mice and ob/ob mice were divided into four groups: A (WT+Sham), B (WT+VSG), C (ob/ob+Sham), and D (ob/ob+VSG). Body weight values were monitored. The IFN-γ expression in mesenteric lymph nodes of ob/ob mice pre- and post-operation was detected by flow cytometry (FCM). The FXR expression in the liver and small intestine was detected by Western blotting. The mouse AML-12 liver cells were stimulated with IFN-γ at different concentrations in vitro. The changes of FXR expression were also examined. The results showed that the body weight of ob/ob mice was significantly declined from (40.6±2.7) g to (27.5±3.8) g on the 30th day after VSG (P<0.05). At the same time, VSG induced a higher level secretion of IFN-γ in mesenteric lymph nodes of ob/ob mice than that pre-operation (P<0.05). The FXR expression levels in the liver and small intestine after VSG were respectively 0.97±0.07 and 0.84±0.07 fold of GAPDH, which were significantly higher than pre-operative levels of 0.50±0.06 and 0.48±0.06 respectively (P<0.05). After the stimulation of AML-12 liver cells in vitro by different concentrations of IFN-γ (0, 10, 25, 50, 100, and 200 ng/mL), the relative FXR expression levels were 0.22±0.04, 0.31±0.04, 0.39±0.05, 0.38±0.05, 0.56±0.06, and 0.35±0.05, respectively, suggesting IFN-γ could distinctly promote the FXR expression in a dose-dependent manner in comparison to those cells without IFN-γ stimulation (P<0.05). It was concluded that VSG induces a weight loss in ob/ob mice by increasing IFN-γ secretion of mesenteric lymph nodes, which then increases the FXR expression of the liver and small intestine.