Treatment of multisegmental vertebral compression, burst fractures, and sandwich vertebra with severe osteoporosis using the PKP technique: a case report and literature review.

This study aimed to present a special case of treatment of a patient with multisegmental vertebral compression fracture, burst fracture, and sandwich vertebra and to review the literature on this condition. An 85 year-old female presented with severe low back pain but no radiating pain in the lower extremities. The patient was diagnosed with T12 and L5 vertebral compression fractures, fresh vertebral burst fractures in L2 and L3, and osteoporosis. The focus was on formulating a surgical treatment strategy. At the 12 month follow-up, no neurological deficits were observed, and the chosen surgical treatment approach yielded favorable clinical outcomes. A comprehensive literature review indicates that percutaneous kyphoplasty (PKP) can effectively alleviate pain and ensure safety in managing osteoporotic vertebral burst fractures. While complications remain a theoretical risk, they can be mitigated through meticulous assessment, careful surgical procedures, and appropriate preventive measures. PKP is an effective and safe treatment modality for osteoporotic vertebral burst fractures. Conservative management of sandwich vertebrae can yield positive clinical outcomes, but regular anti-osteoporosis treatment is necessary.

Is It Necessary to Cross the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion for Multilevel Degenerative Cervical Spine Disease? A Systematic Review and Meta-Analysis.

BACKGROUND: Posterior cervical decompression and fusion (PCF) is a common procedure for treating patients with multilevel degenerative cervical spine disease. The selection of lower instrumented vertebra (LIV) relative to the cervicothoracic junction (CTJ) remains controversial. This study aimed to compare the outcomes of PCF construct terminating at the lower cervical spine and crossing the CTJ. METHODS: A comprehensive literature search was performed for relevant studies in the PubMed, EMBASE, Web of Science, and Cochrane Library database. Complications, rate of reoperation, surgical data, patient-reported outcomes (PROs), and radiographic outcomes were compared between PCF construct terminating at or above C7 (cervical group) and at or below T1 (thoracic group) in patients with multilevel degenerative cervical spine disease. A subgroup analysis based on surgical techniques and indications was performed. RESULTS: Fifteen retrospective cohort studies comprising 2071 patients (1163 in the cervical group and 908 in the thoracic group) were included. The cervical group was associated with a lower incidence of wound-related complications (RR, 0.58; 95% CI 0.36 to 0.92, p = 0.022; 831 patients in cervical group vs. 692 patients in thoracic group), a lower reoperation rate for wound-related complications (RR, 0.55; 95% CI 0.32 to 0.96, p = 0.034; 768 vs. 624 patients), and less neck pain at the final follow-up (WMD, -0.58; 95% CI -0.93 to -0.23, p = 0.001; 327 vs. 268 patients). However the cervical group also developed a higher incidence of overall adjacent segment disease (ASD, including distal ASD and proximal ASD) (RR, 1.87; 95% CI 1.27 to 2.76, p = 0.001; 1079 vs. 860 patients), distal ASD (RR, 2.18; 95% CI 1.36 to 3.51, p = 0.001; 642 vs. 555 patients), overall hardware failure (including hardware failure of LIV and hardware failure occurring at other instrumented vertebra) (RR, 1.48; 95% CI 1.02 to 2.15, p = 0.040; 614 vs. 451 patients), and hardware failure of LIV (RR, 1.89; 95% CI 1.21 to 2.95, p = 0.005; 380 vs. 339 patients). The operating time was reasonably shorter (WMD, -43.47; 95% CI -59.42 to -27.52, p < 0.001; 611 vs. 570 patients) and the estimated blood loss was lower (WMD, -143.77; 95% CI -185.90 to -101.63, p < 0.001; 721 vs. 740 patients) when the PCF construct did not cross the CTJ. CONCLUSIONS: PCF construct crossing the CTJ was associated with a lower incidence of ASD and hardware failure but a higher incidence of wound-related complications and a small increase in qualitative neck pain, without difference in neck disability on the NDI. Based on the subgroup analysis for surgical techniques and indications, prophylactic crossing of the CTJ should be considered for patients with concurrent instability, ossification, deformity, or a combination of anterior approach surgeries as well. However, long-term follow-up outcomes and patient selection-related factors such as bone quality, frailty, and nutrition status should be addressed in further studies.

Changes in paraspinal muscles and facet joints after percutaneous endoscopic transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis: A 3-year follow-up.

Objectives: This study investigates the changes in the paraspinal muscles of lumbar spinal stenosis patients after percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF). Methods: Thirty-three patients from Beijing Chaoyang Hospital who had L4/5 segment lumbar spinal stenosis between January, 2017 and January, 2019were included in this study. Patient-reported outcomes including the visual analog scale scores for back pain and leg pain (VAS-BP and VAS-LP, respectively) and the Oswestry disability index (ODI) scores at pre-operation and 1-week, 3-month, 12-month, and (at least) 3-year follow-up (the final follow-up) were evaluated. Computed tomography (CT) was performed at the 12-month follow-up, 24-month follow-up, and the final follow-up after surgery. Multifidus (MF) muscle functional cross-sectional area (FCSA) and fat infiltration (FI) were evaluated, and the degree of adjacent facet joint degeneration was evaluated using Pathria scores. Results: All patients underwent at least a 3-year follow-up period. The VAS-BP, VAS-LP, and ODI were significantly lower at 1-week, 3-month, 12-month, and 3-year follow-up than at pre-operation (P < 0.05). At the 3-year follow-up, no differences were found in FCSA and FI for any patient's MF muscle at the lower third of the vertebral body (L3) above the operation level (P > 0.05), and there was no statistical difference in the central plane of the L3/4 and L5/S1 vertebral facet joints at pre-operation, 12-month, 24-month, and 3-month follow-up (P > 0.05). Conclusions: PE-TLIF can provide satisfactory clinical outcomes for patients with lumbar spinal stenosis. Furthermore, the technique may also reduce the injury on the paravertebral muscles, especially the MF muscle, as well as on adjacent facet joints.

The effect of allometric partitioning on herbivory tolerance in four species in South China.

Herbivory tolerance can offset the negative effects of herbivory on plants and plays an important role in both immigration and population establishment. Biomass reallocation is an important potential mechanism of herbivory tolerance. To understand how biomass allocation affects plant herbivory tolerance, it is necessary to distinguish the biomass allocations resulting from environmental gradients or plant growth. There is generally a tight balance between the amounts of biomass invested in different organs, which must be analyzed by means of an allometric model. The allometric exponent is not affected by individual growth and can reflect the changes in biomass allocation patterns of different parts. Therefore, the allometric exponent was chosen to study the relationship between biomass allocation pattern and herbivory tolerance. We selected four species (Wedelia chinensis, Wedelia trilobata, Merremia hederacea, and Mikania micrantha), two of which are invasive species and two of which are accompanying native species, and established three herbivory levels (0%, 25% and 50%) to compare differences in allometry. The biomass allocation in stems was negatively correlated with herbivory tolerance, while that in leaves was positively correlated with herbivory tolerance. Furthermore, the stability of the allometric exponent was related to tolerance, indicating that plants with the ability to maintain their biomass allocation patterns are more tolerant than those without this ability, and the tendency to allocate biomass to leaves rather than to stems or roots helps increase this tolerance. The allometric exponent was used to remove the effects of individual development on allocation pattern, allowing the relationship between biomass allocation and herbivory tolerance to be more accurately explored. This research used an allometric model to fit the nonlinear process of biomass partitioning during the growth and development of plants and provides a new understanding of the relationship between biomass allocation and herbivory tolerance.

Global Data Analysis Shows That Soil Nutrient Levels Dominate Foliar Nutrient Resorption Efficiency in Herbaceous Species.

Nutrient resorption plays an important role in ecology because it has a profound effect on subsequent plant growth. However, our current knowledge about patterns of nutrient resorption, particularly among herbaceous species, at a global scale is still inadequate. Here, we present a meta-analysis using a global dataset of nitrogen (N) and phosphorus (P) resorption efficiency encompassing 227 perennial herbaceous species. This analysis shows that the N and P resorption efficiency (NRE and PRE, respectively), and N:P resorption ratios (NRE:PRE) across all herbaceous plant groups are 59.4, 67.5, and 0.89%, respectively. Across all species, NRE, PRE, and NRE:PRE, exhibited different patterns along climatic and soil nutrient gradients, i.e., NRE decreases with increasing mean annual precipitation (MAP) and soil N, PRE increases with aridity index (AI) but decreases with MAP and soil P, and NRE:PRE decreases with increasing potential evapotranspiration (PET), AI, and soil N:P. NRE, PRE, and NRE:PRE also differed in functional species group (graminoids vs. forbs). Soil nutrient level was the largest contributor to the total variations in NRE, PRE, and NRE:PRE, while climate and herbaceous types had relatively smaller effects on NRE, PRE, and NRE:PRE. Collectively, these trends can inform attempts to model biogeochemical cycling at a global scale.

A theoretical framework for whole-plant carbon assimilation efficiency based on metabolic scaling theory: a test case using Picea seedlings.

Simultaneous and accurate measurements of whole-plant instantaneous carbon-use efficiency (ICUE) and annual total carbon-use efficiency (TCUE) are difficult to make, especially for trees. One usually estimates ICUE based on the net photosynthetic rate or the assumed proportional relationship between growth efficiency and ICUE. However, thus far, protocols for easily estimating annual TCUE remain problematic. Here, we present a theoretical framework (based on the metabolic scaling theory) to predict whole-plant annual TCUE by directly measuring instantaneous net photosynthetic and respiratory rates. This framework makes four predictions, which were evaluated empirically using seedlings of nine Picea taxa: (i) the flux rates of CO(2) and energy will scale isometrically as a function of plant size, (ii) whole-plant net and gross photosynthetic rates and the net primary productivity will scale isometrically with respect to total leaf mass, (iii) these scaling relationships will be independent of ambient temperature and humidity fluctuations (as measured within an experimental chamber) regardless of the instantaneous net photosynthetic rate or dark respiratory rate, or overall growth rate and (iv) TCUE will scale isometrically with respect to instantaneous efficiency of carbon use (i.e., the latter can be used to predict the former) across diverse species. These predictions were experimentally verified. We also found that the ranking of the nine taxa based on net photosynthetic rates differed from ranking based on either ICUE or TCUE. In addition, the absolute values of ICUE and TCUE significantly differed among the nine taxa, with both ICUE and temperature-corrected ICUE being highest for Picea abies and lowest for Picea schrenkiana. Nevertheless, the data are consistent with the predictions of our general theoretical framework, which can be used to access annual carbon-use efficiency of different species at the level of an individual plant based on simple, direct measurements. Moreover, we believe that our approach provides a way to cope with the complexities of different ecosystems, provided that sufficient measurements are taken to calibrate our approach to that of the system being studied.

Models and tests of optimal density and maximal yield for crop plants.

We introduce a theoretical framework that predicts the optimum planting density and maximal yield for an annual crop plant. Two critical parameters determine the trajectory of plant growth and the optimal density, N(opt), where canopies of growing plants just come into contact, and competition: (i) maximal size at maturity, M(max), which differs among varieties due to artificial selection for different usable products; and (ii) intrinsic growth rate, g, which may vary with variety and environmental conditions. The model predicts (i) when planting density is less than N(opt), all plants of a crop mature at the same maximal size, M(max), and biomass yield per area increases linearly with density; and (ii) when planting density is greater than N(opt), size at maturity and yield decrease with -4/3 and -1/3 powers of density, respectively. Field data from China show that most annual crops, regardless of variety and life form, exhibit similar scaling relations, with maximal size at maturity, M(max), accounting for most of the variation in optimal density, maximal yield, and energy use per area. Crops provide elegantly simple empirical model systems to study basic processes that determine the performance of plants in agricultural and less managed ecosystems.

Insights into plant size-density relationships from models and agricultural crops.

There is general agreement that competition for resources results in a tradeoff between plant mass, M, and density, but the mathematical form of the resulting thinning relationship and the mechanisms that generate it are debated. Here, we evaluate two complementary models, one based on the space-filling properties of canopy geometry and the other on the metabolic basis of resource use. For densely packed stands, both models predict that density scales as M(-3/4), energy use as M(0), and total biomass as M(1/4). Compilation and analysis of data from 183 populations of herbaceous crop species, 473 stands of managed tree plantations, and 13 populations of bamboo gave four major results: (i) At low initial planting densities, crops grew at similar rates, did not come into contact, and attained similar mature sizes; (ii) at higher initial densities, crops grew until neighboring plants came into contact, growth ceased as a result of competition for limited resources, and a tradeoff between density and size resulted in critical density scaling as M(-0.78), total resource use as M(-0.02), and total biomass as M(0.22); (iii) these scaling exponents are very close to the predicted values of M(-3/4), M(0), and M(1/4), respectively, and significantly different from the exponents suggested by some earlier studies; and (iv) our data extend previously documented scaling relationships for trees in natural forests to small herbaceous annual crops. These results provide a quantitative, predictive framework with important implications for the basic and applied plant sciences.