Identification and experimental validation of Stearoyl-CoA desaturase is a new drug therapeutic target for osteosarcoma.

Osteosarcoma (OS) is the most common malignant bone tumor. Fatty acid reprogramming plays an essential role in OS progression. However, new fatty acid related therapeutic targets of OS have not been completely elucidated. Therefore, we firstly identified 113 differentially expressed fatty acid metabolism genes using bioinformatic analysis, 19 of which were found to be associated with OS prognosis. Then, 7 hub genes were screened out and yielded a strong prediction accuracy (AUC value = 0.88, at 3 years) for predicting the survival status of OS patients. Furthermore, we confirmed that SCD was highly expressed in OS cells and patients. And Knock-down of SCD impaired proliferation and migration of OS cells. Moreover, SCD was transcriptionally activated by c-Myc to promote proliferation and migration of OS cells. Finally, SCD inhibitor could significantly induce OS ferroptosis in vitro and in vivo. In conclusion, we identified that SCD was a reliable risk factor for OS patients. And SCD was activated by c-Myc. The inhibitor of SCD could significantly impaired OS growth and induce OS ferroptosis, which indicated that SCD was a potential drug target for OS treatment.

The role of routine laboratory tests after unilateral total knee arthroplasty.

BACKGROUND: Recent studies suggest that routine laboratory tests are not required within 1 day after partial knee arthroplasty. In this study, we evaluated the utility of routine postoperative laboratory tests after initial unilateral total knee arthroplasty (TKA) in an Asian population. In addition, we explored risk factors associated with abnormal test results. METHODS: Clinical data of patients who underwent original unilateral TKA between 2015 and 2020 were retrospectively analyzed. Patient characteristics and laboratory test results were recorded. Multivariate binary logistic regression analysis was performed to identify risk factors associated with 3 abnormal laboratory results. RESULTS: A total of 713 patients, who underwent relevant laboratory tests within 3 days of TKA surgery, were enrolled. Among them, 8.1%, 9.9%, and 3.4% patients with anemia, hypoalbuminemia, and abnormal serum potassium levels required clinical intervention after surgery. Binary logistic regression analysis revealed that preoperative hemoglobin levels, estimated blood loss, and age were independent risk factors of postoperative blood transfusion in TKA patients. On the other hand, preoperative albumin levels, intraoperative blood loss, and operation time were risk factors associated with postoperative albumin supplementation. In addition, lower body mass index (BMI) and preoperative hypokalemia were potential risk factors of postoperative potassium supplementation. CONCLUSION: Considering that more than 90% of abnormal postoperative laboratory tests do not require clinical intervention, we believe that routine laboratory tests after surgery have little significance in patients with primary unilateral TKA. However, postoperative laboratory testing is necessary for patients with established risk factors.

iTRAQ-based proteomic analysis of the molecular mechanisms and downstream effects of fatty acid synthase in osteosarcoma cells.

BACKGROUND: Fatty acid synthase (FASN) is a lipogenic enzyme that participates in tumor progression. We previously showed that FASN is dysregulated in OS malignancy, but the molecular mechanism(s) of these effects remained unclear. METHODS: We examined differentially expressed proteins (DEPs) in FASN-silenced osteosarcoma 143B cells and their parental cells by isobaric tags for relative and absolute quantitation (iTRAQ). Differentially expressed proteins were classified using GO and KEGG analysis. The association between FASN and heterogeneous nuclear ribonucleoprotein A1 (HNRNPA1) was confirmed using qPCR, Western blot, and immunohistochemistry. The function of HNRNPA1 in osteosarcoma was determined using CCK-8, colony formation, wound healing, transwell migration, and invasion assays. RESULTS: Among the 4971 identified proteins, 567 DEPs (325 upregulated and 242 downregulated) were identified. The top 10 upregulated proteins comprised HIST1H2AB, INA, INTS5, MTCH2, EIF1, MAPK1IP1L, PXK, RPS27, PM20D2, and ZNF800, while the top 10 downregulated proteins comprised NDRG1, CNTLN, STON2, GDF7, HECTD3, HBB, TPM1, PPP4R4, PTTG1IP, and PLCB3. Bioinformatic analysis indicated that the DEPs were related to cellular processes, metabolic processes, biological regulation, binding, and catalytic activity. HNRNPA1 was dysregulated in FASN-silenced 143B and HOS cells. qPCR, Western blot, and immunohistochemistry showed that FASN expression positively correlates with HNRNPA1 expression. Further studies indicated that HNRNPA1 correlates with OS diagnosis and prognosis. And HNRNPA1 silence inhibits the proliferation, migration, and invasion in OS cells. CONCLUSION: HNRNPA1 acts as targets downstream of FASN and potential biomarker and oncogene in OS.

Clinical study for external washing by traditional Chinese medicine in the treatment of multiple infectious wounds of diabetic foot: Study protocol clinical trial (SPIRIT compliant).

BACKGROUND: Diabetic foot (DF) is among the most serious complications of type 2 diabetes. DF infection (DFI) is a key factor in the deterioration and development of DF, so controlling infection plays an important role in the treatment of the disease. Traditional Chinese medicine foot bath has been widely used in China as a complementary and alternative therapy to improve circulation and infection control of DF. However, the existing evidence shows that its efficacy and safety are still insufficient. We report a study protocol about a multicenter, double-blind, randomized, placebo controlled trial which aims to make well-designed clinical trials to evaluate the efficacy and safety of herbal medicine foot bath decoction (FBD) and explore the mechanism of external washing of Chinese herbs in DFI. METHODS: This study is a multicenter, double-blind, randomized, placebo controlled clinical trial in which 60 eligible participants were randomly divided into an experimental group and control group at a 1:2 ratio. Both groups received the same basic treatment for DF disease, the experimental group used FBD and ordinary dressing changes, while half of the patients in the control group received placebo and ordinary dressings, and the other half received placebo and silver ion dressings. Patients in both groups will be evaluated weekly for efficacy during the intervention. The primary efficacy indicators include the types of wound pathogens, interleukin 6 and tumor necrosis factor α. Secondary efficacy indicators included blood glucose, blood lipids, wound area, lower extremity blood vessel diameter, blood flow speed, walking speed, walking distance, and traditional Chinese medicine syndrome scores. We will also conduct a safety evaluation of the drug at the end of the trial. DISCUSSION: This multicenter, double-blind, randomized, placebo clinical trial not only provides data on the efficacy and safety of FBD, but also provides a novel treatment strategy for clinicians and DF patients.

Incidence and Risk Factors of Pressure Injuries in Surgical Spinal Patients: A Retrospective Study.

PURPOSE: The purpose of this study was to measure the incidence and identify risk factors of pressure injury development during the perioperative period in patients undergoing spinal surgery requiring intraoperative positioning in the prone position. DESIGN: Review of medical records. SUBJECTS AND SETTING: The sample comprised 3834 patients; 52.2% (n = 2006) were male and 65.5% (n = 2516) were older than 60 years. Most patients underwent surgery of the lumbosacral spinal segments (43.4%, n = 1667) followed by cervical (32.3%, n = 1241) and thoracic spinal segments (24.2%, n = 932). The study setting was the First Affiliated Hospital of Nanchang University, Jiang XI Province in southeastern China. METHODS: We reviewed charts of patients who underwent spinal surgery requiring intraoperative positioning in the prone position from November 2013 to July 2016. Demographic data, Braden Scale for Pressure Sore Risk cumulative score (measured before preoperative transport), body mass index (BMI), duration of surgery, preoperative time (time between preoperative transport from the inpatient unit to when the operation began), postoperative time (time between when the operation was over and postoperative transport to the inpatient unit), and development of any pressure injury were collected using a standardized form. Factors associated with an increased or decreased likelihood of pressure injury were initially evaluated with χ and independent t tests. Logistic regression was then used to identify potential risk factors for perioperative pressure injury in patients undergoing open spinal surgery requiring placement in the supine position during surgery. RESULTS: One hundred eighty-four of 3840 patients (4.7%) developed pressure injuries. Multivariate analysis indicated that factors associated with intraoperative pressure injury development were older than 60 years (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.02-2.17), BMI under 18 kg/m (OR = 2.45, 95% CI = 4.05-5.21), cumulative Braden Scale score 13 or less (OR = 6.59, CI = 2.23-3.98), prolonged preoperative time (OR = 5.99, 95% CI = 3.21-6.12), and prolonged postoperative time (OR = 14.23, 95% CI = 10.23-21.19). CONCLUSIONS: Based on these findings we recommend extending preventive interventions for pressure injury to incorporate the time from preoperative transport to the surgical suite to inpatient care unit following surgery.

A New Entrance Technique for C2 Pedicle Screw Placement and the Use in Patients With Atlantoaxial Instability.

STUDY DESIGN: A prospective study and a technique note. OBJECTIVES: To introduce a new entrance technique for C2 pedicle screw placement and to measure the related linear and angular parameters about the entrance point on computed tomography (CT) images. The safety of this technique for patients with atlantoaxial instability was also evaluated. BACKGROUND DATA: Although earlier studies have introduced different methods for C2 pedicle screw placement, the entry points and the angular parameters may be variable. Few studies have established a fixed entry point on the basis of the anatomic structure of C2 for pedicle screw placement. METHODS: A total of 60 dry C2 vertebrae were obtained for anatomic measurement in the study. The posterior bilateral nutrient foramens of C2 lamina were selected as the entry points for pedicle screw placement. The foramens were marked with needles and then the vertebrae underwent CT scan. The axial and sagittal planes of C2 pedicles were harvested and 4 linear and 2 angular parameters about the entry point were determined. After that, we used the entrance technique on 31 patients with atlantoaxial instability in a prospective study. CT of the cervical spine was performed to evaluate the safety of the entrance technique. RESULTS: The nutrient foramens exist in 97% of the left lamina and 93% of the right lamina of the C2 vertebra. The overall mean distance from the entry point (nutrient foramen) to the superior border of lamina (PSD), to the inferior border of lamina (PID), to the medial border of the pedicle (PMD), and the length of pedicle screw trajectory (PL, transit the pedicle center) were 3.32±0.63, 8.33±1.21, 6.85±1.00, and 24.47±1.51, respectively. The averaged transverse angle (α) on the axial plane and the superior angle (ß) on the sagittal plane were 19.83±3.83 and 30.12±6.02 degrees, respectively. Then, 31 patients underwent bilateral C2 pedicle screw fixation without screw violation into the spinal canal or vertebral artery injury by the new entrance technique. The overall mean angles α and ß and the length of the pedicle screw were 17.52±3.81 and 34.29±4.18 degrees and 25.85±2.06 mm, respectively. No statistical differences were found in these 3 parameters between the dry C2 vertebrae and the C2 vertebrae of patients who underwent the surgery (P>0.05). CONCLUSIONS: Using the posterior bilateral nutrient foramens of the C2 lamina as the entry point is a helpful intraoperative landmark for C2 pedicle screw placement.

Radiographic Evaluation of the Reliability of Neck Anatomic Structures as Anterior Cervical Surgical Landmarks.

BACKGROUND: Accurate location of the skin incision is helpful to decrease the technical difficulty and save the operative time in anterior cervical spine surgery. Spine surgeons usually use the traditional neck anatomic structures (the hyoid bone, thyroid cartilage, and cricoid cartilage) as landmarks during the surgery. However, the reliability of these landmarks has not been validated in actual practice. OBJECTIVE: To find out which landmark is the most accurate for identifying the cervical levels in anterior cervical spine surgery. METHODS: The lateral flexion and extension radiographs of cervical spine in standing position from 30 consecutive patients from January 2015 to February 2015 were obtained. The cervical vertebral bodies from C2 to C7 were divided equally into 2 segments. The cervical segments corresponding to each of the surface landmarks were recorded on the flexion and extension radiographs, respectively, and the displacement of corresponding cervical segments from the flexion to extension radiographs for each landmark was calculated. RESULTS: Based on the measurements, the main corresponding cervical levels for the mandibular angle were C2 on both of the flexion and extension films, for the hyoid bone were the C3-C4 interspace on flexion film and C3 on extension film, for the thyroid cartilage C5 on both of flexion and extension films, and for the cricoid cartilage C6 on flexion film and C5-C6 interspace on extension film, respectively. The ratios of displacement within 2 segments from flexion to extension were 83.3% (25/30) for mandibular angle, 56.7% (17/30) for hyoid bone, 66.7% (20/30) for thyroid cartilage, and 56.7% (17/30) for cricoid cartilage, respectively. The mean displacement from flexion to extension films were significantly less than 2 cervical segments for the mandibular angle but greater than 2 segments for the other landmarks. Significant differences were found between mandibular angle and the other 3 landmarks for the displacement from flexion to extension. CONCLUSIONS: The angle of mandible was found to be the most accurate landmark for identifying the cervical level, which corresponded to C2 and C2-C3 disc space. The hyoid bone, thyroid cartilage, and cricoid cartilage were not reliable to predict the cervical levels.

A comparison of local bone graft with PEEK cage versus iliac bone graft used in anterior cervical discectomy and fusion.

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a popular procedure for patients with cervical spondylotic myelopathy, but few studies reported the clinical outcomes of cervical local bone graft with a PEEK cage used in it. This retrospective study was performed to compare the clinical and radiological outcomes of using local bone graft with a PEEK cage versus iliac bone graft in ACDF. PATIENTS AND METHODS: A total of 60 consecutive patients who underwent ACDF were evaluated from January 2010 to January 2013. Twenty-nine patients received ACDF with a PEEK cage combined with cervical local bone graft (local bone group) and 31 patients received ACDF with autologous tricortical iliac bone graft (iliac bone group). The intraoperative and perioperative complications of both groups were recorded. Preoperative and postoperative radiographs were taken to calculate the ratio of interbody height to the disc height and the interbody bony fusion rate. The Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) were used to estimate postoperative clinical outcomes. RESULTS: The mean follow-up duration was 25.0±3.8months in the local bone group and 24.4±3.4months in the iliac bone group (P=0.56). Although there was no significant difference between the two groups in terms of blood loss (P=0.17), the length of surgery was significantly less in the local bone group comparing with that of iliac bone group (P=0.01). Postoperatively, VAS scores were significantly decreased, and JOA scores were improved in both groups. However, no statistically significant differences were found between the two groups at final follow up (P=0.45 and P=0.93). The disc space height and segmental interbody angle at the surgical segment were greater in local bone group than those in the iliac bone group (P<0.001 and P<0.001). The fusion rates were 93.1% in local bone group and 90.3% in the iliac bone group at last follow up (P=0.70). Perioperative complication rates in local bone group and iliac bone groups were 6.8% and 29%, respectively (P=0.04). CONCLUSIONS: Based on this study, patients receiving ACDF with local bone graft combined with a PEEK cage had significant shorter operation time, lower perioperative complications rate, and better radiological results comparing with those with an iliac bone graft alone. It seems that the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft for ACDF.

AMD3100 inhibits the migration and differentiation of neural stem cells after spinal cord injury.

It was reported that CXCR4 signaling played an important role in the migration and differentiation of endogenous neural stem cells after spinal cord injury (SCI). However, the molecular mechanism of it is still unclear. Here, we established a model of SCI in rats and AMD3100 was used to treat them. The rats were then sacrificed and the injured spinal cord specimens were harvested. Additionally, the neural stem cells (NSCs) line was culture and treated with AMD3100 in vitro. Results showed the locomotor function of SCI rats was worse after treated with AMD3100. And the expression levels of Nestion in neural stem cells and ß-tubulin in neuron cells were significantly increased in the injured spinal cord, which can be inhibited by the CXCR4 antagonist of AMD3100. Additionally, the expression of ß-catenin and phosphorylase ß-catenin protein was significantly down regulated by AMD3100. In vitro, the NSCs proliferation ability was inhibited and the migration was decreased after treated with AMD3100. Also, the expression of Nestion, ß-tubulin, ß-catenin and phosphorylase ß-catenin protein was significantly decreased in AMD3100 group comparing with untreated group. Taken together, this study suggested that AMD3100 could inhibit the migration and differentiation of endogenous neural stem cells in rats with SCI. The mechanism of it maybe that AMD3100 could down regulate of SDF-1/CXCR4 by targeting ß-catenin signaling pathway.

One-stage posterior surgical management of lumbosacral spinal tuberculosis with nonstructural autograft.

OBJECTIVE: Lumbosacral spinal tuberculosis is rare in current population. Previous studies have reported effective outcomes about anterior, antero-posterior and posterior surgery for treating tuberculosis of lumbosacral region. However, the bone grafts used in these studies are mainly structural bone and mesh cage. The purpose of this study is to evaluate the efficacy and safety of nonstructural autograft in the surgical treatment of lumbosacral tuberculosis by one-stage posterior procedure. PATIENTS AND METHODS: A total of 21 patients with lumbosacral tuberculosis were retrospectively reviewed between January 2012 and December 2014. All the patients underwent one-stage posterior debridement, interbody fusion with nonstructural autograft and posterior instrumentation. The preoperative and postoperative erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) and visual analogue scale (VAS) were recorded. Preoperative and postoperative lumbosacral angle and intervertebral space height were measured on the plain films. American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate the neurological outcomes of the patients. RESULTS: The average follow up period was 22.9±6.7months (range 12-36 months). The preoperative ESR and CRP were 33.4±10.5mm/h and 30.3±20.3mg/l, respectively, which decreased to 15.2±7.1mm/h and 10.6±5.8mg/l postoperatively with significant differences (P<0.05). The lumbosacral angles and intervertebral space height were increased from preoperative 20.4°±4.5° and 9.7±1.9mm to postoperative 25.6°±4.6° and 12.3±2.1mm, respectively (P<0.001 and P<0.001). At the final follow up, a loss of 2.1°of lumbosacral angles and 1.6mm of intervertebral space height was observed. The VAS scores were decreased from 4.73 to 2.71. Bony fusion was achieved in all patients at 6 months after surgery. Neurological outcomes were improved with 1-2 grades in most of the patients. One patient got wound infection and was cured by daily dressing. Complications related to instrumentation or neurological deficit weren't observed. CONCLUSION: Combined with one-stage posterior debridement and instrumentation, interbody fusion with nonstructural autograft is an effective option for lumbosacral tuberculosis.

Is nonstructural bone graft useful in surgical treatment of lumbar spinal tuberculosis?: A retrospective case-control study.

Surgical intervention is an important option for treating spinal tuberculosis. Previous studies have reported different surgical procedures and bone grafts for it. To our knowledge, few studies demonstrated the clinical results of using nonstructural autogenous bone graft in surgical treatment of spinal tuberculosis.The purpose of this study is to compare the clinical outcomes of surgical management lumbar spinal tuberculosis by one-stage posterior debridement with nonstructural autogenous bone grafting and instrumentation versus anterior debridement, strut bone grafting combined with posterior instrumentation.A total of 58 consecutive patients who underwent surgical treatment due to lumbar spinal tuberculosis from January 2011 to December 2013 were included. A total of 22 patients underwent one-stage posterior debridement, nonstructural autogenous bone grafting, and instrumentation (group A), and 36 patients received anterior debridement, strut bone grafting combined with posterior instrumentation (group B). The operative duration, total blood loss, perioperative transfusion, length of hospital stay, hospitalization cost, and complications were recorded. The bony fusion of the graft was assessed by computed tomography scans. American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate the neurological function of patients in the 2 groups.All the patients were followed up, with a mean follow-up duration of 21.6 ±â€Š5.7 months in group A and 22.3 ±â€Š6.2 months in group B (P = 0.47). The average operative duration was 257.5 ±â€Š91.1 minutes in group A and 335.7 ±â€Š91.0 minutes in group B (P = 0.002). The mean total blood loss was 769.6 ±â€Š150.9 mL in group A and 1048.6 ±â€Š556.9 mL in group B (P = 0.007). Also, significant differences were found between the 2 groups in perioperative transfusion volumes, length of hospital stay, and hospitalization cost (P < 0.05), which were less in group A compared with group B. Patients with ASIA grade C/D in the 2 groups were improved with 1 to 2 grades after the surgery with no statistical difference (P = 1.000). The perioperative complications rate was 9.1% (2/22) in group A and 13.9% (5/36) in group B (P = 0.897).Based on a retrospective study, the procedure of one-stage posterior debridement, nonstructural autogenous bone grafting, and instrumentation has a significant shorter operative duration, lower blood loss and perioperative transfusion, shorter hospital stay, and less hospitalization cost compared with the one of anterior debridement, strut bone grafting combined with posterior instrumentation for treating lumber spinal tuberculosis.

Is Urgent Decompression Superior to Delayed Surgery for Traumatic Spinal Cord Injury? A Meta-Analysis.

BACKGROUND: Traumatic spinal cord injury (SCI) is a common disease in current clinical practice. Previous studies have reported that early surgical decompression was better to improve neurologic outcomes than that of late surgery. However, most of the studies set early surgery within 72 hours. Is urgent surgery within 24 hours superior to late surgery for SCI? It remains controversial. OBJECTIVE: To determine whether neurologic outcomes of SCI in patients who underwent early surgery (<24 hours after injury) are better than those who underwent late surgery (≥ 24 hours after injury) by meta-analysis. METHODS: Electronic databases such as PubMed, MEDLINE, EMBASE, and Cochrane library were selected to detect the potentially related trials up to June 2015 that compared the outcomes of early surgery (<24 hours after injury) versus late surgery (≥ 24 hours after injury) for the treatment of traumatic SCI. Data extraction and quality assessment were according to Cochrane Collaboration guidelines. Outcome evaluations were total motor score, neurologic improvement rate, length of hospital stay and intensive care unit (ICU) stay, complications, and mortality. Results were expressed as odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence interval (CI). RESULTS: Nine articles comparing 2 cohorts that had early and late surgery for SCI were identified in this study. Statistically, there were significant differences between early and late surgery in total motor score (MD = 3.30, 95% CI = 0.82 ∼ 5.79, P < 0.01), neurologic improvement rate (OR = 1.66, 95% CI = 1.19 ∼ 2.31, P < 0.01), length of hospital stay (MD = -4.76, 95% CI = -9.19 ∼ -0.32, P = 0.04), and complications (OR = 0.61, 95% CI = 0.40 ∼ 0.91, P = 0.02). However, no significant differences were found between the 2 groups in mortality (OR = 1.39, 95% CI = 0.51 ∼ 3.75, P = 0.52). Two studies showed fewer ICU stays in the early-surgery group than in the late group. CONCLUSIONS: On the basis of this meta-analysis, urgent surgery within 24 hours for SCI significantly improved the neurologic outcomes compared with late surgery. It is suggested that urgent decompression within 24 hours is superior to delayed surgery for SCI.

A comparative study of perioperative complications between transforaminal versus posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis.

BACKGROUND: Both posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are accepted surgical techniques for the treatment of degenerative lumbar spondylolisthesis (DLS). However, it is still unclear one technique offers distinct advantages over the other. OBJECTIVE: A retrospective study was performed to compare perioperative complications and functional outcomes of patients undergoing TLIF versus PLIF for DLS. METHODS: A total of 226 consecutive patients who underwent surgery for treatment of DLS at three institutions were evaluated from January 2012 to December 2014. In this series, 125 patients underwent PLIF and 101 received TLIF. The operative time, blood loss, allogeneic blood transfusion rate and perioperative complications (including re-operative rate, nerve root injury, dural tear, wound infection) were compared between the two groups. Pain (VAS) and functional outcomes of patients (Kirkaldy-Willis criteria) were quantified before surgery and 1 week after surgery. RESULTS: Patients involved in the two groups had similar baseline demographic, clinical and radiographic characteristics. The PLIF group was associated with a higher incidence of post-operative iatrogenic nerve root dysfunction [12 cases (9.6 %) versus 2 cases (1.9 %), P = 0.018] and dural tears [15 cases (12 %) versus 4 cases (3.9 %), P = 0.030]. The re-operation rate was significantly higher in patients undergoing PLIF [13 cases (10.4 %) versus 2 cases (1.9 %), P = 0.011]. In addition, intra-operative blood loss, operative times, and allogeneic blood transfusion rates were higher in the PLIF group when compared to the TLIF group (P < 0.05). The wound infection rate of the PLIF group was similar to that of the TLIF group (7.2 versus 5.0 %, P = 0.486). VAS scores were decreased from 7.08 ± 1.13 to 2.84 ± 0.89 in the PLIF group, and from 7.18 ± 1.09 to 2.84 ± 0.91 in the TLIF group, respectively (P = 0.32). 85.6 % of patients in the TLIF group had good or excellent functional outcomes within the first post-operative week compared to 83.2 % in the PLIF group (P = 0.64). CONCLUSION: Both PLIF and TLIF were equally beneficial in improving short-term functional outcomes for patients with DLS. However, PLIFs were associated with statistically significant higher incidences of nerve root injury, dural tears, allogeneic blood transfusion, increased intra-operative times, blood loss and re-operations. Therefore, caution should be exercised when considering PLIFs.

Hybrid Decompression Technique Versus Anterior Cervical Corpectomy and Fusion for Treating Multilevel Cervical Spondylotic Myelopathy: Which One Is Better?

BACKGROUND: The hybrid decompression technique (corpectomy combined with discectomy) and anterior cervical corpectomy with fusion (ACCF) both provide good neurological recovery and disease stabilization for the treatment of multilevel cervical spondylotic myelopathy (CSM). However, no single study has been large enough to determine definitively which one is superior for this condition. OBJECTIVE: A meta-analysis was conducted to compare the clinical efficacy and safety of the hybrid decompression technique versus ACCF for the treatment of multilevel CSM. METHODS: Electronic databases such as PubMed, MEDLINE, EMBASE, Google Scholar, and the Cochrane Library were selected to search for potentially relevant trials up to April 2015 that compared the outcomes of the hybrid technique with ACCF for the treatment of multilevel CSM. Data extraction and quality assessment were performed according to Cochrane Collaboration guidelines. The outcome assessments were duration of surgery, blood loss, Cobb angle of C2-C7, segment angle, fusion rate, Japanese Orthopedics Association score, Neck Disability Index, and complications. The results were expressed as the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes with a 95% confidence interval (CI). RESULTS: Five controlled clinical trials published between 2009 and 2013, involving 356 patients (hybrid, 196; ACCF, 160) with 3- or 4-level CSM were retrieved in this study. Overall, there were significant differences between the 2 treatment groups for blood loss (MD = -38.69, 95% CI = -54.62 to -22.76, P < 0.01), fusion rate (OR = 2.56, 95% CI = 1.11 to 5.93, P = 0.03), and complications (OR = 0.25, 95% CI = 0.15 to 0.43, P < 0.01). However, no significant differences were found for duration of surgery (MD = -4.50, 95% CI = -22.902 to 13.91, P = 0.63), Cobb angle of C2-C7 after surgery (MD = 3.32, 95% CI = -3.72 to 10.37, P = 0.35), segment angle after surgery (MD = 2.87, 95% CI = -2.47 to 8.21, P = 0.29), Japanese Orthopedics Association score (MD = -0.07, 95% CI = -0.36 to 0.22, P = 0.62), or Neck Disability Index (MD = -0.86, 95% CI = -3.26 to 1.54, P = 0.48). CONCLUSION: Based on this meta-analysis, both the hybrid technique and ACCF can achieve good results for CSM. However, the hybrid technique is associated with significantly less blood loss, complications, and a higher fusion rate than ACCF.

A new source of structural autograft for ACDF surgery: cervical laminae.

STUDY DESIGN: A prospective study and a technical note. BACKGROUND: Autograft is considered to be the gold standard in achieving optimal fusion in anterior cervical discectomy and fusion (ACDF). In patients with combined postero-anterior cervical procedure, whether the cervical laminae harvested from laminectomy can be used as astructural bone graft in ACDF? Few studies have reported about this. OBJECTIVE: To describe the clinical and radio graphic outcomes in patients undergoing combined postero-anterior cervical surgery using autologous laminae as bone graft in ACDF. METHODS: Twenty-two patients (13 males, 9 females) with cervical spondylotic myelopathy underwent one-level combined postero-anterior procedure with anterior plate fixation from January 2010 to January 2014. All the patients received computed tomography scan before surgery and the heights of the target laminae and the middle intervertebral space were measured. Then, patients underwent combined postero-anterior surgery with laminectomy and ACDF. The structural laminae obtained from laminectomy were used as bone graft in ACDF. The clinical and radiographic outcomes of the patients were analyzed and the effectiveness and safety of the surgery was evaluated. RESULTS: The average heights of the target laminae and the middle intervertebral space were 11.18±1.05 mm and 5.75±0.58 mm, respectively. Statistical significant difference was found between the heights of the laminae and the space (P<0.001). The mean operative time was 192±37 minutes with an average blood loss volume of 235±71 ml. All patients were followed up and the average follow-up period was 17.5±3.1 months. All patients had immediate postoperative resolution of symptoms and radiographic evidence of solid fusion 3 months later. Postoperatively, excellent results were reported in 62.5%, good results in 18.8%, and fair results in 18.8% of the patients according to Odom's criteria. Visual analog scale score of the neck and extremities pain was significantly decreased after the surgery (P=0.014). The average preoperative and postoperative lordosis angles of the cervical spine were24.42°±13.84° and 32.91°±7.79°, and the difference was significant (P<0.01). Little loss of the angle was noted at final follow-up (32.91°±7.79° VS 29.30±7.88, P=0.51). Anterior intervertebral space height was significantly increased (P<0.001) after the surgery and a little declined at final follow-up (P=0.43). No intraoperative complication was noted in the patients and three patients got self-limiting dysphagia postoperatively, who recovered spontaneously. CONCLUSION: In patients undergoing combined postero-anterior cervical surgery, structural autograft harvested from the laminae provides an alternative to anterior iliac crest grafting.

Efficacy and Safety of Posterior Versus Combined Posterior and Anterior Approach for the Treatment of Spinal Tuberculosis: A Meta-Analysis.

OBJECTIVE: Surgical treatment is an important strategy for the treatment of spinal tuberculosis (TB). Several approaches have been reported for the surgery. However, no single study has had a large enough sample population to definitively determine whether the single posterior approach is as effective and safe as the combined posterior and anterior approach for the treatment of spinal TB. A meta-analysis was conducted to evaluate the clinical efficacy and safety of posterior versus combined posterior and anterior approach for the treatment of spinal TB. METHODS: In this meta-analysis, electronic databases, such as PubMed, MEDLINE, EMBASE, Google scholar, and Cochrane library, were searched to select the potentially relevant reports that compared the outcomes of the posterior approach (group A) with the combined posterior and anterior approach (group B) in the treatment of spinal TB. Relevant journals and references were also searched manually. Data extraction and quality assessment were according with Cochrane Collaboration guidelines. Outcome assessments were operation time, blood loss, correction of angle, loss of correction, hospital stay, fusion time of the grafting bone, neurological improvement, and complications after surgery. Results were expressed as odds ratio for dichotomous outcomes and mean difference for continuous outcomes with 95% confidence interval. RESULTS: Five controlled clinical trials published between 2012 and 2014, involving 253 patients (group A, 129; group B, 124) with spinal TB were retrieved in this study. The overall meta-analysis showed that there were significant differences (P< 0.01) between groups A and B in operation time, blood loss, hospital stay, and complications after surgery. However, no significant differences (P> 0.05) were observed in correction of angle, loss of correction at the final follow-up, fusion time of the grafting bone, and neurological improvement after surgery between groups A and B. CONCLUSIONS: The posterior approach appeared to have the same clinical efficacy, but with less operation time, blood loss, hospital stay, and complications compared with the combined posterior and anterior approach in the treatment of sinal TB. However, more high-quality, randomized controlled trials are required to compare these approaches and guide clinical decision-making.

Anterior cervical discectomy and fusion versus corpectomy and fusion in treating two-level adjacent cervical spondylotic myelopathy: a minimum 5-year follow-up study.

OBJECTIVE: A retrospective study was performed to compare the clinical and radiological outcomes of two-level anterior cervical discectomy and fusion (ACDF) with those of single-level anterior cervical corpectomy and fusion (ACCF) in treating two adjacent level cervical spondylotic myelopathy (CSM) with at least 5-year follow-up. METHODS: A total of 46 consecutive patients who underwent surgery for the treatment of two-level CSM in our institution were evaluated from February 2002 to December 2007. In this series, 22 patients underwent two-level ACDF (group ACDF) and 24 received single-level ACCF (group ACCF). The operation duration, blood loss, perioperative complication, fusion rate, neural function (mJOA score) and the segmental lordosis of the surgical level were compared between the two groups. RESULTS: The mean follow-up time was 84.5 ± 13 months in group ACDF and 86 ± 11 months in group ACCF (P = 0.723). The rates of perioperative complications were 18.2 % in group ACDF and 20.8 % in group ACCF, respectively (P > 0.05). Although there was no significant difference in neural function (mJOA score) between the two groups at the final follow-up (P > 0.05), the blood loss and the operation duration were significantly less in group ACDF than those in group ACCF (P < 0.05). The fusion rates at the 12th week after surgery were 86.4 % (19/22) in group ACDF and 87.5 % (21/24) in group ACCF (P > 0.05). According to the radiographs measurement, the segmental lordosis at the surgical segment was significantly greater in group ACDF than that in group ACCF (P < 0.05). CONCLUSION: There were high fusion rates and excellent clinical outcomes in both ACDF and ACCF for treating two adjacent level CSM. However, there were less blood loss, less operation duration and better cervical lordosis in group ACDF than those in group ACCF.

A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study.

OBJECTIVE: A retrospective study was performed to compare the clinical and radiological results between local bone graft with a cage and without using a cage in patients treated with posterior lumbar interbody fusion surgery. METHODS: A total of 115 consecutive patients who underwent PLIF in three institutions were evaluated from December 2005 to December 2010. 53 patients received PLIF with local bone graft combined with using one PEEK cage, and 62 patients received the PLIF with local bone graft without using a cage. The clinical data and perioperative complications of the patients in the two groups were recorded. Preoperative and postoperative radiographs were taken to calculate the disc height and the interbody bony fusion rate. Functional outcome was assessed using the Kirkaldy-Willis criteria at the follow-up time. The results between the cage group and no cage group were compared. RESULTS: The mean follow-up time was 19 months in no cage group and 18.5 months in cage group (P = 0.716). 20.9 % of patients (13 cases) in no cage group and 20.7 % of patients (11 cases) in cage group developed surgical complications perioperatively (P = 0.978). 51.6 % patients in no cage group got excellent functional outcome at the final follow-up while 54.7 % patients in cage group (P = 0.944). The mean interbody bony fusion time was 7.5 ± 4.5 months in no cage group and 8 ± 3.5 months in cage group (P = 0.841). According to the radiographs measurement, no significant difference was found for the disc height at each level between the two groups at the final follow-up. CONCLUSION: Local bone graft without a cage is as beneficial as that with a cage for PLIF. Comparing with local bone graft using a single cage, we believe that the purely local bone graft is a more ideal way in single PLIF.

One-stage posterior debridement and transpedicular screw fixation for treating monosegmental thoracic and lumbar spinal tuberculosis in adults.

Spinal tuberculosis is still prevalent in some developing countries. The purpose of this study is to investigate the efficacy and safety of one-stage posterior debridement, autogenous bone grafting, and transpedicular screw fixation in treating monosegmental thoracic and lumbar tuberculosis in adults. 37 patients were retrospectively reviewed in this study. The data of images, operative time and blood loss volume, perioperative complications, time to achieve bony fusion, VAS score, and neurologic function preoperatively and postoperatively were collected. The mean follow-up period was 21.5 ± 3.5 months. The tuberculosis was cured after surgery in all patients, and no recurrence was observed. Bony fusion was achieved in all patients with a mean time of 5.6 ± 2.5 months. Neurological outcome did not change in one case with grade A, and increased by 1-3 grades in the other patients with nerve deficit. The average preoperative and postoperative VAS scores were 5.5 ± 2.23 and 1.5 ± 1.22, respectively; the difference was significant (P < 0.05). There were three perioperative complications (8.1%, 3/37) observed in this study. In conclusion, the procedure of one-stage posterior debridement, interbody fusion with autogenous bone grafting, and posterior fixation with pedicle screw is effective and safe for treating monosegmental thoracic and lumbar spinal tuberculosis in adults.