Midline Lumbar Fusion Versus Posterior Lumbar Interbody Fusion Involving L5-S1 For Degenerative Lumbar Diseases: A Comparative Study.

BACKGROUND: A retrospective cohort study to evaluate the efficacy and safety of midline lumbar fusion (MIDLF) for lumbosacral fusion compared to posterior lumbar interbody fusion (PLIF). METHODS: Patients who had undergone posterior lumbosacral fusion surgery were divided into a MIDLF group (n = 37) and a PLIF group (n = 42). The follow-up time was at least 12 months. The operation data, recovery condition, complications, clinical outcomes, and status of implants and fusion were compared between the 2 groups. RESULTS: The MIDLF group experienced significantly less blood loss, lower postoperative creatine kinase levels and total drainage volume, earlier time to ambulation, and less hospital stay times after surgery compared to the PLIF group (P < 0.05). The mean postoperative back pain visual analog scale scores in the MIDLF group were significantly lower than the PLIF group (P < 0.05). The improvement in Oswestry Disability Index scores during 3-month follow-up displayed a significant difference between the 2 groups (P < 0.05). The fusion rate tended to be higher in the MIDLF group; however, the difference was not significant (P > 0.05). There was no significant difference in respect to screw loosening and cage subsidence rate. There were 2 cases of complications both occurring in the PLIF group. CONCLUSIONS: MIDLF is safe and effective for lumbosacral fusion and in line with the concept of enhanced recovery after surgery.

Comparison of Different Treatment Regimens of Extracorporeal Shockwave Therapy in Chronic Low-back Pain: A Randomized Controlled Trial.

BACKGROUND: Extracorporeal shockwave therapy (ESWT) has shown its efficacy in treating chronic pain. Previous evidence has proven that ESWT in patients with chronic low-back pain (CLBP) results in significant reductions in pain. However, the optimal regimen for conducting ESWT in these patients remains unknown. OBJECTIVES: This study aimed to investigate, under the same total energy dose, the effectiveness and safety of low-intensity versus medium-intensity ESWT on CLBP. STUDY DESIGN: A prospectively registered, randomized controlled trial in accordance with the Consolidated Standards of Reporting Trials (CONSORT) Statement. The study was registered at the Chinese Clinical Trial Registry (No. ChiCTR2100049871). This study was approved by the ethics committee of our hospital (No.2021-193). SETTING: A tertiary hospital in China. METHODS: Sixty-nine patients with CLBP were randomly allocated into either the low-intensity (LI) or the medium-intensity (MI) group. In a 2-week treatment course, patients in the LI group received 6 sessions of ESWT (0.03 millijoules [mJ]/mm2) and patients in MI group received 2 sessions of ESWT (0.09 mJ/mm2). Outcome assessments included the Visual Analog Scale (VAS) at rest and at movement, the Oswestry Disability Index (ODI), and the Hospital Anxiety and Depression Scale (HADS). Follow-up visits were scheduled at 2 weeks, 4 weeks, 6 weeks, and 3 months after randomization. The primary outcome was the 11-point VAS at movement reported at 4 weeks after randomization. Adverse events were recorded. Overall therapeutic satisfaction on a 5-point Likert scale was collected at the last follow-up. RESULTS: From August 2021 through December 2021, 69 eligible patients were enrolled in the randomized controlled trial; 68 patients completed the whole treatment. Compared with baseline, both the LI group and MI group manifested significant improvement in VAS, ODI, and HADS scores at each follow-up time point (all P < 0.05). The between-group comparison indicated that the LI group had lower VAS scores at movement at 2 weeks, 4 weeks and 6 weeks after randomization (all P < 0.05), while the VAS score at rest was significantly lower in the LI group than in the MI group (P = 0.018) at 6 weeks after randomization. The ODI score in the LI group was significantly lower than the MI group at 2 weeks and 6 weeks after randomization (both P < 0.05). In addition, the HADS score was lower in the LI group than the MI group at 2 weeks after randomization (P = 0.021). However, at 3-months follow-up, no significant difference in VAS, ODI, or HADS were observed between the 2 groups. No notable shockwave-related side effects occurred in either group. LIMITATION: The limitations of our study include the small sample size and the lack of an untreated control group. CONCLUSION: Low-intensity ESWT treatment with more sessions is more effective in relieving pain and improving disability in the short-term than medium-intensity treatment with fewer sessions under the same total energy dose.

Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: A retrospective cohort study.

Objective: To assess the mid-long-term clinical and radiological outcomes of zero-profile (ZP) compared with stand-alone (ST) cages for two-level anterior cervical discectomy and fusion (ACDF). Methods: We included 77 patients (39 women and 38 men) who underwent two-level ACDF between May 5, 2016, and May 5, 2020, and who were followed up for at least 1 year. The subjects were divided into the ST (n = 38) and ZP (n = 39) group. For the evaluation of functional status, Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores were used. Additionally, radiological outcomes and procedure complications were observed at final follow-up. Results: Both groups had excellent clinical outcomes at the final follow-up. There were no significant intergroup (ZP vs. ST) differences in the fusion rate (91.02% vs. 90.79%, P > 0.05) and postoperative dysphagia (15.4% vs. 2.6%, P = 0.108). However, the disc height at the final follow-up in the ZP group was higher than that in the ST group (6.86 ± 0.84 vs. 6.17 ± 1.03, P = 0.002). The ZP group accomplished a lower loss of cervical lordosis (18.46 ± 4.78 vs. 16.55 ± 4.36, P = 0.071), but without reaching statistical significance. Conclusion: ACDF with either ZP or ST cages turns out to be a dependable strategy for two-level ACDF in terms of clinical results. However, compared with the ST, the ZP cage may achieve a significantly lower loss of disc height.

A Novel Calcium Phosphate-Based Nanocomposite for Augmentation of Cortical Bone Trajectory Screw Fixation.

Purpose: To evaluate the effect of cement augmentation of cortical bone trajectory (CBT) screws using a novel calcium phosphate-based nanocomposite (CPN). Material and Methods: CBT screws were placed into cadaveric lumbar vertebrae. Depending on the material used for augmentation, they were divided into the following three groups: CPN, polymethylmethacrylate (PMMA), and control. Radiological imaging was used to evaluate the cement dispersion. Biomechanical tests were conducted to measure the stability of CBT screws. A rat cranial defect model was used to evaluate biodegradation and osseointegration of the CPN. Results: After cement augmentation, the CPN tended to disperse into the distal part of the screws, whereas PMMA remained limited to the proximal part of the screws (P < 0.05). As for cement morphology, the CPN tended to form a concentrated mass, whereas PMMA arranged itself as a scattered cement cloud, but the difference was not significant (P > 0.05). The axial pullout test showed that the average maximal pullout force (Fmax) of CPN-augmented CBT screws was similar to that of the PMMA group (CPN, 1639.56 ± 358.21 N vs PMMA, 1778.45 ± 399.83 N; P = 0.745) and was significantly greater than that of the control group (1019.01 ± 371.98 N; P < 0.05). The average torque value in the CPN group was higher than that in the control group (CPN, 1.51 ± 0.78 N∙m vs control, 0.97 ± 0.58 N∙m) and lower than that in the PMMA group (1.93 ± 0.81 N∙m), but there were no statistically significant differences (P > 0.05). The CPN could be biodegraded and gradually replaced by newly formed bone tissue after 12 weeks in a rat cranial defect model. Conclusion: The biocompatible CPN could be a valuable augmentation material to enhance CBT screw stability.

Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature.

BACKGROUND: Deep venous thrombosis (DVT) is a serious complication of lumbar spine surgery. Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery. May-Thurner syndrome (MTS), a venous anatomical variation that may require invasive intervention, is an often overlooked cause of DVT. To date, no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published. CASE SUMMARY: We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery, and MTS was only considered after surgery, during a review of a gynecological enhanced computed tomography image taken before the procedure. CONCLUSION: In conclusion, clinicians should consider MTS in the presence of a dangerous triad: spondylolisthesis, elevated D-dimer levels, and sonographically indicated unilateral deep vein dilation. Consultation with a vascular surgeon is also essential to MTS management.

Hydrogen sulfide regulates autophagy in nucleus pulposus cells under hypoxia.

OBJECTIVE: Hydrogen sulfide (H2S) has been found to act as an important gasotransmitter to regulate cell activities. This study aimed to investigate the effect of H2S on autophagy of nucleus pulposus (NP) cells under hypoxia and possible mechanism. MATERIALS AND METHODS: NP cells were isolated from rat caudal discs. Cobalt chloride was used to mimic hypoxia, sodium hydrosulfide was used to emulate exogenous H2S and 3-methyladenine was used to block cell autophagy. Cell viability was assessed by phase contrast microscope and Cell Counting Kit-8 method. Moreover, expression of key autophagic proteins was analyzed via western blotting, and transmission electron microscopy was performed to detect autophagosomes. RESULTS: Hypoxia markedly impaired NP cell proliferation compared with control. Whereas H2S provided pro-proliferation and pro-autophagy effects on hypoxic NP cells. However, these beneficial impact of H2S on hypoxic NP cells were reversed by autophagy inhibitor. CONCLUSIONS: Our results showed that H2S played a cytoprotective role in NP cells exposed to hypoxia in an autophagy-dependent manner.