Misdiagnosis of brown tumour caused by primary hyperparathyroidism: a case report with literature review.

BACKGROUND: Brown tumour is a rare tumour-like lesion of the bone, which is considered as an end-stage lesion of abnormal bone metabolism caused by persistently high parathyroid hormone (PTH) levels. Brown tumour can be found in any part of the skeleton; in some cases, it can occur in multiple bones and can be easily misdiagnosed as a metastatic tumour. CASE PRESENTATION: We report the case of a 44-year-old man who presented to the Department of Oncology in our hospital with a 2-month history of local pain in his left shoulder joint. The initial diagnosis was an aneurysmal bone cyst by biopsy, for which the patient underwent tumour resection surgery. The diagnosis of a malignant tumour was made again following postoperative pathological examination. The pathological sections and all clinical data were sent to the Department of Pathology of the First Affiliated Hospital of Sun Yat-sen University; the diagnosis made there was brown tumour. His blood PTH level was 577 pg/ml (15-65 pg/ml). Colour Doppler ultrasonography of the parathyroid gland suggested a parathyroid adenoma. For further treatment, the left parathyroid adenoma was removed by axillary endoscopic resection. Postoperatively, a pathologic examination was performed, and the diagnosis of a parathyroid adenoma was confirmed. One year after the surgery, the left humerus was completely healed, and the left shoulder joint had a good range of movement. CONCLUSIONS: In summary, histopathological diagnosis is not sufficient for the diagnosis of brown tumours. A comprehensive analysis combining clinical symptoms with findings of imaging and laboratory tests is also required. Generally, the treatment of brown tumour includes only partial or complete resection of the parathyroid glands. However, when the tumour is large, especially when it involves the joint, surgery is indispensable.

The change of cervical spine alignment along with aging in asymptomatic population: a preliminary analysis.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To investigate the correlation of cervical spine alignment changes with aging in asymptomatic population. BACKGROUND: Previous studies demonstrated the influence of lumbar and thoracic spine on cervical spine alignment, but few has reported the cervical spine alignment change along with aging in asymptomatic population. METHODS: Asymptomatic population were divided into four groups according to different ages (Group A: ≤20 years; Group B: 21-40 years; Group C: 41-60 years; Group D: ≥61 years). Each group was composed of 30 subjects. The following parameters were measured: C0-1 Cobb angle, C1-2 Cobb angle, C2-7 Cobb angle, C1-7 sagittal vertical axis (C1-7 SVA), C2-7 SVA, central of gravity to C7 sagittal vertical axis (CG-C7 SVA), Thoracic Inlet Angle (TIA), Neck Tilt (NT), cervical tilt, cranial tilt, T1 slope (TS), TS-CL, and ANOVA statistical method was used to analyze the differences among four groups, and then, linear regression analysis was performed to analyze correlation of the cervical spine alignment with the aging. RESULTS: C1-7 SVA, C2-7 SVA, CG-C7 SVA, TIA, NT, TS, and cranial tilt were found statistically different among four groups (P < 0.01). From Group A to Group D, the mean C1-7 SVA were 30.7, 26.0, 21.8, and 36.9 mm, the mean C2-7 SVA were 18.7, 14.7, 11.9, and 24.7 mm, and the mean CG-C7 SVA were 19.6, 16.6, 9.4, and 26.7 mm. The mean TIA were 62.4°, 65.0°, 71.8°, and 76.9°, the mean NT were 39.4°, 43.8°, 46.3°, and 48.2°, the mean TS were 23.0°, 21.1°, 25.5°, and 28.7°, and the mean cranial tilt were 5.7°, 4.8°, 3.0°, and 9.5°. Further linear regression indicated that TIA (r = 0.472; P < 0.0001), NT (r = 0.337; P = 0.0006), and TS (r = 0.299; P = 0.0025) were positively correlated with aging. CONCLUSION: A gradual increase of TIA, NT, and TS, accompanied with an increased CL, is found along with aging in asymptomatic population, among which TIA, NT, and TS are significantly correlated with physiological nature of aging.

Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis.

BACKGROUND: Cervical spinal tuberculosis is relatively common in some developing countries. It erodes vertebrae and discs, which sometimes results in cervical kyphosis and myelopathy. However, to our knowledge, no studies have evaluated improvements to patient-reported outcomes among patients who undergo surgical cervical sagittal realignment after kyphotic cervical spinal tuberculosis has been treated by débridement and reconstruction. QUESTIONS/PURPOSES: (1) Can a spine with kyphotic cervical spinal tuberculosis be returned to normal alignment and fused successfully? (2) Will patient-reported outcomes be improved with this intervention? (3) Are patient-reported outcomes correlated with realignment? METHODS: Forty-six patients with kyphotic cervical spinal tuberculosis were evaluated in this retrospective study. We generally performed surgery on patients with this condition when patients with cervical spinal tuberculosis presented with cervical kyphosis with or without neurologic deficits. Patients who did not meet these criteria were treated with other surgical procedures during the study period. Study patients were evaluated with cervical imaging, patient-reported outcomes questionnaires (Neck Disability Index [NDI], and the Japanese Orthopaedic Association [JOA] score), and physical examinations. Scores were collected by fellows preoperatively and at followup. No patient died during the followup. The mean followup was 26.8 months (range, 20-35 months). Preoperative and 2-year followup radiologic parameters were measured, including C0-2 Cobb angle, C2-7 Cobb angle, C2-7 sagittal vertical axis, center of gravity (CG) to C7 sagittal vertical axis (CG-C7 sagittal vertical axis), thoracic inlet angle, T1 slope, and neck tilt. The correlations between cervical alignment and the NDI and JOA score were analyzed. Factors correlated with the NDI and JOA score improvements were identified by multiple stepwise regression analysis. CT was used to assess bone fusion after surgery. RESULTS: All 46 patients showed bone fusion on CT scans. The preoperative C0-2 Cobb angle improved after surgery (mean difference, 5.0°; 95% CI, 2.3°-7.7°; p = 0.0068), as did C2-7 Cobb angle (mean difference, -33°; 95% CI, -35° to -31°; p = 0.0074), C2-7 sagittal vertical axis (mean difference, -28 mm; 95% CI, -30 mm to -26 mm; p = 0.0036), CG-7 sagittal vertical axis (mean difference, -26 mm; 95% CI, -28 mm to -24 mm; p = 0.0049), T1 slope (mean difference, 6.0°; 95% CI, 3.7°-8.3°; p = 0.0053) and the thoracic inlet angle (mean difference, 8.0°; 95% CI, 3.7°-12°; p = 0.0072). With the numbers available, the neck tilt angle did not improve (mean difference, -0.2°; 95% CI, -1.0° to 0.6°; p = 0.079). The preoperative NDI of 34 ± 5.1 decreased to 17 ± 4.6 (p = 0.0096) at followup. Improvements in NDI were correlated with the magnitude of correction of the cervical deformities, including C0-2 Cobb angle (r = -0.357, p = 0.007), C2-7 Cobb angle (r = 0.410, p = 0.002), T1 slope (r = -0.366, p = 0.006, thoracic inlet angle (r = -0.376, p = 0.005), C2-7 sagittal vertical axis (r = 0.450, p = 0.001), and CG-C7 sagittal vertical axis (r = 0.361, p = 0.007). The JOA score improved to 13 ± 2.6 from 7.2 ± 1.9, which did not correlate with postoperative cervical realignment. After controlling for potential confounding variables like Cobb angles and T1 slope, we found C2-7 sagittal vertical axis was the most influential factor correlated with NDI improvement (r = 0.450, p = 0.002). CONCLUSION: When treating kyphotic cervical spinal tuberculosis by débridement, decompression, and reconstruction, more attention should be drawn to realigning the cervical spine, in particular to restoring the C2-7 sagittal vertical axis. However, how best to restore the C2-7 sagittal vertical axis and cervical alignment in a kyphotic cervical spine needs further study. LEVEL OF EVIDENCE: Level III, therapeutic study.

The accuracy of the lateral vertebral notch-referred pedicle screw insertion technique in subaxial cervical spine: a human cadaver study.

STUDY DESIGN: This is a cadaver specimen study to confirm new pedicle screw (PS) entry point and trajectory for subaxial cervical PS insertion. OBJECTIVE: To assess the accuracy of the lateral vertebral notch-referred PS insertion technique in subaxial cervical spine in cadaver cervical spine. BACKGROUNDS: Reported morphometric landmarks used to guide the surgeon in PS insertion show significant variability. In the previous study, we proposed a new technique (as called "notch-referred" technique) primarily based on coronal multiplane reconstruction images (CMRI) and cortical integrity after PS insertion in cadavers. However, the PS position in cadaveric cervical segment was not confirmed radiologically. Therefore, the difference between the pedicle trajectory and the PS trajectory using the notch-referred technique needs to be illuminated. METHODS: Twelve cadaveric cervical spines were conducted with PS insertion using the lateral vertebral notch-referred technique. The guideline for entry point and trajectory for each vertebra was established based on the morphometric data from our previous study. After 3.5-mm diameter screw insertion, each vertebra was dissected and inspected for pedicle trajectory by CT scan. The pedicle trajectory and PS trajectory were measured and compared in axial plane. The perforation rate was assessed radiologically and was graded from ideal to unacceptable: Grade 0 = screw in pedicle; Grade I = perforation of pedicle wall less than one-fourth of the screw diameter; Grade II = perforation more than one-fourth of the screw diameter but less than one-second; Grade III = perforation more than one-second outside of the screw diameter. In addition, pedicle width between the acceptable and unacceptable screws was compared. RESULTS: A total of 120 pedicle screws were inserted. The perforation rate of pedicle screws was 78.3% in grade 0 (excellent PS position), 10.0% in grade I (good PS position), 8.3% in grade II (fair PS position), and 3.3% in grade III (poor PS position). The overall accepted accuracy of pedicle screws was 96.7% (Grade 0 + Grade I + Grade II), and only 3.3% had critical breach. There was no statistical difference between the pedicle trajectory and PS trajectory (p > 0.05). Compared to the pedicle width (4.4 ± 0.7 mm) in acceptably inserted screw, the unacceptably screw is 3.2 ± 0.3 mm which was statistically different (p < 0.05). CONCLUSION: The accuracy of the notch-referred PS insertion in cadaveric subaxial cervical spine is satisfactory.

Interspinous spacers versus posterior lumbar interbody fusion for degenerative lumbar spinal diseases: a meta-analysis of prospective studies.

PURPOSE: Our aim is to evaluate the safety and effectiveness of interspinous spacers versus posterior lumbar interbody fusion (PLIF) for degenerative lumbar spinal diseases. METHODS: A comprehensive literature search was performed using PubMed, Web of Science and Cochrane Library through September 2015. Included studies were performed according to eligibility criteria. Data of complication rate, post-operative back visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, estimated blood loss (EBL), operative time, length of hospital stay (LOS), range of motion (ROM) at the surgical, proximal and distal segments were extracted and analyzed. RESULTS: Ten studies were selected from 177 citations. The pooled data demonstrated the interspinous spacers group had a lower estimated blood loss (weighted mean difference [WMD]: -175.66 ml; 95 % confidence interval [CI], -241.03 to -110.30; p < 0.00001), shorter operative time (WMD: -55.47 min; 95%CI, -74.29 to -36.65; p < 0.00001), larger range of motion (ROM) at the surgical segment (WMD: 3.97 degree; 95%CI, -3.24 to -1.91; p < 0.00001) and more limited ROM at the proximal segment (WMD: -2.58 degree; 95%CI, 2.48 to 5.47; p < 0.00001) after operation. Post-operative back VAS score, ODI score, length of hospital stay, complication rate and ROM at the distal segment showed no difference between the two groups. CONCLUSIONS: Our meta-analysis suggested that interspinous spacers appear to be a safe and effective alternative to PLIF for selective patients with degenerative lumbar spinal diseases. However, more randomized controlled trials (RCT) are still needed to further confirm our results.

Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy.

PURPOSE: The purpose of this study is to evaluate the clinical outcomes, complications, and surgical trauma between anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy (CSM). STUDY DESIGN: Systematic review and meta-analysis. METHODS: Randomized controlled trials or non-randomized controlled trials published up to November 2014 that compared the clinical effectiveness of anterior and posterior surgical approaches for the treatment of multilevel CSM were acquired by a comprehensive search in four electronic databases (PubMed, EMBASE, Cochrane Controlled Trial Register and MEDLINE). Exclusion criteria were non-controlled studies, combined anterior and posterior surgery and cervical myelopathy caused by ossification of the posterior longitudinal ligament. The main end points included: recovery rate; Japanese Orthopedic Association (JOA) score; complication rate; reoperation rate; blood loss; operation time and length of stay. RESULTS: A total of ten studies were included in the meta-analysis; none of which were randomized controlled trials. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale. In six studies involving 467 patients, there was no significant difference in the preoperative JOA score between the anterior surgery group and the posterior group [P > 0.05, WMD -0.00 (-0.50, 0.50)]. In four studies involving 268 patients, the postoperative JOA score was significantly higher in the anterior surgery group compared with the posterior surgery group [P < 0.05, WMD 0.79 (0.16, 1.42)]. In five studies involving 420 patients, there was no statistically significant difference in recovery rate between the anterior and posterior surgery groups [P > 0.05, WMD 2.73 (-8.69, 14.15)]. In nine studies involving 804 patients, the postoperative complication rate was significantly higher in the anterior surgery group compared with the posterior surgery group [P = 0.009, OR 1.65 (1.13, 2.39)]. In five studies involving 294 patients, the reoperation rate was significantly higher in the anterior surgery group compared with the posterior surgery group [P = 0.0001, OR 8.67 (2.85, 26.34)]. In the four studies involving 252 patients, the intraoperative blood loss and operation time was significantly higher in the anterior surgery group compared with the posterior surgery group [P < 0.05, WMD -40.25 (-76.96, -3.53) and P < 0.00001, WMD 61.3 (52.33, 70.28)]. In the three studies involving 192 patients, the length of stay was significantly lower in the anterior surgery group compared with the posterior surgery group [P < 0.00001, WMD -1.07 (-2.23, -1.17)]. CONCLUSIONS: In summary, our meta-analysis suggested that a definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel CSM. Although anterior approach was associated with better postoperative neural function than posterior approach in the treatment of multilevel CSM, there was no apparent difference in the neural function recovery rate between the two approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when anterior approach is used for patients with multilevel CSM.

Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion meta-analysis of prospective studies.

PURPOSE: To evaluate the incidence of adjacent segment disease (ASD) requiring surgical intervention between anterior cervical decompression and fusion (ACDF) and total disc replacement (TDR). BACKGROUND: The concern for ASD has led to the development of motion-preserving technologies such as TDR. However, whether replacement arthroplasty in the spine achieves its primary patient-centered objective of lowering the frequency of adjacent segment degeneration is not verified yet. METHODS: A comprehensive literature search was performed using PubMed, Cochrane Central Register of Controlled Trials and Embase. These databases were thoroughly searched for prospective randomized studies comparing ACDF and TDR. Eight studies met the inclusion criteria for a meta-analysis and were used to report an overall rate of ASD for both ACDF and TDR. RESULTS: Pooling data from 8 prospective studies, the overall sample size at baseline was 1,726 patients (889 in the TDR group and 837 in the ACDF group). The ACDF group had significantly more ASDs compared with the TDR group at 24 months postoperatively [odds ratios (OR), 1.31; 95 % confidence interval (CI), 1.04-1.64; p = 0.02]. The TDR group had significantly fewer adjacent segment reoperations compared with the ACDF group at 24 months postoperatively (OR, 0.49; 95 % CI, 0.25-0.96; p = 0.04). CONCLUSIONS: For patients with one-level cervical degenerative disc disease (CDDD), total disc replacement was found to have significantly fewer ASDs and reoperations compared with the ACDF. Cervical replacement arthroplasty may be superior to ACDF in ASD. Therefore, cervical arthroplasty is a safe and effective surgical procedure for treating CDDD. We suggest adopting TDR on a large scale.

Two-level anterior cervical discectomy and fusion using self-locking stand-alone polyetheretherketone cages with two anchoring clips placed in the upper and lower vertebrae, respectively.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical procedure for the treatment of cervical degenerative disk diseases (CDDD). The purpose of our study was to investigate the reliability and efficacy of ACDF using self-locking stand-alone polyetheretherketone (PEEK) cages, with two anchoring clips placed in the upper and lower vertebrae, respectively. METHODS AND MATERIALS: Twenty-six patients who underwent ACDF using a stand-alone PEEK cage packed with local osteophytes and cancellous allograft bone from January 2010 to January 2012 were enrolled in this study. Clinical findings were assessed using a visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and Odom criteria. Intervertebral height and cervical fusion status were assessed on X-ray. RESULTS: Twenty-six patients underwent ACDF using a stand-alone PEEK cervical cage. All patients had a minimum 2 years of follow-up. The operative levels were C3/4, C4/5 in seven patients, C4/5, C5/6 in 13 patients, and C4/5, C6/7 in six patients. At 3 days, 6 months, and 2 years of follow-ups, the JOA scores were 10.41 ± 1.67, 13.78 ± 1.91, 14.42 ± 2.09, respectively, which was significantly higher (p < 0.01) than preoperative (7.34 ± 1.71), whereas VAS overall pain score was 4.35 ± 1.32, 1.73 ± 0.44, 1.32 ± 0.57, respectively, which was significantly lower (p < 0.01) than preoperative (8.01 ± 1.16). The NDI preoperatively was 33.94 ± 11.75, 23.53 ± 10.92 at 3 days postoperatively, 12.64 ± 8.36 at 6 months, and 10.74 ± 7.92 at 2 years of follow-ups. Intervertebral height was 5.99 ± 0.31 mm preoperatively, 8.70 ± 0.23 mm at 3 days, 8.34 ± 0.61 mm at 6 months, and 8.22 ± 0.35 mm at 2 years of follow-ups. According to Odom criteria, 10 patients (38.4%) presented with an excellent clinical outcome, 15 good (57.6%), 1 fair (3.8%), and no patient presented a poor outcome. Solid fusion was achieved in all patients (100%) at a mean time of 4.5 months. CONCLUSION: ACDF using a self-locking stand-alone PEEK cage with two anchoring clips placed in the upper and lower vertebrae, respectively, could be considered a safe and effective substitute for fusion in patients with two-level CDDD; it can effectively restore the intervertebral height, facilitate radiologic follow-up, cause few complications, and lead to satisfactory outcomes.

Comparison of artificial cervical arthroplasty versus anterior cervical discectomy and fusion for one-level cervical degenerative disc disease: a meta-analysis of randomized controlled trials.

PURPOSE: The aim of the study was to evaluate whether there is a superior clinical effect of artificial cervical arthroplasty compared with anterior cervical discectomy and fusion (ACDF) for the treatment of one-level cervical degenerative disc disease (CDDD). METHODS: A comprehensive literature search of multiple databases, including PubMed, ScienceDirect, Scopus, Embase, Cochrane Central Register of Controlled Trials, was conducted to identify studies that met the inclusion criteria. Methodological quality was assessed and relevant data were extracted, and if appropriate, meta-analysis was performed. RESULTS: Thirteen randomized controlled trials were identified. At 24 months post-operatively, total disc replacement (TDR) was demonstrated to be more beneficial for patients compared with ACDF for the following outcomes: neurological success [odds ratio (OR) 1.92; 95% confidence interval (CI) 1.47-2.49; p < 0.00001], range of motion [mean differences (MD), 6.67; 95% CI 4.82-8.53; p < 0.00001], secondary surgical procedures (OR 0.50; 95% CI 0.37-0.68; p < 0.00001), and visual analogue scale neck pain scores (MD -5.99; 95% CI -10.54 to -1.45; p = 0.001) and visual analogue scale arm pain scores (MD -3.23; 95% CI -6.48 to 0.02; p = 0.004). Other outcomes, including length of the hospital stay (MD -0.03; 95% CI -0.18 to 0.12; p = 0.68), blood loss (MD 6.92 mL; 95% CI -3.09 to 16.92 mL; p = 0.18), Neck Disability Index scores (MD -1.00; 95% CI -5.28 to 3.28; p = 0.65) and rate of adverse events [risk ratio (RR), 0.93; 95% CI 0.76-1.15; p = 0.52] demonstrated no differences between the 2 groups. Although the TDR group had a significantly longer operation time than the ACDF group, it was not considered clinically important. CONCLUSIONS: For patients with one-level CDDD, TDR was found to be more superior than ACDF in terms of neurological success, secondary surgical procedures, visual analogue scale pain scores and range of motion at 24 months post-operatively. Therefore, cervical arthroplasty is a safe and effective surgical procedure for treating one-level CDDD. We suggest adopting TDR on a large scale; with failure of TDR, ACDF would be performed.

Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review.

BACKGROUND: In recent years, unilateral biportal endoscopic spinal surgery has been used for the treatment of lumbar spinal stenosis with good results. Some investigators counted the total incidence of complications in unilateral biportal endoscopic surgery for lumbar spinal stenosis, but none have analyzed the incidence of specific complications. The present study further counted the incidence of specific complications and gave the possible causes of the complications. METHODS: English databases including PubMed were searched to collect relevant literature on unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis. The inquiry period is from January 1, 2015, to July 1, 2022. The literature was screened, information extracted, and risk of bias evaluated by the researchers, followed by Meta analysis using R4.2.1 and RStudio statistical software. RESULTS: In total, we included 14 studies involving 707 patients. The included studies were retrospective case series, The results of the single-arm rate meta-analysis showed that the total complication rate of unilateral biportal endoscopic surgery treatment of lumbar spinal stenosis was 8.1% (95% confidence interval [CI] [0.060; 0.103]); of which, the highest incidence of dural tear was 4.5% (95% CI [0.030; 0.064]), the incidence of symptomatic postoperative spinal epidural hematoma was approximately 1.1% (95% CI [0.001; 0.027]), the incidence of incomplete decompression was 2.0% (95% CI [0.007; 0.038]), the incidence of transient palsy was 2.6% (95% CI [0.005; 0.057]). CONCLUSIONS: The incidence of total complications of unilateral biportal endoscopic surgery for lumbar spinal stenosis was 8.1%, dural tear remained a major complication with an incidence of 4.5%, incomplete decompression was 2.0%, transient palsy was 2.6%, and, unexpectedly, symptomatic postoperative spinal epidural hematoma was only 1.1%.

The role and mechanism of JAK2/STAT3 signaling pathway regulated by m6A methyltransferase KIAA1429 in osteosarcoma.

Osteosarcoma (OS) is the most malignant bone tumor which mainly occurs in childhood or adolescence. The previous studies indicated that OS is difficult to treat. KIAA1429 is one of the components of m6A complex that regulating the process of m6A modification, which plays a crucial role in tumorigenesis. But the mechanism of KIAA1429 regulating OS cell identity was not entirely clear, which needs further investigate. RT-qPCR and western blotting were applied to determine KIAA1429 expression station in OS cells and tissues. To further detect the KIAA1429 function in OS cells, the ability of proliferation, migration and invasion were analyzed by Edu, wound-healing and transwell experiments respectively. Besides, RNA sequencing was also used to further find the downstream of KIAA1429 regulation and small molecule inhibitor was added to explore the specific role of signaling pathway. Our data found that KIAA1429 is up-regulated in human OS cell lines compared to the human osteoblast cells. Meanwhile, the deletion of KIAA1429 significantly decreased cell proliferation, migration, and invasion. Interestingly, the JAK2/STAT3 signal pathway was involved in KIAA1429 regulation on OS cell characters. The KIAA1429 eliminated OS cells exhibited a decreased activity of JAK2/STAT3 signal. And the addition of JAK2/STAT3 stimulator (colivelin) could distinctly rescue the decreased OS cells' proliferation, migration, and invasion upon KIAA1429 knockdown. In summary, these data demonstrated that KIAA1429/JAK2/STAT3 axis may a new target for OS therapy.

Unilateral biportal endoscopy versus microscopic decompression in the treatment of lumbar spinal stenosis: A meta-analysis.

BACKGROUND: The aim of this study was to evaluate whether there is a superior clinical effect of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis. METHODS: We searched CNKI, WANFANG, CQVIP, CBM, PubMed, and Web of Science up to January 2022, and selected studies that met our inclusion criteria. RESULTS: The results of this meta-analysis indicated that unilateral biportal endoscopy was demonstrated to be more beneficial for patients compared with microscopic decompression for the following outcomes: Operation time [standardized mean difference (SMD) = -0.943, 95% confidence interval (CI) (-1.856, -0.031), P = .043], hospital stays [SMD = -2.652, 95% CI (-4.390, -0.914), P = .003], EuroQol 5-Dimension questionnaire [SMD = 0.354, 95% CI (0.070, 0.638), P = .014], back pain visual analogue score [SMD = -0.506, 95% CI (-0.861, -0.151), P = .005], leg pain visual analogue score [SMD = -0.241, 95% CI (-0.371, -.0112), P = .000], the C-reactive protein level [SMD = -1.492,95% CI (-2.432, -0.552), P = .002]. Other outcomes demonstrated no significant differences between the 2 groups. CONCLUSION: For patients with lumbar spinal stenosis, unilateral biportal endoscopy was found to be more superior than microscopic decompression in terms of operation time, hospital stays, EuroQol 5-Dimension questionnaire, back visual analogue score, leg visual analogue score and the C-reactive protein level. There was no significant difference between the 2 groups in other outcome indicators.

LncRNA HEIH expression in cancer prognosis: A review and meta-analysis.

BACKGROUND: As a newly discovered lncRNA, lncRNA High expression in hepatocellular carcinoma (HEIH) has been reported to correlate with poor clinical outcomes in several different cancers, In addition, studies have shown that HEIH is overexpressed in a variety of cancers and plays an oncogenic role. The present meta-analysis aims to elucidate the relationship between HEIH expression and prognosis and clinicopathological features among cancer patients. METHODS: PubMed, Web of Science, Cochrane Library, and EMBASE database were comprehensively and systematically searched. pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence interval (CI) were employed to assess the relationship between HEIH expression and clinical outcomes and clinicopathological features in cancer patients. CONCLUSION: The present study finally enrolled 11 studies which included 1227 cancer patients. The combined results indicated that HEIH overexpression was significantly associated with shorter overall survival (OS) (pooled HR = 2.03, 95% CI 1.74-2.38, P < .00001).Meanwhile, regarding clinicopathology of cancer patients, upregulated HEIH expression was closely related to larger tumor size (OR = 2.65, 95% CI: 1.52-4.65, P = .0006), advanced tumor T stage (OR = 2.41, 95 % CI: 1.54-3.77, P = .0001), advanced TNM stage (OR = 4.76, 95% CI: 2.73-8.29, P < .00001), distant metastasis (OR = 2.94, 95% CI: 1.75-4.96, P < .0001) and lymph node metastasis (OR = 2.07, 95% CI: 1.05-4.07, P = .04), respectively. CONCLUSIONS: High expression of HEIH in some cancers predicts shorter overall survival and higher clinical stage as well as larger tumor size. HEIH has great potential to become a prognostic marker for cancer patients.

Structural Versus Nonstructural Bone Grafting Via the Posterior Approach in the Treatment of Thoracic and Lumbar Tuberculosis: A Systematic Review and Meta-Analysis.

BACKGROUND: Bone grafting is necessary in spinal tuberculosis surgery. Structural bone grafting is considered the gold standard treatment for spinal tuberculosis bone defects; however, nonstructural bone grafting via the posterior approach has recently gained attention. In this meta-analysis, we evaluated the clinical efficacy of structural versus nonstructural bone grafting via the posterior approach in the treatment of thoracic and lumbar tuberculosis. METHODS: Studies comparing the clinical efficacy of structural and nonstructural bone grafting via the posterior approach in spinal tuberculosis surgery were identified from 8 databases from inception to August 2022. Study selection, data extraction, and evaluation of the risk of bias were performed, and meta-analysis was conducted. RESULTS: Ten studies including 528 patients with spinal tuberculosis were enrolled. Meta-analysis revealed no between-group differences in fusion rate (P = 0.29), complications (P = 0.21), postoperative Cobb angle (P = 0.7), visual analog scale score (P = 0.66), erythrocyte sedimentation rate (P = 0.74), or C-reactive protein level (P = 0.14) at the final follow-up. Nonstructural bone grafting was associated with less intraoperative blood loss (P < 0.00001), shorter operation time (P < 0.0001), shorter fusion time (P < 0.01), and shorter hospital stay (P < 0.00001), while structural bone grafting was associated with lower Cobb angle loss (P = 0.002). CONCLUSIONS: Both techniques can achieve a satisfactory bony fusion rate for spinal tuberculosis. Nonstructural bone grafting has the advantages of less operative trauma, shorter fusion time, and shorter hospital stay, making it an attractive option for short-segment spinal tuberculosis. Nevertheless, structural bone grafting is superior for maintaining corrected kyphotic deformities.

LncRNA LOXL1-AS1 expression in cancer prognosis: A meta-analysis.

BACKGROUND: Several studies showed that LncRNA LOXL1 antisense RNA 1 (LOXL1-AS1) is overexpressed in a variety of cancers and plays a role as an oncogene in cancer. The present meta-analysis aims to elucidate the relationship between LOXL1-AS1 expression and prognosis and clinicopathological features among cancer patients. METHODS: PubMed, Web of Science, Cochrane Library, and EMBASE database were comprehensively and systematically searched. Pooled odds ratios (ORs) and hazard ratios with a 95% confidence interval (CI) were employed to assess the relationship between LOXL1-AS1 expression and clinical outcomes and clinicopathological features in cancer patients. RESULTS: The present study finally enrolled 8 studies which included 657 cancer patients. The combined results indicated that the overexpression of LOXL1-AS1 was significantly associated with shorter overall survival (pooled hazard ratio = 1.99, 95% CI 1.49-2.65, P < .00001). Meanwhile, regarding clinicopathology of cancer patients, the upregulation of LOXL1-AS1 expression was closely related to lymph node metastasis (yes vs no OR = 4.01, 95% CI: 2.02-7.96, P < .0001) and distant metastasis (yes vs no OR = 3.04, 95% CI: 1.82-5.06, P < .0001), respectively. CONCLUSION: High expression of LOXL1-AS1 in some cancers predicts shorter overall survival, distant metastasis, and lymph node metastasis. LOXL1-AS1 shows great promise as a prognostic biomarker in cancer patients.

Early Clinical Efficacy of Endo-TLIF in the Treatment of Lumbar Disc Herniation.

OBJECTIVE: We aimed to compare the early clinical efficacy of endoscopy-assisted transforaminal lumbar interbody fusion (Endo-TLIF) and traditional Open-TLIF in the treatment of lumbar disc herniation and lumbar instability. METHODS: Forty-six patients with lumbar disc herniation and lumbar instability admitted to the hospital were retrospectively studied from October 11, 2018 to October 11, 2020. Patients (including 17 males and 29 females) were randomly divided into Endo-TLIF and Open-TLIF groups according to the different surgical treatment. Parameters such as intraoperative blood loss, operation time, and intraoperative fluoroscopy time during the surgery as well as preoperative and postoperative lumbar lordosis angle and lumbar clearance height and related complications were recorded in detail. RESULTS: Endo-TLIF significantly reduced intraoperative blood loss and bleeding volume compared with traditional Open-TLIF. The incision length in the Endo-TLIF group was shorter than in the Open-TLIF group and the intraoperative fluoroscopy time was also shorter than in the Open-TLIF group. The bed rest time and hospital discharge time were shortened in Endo-TLIF surgery compared with traditional Open-TLIF surgery. The creatine kinase (CK) values of the Endo-TLIF group were lower than that of the Open-TLIF group on the 1st and 3rd day after operation. Although computed tomography images of the lumbar lordosis angle did not show a significant difference between the Endo-TLIF group (43.97 ± 8.91°) and Open-TLIF group (49.08 ± 9.42°), the visual analogue scale score and Oswestry dysfunction index of lower back pain in the Endo-TLIF group were significantly lower than in the Open-TLIF group at 1 month and half a year after surgery. Complications in the Endo-TLIF group, such as lower limb neurological dysfunction and diseases of the respiratory or urinary system, effectively improved compared with the Open-TLIF group. CONCLUSION: Endo-TLIF appears to be a safer and more effective option for the treatment of lumbar disc herniation and lumbar instability, with a shorter recovery time, less trauma, less bleeding, no need for postoperative drainage, and less iatrogenic injury.

The role of PI3K/Akt signalling pathway in spinal cord injury.

Spinal cord injury (SCI) is a severely disabling central nervous system injury with complex pathological mechanisms that leads to sensory and motor dysfunction. The current treatment for SCI is aimed at symptomatic symptom relief rather than the pathological causes. Several studies have reported that signaling pathways play a key role in SCI pathological processes and neuronal recovery mechanisms. The PI3K/Akt signaling pathway is an important pathway closely related to the pathological process of SCI, and activation of this pathway can delay the inflammatory response, prevent glial scar formation, and promote neurological function recovery. Activation of this pathway can promote the recovery of neurological function after SCI by reducing cell apoptosis. Based on the role of the PI3K/Akt pathway in SCI, it may be a potential therapeutic target. This review highlights the role of activating or inhibiting the PI3K/Akt signaling pathway in SCI-induced inflammatory response, apoptosis, autophagy, and glial scar formation. We also summarize the latest evidence on treating SCI by targeting the PI3K/Akt pathway, discuss the shortcomings and deficiencies of PI3K/Akt research in the field of SCI, and identify potential challenges in developing these clinical therapeutic SCI strategies, and provide appropriate solutions.

Single Posterior Approach versus Combined Anterior and Posterior Approach in the Treatment of Spinal Tuberculosis: A Meta-Analysis.

BACKGROUND: Spinal tuberculosis is the most common form of tuberculosis affecting bone and often needs surgical treatment. Single anterior, single posterior, and combined anterior and posterior approaches are the 3 most commonly used approaches in surgical treatment. Clinically, the choice of optimal surgical approach remains controversial. The purpose of this meta-analysis was to evaluate clinical efficacy of single posterior approach versus combined anterior and posterior approach. METHODS: Studies comparing surgical treatment of spinal tuberculosis by single posterior approach versus combined anterior and posterior approach were identified in a literature search conducted from study inception to July 2020. Selection of studies, extraction of data, and evaluation of bias risk of studies were performed independently by 2 authors, and meta-analysis was conducted using RevMan 5.3 software. RESULTS: The meta-analysis included 15 studies and 793 spinal tuberculosis cases. Single posterior approach was used in 397 patients, and combined anterior and posterior approach was used in 396 patients. There were no statistical differences in visual analog scale score (P = 0.51), correction of Cobb angle (P = 0.14), neurological improvement (P = 0.71), erythrocyte sedimentation rate (P = 0.32), C-reactive protein after operation (P = 0.81), and loss of correction at final follow-up (P = 0.44) between approaches. Single posterior approach was associated with less intraoperative hemorrhage (P < 0.00001), shorter operative time (P < 0.00001), shorter length of hospital stay (P < 0.00001), and fewer complications (P < 0.00001). Combined anterior and posterior approach was associated with shorter fusion time (P = 0.04). CONCLUSIONS: Both approaches can achieve satisfactory clinical outcomes. Posterior-only approach can safely and effectively achieve lesion débridement, decompression, and stability reconstruction and maintenance with advantages of less invasive surgery, less bleeding, shorter surgery time and hospital stay, and fewer complications and seems to be superior to combined posterior-anterior approach.

Dynesys system vs posterior decompression and fusion for the treatment of lumbar degenerative diseases.

BACKGROUND: The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. The purpose of this study is to evaluate the clinical efficacy between Dynesys and posterior decompression and fusion for lumbar degenerative diseases. METHODS: The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software was used for data analysis. RESULTS: A total of 17 studies were included in the meta-analysis. There were no significant differences in Oswestry disability index and visual analogue score for leg pain, visual analogue score for back pain, L2-S1 ROM between Dynesys and fusion group. Operation time, blood loss, length of stay and complications in the Dynesys group were significantly less than that in the fusion group. Adjacent-segment degeneration in the fusion group was significantly higher than that in the Dynesys group. In addition, postoperative operated segment ROM was significantly less in the fusion group as compared to the Dynesys group. CONCLUSIONS: Our meta-analysis suggests that Dynesys system acquires comparable clinical outcomes compared to fusion in the treatment of lumbar degenerative diseases. Moreover, compared with fusion, Dynesys could remain ROM of surgical segments with less operation time, blood loss, length of stay, adjacent-segment degeneration, and lower complication. Further studies with large samples, long term follow up and well-designed are needed to assess the two procedures in the future.

Hirayama Disease Treated by Anterior Cervical Diskectomy and Fusion: Case Report and Literature Review.

OBJECTIVE: We present the case of a 19-year-old boy who had the classic radiologic and clinical presentations of Hirayama disease treated with anterior cervical diskectomy and fusion (ACDF). We also propose ACDF as promising surgery for the treatment of Hirayama disease. Hirayama disease is an initially progressive disease caused by cervical neck flexion compressing the anterior horns of the lower cervical spinal cord. CASE DESCRIPTION: Our patient presented with an insidious, progressive weakness in his right hand, which had been ongoing for 1 year. Physical examination revealed various degrees of right forearm and hand muscle wasting, and decreased right hand extend power with motor grade Ш. Cervical flexed magnetic resonance imaging showed a spinal cord was being compressed-most noticeably at the level of the fifth cervical vertebral body-and that the dorsal epidural space was abnormally expanding. The patient underwent ACDF at the C4-6 level. The pain and paresthesia improved immediately after the surgery. His motor grade improved immediately after the operation, and there were improvements of a modest reversal of muscle wasting at 1 year postoperatively. CONCLUSIONS: ACDF could be considered as an effective treatment option for the treatment of Hirayama disease. Our patient's finger function improved. Therefore we believe that anterior fusion might be the best choice of treatment.