Single Posterior Surgery Versus Combined Posterior-Anterior Surgery for Lumbar Tuberculosis Patients.

OBJECTIVE: Posterior approach of debridement, interbody graft, and instrumentation, and combined posterior-anterior approach of posterior instrumentation and anterior debridement and interbody graft are two essential surgeries for the surgical treatment of spinal tuberculosis (TB), and, until now, which one should be chosen is still controversial. This study aimed to compare the therapeutic efficacy between the single posterior surgery and combined posterior-anterior surgery for lumbar tuberculosis (LTB) patients to elucidate the role of debridement and the effects that result from posterior structure resection. METHODS: One hundred and nineteen LTB patients managed with single posterior debridement, interbody graft, and instrumentation surgery (Group P, 73 cases), or combined posterior-anterior surgery of posterior instrumentation and anterior debridement and interbody graft (Group P-A, 46 cases) from January 2008 to December 2016 were retrospectively analyzed. Different indexes were compared between the two groups to evaluate the curative effect and explore the role of debridement and the effects that result from posterior structure resection: operation time, blood loss, visual analog scale (VAS), Japanese Orthopaedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), surgical complication type and rate, spinopelvic sagittal parameters (local kyphosis [LK], pelvic incidence [PI] and pelvic tilt [PT], lumbar lordosis [LL], and sacral slope [SS]), drainage retention duration, hospital stay, time of abscess disappearance, time of activity recovery, and time of bone graft fusion by t-test or χ2 test. RESULTS: The follow-up period ranged from 24 to 60 months. No significant variations were detected between the two groups for age, sex ratio, BMI, disease duration, indication, and the preoperative values of VAS, JOA, ESR, CRP, and LK (p > 0.05). The VAS, JOA, ESR, and CRP significantly improved in both groups after the operation (p < 0.05), along with the LK and LL (p < 0.05). Meanwhile, the SS, PI, and PT showed minor improvement after the operation (p > 0.05). Compared to the P-A group, the P group had shorter operation time and less blood loss and hospital stay (p < 0.05). However, both groups presented similar VAS, JOA, ESR, CRP, and LK improvements (p > 0.05). Additionally, the surgical complication type and rate, postoperative spinopelvic sagittal parameters, and bone graft fusion time did not differ between the two groups (p > 0.05). On the other hand, the patients in the P-A group had a shorter time of abscess disappearance and activity recovery (p < 0.05) but a similar time of drainage retention (p > 0.05) compared to the P group. CONCLUSION: Both single posterior and combined posterior-anterior surgeries presented a good therapeutic effect for LTB patients with a low surgical complication rate and good quality of LK correction and LL reconstruction and maintenance. Moreover, single posterior surgery was less traumatic than combined posterior-anterior surgery but with slower TB lesion healing and activity recovery. Compared to debridement, stability seems to be more vital for STB healing, posterior structure resection does not affect the effect of spinopelvic realignment.

MiR-19b-3p Attenuates Chondrocytes Injury by Inhibiting MAPK/NF-Κb Axis via Targeting SOCS1.

In this study, miR-19b-3p was downregulated in osteoarthritic cartilage tissues and IL-1ß-stimulated primary chondrocytes, and miR-19b-3p overexpression reversed the inhibitory effect of IL-1ß on cell viability, the promotion effects of apoptosis, inflammatory factor secretion and extracellular matrix degradation, whereas the opposite effect was observed with miR-19b-3p inhibitor. Moreover, SOCS1 is a target gene of miR-19b-3p. Furthermore, SOCS1 overexpression enhanced cell injury compared with IL-1ß alone treatment, whereas knockdown of SOCS1 restored cell damage caused by IL-1ß. Further studies revealed that miR-19b-3p promoted chondrocyte injury repair by suppressing SOCS1 expression, and we found that was mediated by blocking the MAPK/NF-κB axis. Taken together, our findings may provide a new therapeutic strategy for osteoarthritis.

Comparison between single anterior and single posterior approaches of debridement interbody fusion and fixation for the treatment of mono-segment lumbar spine tuberculosis.

PURPOSE: To compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients. METHODS: Eighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups. RESULTS: The average period of follow-up was 34.3 ± 9.5 months (24-56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up. CONCLUSION: Both single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.

[Comparison of clinical effects of different anterior surgical methods for the treatment of single segment cervical disc herniation].

OBJECTIVE: To compare the clinical effects of different anterior surgical methods in treating single segment cervical disc herniation. METHODS: The clinical data of 46 patients with single-segment cervical disc herniation underwent surgical treatment from September 2013 to September 2018 were retrospectively analyzed. The patients were divided into three groups according to different surgical methods. Among them, 23 patients in the anterior percutanousendomic cervical dissection (APECD) group, there were 8 males and 15 females, aged (47±3) years old, prominent segments were C3,4 of 1 case, C4,5 of 6 cases, and C5,6 of 16 cases;10 patients in cervical disc replacement(CDR) group, there were 4 males and 6 females, aged (46± 3) years old, prominent segments were C3,4 of 1 case, C4,5 of 6 cases, C5,6 of 3 cases;13 patients in transcervical anterior cervical disc fusion (ACDF) group, there were 8 males and 5 females, aged (53±2) years old, protruding segments were C3,4 of 1 case, C4,5 of 3 cases, C5,6 of 9 cases. The operation time, intraoperative blood loss, and length of hospitalization were compared among three groups;visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical efficacy. RESULTS: All 46 patients were followed up for 12 to 24 (17.57±3.15)months. The follow-up time of APECD, CDR, ACDF groups were (17.30±3.25), (17.80±3.16), (17.85±2.88) months, and operation time were (95.48 ±13.85), (58.50±7.09), (76.00±15.72) min, respectively, there were no significant differences in follow-up time and operation time between two groups(P>0.05). The intraoperative blood loss of APECD, CDR, ACDF groups were (80.00±20.22), (82.60±7.20), (121.54±18.75) ml, there was significant difference between CDR group and ACDF group (P<0.05);and there was no significant difference between other groups (P>0.05). The length of hospitalization was (6.95±1.50) days in APECD group, (6.60± 0.80) days in CDR group, (6.54±0.75) days in ACDF group, and there was no significant difference between two groups (P> 0.05). At the latest follow up, VAS scores were decreasedfrom preoperative 6.78±0.83 to 2.57±0.65 in APECD group, decreased from 5.70±0.78 to 2.00±0.45 in CDR group, decreased from 6.77±0.42 to 1.38±0.49 in ACDF group. The JOA scores at final follow-up were increased from 8.91±0.97 to 13.04±1.40 in APECD group, and the improvement rate of (65±15)%;increased from 11.50±1.20 to 14.90±1.14 in CDR group, and the improvement rate of (76±19)%;increased from 8.54±0.93 to 14.00±0.96 in ACDF group, and the improvement rate of (74±8)%;there was significant difference in improvement rate between APECD group and CDR group (P<0.05). At final follow-up, the activities of the responsible segment in APECD group and CDR group were well preserved and improved (P<0.05). In the APECD group, the symptoms of two cases recurred during the mid-term follow-up (4 months and 6 months after surgery), one of which improved after strictly conservative treatment;the other one received ACDF surgery a second time, and the postoperative follow-up effect was satisfactory. CONCLUSION: The three anterior surgical approaches can achieve satisfactory clinical results for the treatment of single-segment cervical disc herniation. However, the improvement rate of the CDR group and the activity of the retained responsibility segment are better than those of the other two groups. APECD surgery may have recurrence.

[Effectiveness of internal fixation with headless compression hollow embedding screws for intraarticular fracture of elbow].

OBJECTIVE: To evaluate the effectiveness of internal fixation with headless compression hollow embedding screws in the treatment of intraarticular fracture of elbow. METHODS: Between March 2012 and September 2018, 12 patients with intraarticular fracture of elbow were treated with internal fixation with headless compression hollow embedding screws. There were 7 males and 5 females with an average age of 50.3 years (range, 22-65 years). Cause of injury included falling in 7 cases, falling from high places in 4 cases, and traffic accident in 1 case. Ten patients were distal humerus fractures which were classified as type 13-B3 in 8 cases and type 13-C3 in 2 cases according to the International Association of Internal Fixation Research (AO/ASIF). Two patients were radial head fractures which were classified as type Ⅲ according to the modified Mason classifications. The preoperative visual analogue scale (VAS) score was 8.25±0.83. The time from injury to operation was 3-5 days (mean, 3.7 days). RESULTS: All incisions healed by first intention. All 12 patients were followed up 6-15 months, with an average of 8.4 months. The results of X-ray films and CT examination showed that the fracture ends were anatomic reduction, and the fractures healed at 6-11 months after operation, with an average of 7.8 months. One patient had heterotopic ossification at 4 months after operation. The VAS scores were 5.17±0.79 at 2 weeks after operation and 0.50±0.50 at last follow-up. There were significant differences between the time points ( P<0.05). At last follow-up, the Mayo elbow function score was 68-95, with an average of 83.9. The activity of elbow joint recovered. CONCLUSION: The intraarticular fracture of elbow can be firmly fixed by the headless compression hollow embedding screw, which can allow the early functional training of the elbow joint, reduce the incidence of heterotopic ossification, and obtain good effectiveness.

[Posterior debridement and bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis].

OBJECTIVE: To explore the clinical effects of posterior debridement, bone grafting via intervertebral space combined with internal fixation for the treatment of lumbosacral tuberculosis. METHODS: The clinical data of 32 patients with lumbosacral tuberculosis underwent the procedure of one-stage posterior intervertebral debridement, bone grafting and internal fixation from January 2007 to July 2013 were retrospectively analyzed. There were 17 males and 15 females, aged from 27 to 63 years with an average of (49.8±9.2) years. The course of disease was from 5 to 18 months with the mean of (10.7±3.2) months. There was involved the vertebral body of L5 in 1 case, the intervertebral space of L5S1 in 8 cases, and the vertebral body of L5 or S1 combined with intervertebral space of L5S1 in 23 cases. VAS, ESR, CRP, the lumbosacral angle, the height of intervertebral space of L5S1, and ASIA grade were used to evaluate clinical effects. RESULTS: All the patients were followed up from 18 to 39 months with an average of 21.6 months. Operative time was 120 to 260 min with the mean of 175 min, and intraoperative bleeding was 700 to 1 450 ml with the mean of 1 050 ml. VAS before operation was 8.4±1.6, then descended to 3.5±0.8(P<0.05) on the 3rd month after operation and redescended to the level of 1.7±0.6(P<0.05) at the final follow-up. The ESR and CRP before operation were (48.8±10.2) mm and (58.6±5.6) mg/L, respectively, then decreased to (35.6±6.9) mm and (22.5±4.3) mg/L (P<0.05) at the 3rd month after operation and returned to the normal level at the final follow-up. The height of intervertebral space of L5S1 and lumbosacral angle before operation were (7.7±0.4) mm and (19.3±1.2)°, respectively, then improved to (10.3±0.3) mm and (22.4±1.5)° on the 3rd month after operation(P<0.05), and maintained such level, no obvious lost at later. According to ASIA grade, 8 cases were grade C, 19 were grade D, 5 were grade E before operation, and at final follow-up, 1 case still was grade D, others were grade E. CONCLUSIONS: The procedure of posterior debridement, bone grafting via intervertebral space combined with internal fixation is an effective and safe method in treating lumbosacral tuberculosis, it can effectively debride tuberculose focus, maintain the spinal stability, and improve the dysfunction with less complication.

[Treatment of unstable lumbar intervertebral disc herniation by modified lamina osteotomy replantation].

OBJECTIVE: To evaluate the clinical effects of the modified lamina replantation for the treatment of unstable lumbar intervertebral disc herniation. METHODS: From March 2009 to August 2011,63 patients with unstable lumbar intervertebral disc herniation were treated by discectomy, interbody fusion, pedicle screw fixation, and modified lamina replantation. There were 33 males and 30 females with an average age of 48.4 years old ranging from 22 to 68 years old. The average duration of disease was 38.8 months ranging from 3 months to 13 years. All patients had lower back and leg pains. X-ray,CT and MR results showed unstable lumbar intervertebral disc herniation. Preoperative and postoperative ODI, JOA scores, complication incident rates,radiographic healing rates,and lower back and leg pain recurrence rates were observed and recorded. RESULTS: Sixty-two incisions were healed at first stage, 1 at second stage. There were no complications such as deep vein thrombosis, intervertebral infection and so on. Sixty-one patients were followed up for more than one year, and the mean duration was 33 months. Nerve and dural injury occurred in 2 patients and 1 patient respectively. One-year fusion happened in 58 patients while the recurrence of lower back pain and leg pain after 1 year were noted in 4 patients and 1 patient respectively. ODI, and JOA scores were respectively re-assessed at 2 weeks, 6 months and 1 year after the operation, and the results showed a significant difference from the preoperative scores (P < 0.05). CONCLUSION: Modified lamina replantation for unstable lumbar intervertebral disc herniation showed lower rates of dural and nerve damage, as well as a higher lamina healing rate, lower back and leg pain recovery rate, and a better clinical score. It is a safe and efficient operation choice for lumbar spine surgery.