Clinical evaluation of the patterns and risk factors of bone cement leakage and its related risk factors secondary to vertebral augmentation / 中华骨科杂志

Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are safe and effective minimally invasive spinal techniques for the treatment of osteoporotic and pathological vertebral fractures, which are widely used in clinical practice. Cement leakage is the most common complication, which can lead to serious consequences such as adjacent vertebral refracture, pulmonary or cerebral embolism and paraplegia. Clinically, bone cement can penetrate into different sites along different paths, form different morphologies, and present different clinical symptoms. Therefore, an impeccable classification of bone cement leakage is beneficial to study its incidence, risk factors and prevention and treatment measures. So far, domestic and foreign scholars have proposed a variety of bone cement leakage classifications and elucidated its clinical significance despite certain limitations, but no uniform standard is established. Therefore, this review summarizes various classification and risk factors of cement leakage and evaluates their clinical implications, aiming at providing a reference for further clinical studies.

Prevalence and distribution of diffuse idiopathic skeletal hyperostosis in patients with thoracic ossification of the ligamentum flavum / 中华骨科杂志

Objective:To analyze the prevalence and distribution characteristics of diffuse idiopathic skeletal hyperostosis (DISH) in hospitalized patients with thoracic ossification of the ligamentum flavum (TOLF).Methods:The clinical records of 132 consecutive TOLF patients from January 2018 to June 2019 were retrospectively studied. DISH was identified by the preoperative X-ray and CT and its prevalence was calculated. The prevalence of patients with different genders, different age groups and different ossification types was compared. The segmental distribution of DISH and the distribution in the upper (T 1-T 4), middle (T 5-T 8), and lower thoracic spine (T 9-T 12) were analyzed. Ossification degree of DISH was evaluated based on the Meta scoring system. The demographic characteristics (age, gender, BMI, etc.) were compared between DISH and non-DISH group. Results:Forty-nine patients was diagnosed as DISH with the prevalence of 37.1% in all included cases. The prevalence was about twice as high in male (46.3%) than in female (23.1%) ( χ2=8.806, P=0.003). The prevalence in the age groups of <40, 40-49, 50-59, 60-69 and ≥70 years was 20.0%, 28.0%, 34.4%, 44.0%, and 66.7%, respectively. The prevalence in long-segment TOLF patients (45.1%) was significantly higher than that in short-segment TOLF patients (24.0%) ( χ2=5.937, P=0.015). DISH most frequently affected T 8,9 levels (91.8%). The total number and mean number of ossified segments were 365 and 7.4, respectively. Ossification lesions in the upper, middle, lower thoracic spine accounted for 26.03%, 40.54%, and 33.15%, respectively. Grade I, grade II, and grade III ossification accounted for 21.4%, 28.5% and 50.1%, respectively. The mean age of the DISH group was older than the non-DISH group ( t=2.024, P=0.045). The proportion of male patients in the DISH group was significantly higher than that in the non-DISH group ( χ2=8.806, P=0.003). The average height and weight in the DISH group were significantly greater than those in the non-DISH group ( t=2.564, P=0.012; t=2.191, P=0.030), whereas no significant differences in BMI and constituent ratio of concurrent diabetes, cardiac disease, hypertension between two groups were observed. Conclusion:The prevalence of DISH in patients with TOLF is 37.1%. Male, elderly and long-segment TOLF patients are associated with higher prevalence. DISH frequently occurs in the middle and lower thoracic spine, and T 8,9 is the common affected segment. Ossification lesions may develop with age. Demographic characteristics of DISH group differ, to some extent, from those of non-DISH group.

Advance in the study of distal junctional problem after thoracolumbar surgery / 中华骨科杂志

Distal junctional problem (DJP) is one of the severe complications after spinal correction, fixation and fusion. As the number of patients receiving spinal surgery increased recently, the incidence of DJP also increased dramatically. Compared with proximal junctional problem, the incidence of DJP is low. However, the clinical symptoms are severe, and the rate of surgical revision is high in patients with distal junctional problems. DJP include distal junctional kyphosis (DJK) and distal junctional failure(DJF). The definition of DJK is confusing, however, and the most commonly used was that the distal junction Angle at the last follow-up was greater than 10° and increased by 10° compared with that before surgery. There are 6 DJF modes: progressive loss of lumbar lordosis,acute wedging in the disc below the instrumentation, fracture of LIV, osteoporotic fracture below the long rigid fixation, failure of the instrumentation at LIV, spinal stenosis and or segmental instability underneath the instrumentation. Possible risk factors for DJP include weight, age, type of spinal deformity, osteoporosis, choice of LIV, hip disease, deformity location, surgical approach, surgical procedure, fusion segments, fixation devices, LIV at L5, fixed to S1 with no iliac screws, poor restoration of spinal alignment, et al. Currently, there are some controversies in DJP, mainly including the incidence, risk factors whether needs to and how to revise. The review intends to conduct a simple literature review of the current DJP diagnostic criteria, incidence, risk factors, and other research progress, in order to improve the understanding of the distal junction problem.

Research progress of molecular signaling pathways in thoracic ossification of ligamentum flavum / 中华骨科杂志

Thoracic ossification of ligament flavum (TOLF) is a chronic progressive disease presenting the heterotopic ossification of the ligamentum flavum of the thoracic spine, which leads to a series of symptoms and signs of thoracic spinal cord, nerveor vascular compression, with a high incidence in East Asian countries such as China and Japan. The pathology of TOLF is endochondral ossification in nature and surgical intervention is currently the only effective treatment due to conservative treatment does not work. The older age, the insidious onset, the various clinical manifestations of TOLF patients make the localization diagnosis and surgery management difficult and even bring about the high incidence of postoperative complications. Therefore, it is particularly important to study the mechanism of osteogenic differentiation of TOLF to find a way of early diagnosis and prevention. A variety of factors related to osteogenic differentiation of TOLF have been found, such as genetics, mechanical stimuli, molecular biological factors, metabolic and trace element abnormalities and so on. Moreover, molecular signaling pathways play a crucial role in regulating cell proliferation and directed differentiation. Therefore, this article reviews the confirmed relevant signaling pathways in the process of ligamentum flavum ossification, including bone morphogenetic protein (BMP) signaling pathway, mitogen-activated protein kinase (MAPK) signaling pathway, Wnt signaling pathway, Notch signaling pathway, STAT3 signaling pathway and other signaling pathways and factors, and also summarizes the promotion and inhibition of these signaling pathways in the osteogenic differentiation of ligamentum flavum cells, aiming at establishing a basis for the further research of the molecular biological mechanism of TOLF, and providing a possible direction for exploration of effective preventive and therapeutic targets.

Research progress in classification system of thoracic ossification of ligament flavum / 中华骨科杂志

Thoracic ossification of ligament flavum (TOLF) is a pathological process of heterotopic bone formation from ligamentum flavum tissue, which is the most common cause of thoracic spinal stenosis and thoracic myelopathy. Imaging examination is the predominant measure for localization and qualitative diagnosis for TOLF. Various TOLF classification systems have been reported currently, based on its morphology, distribution, configuration of compressed spinal cord or its association with peripheral tissue structures. However, there has been no unified classification due to confusing clinical applications. Therefore, we conducted a review to summarize TOLF classification systems and to evaluate the reliability of these classification systems and the diagnostic accuracy of various imaging modalities. As demonstrated in literatures, the diagnostic accuracy of radiography and the reliability of related classification were low. CT-based Sato classification (lateral, extended, enlarged, fused, tuberous) and Kuh classification (unilateral, bilateral, bridging), MRI-based Kuh classification (round, beak) and Chen Zhongqiang classification (isolated, skipping, continuous), Muthukumar classification combined with dural ossification (Tram track sign, Comma sign) elaborated ossification characteristics from different angles and dimensions. These classification systems were clinically significant in pathogenesis implication, risk assessment, treatment guidance and prognosis judgement, which showed high diagnostic accuracy and reliability. Combining multi-dimension and multi-level parameters of CT and MRI will play an important role in the diagnosis, treatment and new classification research of TOLF.

Clinical characteristics and surgical strategies of tandem ossification of the intraspinal ligaments / 中华骨科杂志

Ossification of posterior longitudinal ligament (OPLL) and ossification of ligamentum flavum (OLF) are clinically common heterotopic ossification diseases, which are the main causes of cervical and thoracic spinal stenosis and spinal cord injury. In some cases, OPLL and OLF may involve multiple spinal sites, individually or concurrently, increasing the difficulty of clinical diagnosis and treatment. This review initially attempts to define this specific ossification phenomenon as Tandem ossification of intraspinal ligaments (TOIL). It refers to a kind of severe spinal ligament ossification diseases caused by multiple factors, that OPLL and OLF occur alone or in combination at two or more sites of the cervical, thoracic, or lumbar spine with five or more ossified segments, progressively compressing the spinal cord or nerves, thereby resulting in a series of complex clinical symptoms. The prevalence of TOIL remains unknown, but its clinical detection rate is relatively high, and the most common TOIL is cervical OPLL combined with thoracic OPLL or/and OLF. Moreover, occurrence and development of TOIL involve many factors and its definitepathogenesis is not clear. Damage of upper and lower motor neurons can occur simultaneously in TOIL patients so that their clinical symptoms and signs often interfere with each other. TOIL has various forms, complex imaging features, and no uniform diagnostic and localization diagnostic criteria, which may easily lead to missed diagnosis and misdiagnosis. It is recommended that TOIL is identified by the typical symptoms and signs as the basis, CT three-dimensional reconstruction and MRI signs as the reference, and combination of the possible risk factors and clinical experience. Currently, surgical decompression for responsible lesions is the only effective treatment for symptomatic TOIL. However, domestic and foreign scholars still have great arguments on the optimal surgical strategy of TOIL. No consensus has been reached on how to determine the operating segment and the extent of decompression, which surgical approach and technique to be adopted, and when to select staged or one-stage combined surgery. Therefore, this review summarizes and discusses the current status and progress of the clinical characteristics and surgical strategies of TOIL through searching the relevant literature, to provide a reference for clinicians to diagnose and treat TOIL.

Bone cement augmentation of the pedicle screw in spinal surgery / 中华骨科杂志

Osteoporosis is a common metabolic bone disease in the elderly. It may be one of the factors which contributes to instrumentation failure in spinal surgery. Bone cement augmentation of the pedicle screw is a technique to enhance fixation strength, and it is now mainly applied in patients with osteoporosis and revision surgery, as well as spinal tumor surgery. According to clinical studies, bone cement augmentation can decrease screw loosening rate, prevent correction loss of the spine deformity, and increase the fusion rate. Pedicle screw fracture and pulloutare rare following screw augmentation surgery. The pedicle screw loosening rates following screw augmentation surgery with bone cement are higher in patients with osteoporotic vertebral fracture and lower in patients with spinal degenerative diseases. The main material for bone cement augmentation is Polymethylmethacrylate, and the volume for each screw is about 1-3 ml. Some researchers suggest less volume use in thoracic vertebrae than lumbar vertebrae. Both traditional and cannulated screws can be applied as the augmented pedicle screws, as well as the expandable pedicle screw. Cannulated screws can decrease the risk of bone cement extravasation compared with traditional screws. The mini-mally invasive technique of screw augmentation with bone cement can be used both in primary spinal surgery and augmentation of loosed screws. The main complications of the bone cement augmentation technique are cement leakage and pulmonary cement em-bolism. X-ray fluoroscopy is generally used to detect cement extravasation during the bone cement procedure. The 3D navigation and neurological monitoring are also recommended to reduce cement leakage in some studies. Most local cement leakage events are asymptomatic and need no treatment. Management of pulmonary cement embolism depends on the clinical presentation and the position of the emboli, including regular follow-up, oxygen inhalation, anti-coagulation therapy and embolectomy.

Efficacy analysis of Smith-Petersen osteotomy assisted by releasing disk space from posterior approach for thoracolumbar kyphosis / 中华外科杂志

Objective@#To evaluate the efficacy and safety of Smith-Petersen osteotomy (SPO) assisted by releasing disk space from posterior approach for thoracolumbar kyphosis.@*Methods@#A review was conducted on 8 patients (3 males and 5 females) with thoracolumbar kyphosis were treated with SPO assisted by releasing disk space from posterior approach at Department of Orthopaedics, Peking University Third Hospital from June 2016 to September 2017. The age was 56.5 years (range:18-71 years). There were 3 cases of Scheuermanns kyphosis, 2 cases of degenerative kyphosis, 1 case of proximal junctional kyphosis (PJK) after lumbar surgery, and 2 cases of kyphosis after thoracolumbar laminectomy. The paired t test was used for statistical analysis in thoracolumbar kyphosis angle, osteotomy segment kyphosis angle, sagittal vertical value (SVA), visual analogue score (VAS), Oswestry dysfunction index (ODI) before and after surgery. Statistical difference was confirmed with P<0.05.@*Results@#Osteotomy level included 2 cases in T11-12, 3 cases in T12-L1, 3 cases in L1-2. The average operation time was 339 min (range: 247-416 min), bleeding volume was 1 275 ml (range: 500-2 500 ml). The mean follow-up time was 16.5 months (range: 12-24 months). The average thoracolumbar kyphosis angle was 59.9° (range: 40°-73°) pre-operation, 9.5°(range:-5.1°-20°) post-operation and 13.5°(range:-1.3°-28°) at the latest follow-up. It made an average correction with 46.4°and corrective rate with 78.0%. The osteotomy segment kyphosis angle was 37.9° (range: 26°-46°) pre-operation, -1.3° (range:-11°-13°) post-operation making an 39.2° open-up angle, and 2.0° (range:-13.5°-13°) at the latest follow-up. Lumbar lordosis was 47.5° (range: 2°-76°) pre-operation, 41.2°(range:15°-62°) post-operation and 36.9°(range:15°-58°) at the latest follow-up. SVA was 54 mm(range:-34 mm-149 mm) pre-operation and 39 mm(range:-3 mm-119 mm) at the latest follow-up. VAS score of low back pain was 6.3(range:0-9) pre-operation and 3.0(range:0-6) at the latest follow-up. ODI score was 21.9(range: 0-42) pre-operation and 11.0(range: 0-26) at latest follow-up. Comparing to pre-operation value, there were statistical difference in the thoracolumbar kyphosis angle(t= 8.547, P=0.000), osteotomy segment kyphosis angle(t=9.739, P=0.000), VAS(t=3.077, P=0.018), ODI(t=5.800, P=0.001) at the latest follow-up. There was no neuropathic complication in all patients. Cerebrospinal fluid leakage occurred in 2 cases with spinal surgery history, and recovered after symptomatic treatment.@*Conclusions@#SPO assisted by releasing disk space from posterior approach could safely achieve effective correction of rigid thoracolumbar kyphosis deformity within 40°.

Posterior approach laminectomy combined with localized resection of ossified posterior longitudinal ligament and dekyphosis for multilevel ossification of the posterior longitudinal ligament in the thoracic spine / 中华骨科杂志

Objective To investigate the safety and effectiveness of posterior approach laminectomy combined with localized resection of ossified posterior longitudinal ligament and dekyphosis for multilevel ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine.Methods Thirty-one cases of thoracic multilevel OPLL was treated with this new technique between August of 2012 and August of 2016.Twenty-nine among the 31 cases were successfully followed up more than two years.Among these 29 cases,9 were male and the other 20 were female,with an average age of 48.5±7.1 years.The average segment number of OPLLwas 6.5±2.2 (range,3-11).The average segment number of laminectomy was 7.9±2.5 (range,4-13).There were 26 cases combined with ossification of the ligamentum flavum (OLF).Posterior approach laminectomy combined with localized resection of OPLL and dekyphosis for multilevel OPLL in the thoracic spine was applied to all cases.Firstly,en-bloc laminectomy was performed to all the segments of OPLL.Then the nearest segment of ossification to the kyphotic apex and the most stenotie level was selected and limitedly resected.Finally,wedge-shaped osteotomy was conducted to decrease the kyphosis.The outcomes including recovery rate of myelopathy and the radiological changes were recorded during the post-operative follow-up.Single group pre and post analysis was conducted by using paired t-test.Results Twenty-seven cases underwent one-level circumferential decompression,and the other two case underwent two-level localized resection of the ossified posterior longitudinal ligament.The average operation time was 245.2±75.1 min (range,131-423 min).The average blood loss was 1 307.9±1 457.7 ml(range,300-6 000 ml).The average follow-up time was 40.2± 14.9 months (range,25-69 months).The kyphotic angle of the stenotic segments decreased 11.4°±3.5° averagely after the surgery,from pre-operative 28.7°±9.6° to post-operative 17.3°±8.6°.The decreased kyphotic angle was 7.4°±3.1 ° at the final follow-up with an average kyphotic angel of 22.3°± 10.3°.The average length of the resected ossified posterior longitudinal ligament was 11.3±3.9 mm,and the average shortening length of the spinal column was 5.0±3.0 mm (range,0.4-13.8 mm).The pre-operative Japanese Orthopedic Association (JOA) score was 4.3±2.2 averagely (range,1-9),and the final JOA score increased to 9.3±2.3 (rang,3-11).The average recover rate was 85.7％ (range,-100％ to 100％),and the rate of excellent or good was 89.7％.Among the 29 cases,6 cases occurred post-operative transient deterioration and regained a satisfactory recovery eventually;one case occurred post-operative paraplegia and never recovered;19 cases occurred post-operative cerebrospinal fluid leakage and healed under conservative treatment.Conclusion For the thoracic multilevel OPLL,one-stage posterior approach laminectomy combined with localized resection of the ossified posterior longitudinal ligament and dekyphosis can significantly improve the outcomes of the myelopathy with low rate of post-operative paraplegia.Therefore,this new surgery technique is a safe and effective treatment for multilevel OPLL in thoracic spine.

Bone cement augmentation of the pedicle screw in spinal surgery / 中华骨科杂志

Osteoporosis is a common metabolic bone disease in the elderly.It may be one of the factors which contributes to instrumentation failure in spinal surgery.Bone cement augmentation of the pedicle screw is a technique to enhance fixation strength,and it is now mainly applied in patients with osteoporosis and revision surgery,as well as spinal tumor surgery.According to clinical studies,bone cement augmentation can decrease screw loosening rate,prevent correction loss of the spine deformity,and increase the fusion rate.Pedicle screw fracture and pulloutare rare following screw augmentation surgery.The pedicle screw loosening rates following screw augmentation surgery with bone cement are higher in patients with osteoporotic vertebral fracture and lower in patients with spinal degenerative diseases.The main material for bone cement augmentation is Polymethylmethacrylate,and the volume for each screw is about 1-3 ml.Some researchers suggest less volume use in thoracic vertebrae than lumbar vertebrae.Both traditional and cannulated screws can be applied as the augmented pedicle screws,as well as the expandable pedicle screw.Cannulated screws can decrease the risk of bone cement extravasation compared with traditional screws.The mini-mally invasive technique of screw augmentation with bone cement can be used both in primary spinal surgery and augmentation of loosed screws.The main complications of the bone cement augmentation technique are cement leakage and pulmonary cement em-bolism.X-ray fluoroscopy is generally used to detect cement extravasation during the bone cement procedure.The 3D navigation and neurological monitoring are also recommended to reduce cement leakage in some studies.Most local cement leakage events are asymptomatic and need no treatment.Management of pulmonary cement embolism depends on the clinical presentation and the position of the emboli,including regular follow-up,oxygen inhalation,anti-coagulation therapy and embolectomy.

Polymicrobial and Monomicrobial Infections after Spinal Surgery: A Retrospective Study to Determine which Infection is more Severe

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.

Research progress on Andersson lesion in ankylosing spondylitis / 中华外科杂志

Andersson lesion is a destructive vertebral or disco-vertebral lesion that occurs in the late stage of the ankylosing spondylitis. According to the etiology, these lesions are usually classified into localized lesions and extensive lesions. The history of ankylosing spondylitis and characteristic imaging is the key to the diagnosis of Andersson lesion. Conservative treatment may be effective for localized lesions. However, surgical intervention is often required for the failure of conservative treatment and extensive lesions. Currently, the optimal procedure for this problem is spinal osteotomy through pseudarthrosis and debridement via posterior-only approach.

The evaluation of osteogenic potency of ligament cells in thoracic ossification of the ligamentum flavum and relevant transcriptome high-throughput sequencing analysis / 中华骨科杂志

Objective To investigate the osteogenic differentiation potency of ligament cells in thoracic ossification of the ligamentum flavum (TOLF) and analyze further by using transcriptome high-throughput sequencing.Methods Clinically,the patients with non-TOLF and TOLF (n=10 in each group) who underwent surgery in our hospital from October 2015 to April 2016 were included in this study.The primary ligament cells that derived from the two groups were separately cultured and induced osteogenesis with 15％ strength of cyclic mechanical stress for 12h and 24h using a device called Flexcell FX-4000.The ALP activity was determined to evaluate the osteogenesis using quantitative analysis and ALP staining assay.Real-time PCR and westernblotting were used to detect the mRNA and protein expression of osteogenic-related genes including ALP,BMP-2 and Osteocalcin.Then,three patients in each group were included in the study of transcriptome high-throughput sequencing and bioinformatics analysis using Illumina HiSeqTM 2500 sequencing platform to compare further.Results The morphology of the cells that derived from two groups was basically similar,all presented an elongate spindle-shape.To evaluate the ostogenesis,ALP activity assays including quantitative and staining assays were performed.Under microscope,the ALP staining in the TOLF group was higher than non-TOLF group and increased with the longer duration of stress induction.The result of semi-quantitative analysis showed the stained area and positive cells in TOLF group were more than non-TOLF group significantly at 0 h,and were increased with the induction.The results of quantitative analysis showed ALP activity in the TOLF group was significantly higher than non-TOLF group and were increased with the induction significantly all the time.But no significant change in ALP staining or quantitative analysis was found in non-TOLF.The results of real-time PCR indicated that the expression of ostegenic markers above in the TOLF group was more than non-TOLF group significantly except the expression of OCN at 0 h.The expression of the three ostegenic markers in TOLF group was increased with the stress induction for 12 h and 24 h significantly except the expression of BMP-2 and OCN at 12 h.The results of western-blotting indicated that the expression of the three ostegenic markers above in the TOLF group was more than non-TOLF group significantly except the expression of ALP at 0 h.The expression of the three ostegenic markers in TOLF group was increased with the stress induction for 12 h and 24 h,but only the expression of ALP at 24 h was significant.And no significant change in the expression of mRNA and protein was found in non-TOLF group.In the transcriptome analysis,671 genes of TOLF group were up-regulated and 314 genes were found to be down-regulated compared to the control group.In addition,22 significant GO terms associated with upregulated genes were found to be closely related to ossification.Conclusion TOLF ligament cells have high osteogenic differentiation potency,which could express obvious osteogenesis-related gene spectrum,and differentially expressed genes including L1RL1 、PTHLH、DKK1 、BMP6、SPP1 and FGF1 may be related with the osteogenic potency of ligament cells in thoracic ossification.

Analysis of Global Sagittal Postural Patterns in Asymptomatic Chinese Adults

STUDY DESIGN: A prospective imaging study. PURPOSE: To characterize the distribution of the global sagittal postural patterns in asymptomatic Chinese adults using Roussouly classification. OVERVIEW OF LITERATURE: The norms of sagittal parameters in asymptomatic Chinese population have been previously described, but no report described their global sagittal postural patterns as characterized by Roussouly classification. METHODS: A cohort of 272 asymptomatic Chinese adults was recruited. Data was assimilated by reviewing the films for each subject. Sagittal parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. The pattern distributions were compared across genders within the study cohort. We also compared the data across different ethnicities from our study and a previous study to further characterize Chinese sagittal postures. RESULTS: The cohort included 161 males and 111 females, with mean age of 23.2±4.4 years. The average descriptive results were as below: pelvic incidence (PI) 46.4°±9.6°, thoracic kyphosis (TK) 24.2°±9.0°, lumbar lordosis (LL) 50.6°±10.6°, sacral slope (SS) 37.2°±7.6°, pelvic tilt (PT) 9.4°±6.8°, spinosacral angle (SSA) 131.1°±7.5° and sagittal vertical axis (SVA) 17.24±32.36 mm. Despite a significant difference between two genders in LL, PI, SSA, and SVA, no difference was found in the distribution of Roussouly types among them. 47.8% of our cohort belonged to Roussouly type 3, while type 1, 2 and 4 comprised 23.2%, 14.0% and 15.1% of the subjects, respectively. Roussouly classification was capable of categorizing sagittal parameters except for the PT. This study also found that 4.4% of the recruited subjects belonged to the C7-anterior subgroup. CONCLUSIONS: From a characterization of the sagittal postural patterns of asymptomatic Chinese adults using Roussouly classification, the distribution was similar between Chinese males and females; however, from a cross-study comparison, it was different between asymptomatic Chinese and Caucasian adults, with a higher proportion of Roussouly type 3 in Chinese adults.

Cerebrospinal Fluid Leakage after Surgeries on the Thoracic Spine: A Review of 362 Cases

STUDY DESIGN: A retrospective clinical review. PURPOSE: To describe the incidence of cerebrospinal fluid leakage (CSFL) after thoracic decompression and examine the CSFL predisposing clinical factors. OVERVIEW OF LITERATURE: CSFL is a common complication following thoracic decompression but has not been sufficiently addressed in former studies. METHODS: A cohort of 362 cases of thoracic decompression from February of 2005 to June of 2013 was examined. The case medical records were reviewed and the occurrence of CSFL and the related clinical parameters were noted. The incidence of CSFL for the entire cohort and each surgical approach were described. Besides, the relationship between CSFL and other clinical parameters were assessed, of which odds ratio values of all CSFL-associated parameters were calculated using multivariate logistic regression analysis. RESULTS: The incidence of CSFL for the entire cohort was 32.3%. Different surgical approaches had different incidences of CSFL, and circumferential decompression had the highest incidence. Though many different clinical parameters were related to the occurrences of CSFL, being older than 52 years, having ossification of the posterior longitudinal ligament or having longer operative segments than 3 vertebrae were significant risk factors for CSFL (p <0.05). Besides, surgeries on the mid-thoracic spine had an increased risk of CSFL (p <0.05). CONCLUSIONS: From our analysis, CSFL was a common complication after thoracic decompression with the incidence of up to 32.3%. This study identified the predisposing clinical factors, and spinal surgeons should be aware of these risk factors to reduce its incidence.

Cerebrospinal Fluid Leakage after Surgeries on the Thoracic Spine: A Review of 362 Cases

STUDY DESIGN: A retrospective clinical review. PURPOSE: To describe the incidence of cerebrospinal fluid leakage (CSFL) after thoracic decompression and examine the CSFL predisposing clinical factors. OVERVIEW OF LITERATURE: CSFL is a common complication following thoracic decompression but has not been sufficiently addressed in former studies. METHODS: A cohort of 362 cases of thoracic decompression from February of 2005 to June of 2013 was examined. The case medical records were reviewed and the occurrence of CSFL and the related clinical parameters were noted. The incidence of CSFL for the entire cohort and each surgical approach were described. Besides, the relationship between CSFL and other clinical parameters were assessed, of which odds ratio values of all CSFL-associated parameters were calculated using multivariate logistic regression analysis. RESULTS: The incidence of CSFL for the entire cohort was 32.3%. Different surgical approaches had different incidences of CSFL, and circumferential decompression had the highest incidence. Though many different clinical parameters were related to the occurrences of CSFL, being older than 52 years, having ossification of the posterior longitudinal ligament or having longer operative segments than 3 vertebrae were significant risk factors for CSFL (p <0.05). Besides, surgeries on the mid-thoracic spine had an increased risk of CSFL (p <0.05). CONCLUSIONS: From our analysis, CSFL was a common complication after thoracic decompression with the incidence of up to 32.3%. This study identified the predisposing clinical factors, and spinal surgeons should be aware of these risk factors to reduce its incidence.

Effects of Individual Prehabilitation on Functional Outcome Six Weeks after Total Knee Arthroplasty / 中国康复理论与实践

Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P2.827, P0.05), and it increased in the control group six weeks after TKA (t>3.555, P0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P2.387, P0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.

Effect of Acupuncture at Affected-limb Gallbladder Meridian Points on the Recovery of Lower Limb Function in Hemiplegia Patientswith Cerebral Infarction / 上海针灸杂志

Objective To investigate the clinical efficacy of acupuncture at affected-limb gallbladder meridian points and its effect on the recovery of lower limb function in treating hemiplegia patients with cerebral infarction. Methods Sixty hemiplegia patients with cerebral infarction were randomly allocated to treatment and control groups, 30 cases each. The treatment group received acupuncture at the gallbladder meridian points of the affected-side lower limb as main therapy and the control group, conventional acupuncture. After two courses of treatment, a pre-/post-treatment change in the Lower Extremity Fugl-Meyer Assessment score was observed in the two groups and post-treatment walking paces, pace lengths and incidences of strephenopodia were compared between the two groups.Results There was a statistically significant pre-/post-treatment difference in the Lower Extremity Fugl-Meyer Assessment score in the two groups (P<0.01). There was a statistically significant post-treatment difference in the Lower Extremity Fugl-Meyer Assessment score between the treatment and control groups (P<0.05). There were statistically significant post-treatment differences in walking pace, pace length and the incidence of strephenopodia between the treatment and control groups (P<0.05).Conclusion Acupuncture at affected-limb gallbladder meridian points can improve lower limb function and reduce the incidence of strephenopodia in hemiplegia patients with cerebral infarction.

Knockdown of tissue transglutaminase in SaOS-2 cell line inhibits its osteoblastic differentiation and mineralization / 中国实验动物学报

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.

Analysis of risk factors for deep surgical site infection after posterior thoracic and lumbar surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To study the risk factors for deep surgical site infection after posterior thoracic and lumbar surgery.</p><p><b>METHODS</b>The medical data of the patients with deep surgical site infection after posterior thoracic and lumbar surgery from January 2008 to December 2013 were reviewed.For each case patient, 3 non-infected controls were randomly selected from the same database of all patients who underwent posterior thoracic and lumbar surgery.Patients who had diagnosis of spinal fractures, infection, tuberculosis, and tumor were excluded. The microbiology and related factors were collected and analyzed. T-test, χ2 test and Logistic analysis were used to analyze the data, respectively.</p><p><b>RESULTS</b>Ninety-nine cases were identified (infection group), 57 men and 42 women, average 54.5 years old, average body mass index 26.4 kg/m2. Fifty-five (55.6%) patients were identified with organisms, and the most common identified organism was Staphylococcus Aureus. Compared with the cases in the control group (44.4 g/L), the cases in the infection group (43.1 g/L) had a significant low albumin preoperatively (P=0.001). Multivariate Logistic analysis showed that obesity (OR=2.102, 95% CI=1.259-3.508), diabetes (OR=1.926, 95% CI=1.041-3.563), number of surgical levels≥3 (OR=1.985, 95% CI=1.130-3.486) were risk factors for this complication (P<0.05).</p><p><b>CONCLUSION</b>For deep surgical site infection after posterior thoracic and lumbar surgery, obesity, diabetes, preoperative low albumin and number of surgical levels≥3 are risk factors.</p>