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Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.
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Objective:To evaluate the accuracy and safety of cervical pedicle screw (CPS) placement under orthopaedic robot navigation system guidance.Methods:From March 2019 to February 2021, the data of 33 patients (19 males and 14 females, aged from 26 to 75 years, with an average age of 50.5 years) treated with pedicle screw fixation with the assistance of orthopaedic surgery robot through the posterior cervical spine were retrospectively analyzed. In clinical diagnosis, there was upper cervical fracture with instability in 14 patients (fracture nonunion in 2 patients), upper & subaxial cervical fracture in 1 patient, cervical spinal cord injury with spinal stenosis in 2 patients, cervical spinal stenosis in 9 patients, occipitocervical deformity in 2 patients, post-operative revision of cervical spondylosis in 2 patients, cervical intraspinal tumor in 3 patients. A total of 151 CPSs were inserted in C 1-C 7 using robot navigation system based on intraoperative three-dimensional C-arm fluoroscopy to assist in screw placement in posterior cervical surgery. Among them, 74 screws were implanted into upper cervical spine; 77 screws were implanted in the lower cervical spine. CT was used to obtain image data within 7 days after operation, and Neo classification was used to evaluate the accuracy of cervical pedicle screw placement. The patients were followed up for 2 weeks to observe the clinical symptoms and signs, and to determine whether there were surgical complications such as nerve and blood vessel injury and incision infection. Results:According to Neo classification, 91.4% (138/151) screws were completely contained in the pedicle without breaking through the pedicle cortex (grade 0). Among them, the accuracy of C 1 screws was 97.1% (34/35), C 2 screws was 92.3% (36/39), C 3 screws was 88.2% (15/17), C 4 screws was 71.4% (10/14), C 5 screws was 85.7% (12/14), C 6 screws was 93.3% (14/15), C 7 screws was 100.0% (17/17). The screw accuracy was highest in C 7, the lowest in C 4. The Kruskal-Wallis H test was performed on the accuracy of screw placement in different cervical level, and the results showed that there was no statistical difference (χ 2=1.31, P=0.971). However, a total of 13 screws were found to perforate the cortex of pedicle, although any neural or vascular complications associated with CPS placement were not encountered. Among them, 9 screws were found to perforate laterally, and 4 screws were found to perforate medially. No postoperative incision infection occurred in all cases. Conclusion:The safety of CPS placement can be effectively guaranteed with the assistance of the orthopaedic robot system.
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Objective To investigate the impact of endplate fracture on the clinical efficacy of minimally invasive percutaneous pedicle screwing for thoracolumbar burst fractures.Methods From September 2012 to June 2016,35 patients with thoracolumbar burst fracture underwent minimally invasive percutaneous pedicle screwing at Department of Orthopaedics,The First Affiliated Hospital to Nanjing Medical University.They were divided into 2 groups according to the severity of endplate fracture:a mild fracture group of 17 cases and a severe fracture group of 18 cases.Their clinical data were recorded and compared between the 2 groups before surgery,before discharge,6 months after surgery and at the last follow-up with respects to kyphosis cobb angle and height compression rate of the injured vertebra,and visual analogue scale (VAS),Oswestry disability index (ODI) and the MOS 36-item Short Form Health Survey (SF-36) scores.Results The kyphosis cobb angle and height compression rate of the injured vertebra,and VAS,ODI and SF-36 scores before discharge,6 months after surgery and at the last follow-up were all significantly improved in all the patients compared to the values before surgery (P ＜ 0.05).There were no significant differences between the 2 groups in the kyphosis cobb angle of the injured vertebra before surgery,before discharge,6 months after surgery or at the last follow-up (P ＞ 0.05).At the last follow-up,the height compression rate of the injured vertebra,and VAS,ODI and SF-36 scores in the mild fracture group were significantly lower than in the severe fracture group (P ＜ 0.05),and the height compression rate of the injured vertebra,and VAS,ODI and SF-36 scores of the severe fracture group were significantly higher than the values 6 months before (P ＜ 0.05).Conclusions The severity of endplate fracture may have no significant impact on the recovery of vertebral height in the early-to-mid stage after minimally invasive percutaneous pedicle screwing for thoracolumbar burst fractures.However,the patients complicated with severe endplate fracture are likely to suffer a height loss of the injured vertebral body and decreased quality of life in the long run.
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The regulation of immune response is affected by several factors in order to maintain homeostasis.Indoleamine 2,3-dioxygenase(IDO) is a tryptophan-catabolizing enzyme expressed by different types of APC,including macrophages and dendritic cells.IDO activity leads to regulatory effects on T cells,which are mediated by tryptophan depletion in specific local tissue microenvironments,the production of proapoptotic metabolites,and inhibition of T-cell clone proliferation through regulatory T cells.IDO plays an important role in protecting the allogeneic fetus from rejection,the development of autoimmune diseases,allograft rejection,and cancer.So regulation of IDO activity may offer a novel drug-based strategy to treat immune-related diseases.