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The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.
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Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.
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Objective:To analyze and summarize the clinical effects of 3D printed porous titanium-alloy prosthesis implantation in the treatment of long bone defects of lower extremities.Methods:We retrospectively studied the clinical cases with lower extremity bone defect treated by 3D printed porous titanium prostheses from December 2017 to November 2021. 18 patients who were followed up for more than 12 months were included in this study. The enrolled patients included 12 males and 6 females, with an average of 48.9±22.5 years (range, 13-79 years), and an average body mass index of 23.1±4.3 kg/m 2 (range, 17.2-27.1 kg/m 2). There were 14 osteomyelitis-derived bone defects and 4 nonunion-derived bone defects. The bone defect locations included 10 cases of femur and 8 cases of tibia. The average bone defect distance was 13.9±9.7 cm (range, 5.8-31.2 cm), and the proportion of the defect length to the long bone (femur of tibia) was average 33.7%±16.8% (range, 15.0%-63.0%). The clinical efficacy was comprehensively evaluated through gross observation, imaging evaluation, changes in the total length of lower extremities and long bones, femorotibial angle (FTA) measurement, lower extremity functional scale (LEFS), satisfaction, complications and other indicators, focusing on the stabilization mechanism of the prosthesis and the regeneration of new bone. Results:All 18 patients were followed up for 12-35 months, with an average of 16.3 months. Postoperative X-rays at 1, 3, 12 and 24 months showed that new bone could gradually creep along the prosthesis surface. The preoperative bone defect length of long bone and total length of lower limb were respectively 39.4±4.0 cm and 80.5±5.7 cm, which were different from those of the healthy side by 1.6±1.0 cm and 1.5±1.1 cm. One week after implantation, the length of long bone and lower limb was 39.9±3.5 cm and 80.9±6.2 cm, respectively, and the average difference was 1.0±0.6 cm and 0.9±1.1 cm compared with the healthy side. At the last follow-up, the length of long bone and lower limb was 39.7±3.6 cm and 80.9±7.8 cm, with an average difference of 1.8±1.1 cm and 1.0±0.7 cm from the healthy side. There were no significant differences in the length of long bone and lower limbs at the three time points before surgery, one week after surgery and the last follow-up ( F=0.12, 0.04; P>0.05). The average FTA of the affected limb was 174.7° (173.9°, 175.5°), 175.2°(173.5°, 176.4°), and 175.0°(173.5°, 176.3°) at three time nodes, before surgery, one week after surgery and the last follow-up, respectively, and there was no significant statistical difference in pairwise comparison ( Z=0.01, P>0.05). Patients had a mean LEFS score of 50 (46, 51) at the last follow-up, significantly higher than the preoperative score of 20 (17, 21) ( Z=-5.56, P<0.001). The mean satisfaction score of the 18 patients at the last follow-up was 9.7. Two patients (11.1%) had screw fractures but all 3D printed porous titanium alloy prostheses remained stable without significant loosening or displacement. Two patients (11.1%) had nail channel infection of external fixator, all patients with channel infection were cured by intravenous antibiotics combined with local disinfection and dressing change. Conclusion:The implantation of 3D printed porous titanium-alloy prosthesis could efficiently and safely repair the long bone defects of the lower extremities. The prosthesis could maintain stable in the early and middle postoperative period. The length of the long bones and lower limbs did not change significantly with the weight-bearing and functional exercise of the limbs. The new bone could gradually crawl and grow from both ends of the defect, and the patient's limb function recovered significantly, and the patient's satisfaction was high.
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Objective:To analyze the curative effect of discectomy under Quadrant expandable channel associated with annulus repair for the treatment of adolescent lumbar disc herniation (ALDH).Methods:10 ALDH patients received discectomy under Quadrant expandable channel associated with annulus repair (annulus repair group) and 12 patients received discectomy (control group) in Clinical Medical College of Yangzhou University from January 2013 to December 2017 were retrospectively collected. The length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The degree of pain was assessed by visual analogue scale (VAS) before operation, 24 h, 1 week and 1 year after operation, and the lumbar function was assessed by Oswestry disability index (ODI) before operation, 1 week and 1 year after operation. At the last follow-up, the curative effect was evaluated by MacNab Scale, and the recurrence of lumbar disc herniation during the follow-up was recorded.Results:There were no significant differences in the amount of intraoperative bleeding, operation time and duration of hospitalization between the two groups ( P>0.05). The skin incision length of the annulus repair group was less than that of control group ( P<0.05). The postoperative VAS score and ODI score at each follow up time point in both groups were significantly improved when compared with the preoperative ones ( P<0.05). There were no statistically significant difference between the two groups in the VAS score and ODI score 1 week postoperative and 1 year postoperative ( P>0.05). According to the MacNab criteria, there was no statistically significant difference between the two groups in the excellent and good rate (annulus repair group: 9/10, control group: 10/12; P>0.05). There was no recurrence case in the annulus repair group, but two cases of recurrence (one recovered by conservative treatment, the other needed second operation) in the control group ( P<0.05). Conclusions:Discectomy under Quadrant expandable channel associated with annulus repair can achieve early satisfied outcome, reduce surgery related trauma, pain in the early period postoperative and recurrence rate after operation in the treatment of ALDH.
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Objective:To explore the relevant prognostic factors and construct a nomogram to predict the relapse-free survival of cervical chordoma.Methods:Data of 48 patients with cervical chordoma treated by operation from November 1994 to June 2018 were retrospectively analyzed, including 28 males and 20 females, aged 48.5±15.4 years (range 5-70 years). Data extraction comprised patients age, gender, Karnofsky performance status scale (KPS), duration of preoperative symptoms, location, involved segments, preoperative Frankel score, diagnostic biopsy method, adjuvant radiotherapy, surgical option and complications. Follow-up was conducted at 3, 6, 12 months after surgery and annually, X-Ray/CT/MRI were used to evaluate the progress of disease. Univariate analysis was performed using Kaplan-Meier survival analysis and Log Rank test to identify prognostic factors relevant to relapse-free survival, and multivariate Cox regression analysis was used in multivariate analysis, then R 3.6.2 was used to construct a nomogram.Results:Mean follow-up time was 66.6±51.1 months (range 14-228 months), 35 cases relapsed up to follow-up time, the cumulative 1-year, 3-year and 5-year relapse-free survival were 70.8%, 42.1% and 30.9%. Univariate analysis showed that diagnostic biopsy method ( P=0.016), adjuvant radiation therapy ( P=0.027), surgical option ( P<0.001) were relevant to relapse-free survival of cervical chordoma. Multivariate Cox regression analysis showed that surgical option (intralesional resection after extracapsular separation vs. directly intralesional resection), HR=0.209, 95% CI (0.076, 0.575) had significant impacts on relapse-free survival of cervical chordoma. A nomogram with c-index of 0.760 to predict 1-year, 3-year and 5-year relapse-free survival was conducted basing on age, gender, location, involved segments, diagnostic biopsy method, adjuvant radiation therapy, surgical option. Conclusion:Aspiration biopsy, intralesional resection after extracapsular separation and adjuvant radiation therapy could prolong the relapse-free survival of cervical chordoma. The nomogram in this study could predict 1-year, 3-year and 5-year relapse-free survival of cervical chordoma with relatively good accuracy.
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The important function of the endplate is to transmit stress and supply nutrition. Endplate degeneration might induce or promote degeneration of the intervertebral disc, causing a series of spine diseases that seriously impair people’s health and life quality. Endplate chondrocytes can respond to mechanical stimulation, which is an important factor affecting endplate degeneration. Inappropriate mechanical stimulation will accelerate endplate degeneration. This review summarized the effects of mechanical stimulation on vertebral endplate chondrocyte apoptosis, synthesis inhibition, calcification, and extracellular matrix degradation. The endplate degeneration induced by mechanical stimulation is regulated by a complex network of signal pathways composed of various signal transduction factors. The signal pathways involved in this review included NF-κB, Wnt, Hedgehog, MAPK, RhoA/Rock-1, AKT/mTOR, TGF-β signaling pathway and miRNA related signals. The interconnection of these pathways was highlighted and summarized. Multiple signaling pathways work together to regulate endplate chondrocyte metabolism, which ultimately leads to the endplate degeneration. This review might shed light on early diagnosis and precise treatment of cartilage endplate degeneration.
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Objective:to review the clinical features, diagnosis and treatment of spinal Rosai-Dorfman disease(RDD).Methods:we conducted a systemic review and collected the cases reported from 2010. The key words were Rosai-Dorfman disease, spine/central nervous system. We screened both English and Chinese database. There were 43 reports finally included in the study, containing 52 cases. We distracted the information of interest and, subsequently, analyzed the harvested data using specific statistical software packages. The study focused on the summary and description of the clinical features, diagnosis and treatment and prognosis of spinal RDD.Results:The included articles reported 52 cases. The average age was 32.1±17.1 years (ranging from 6 to 76 years old). The ratio of male to female was 1.9/1. The median follow-up period was 19.9 months. The initial symptoms of 41 patients (78.8%) were spinal lesion-related. The cases with painless lymph nodes enlargement, other organ lesions and abnormal lab tests were 11.5%, 36.5% and 23.1%, respectively. The frequent infringed segments were cervical (43.1%) and thoracic (39.2%) spine. 53.2% lesions were dura-based, while 17.0% and 10.6% for bone and cord, respectively. Surgery was the mainstream of the treatment armamentarium, composing 83.7% cases, among which 46.3% underwent total resection. Cases only treated with radiotherapy, chemotherapy and steroids were 10.2%. Very Few cases remitted spontaneously (2.0%). The risk of recurrence and occurrence at other vertebral levels was 22.0%.Conclusion:It is rare for spinal involvement of RDD. This entity has no pathognomonic clinical and imaging features. RDD has a tendency of multi-organ involvement and recurrence. Surgery remains the mainstay of the treatment, but the efficacy of other adjuvant therapies is not sure. A wait and watch strategy is employed for asymptomatic patients.
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According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.
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Objective To quantitatively compare the effect of preservation or removal of atlas posterior arch on cervical posterior decompression,so as to provide a basis for reasonable selection of upper cervical spine decompression range and determination of surgical indications for atlas posterior arch resection.Methods The data of 45 patients with posterior decompression of upper cervical spine were retrospectively analyzed.According to the decompression range,the patients were divided into C2-C7 group and C1-C7 group.There were 25 cases in the C2-C7 group,19 males and 6 females,with an average age of 56.3 years (40-71 years),4 cases of cervical spondylotic myelopathy and 21 cases of ossification of the posterior longitudinal ligament of cervical spine.All of the 25 patients underwent open-door laminoplasty:20 cases with hinge side anchoring procedure and 5 cases with preservation of the unilateral posterior muscular-ligament complex procedure (titanium cable procedure).There were 20 cases in C1-C7 group,12 males and 8 females,with an average age of 58A years (44-75 years).All of the 20 cases underwent atlas posterior arch resection as well as C2-C7 open-door laminoplasty,including anchoring procedure in 1 case,titanium miniplate procedure in 4 cases,and titanium cable procedure in 15 cases.Standardized vertebral-cord distance (SVCD) at each level from atlas to level C~ was measured on T2-weighted images of MR on the mid-sagittal plane in the neutral position pedormed 3-12 months postoperatively at each individual level.As the main outcomes,the SVCD values obtained at the same level of the two groups were compared between the two groups.Shapiro-Wilk normality test was performed on the SVCD values at C1.2 and C2 levels of two groups.The area under the normal distribution curve of SVCDs was used to calculate the corresponding residual compression rate with different magnitude of compression mass to further discover the difference of the decompression effect between the two groups.Results The SVCD obtained at the level of the anterior arch of atlas (C1),the junction of odontoid process and axis (C1,2) and the middle part of axis body (C2) in the C2-C7 group was 9.91±1.34 mm,8.35±1.27 mm,and 8.22 ±1.43 mm,respectively.The SVCD at the same levels was 11.02±1.60 mm,9.72±1.24 mm,and 9.12±1.11 mm,respectively.SVCDs differed significantly in the above range between the two groups.However,from level C2,3 to C6,7,there was no significant difference in SVCDs between the two groups.The JOA score of group C2-C7 was 11.8±2.7 preoperatively and increased significantly to 14.7±1.8 at 12 months postoperatively(t=-7.006,P＜0.001) with a recovery rate of 57.0％±32.2％.The JOA score of group C1-C7 was 11.7±2.8 preoperatively and increased significantly to 14.2±2.3 at 12 months postoperatively(t=-6.177,P＜0.001) with a recovery rate of 51.9％±32.1％.Conclusion Atlas posterior arch resection can significantly increase the decompression effect of posterior cervical surgery from the anterior arch of atlas to the middle part of axis body,but it would not increase the decompression effect at level C2.3 or below.When the magnitude of the ventral compression factor exceeds the decompression limit (8.5 mm) available with C2-C7 decompression in the range from atlas to the middle of the axis body,extending the decompression range by atlas posterior arch resection is an effective means to achieve adequate decompression.
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The cross-fusion research of artificial intelligence technology and spinal surgery represented by machine learning and neural network model is a new research direction and hot issue in the field of artificial intelligence in recent years. The anatomy and disease symptoms of the spine are complex, and the diagnosis and treatment of spinal surgery require rich clinical experience. However, the distribution of medical resources in China is seriously uneven. How to improve the ability of primary medical services so that the most extensive patient groups can benefitis still an urgent problem to be solved. Artificial intelligence is a technical science that researches and develops theories, methods, technologies, and application systems for simulating, extending and expanding human intelligence. With the advent of the era of big data medical technology, artificial intelligence technology may solve this problem by transforming "experts sinking" into "tech sinking" . At present, technologies such as confrontation learning, weakly supervised learning, intensive learning and graph neural networks have become research hotspots in the field of artificial intelligence, and have also played an important role in many fields of clinical medicine. Based on the advantages of deep learning and neural network in disease learning, many spine surgeons combine it with the diagnosis and treatment of cervical spondylosis, low back pain, lumbar degenerative diseases, spinal deformity, spinal tumors, and other spine-related diseases. The rapid location and accurate diagnosis of the disease not only makes it an effective tool for the comprehensive diagnosis of spinal diseases but also provides the basis for the most reasonable treatment options for spinal diseases. In the domestic application of artificial intelligence in the diagnosis and treatment of spinal surgery, it can also solve the problems of difficult diagnosis and complicated treatment of spinal diseases faced by primary doctors, reduce the rate of misdiagnosis and missed diagnosis, and effectively reduce the economic and social burden of spinal diseases. This paper reviews the research progress of artificial intelligence represented by deep learning in the field of diagnosis and treatment of spinal surgery at home and abroad, and the advantages and application prospects of artificial intelligence in the diagnosis and treatment of spinal surgery.
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The cross-fusion research of artificial intelligence technology and spinal surgery represented by machine learning and neural network model is a new research direction and hot issue in the field of artificial intelligence in recent years.The anatomy and disease symptoms of the spine are complex,and the diagnosis and treatment of spinal surgery require rich clinical experience.However,the distribution of medical resources in China is seriously uneven.How to improve the ability of primary medical services so that the most extensive patient groups can benefitis still an urgent problem to be solved.Artificial intelligence is a technical science that researches and develops theories,methods,technologies,and application systems for simulating,extending and expanding human intelligence.With the advent of the era of big data medical technology,artificial intelligence technology may solve this problem by transforming "experts sinking" into "tech sinking".At present,technologies such as confrontation learning,weakly supervised learning,intensive learning and graph neural networks have become research hotspots in the field of artificial intelligence,and have also played an important role in many fields of clinical medicine.Based on the advantages of deep learning and neural network in disease learning,many spine surgeons combine it with the diagnosis and treatment of cervical spondylosis,low back pain,lumbar degenerative diseases,spinal deformity,spinal tumors,and other spine-related diseases.The rapid location and accurate diagnosis of the disease not only makes it an effective tool for the comprehensive diagnosis of spinal diseases but also provides the basis for the most reasonable treatment options for spinal diseases.In the domestic application of artificial intelligence in the diagnosis and treatment of spinal surgery,it can also solve the problems of difficult diagnosis and complicated treatment of spinal diseases faced by primary doctors,reduce the rate of misdiagnosis and missed diagnosis,and effectively reduce the economic and social burden of spinal diseases.This paper reviews the research progress of artificial intelligence represented by deep learning in the field of diagnosis and treatment of spinal surgery at home and abroad,and the advantages and application prospects of artificial intelligence in the diagnosis and treatment of spinal surgery.
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Objective To compare the effect of different size needle gauges to the degenerative response in rat caudal discs.Methods A total of 40 Sprague Dawley (SD) rats,level 5/6,7/8 and 9/10 interverbral discs of rat caudal spine were punctured with 18 or 21 or 25-gauge needles respectively.Radiographs and magnetic resonance imaging (MRI) were obtained at 1,2,4 and 6 weeks postsurgery.At each time point,ten rats from each group were sacrificed for histological analysis.Real-time fluorescent quantitative polymerase chain reaction (qPCR) was used to examine mRNA expression level.Results Significant differences were identified in the disc height index (DHI ％) and MRI grade between 18 G and normal group,MRI grade,histological score between 21 G and normal group at 2,4,and 6 weeks postsurgery.Significant differences were also identified in the histological score and mRNA expression levels between 18 G and normal group,alcian blue stain and hypoxia inducible factor-1α (HIF-1 α) mRNA expression level between 21G and normal group at all time point postsurgery.Significant differences existed in DHI％,type Ⅱ collagen and aggrecan mRNA expression levels between 21 G and normal group,all type mRNA expression levels between 25 G and normal group at 4,6 weeks.There were significant differences in MRI grade and histological score between 25 G and normal group at 6 weeks.Significant differences existed in almost all parameters compared between 18 G and 25 G at all time point.There were significant differences in DHI％,MRI grade,histological score and HIF-1α mRNA expression levels between 18 G and 21 G at 4,6 weeks.There were significant differences in type Ⅱ collagen and aggrecan mRNA expression levels between 18 G and 21 G at all time point.Significant differences exist in DHI％ and HIF-1α mRNA expression level between 21 G and 25 G at 6 weeks.Compared with the 25 G group,the DHI％ and Pfirrmann scores and the pathological score of each time at 2,4 and 6 weeks after operation in 18 G group have significant difference (P ＜ 0.05).Conclusions The middle size needle (21G) is better to induce disc degeneration.The 2-week time point may be the better time frame to further experimental treatments.
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Objective To investigate the role of vitamin D in the synthesis and degradation of aggrecan in rat articular chondrocytes at cellular level. Methods Rat articular chondrocytes were stimulated by IL-1α, IL-1β and TNF-α, respectively. Normal and inflammatory chondrocytes were treated with different doses of vitamin D, respectively. CCK8, Flow cytometry, real time-PCR and western blot analysis were used to examine the proliferation activity and apoptosis level of chondrocytes, and the expression of aggrecan, ADAMTS-4 and ADAMTS-5 at both mRNA and protein levels. Results IL-1α,IL-1β and TNF-α significantly decreased the proliferation activity and increased the apoptosis level of the chondrocytes. Furthermore, IL-1α, IL-1β and TNF-α significantly decreased the expression of aggrecan, and increased the expressions of ADAMTS-4 and ADAMTS-5 at both mRNA and protein levels in the chondrocytes. 1α,25 (OH)2D3supplementation significantly increased the proliferation activity and decreased the apoptosis level of chondrocytes stimulated by IL-1α, IL-1β and TNF-α in a dose-dependent manner, but not affected the normal chondrocytes. Meanwhile, 1α,25(OH)2D3also significantly increased the expression of aggrecan, and decreased the expressions of ADAMTS-4 and ADAMTS-5 at both mRNA and protein levels in the chondrocytes under inflammatory conditions. Conclusions Vitamin D may promote the anabolism of aggrecan and inhibit aggrecanase activity in chondrocytes under inflammatory conditions, which may impact overall protection for articular cartilage.
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Spinal metastases may cause pain,pathological fracture and/or neurological symptoms.The most common treatment of spinal metastases is conservative therapy.Surgical intervention is necessary when there are pathological and/or neurological deficits.Total en bloc spondylectomy (TES) has lower local recurrence rate and may be applicable to a patient with single metastatic tumor and a long survival expectancy,While debulking surgery is less risky and higher recurrence rate.Conventional radiotherapy is a kind of effective supplement to reduce the local recurrence rate in spinal metastases.However,the local dose is often failed to reach the effective dose because of the close connection of tumor and spinal cord and it is less effective for relatively radioresistant histologies.With the development of radiotherapy technology,spinal radiotherapy has become increasingly accurate to avoid of spinal cord injury.In addition,conventional radioresistant tumors has become treatable with high-dose stereotactic body radiotherapy (SBRT).At the same time,SBRT is also an important basis for the implementation of separation surgery of spinal metastases.Separation surgery is to separate the tumor and dura and achieve circumferential decompression and stabilization through posterior approach.As a result,a high-dose SBRT can be performed because of the small interspace to protect the spinal cord,which greatly reduces the local recurrence rate.Compared with TES,separation surgery combined with high-dose radiotherapy not only reduces the difficulty of surgery,but also has a good local control rate,which is a relatively "minimally invasive" strategy.Separation surgery is particularly suitable for patients with high-grade epidural spinal cord compression and moderately sensitive or insensitive to radiotherapy.Although the concept of separation surgery has been proposed for several years,only a few applications have been reported in foreign literature and fewer in domestic literature.This article aims to summarize the relevant concepts and clinical applications of separation surgery in spine metastases and to provide a reference for the treatment of spinal metastases.
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Objective To observe the perioperative complications for metastatic cervical tumor,and explore their possible risk factors.Methods From January 2012 to January 2016,57 patients undergoing surgery for cervical spine metastasis were retrospectively analyzed,who were followed-up for at least 12 months or until death.Data collected included pain (a 10-point visual analogue scale,VAS),Karnofsky performance status score,neurologic status according to Frankel scale,perioperative complications,postoperative mortality and so on.Results The VAS score decreased significantly postoperation (P＜0.001).The Frankel grade was significantly improved (P=0.025).The Karnofsky score was also significantly improved (P＜0.001).The rate of local recurrence was 12.3％.Perioperative mortality rate (30 days after surgery) was 3.5％.Perioperative complication incidence was 24.6％.Univariate analysis found that comorbidity,preoperative Karnofsky score ＜60,multisegmental resection,and intraoperative blood loss ＞300ml were significant risk factors for the complication.Multivariable analysis showed that iIntraoperative blood loss ＞300ml and preoperative Karnofsky score ＜60 were the independent predictors for the complication.Conclusions Surgical management for cervical spinal metastasis is effective in terms of neurological recovery,pain control,and performance status recovery.However,the surgery had a high risk of complications that special attention should be paid to.Furthermore,complications might be related to preoperative Karnofsky score and intraoperative blood loss.
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Objective: To evaluate the clinical result of atlantoaxial reduction and fixation guided by the intraoperative CT.Methods: Sixteen cases were retrospectively studied, including seven males and nine females, with the mean age of 49.9 years.Twelve cases were diagnosed as chronic atlantoaxial instability or dislocation, while four cases as acute odontoid fracture and dislocation.Among the sixteen cases, fourteen underwent atlantoaxial fusion, while two underwent temporary atlantoaxial fixation without fusion.The intraoperative CT was used in the setting of: 1.Evaluating the atlantoaxial reduction before the screw insertion;2.Guiding the C1 and C2 pedicle drilling (two cases using additional three-dimensional printing drilling template);3.Evaluating the position of the screws and reduction after the atlantoaxial fixation.In addition, three-dimensional drilling template combined with intraoperative CT was used in two cases.CT scanning frequency was calculated.To evaluate the accuracy rate of screw fixation under the intraoperative CT, 19 cases without the intraoperative CT were studied as the control group.Results: Averaged CT scanning frequency was 1.4 times (Once in eleven cases, twice in four and three times in one).Among the sixteen cases, mal-positioned C1 screws were found and revised in two cases.No spinal cord injury or vertebral artery injury occurred.The follow-up ranged from three to ten months, with the mean of 6.7 months.Fourteen cases achieved solid osseous fusion, and two with temporary fixation had odontoid fracture union.Anatomic reduction was achieved in all the cases.Eleven cases with preoperative myelopathy had postoperative improvement and their mean JOA scores improved from 12.1 to 14.4.To the last follow-up, no hardware complications were found including screw broken, rod broken or fixation loosening.All the screws of intraoperative CT group had good positions.For 19 cases of the control group, there were two cases of mal-positioned screws (10.5%).Conclusion: Advantages of atlantoaxial reduction and fixation guided by the intraoperative CT included: improving the accuracy of the atlantoaxial screws, exactly evaluating the reduction of the atlantoaxial joint, immediately discovering the mal-positioned screws and avoiding the revision surgery.A good clinical result was found in the preliminary study.
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Objective To explore the imaging appearances of adult Langerhans cell histiocytosis (LCH) in spine and improve the awareness of this disease.Methods Imaging appearances of 29 patients with adult LCH in spine confirmed by clinic and pathology were analyzed retrospectively and the lesions number,location,the type of bone destruction,paravertebral and intraspinal and MRI signal and enhancement characters were evaluated.Results The total sum of spine lesions was 48 including 26 cervical lesions,17 thoracic lesions and 5 lumbar-sacrum lesions among 29 cases,and 11 cases involved multiple segments.Bone destruction was located in vertebral body in 15 cases accounting for 51.72％ (15/29),and 14 cases involved posterior arch accounting for 48.28％ (14/29).Sclerosis rim was found in 10 cases (10/29,34.48％) and bone sclerosis was found in 4 cases (4/29,13.79％).75.86％ (22/29) LCH extended to paravertebral space and the incidence of compressed fracture was 48.28％ (14/29),4.13％ (7/29) appeared as vertebra plana.On T2-weighted image,LCH showed iso-or-hypointensity (11/19,57.89％),hyperintensity (6/19,31.58％),heterogenous signal (2/19,10.53％).On MR enhanced scan,94.12％ (16/17) cases was significant enhanced,5.88％ (1/17) was moderate enhanced.Conclusion Cervical was commonly found in adult LCH,and bone destruction was mainly in vertebrae.It may involve one or multiple spine segments and bone destruction may be continuous or skip distribution.Vertebra plana was not rare.Bone sclerosis around bone destruction may be helpful for diagnosing LCH.
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STUDY DESIGN: A retrospective clinical review. PURPOSE: To investigate the difference in clinical manifestations and severity between polymicrobial and monomicrobial infections after spinal surgery. OVERVIEW OF LITERATURE: Surgical site infections (SSIs) after spinal surgery are a major diagnostic and therapeutic challenge for spinal surgeons. Polymicrobial infections after spinal surgery seem to result in poorer outcomes than monomicrobial infections because of complementary resistance to antibiotics. However, comparison of the clinical manifestations and severity between polymicrobial and monomicrobial infections are limited. METHODS: Sixty-seven patients with SSIs after spinal surgery were studied: 20 patients with polymicrobial infections and 47 with monomicrobial infections. Pathogenic bacteria identified were counted and classified. Age, sex, and body mass index were compared between the two groups to identify homogeneity. The groups were compared for clinical manifestations by surgical site, postoperative time to infection, infection site, incisional drainage, incisional swelling, incisional pain, neurological signs, temperature, white blood cell count, and the percentage of neutrophils. Finally, the groups were compared for severity by hospital stay, number of rehospitalizations, number of debridements, duration of antibiotics administration, number of antibiotics administered, and implant removal. RESULTS: Polymicrobial infections comprised 29.9% of SSIs after spinal surgery, and most polymicrobial infections (70.0%) were caused by two species of bacteria only. There was no difference between the groups in terms of clinical manifestations and severity. In total, 96 bacterial strains were isolated from the spinal wounds: 60 strains were gram-positive and 36 were gram-negative pathogenic bacteria. Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Enterobacter cloacae were cultured in order of the frequency of appearance. CONCLUSIONS: Most polymicrobial infections were caused by two bacterial species after spinal surgery. There was no difference in clinical manifestations or severity between polymicrobial and monomicrobial infections.
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Humans , Anti-Bacterial Agents , Bacteria , Body Mass Index , Coinfection , Debridement , Drainage , Enterobacter cloacae , Escherichia coli , Length of Stay , Leukocyte Count , Neutrophils , Postoperative Complications , Retrospective Studies , Spine , Staphylococcus aureus , Staphylococcus epidermidis , Surgeons , Surgical Wound Infection , Wounds and InjuriesABSTRACT
Objective To investigate whether TG2 plays an important role in the osteoblast differentiation and mineralization.Methods TG2 mRNA of SaOS-2 cells was knocked down using a lentivirus stably expressing short-hairpin ( sh) RNA targeting TG2.Then the cells were cultured in osteo-inductive medium for 14 d to measure mineralization and for 7 d to measure the levels of osteoblastic differentiation markers including ALP activity and mRNA of collagen I, osteocalcin ( OCN) and BMP-2.The wild-type SaOS-2 cells and scrambled shRNA-transducted SaOS-2 cells served as the controls. Results The controls displayed an increasing trend of the level of ALP activity and mRNA of collagen I, osteocalcin and BMP-2,and notable mineralization at 14 d.When TG2 was knocked down, ALP activity, mRNA of collagen I, osteocalcin and BMP-2 at 7d,and mineralization at 14 d were all significantly lower in comparison with the corresponding values in the controls.Conclusion TG2 is involved in the differentiation and mineralization of osteoblasts in vitro.
ABSTRACT
Objective To investigate whether the hyperintensity on T2?weighted MRI affects the outcome of cervical ar?throplasty (CA) for cervical spondylotic myelopathy (CSM). Methods 69 patients with CSM who had undergone CA between June 2005 and December 2007 were retrospectively reviewed. They were divided into three groups according to the intensity of T2?weighted images:Group A, whose intensity of T2?weighted images in spinal cord compression spot was equisignal;Group B, hyper?intensity with obscure border; Group C, hyperintensity with clear border. There were 22 males and 19 females in group A aged from 27 to 63 years old, whose duration of disease was between 3 to 72 months, and there were 34 single?segment cases, 5 double?segment and 2 triple?segment cases. There were 9 males and 9 females in group B aged from 30 to 61 years old whose duration of disease was between 3 to 24 months, and there were 12 single?segment and 6 double?segment cases. There were 4 males and 6 fe?males in group C aged from 28 to 56 years old whose duration of disease was between 1 to 24 months, and there were 8 single?seg?ment and 2 double?segment cases. Two types of artificial cervical disc were used:Bryan Disc in 42 cases and Prodisc?C in 44 cas?es. The duration of Group A (24.7 ± 27.9 months) was significantly longer than that in Group B (6.6 ± 7.4 months) and Group C (11.1±9.5 months). The follow?up period was from 48 to 86 months with an average time of 61 months. The preoperative X?ray and MR as well as postoperative X?ray were collected. The history, compress ratio of MRI, the ROM of cervical segments pre and post?operatively were recorded and Japanese Orthopaedic Association (JOA) was used to evaluate the neurological function. Results Preoperative compress ratio of MRI were 43.3%± 15.2%, 42.4%± 10.7%and 41.9%± 14.8%respectively;preoperative segmental ROM were 9.6°±2.5°, 9.0°±1.7° and 9.1°±1.9° respectively. Preoperative JOA score were 13.6±1.2, 13.1±1.3 and 12.9±1.8, re?spectively. Postoperative JOA score at the latest follow?up were 16.2±1.0, 15.8±1.2 and 15.7±1.6 respectively. There was no statis?tic difference among these groups. Preoperative increased signal intensify on T2?weighted MRI in patients with cervical spondylot?ic myelopathy may not affect the outcome of cervical arthroplasty.