Single-cell RNA Sequencing Reveals Thoracolumbar Vertebra Heterogeneity and Rib-genesis in Pigs / 基因组蛋白质组与生物信息学报·英文版

Development of thoracolumbar vertebra (TLV) and rib primordium (RP) is a common evolutionary feature across vertebrates, although whole-organism analysis of the expression dynamics of TLV- and RP-related genes has been lacking. Here, we investigated the single-cell transcriptome landscape of thoracic vertebra (TV), lumbar vertebra (LV), and RP cells from a pig embryo at 27 days post-fertilization (dpf) and identified six cell types with distinct gene expression signatures. In-depth dissection of the gene expression dynamics and RNA velocity revealed a coupled process of osteogenesis and angiogenesis during TLV and RP development. Further analysis of cell type-specific and strand-specific expression uncovered the extremely high level of HOXA10 3'-UTR sequence specific to osteoblasts of LV cells, which may function as anti-HOXA10-antisense by counteracting the HOXA10-antisense effect to determine TLV transition. Thus, this work provides a valuable resource for understanding embryonic osteogenesis and angiogenesis underlying vertebrate TLV and RP development at the cell type-specific resolution, which serves as a comprehensive view on the transcriptional profile of animal embryo development.

Clinical application of extracorporeal pneumatic reduction combined with bone-filled mesh bag implantation for the treatment of thoracolumbar osteoporotic burst fracture without spinal cord injury / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of pneumatic reduction combined with bone-filled mesh bag implantation and pneumatic reduction combined with kyphoplasty in the treatment of thoracolumbar burst fracture without spinal cord injury.@*METHODS@#The clinical data of 160 patients with thoracolumbar osteoporotic burst fracture without spinal cord injury treated from January 2014 to July 2017 were retrospectively analyzed. There were 66 males and 94 females, aged from 72 to 84 years old with an average of 76.4 years old. The patients were divided into two groups according to different surgical methods, including 80 cases of pneumatic reduction combined with bone-filled mesh bag implantation(treatment group) and 80 cases of pneumatic reduction combined with kyphoplasty(control group). The intraoperative bone cement leakage rate was compared between two groups. The height of the injured vertebrae was measured by X-rays preoperatively and 6-month postoperatively in order to assess height loss of injured vertebrae. VAS score and ODI score were used for follow-up to assess lumbar back pain and autonomic dysfunction before surgery and 2 weeks, 6 months, 1 year after surgery.@*RESULTS@#In treatment group, 3 cases occurred bone cement leakage during operation and leakage rate was 3.75%(3/80); In control group, 14 cases had cement leakage with leakage rate of 17.5%; The difference between two groups was statistically significant(<0.05). All patients were followed up for 13 to 24 months with an average of 14.6 months. Among them, 2 cases occurred postoperative infections which were superficial infections. After oral antibiotics and outpatient treatment infections were controlled. At 6 months after surgery, the height of the injured vertebra was measured by X-ray. Treatment group recovered (5.12±1.31) % and control group recovered (14.11±1.17) %. The difference between two groups was statistically significant (<0.05). At 1 year after surgery, ODI score was 4.03±1.62 in treatment group and 10.03±1.54 in control group. The difference between two groups was statistically significant(<0.05). VAS score was 1.03±0.62 in treatment group and 2.67±0.55 in control group. The difference between groups was statistically significant(<0.05).@*CONCLUSIONS@#Extracorporeal pneumatic reduction combined with bone-filled mesh bag implantation technique can significantly reduce the occurrence of intraoperative cement leakage in the treatment of thoracolumbar osteoporotic burst fractures, effectively improve reposition of the injured vertebrae, relieve the pain and recover the function of lower back. However, high price of bone-filled mesh bags obstructs its clinical popularization.

A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures

OBJECTIVE: To evaluate the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures. METHODS: Fifty-six cases of thoracolumbar vertebral fractures treated in our trauma center from October 2012 to October 2013 were included in this study. The fractures were classified by the anteroposterior classification, whereas the severity of intervertebral disc injury was evaluated using magnetic resonance imaging. The Spearman correlation coefficient was used to analyze the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar fractures, whereas a χ2 test was adopted to measure the variability between different fracture types and upper and lower adjacent disc injuries. RESULTS: The Spearman correlation coefficients between fracture types and the severity of the upper and lower adjacent disc injuries were 0.739 (PU<0.001) and 0.368 (PL=0.005), respectively. It means that the more complex Arbeitsgemeinschaft für Osteosynthesefragen (AO) classifications are the disc injury is more severe. There was also a significant difference in the severity of injury between the upper and lower adjacent discs near the fractured vertebrae (p<0.001). CONCLUSIONS: In thoracolumbar spinal fractures, the severity of the adjacent intervertebral disc injury is positively correlated with the anteroposterior fracture type. The injury primarily involves intervertebral discs near the fractured end plate, with more frequent and severe injuries observed in the upper than in the lower discs. The presence of intervertebral disc injury, along with its severity, may provide useful information during the clinical decision-making process.

POSTEROLATERAL FUSION AND PEDICLE SCREW FIXATION FOR TREATING OLD THORACOLUMBAR FRACTURE COMBINED WITH KYPHOSIS IN ELDERLY PATIENTS / 中国修复重建外科杂志

OBJECTIVE: To investigate the clinical efficacy and the indications of posterolateral fusion and pedicle screw short-segment fixation via injured vertebra for treating old thoracolumbar fracture combined with kyphosis in elderly patients. METHODS: Between January 2012 and December 2014, 24 patients with old thoracolumbar fracture and kyphosis received posterolateral fusion and pedicle screw short-segment fixation via injured vertebra. Of 24 cases, 8 were male and 16 were female with an average age of 66.3 years (range, 56-79 years). The mean disease course was 17.5 months (range, 5-36 months). There were 13 cases of osteoporosis, 9 cases of osteopenia, and 2 cases of normal bone. The visual analogue scale (VAS) was 6.53±0.95, and Oswestry disability index (ODI) was 52.63%±5.74% preoperatively. The thoracolumbar kyphosis located at T10 to L2, and the kyphotic Cobb angle was (28.79±5.04)° before operation. RESULTS: The operation was completed successfully without related complications. The operative time was 1.2-2.3 hours (mean, 1.6 hours), and intraoperative blood loss was 80-210 mL (mean, 158 mL). No nerve injury occurred. Poor healing of incision was observed in 1 patient with diabetes, and primary healing of incision was obtained in the other patients. Nineteen patients were followed up 6-30 months (mean, 14.4 months), and there were 2 deaths. Pain relief and function recovery were obtained in 19 patients after operation. The VAS score and ODI were significantly decreased to 2.4±0.7 and 32.14%±5.12% at last follow-up (t=8.542, P=0.000; t=9.826, P=0.000). The kyphotic Cobb angle was significantly decreased to (21.23±4.30)° at immediate after operation (P0.05). No loosening or breakage of internal fixation was observed during follow-up. CONCLUSIONS: Posterolateral fusion and pedicle screw short-segment fixation via injured vertebra is a safe and effective treatment for elderly patients with old thoracolumbar fracture combined with kyphosis (Cobb angle less than 40°).

Experience of nursing AS patients with fractures of thoracolumbar vertebra combined with kyphotic deformity treated with osteotomy and internal fixation / 现代临床护理

Objective To explore the strategies for nursing the ankylosing spondylitis(AS)patients with fractures of thoracolumbar vertebra combined with kyphotic deformity treated with osteotomy and internal fixation.Method The nursing histories of 8 AS patients with fractures of thoracolumbar vertebra combined with kyphotic deformity treated with osteotomy and internal fixation were retrospectively analyzed to summarize the nursing strategies.Result All the 8 patients lived through the perioperative periods, with kyphotic derformity corrected and no complications like pulmonary or urinary system infections.Conclusion Pertinent care and effective special instructions to the patients may be clinically effective in improvement of heal rates of fractures of thoracolumbar vertebra combined with kyphotic deformity,reduction of complications and facilitation of their rehabilitation.

Efficacy of posterior vertebral column resection for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia / 中国综合临床

Objective To observe the therapeutical effect of posterior vertebral column resection on chronic thoracolumbar tuberculosis with secondary paraplegia and to provide a safe and effective method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.MethodsFrom Aug.2007 to Mar.2010,12 cases with chronic thoracolumbar tuberculosis and secondary paraplegia were surgically treated by posterior vertebral column resection and Titanium net support for bone graft and internal fixation operation treatment.Cobb angle was measured,and conditions of internal fixation were observed before and after the operation by X-ray films.Neurological status were evaluated by Frankel grades.ResultsThe follow-up periods was 6- 18 months( on average 11 months).Operations eased all patients' back and chest pain.Frankel grade increased from C preoperatively to grade D or E postoperatively in 6 cases,from grade D to E in 4 cases and from grade B to C in 1 case.No obvious improvement of Frankel grade was observed in the other patient of grade B.The average Cobb angles were(76.0 ± 23.4) ° before surgery,( 15.5 ± 6.3 ) ° at one week after surgery and ( 16.0 ± 8.2) °at the last follow-up.The difference in the Cobb angle before and at one week after treatment was significant( t =3.41,P ＜ 0.01 ).No difference was found in the Cobb angle between at one week after treatment and at the last follow-up (t =1.58,P ＞ 0.05 ).All patients got bony fusion with Titanium net.No complications occurred with internal fixation.Conclusion Posterior vertebral column resection is a feasible method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.It achieves neurological decompression with high correction rate and minor injury,and no anterior surgery is needed.

Long segment pedicle screw fixation for the thoracolumbar fracture and dislocation / 国际外科学杂志

Objective To discuss the value of the posterior long segments pedicle screws fixation in surgical treatment of thoracolumbar fracture-dislocation,and summarize the experience.Method s We reviewed the clinical information of 27 cases of thoracolumbar fracture-dislocation since July 2007 to March 2010; all the cases were treated with the posterior long segments pedicle screws fixation.In these cases,20were male,7 were female.And the age ranged from 18 to 58 years old (average age was 35 years).The posterior approach was used,and the pedicle screws were inserted into the 2 vertebrae above and below the fractured vertebrae.Posterior decompression and bone grafts for fusion were also accomplished during the operation.Results Follow-up ranged from 7 to 25 months,averaging 14 months.Completely restoration of the dislocation was got in 25 cases and the spine sequence resumed to nearly normal.One case with lateral dislocation failed to complete correction; another 1 case operated 20 days after surgery failed to complete correction of forward dislocation.At the last follow-up,the mean Cobb angle loss was 3 degrees,the height of the vertebral had obvious loss compared with that of post-operation.The loosen of screw nut was found during the follow-up,but no dislocation and secondary deformity were observed after fixation.There was no death,no infection.Conclusions The technique of posterior long segments pedicle screw fixation is of great value in the clinical applications,since it has the following advantages:the operation is simple,trauma is small,the fixation is firm,good restoration of fracture and dislocations can be easily got,and most importantly,it can effectively prevent long-term vertebral height loss and the backward protruding deformity.

Advance in Thoracolumbar Pedicle Screw Fixation (review) / 中国康复理论与实践

@# This paper reviewed the thoracolumbar pedicle screw internal fixation,including operation,instruments,image guided navigation,robot navigation,electrophysiological monitoring and integrated applications of various methods.It suggested that traditional implantation of thoracolumbar pedicle screw were widely used,computer-assisted navigation is being accepted by more and more surgeons,MR can make special image of the tissue being drilled by the probe tip during operation.However,being expensive,it is difficult for MRI navigation to be popularized.

Emergency Operative Treatment on Thoracolumbar Compression or Burst Fractures Using Pedicle Screw Instrument Through Posterior Approach and Indirect Reduction / 中国康复理论与实践

@#Objective To observe the clinical effect of emergency operative treatment on thoracolumbar compression or burst fractures using pedicle screw instrument through posterior approach and indirect reduction.Methods53 acute thoracolumbar compression or burst fractures cases injured within 4 days were accepted the emergency operation of indirect reduction, decompression and fixation using pedicle screw instrument through posterior approach. The mean percentage of traumatic vertebral body height, sagittal diameter of spinal canal, degrees of kyphosis and Frankel scoring of nerve function were evaluated before and after operation.ResultsAll cases received two weeks following-up, 47 cases had more than one-year following-up. The mean percentage of traumatic vertebral height restored from 42.28% (pre-operation) to 93.46% (post-operation); the mean degrees of kyphosis recovered from 26.44° (pre-operation) to 17.73° (post-operation); the mean percentage of sagittal diameter of spinal canal changed from 63.14% (pre-operation) to 78.55% (post-operation). All but cases with completely spinal cord injury got more than one grade nerve functional restoration. Neither later spinal cord injury nor back pain existed among the patients. Three cases emerged partial internal fixation device failure, but neither symptoms nor abnormality correction missed.ConclusionEmergency operation using pedicle screw instrument through posterior approach is a feasible and confirmatory choice in treatment of the acute thoracolumbar compression or burst fractures if the cases are selected properly.

Comparison between anterior and posterior surgical treatments of thoracolumbar burst fractures / 中华创伤骨科杂志

Objective To discuss the results and characteristics of surgical treatments through anterior or posterior approach for thoracolumbar burst fractures. Methods The retrospective review included 43 cases with an average age of 30.4 years from September, 1999 to November, 2004. The surgical approach was chosen according to conditions of the injury. 17 cases received an anterior approach operation. The Frankel scale was used for assessment of nerve function. 3 cases were rated as Grade A, 12 as Grade B, 19 as Grade C, and 9 as Grade D before surgery. Results The mean follow-up period was 36.7 months. There were no severe postoperative complications, such as deterioration of nerve function. All the cases showed notable improvement. Except in 3 cases of complete paraplegia, the improvement was 1.6 and 1.3 Frankel grades respectively for the anterior and posterior approach operations. Conclusions The anterior and posterior approaches are different in advantages and characteristics. The surgery through anterior approach provides more decompression and better maintenance of sagittal plane alignment.

Percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar vertebral compression fracture by filling auto-solidification calcium phosphate cement / 中华创伤骨科杂志

Objective To explore the clinical effect of the percutaneous vertebroplasty(PVP) and filling auto-solidification calcium phosphate cement(CPC) in treatment of osteoporotic thoracolumbar vertebral fractures. Methods From January, 2004, 26 patients with osteoporotic thoracolumbar vertebral compression fracture (29 vertebral bodies) were treated with intraoperative manipulative reduction, PVP and filling auto-solidification CPC. Results PVP were successfully performed with unilateral or bilateral vertebral pedicles for the 29 vertebrae. The average injection dose of CPC was 4.6 mL. CPC leakage occurred during the procedure in 5 vertebrae of 5 cases. All the patients were followed up for 3 to 8 months (averaging 4.6 months) and experienced complete pain relief. There was no severe complication related to the treatment. Except in 3 patients who lost 15%of the vertebral body height, the anterior height of the injured vertebral body in the other 23 patients recovered averagely to 80%of the normal one. Conclusion PVP with filling auto-solidification CPC is safe and effective in the treatment of osteoporotic thoracolumbar vertebral compression fractures.

Aspergillosis of Thoracolumbar Vertebra: A Case Report

As the use of the antibiotics, antitumor substances, steroid hormone and immunosuppressive agent have been increased remarkably, the incidence of the fungal infection has also been increased. Aspergillus is a fungus belonged to ascomycetes family and distributed world-widely. Aspergillus infection of the spine is very rare. Mode of vertebral Aspergillosis is direct extension of primary lesion of lung in children, on the other hand, hematogenous metastasis in adults. We report a adult woman who suffered from thoracolumbar pain without any neurological deficit for 6 months prior to admission. Imaging studies revealed irregular bony destruction on the adajacent end plates of T12 and L1 vertebras with kyphotic change. We underwent operation via anterolateral approach using Z-plate fixation. followed by amphotericin-B administration.