Clinical efficacy and imaging analysis for the surgical treatment of thoracolumbar infections in elderly patients: a retrospective study.

Few reports have been conducted to comparing surgical results and safety evaluations between the different types of infections in geriatric patients with thoracolumbar infections. The aim of this study is to investigate the safety and efficacy of surgical treatment for thoracolumbar infections in elderly patients. 21 patients with pyogenic spondylodiscitis (PS) and 26 patients with tuberculous spondylodiscitis (TS) were enrolled in the study. All patients were treated using one-stage posterior debridement, decompression, and pedicle screw fixation. Comparison of operative safety parameters between the two groups. Clinical efficacy was evaluated using visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, the short form (SF)-36 survey and Oswestry disability index (ODI) to determine patient quality of life pre- and post-operatively. Hospitalisation and intensive care unit duration in the PS group were significantly shorter than in the TS group (P < 0.05). The total incidence of post-operative complications for both groups was 44.7%. More complications occurred in the TS group, but the difference was not significant. The scores of VAS, ODI and SF-36 of all 47 patients were significantly improved compared with those before operation.The VAS and SF-36 scores (physical component) were significantly better in the PS group 6 months post-operatively, and the SF-36 (mental component) scores were significantly better in the PS group at the 1-year follow-up. Neurological status in both groups improved post-operatively, and 83% of patients reported satisfactory results based on the modified MacNab standard. Imaging results showed that bone graft fusion improved in both groups at 6 months, 1 year and at the final follow-up. One-stage posterior debridement, decompression, interbody fusion, and internal fixation can be considered a safe and effective method of treating spinal infections in the elderly. This method can improve nerve function, reconstruct spinal stability, and enhance the quality of life of elderly patients. Both PS and TS who underwent surgery achieve similar clinical and radiological results.

Investigation of the prevalence of deciduous teeth caries and its correlation with nutritional status among kindergarten children in Zhag yab of Tibet in 2022 / 中国学校卫生

Objective@#To investigate the health of deciduous teeth and the effect of deciduous teeth caries on the nutritional status of Tibetan children in kindergartens in Zhag-yab of Tibet, so as to provide a reference for the prevention and treatment of dental caries in local children.@*Methods@#A cross sectional survey was conducted among all Tibetan children aged 3 to 7 years in kindergartens from 13 districts in Zhag yab of Tibet, a total of 1 263 eligible children were included. Oral examination, height, weight measurement and hemoglobin test were performed. The health status of children was evaluated according to WHO diagnostic criteria of dental caries rate, average of decayed missing filled tooth(DMFT), malnutrition and anemia, and the correlation between deciduous teeth caries and nutritional status of children were analyzed.@*Results@#The overall deciduous teeth caries prevalence rate of Tibetan children in Zhag yab kindergarten was 62.6%, and the mean dmft was (4.0±4.6). Aged 3, 4, 5, 6, 7-year-old children s deciduous teeth caries rate were 31.1%, 55.3%, 63.8%, 70.9%, 76.6%, respectively, mean dmft were (1.1±2.0) (2.9±3.4) ( 3.5± 3.3) (5.4±5.4) (5.9±6.6) respectively. The prevalence of deciduous teeth caries and mean dmft increased with age, and the differences among age groups were statistically significant ( χ 2/F=72.17, 33.47, P <0.05). The overall detection rate of malnutrition( 25.4% ), stunting(12.3%), underweight(12.6%), wasting(10.9%) and anemia(29.6%) in caries children were higher than those in children without caries(19.5%, 8.1%, 6.1%, 6.6%, 15.5%), the differences were statistically significant ( χ 2=5.81, 5.49, 13.61 , 6.52, 32.02, P <0.05). Caries children s overweight rate (3.7%) was higher than that of children without caries (3.4%), obesity rate ( 1.3% ) was lower than that of children without caries(1.9%), there was no statistically significant difference ( χ 2=0.07, 0.82, P >0.05).@*Conclusion@#The problem of deciduous teeth caries in kindergartens in Zhag yab is serious, and it is closely related to the occurrence of malnutrition and anemia. The prevention and intervention of dental caries in local children should be strengthened.

Characteristics and risk factors of bacterial meningitis caused by Streptococcus agalactiae, Streptococcus pneumoniae or Escherichia coli in Guangzhou China from 2015 to 2022.

Introduction: Bacterial meningitis (BM) is an infectious disease with high morbidity and mortality rates in children. Although vaccination has improved prevention of BM, this severe disease continues to cause considerable harm to children across the globe. Several risk factors have been identified for BM, including immune status, age, and sex. However, additional patient and disease information is required in order to better understand the local characteristics, epidemiology and risk factors of BM. Methods: Here, we collected information from 252 children with BM in the Guangzhou Women and Children Medical Centre medical record database infected with Streptococcus agalactiae, Streptococcus pneumoniae, or Escherichia coli between May 2015 and May 2022. Results: The three pathogen infected BM cased showed distinct trends during the period, and distribution of three BM pathogens across age groups varied significantly. We reviewed the antimicrobial resistance patterns for each of the pathogens which may direct drug use in BM. Finally, we found blood WBC was a protective factor, while glucose levels in the CFS was risk factor, for the length of hospitalization. Discussion: Collectively, this study provides multi-parameter characteristics of BM, and potentially guide the drug use.

In vivo 3-Dimensional Kinematics Study of the Healthy Cervical Spine Based on CBCT Combined with 3D-3D Registration Technology.

STUDY DESIGN: A cervical biomechanical study. OBJECTIVE: We sought to demonstrate the three-dimensional (3D) intervertebral motion characteristics of the cervical spine in healthy volunteers using cone beam computed tomography (CBCT) combined with 3D-3D registration technology. SUMMARY OF BACKGROUND DATA: No previous studies have used CBCT combined with 3D-3D registration technology to successfully documented in vivo 3D intervertebral six-degrees-of-freedom (6-DOF) motions of the cervical spine. METHODS: Twenty healthy subjects underwent cervical (C1-C7) CBCT scans in seven functional positions. Segmented 3D vertebral body models were established according to the cervical CBCT images. A 3D-to-3D registration was then performed for each vertebral body in the different positions to calculate the 3D segmental motion characteristics in vivo. RESULTS: During flexion-extension, the range-of-motion (ROM) of C1-C2 and C4-C5 was significantly greater than the other segments. The average coupled axial rotation and lateral bending of each segment were between 0.6° and 3.2°. The average coupling translations in all directions were between 0.2 and 2.1 mm. During axial rotation, the ROM of C1-C2 was 65.8 ±â€Š5.9°, which accounted for approximately 70% of all axial rotation. The motion and displacement of C1-C2 coupled lateral bending were 11.4 ±â€Š5.2° and 8.3 ±â€Š1.9 mm, respectively. During lateral bending, the ROM of C3-C4 was significantly greater than C1-C2, C5-C6, and C6-C7. The coupled axial rotation of C1-C2 was 34.4 ±â€Š8.1°, and the coupled lateral translation was 3.8 ±â€Š0.5 mm. The coupled superoinferior and anteroposterior translation of each cervical segment were between 0.1 and 0.6 mm. CONCLUSION: CBCT combined with 3D-3D registration was used to accurately measure and record the ROMs of lateral bending, axial rotation, and flexion-extension in cervical vertebrae under physiological-load conditions. Our findings may contribute to the diagnosis of cervical spinal disease, the development of new surgical techniques, and the restoration of normal, cervical segmental movement.Level of Evidence: 3.

Motion characteristics of the lower lumbar spine in individuals with different pelvic incidence: An in vivo biomechanical study.

BACKGROUND: Pelvic incidence is the quantification of the pelvis anatomical shape which has significant effect on the occurrence of various lumbar degenerative diseases. The aim of this study was to measure the in vivo dynamic motion characteristics of the lower lumbar spine in people with different pelvic incidence. METHODS: A total of 55 volunteers were included in the study. The participants were devided into 3 groups (A: pelvic incidence≤40°, B: 40° < pelvic incidence <60° and C: pelvic incidence ≥60°). The L3-S1 vertebrae of each subject was MRI scanned to construct 3D models. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed physiological position. The 3D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral positions along the motion path. The relative translations and rotations of each motion segment were analyzed. FINDINGS: At the L5-S1 segment, the primary ranges of motion for left-right axial rotation and flexion-extension of the patients with large pelvic incidence (3.28° ± 0.79°, 7.56° ± 1.81°) were significantly larger than normal pelvic incidence (2.61° ± 1.01°, 6.57° ± 2.18°) and small pelvic incidence (2.00° ± 0.60°, 5.83° ± 1.67°). INTERPRETATION: The anatomic variable pelvic incidence is associated with the ranges of motion in lower lumbar vertebrae, especially in the L4-5 and L5-S1 segments.

A Technique for the In Vivo Study of Three-dimensional Cervical Segmental Motion Characteristics After Anterior Screw Fixation for Odontoid Process Fractures.

STUDY DESIGN: Kinematics of the cervical spine was investigated using cone beam computed tomography (CBCT) images combined with three dimensions to three dimensions (3D-3D) registration technology in patients after anterior odontoid screw fixation (AOSF) surgery. OBJECTIVE: The aim of this study was to investigate in vivo 3D cervical motion characteristics of patients who had undergone AOSF surgeries. SUMMARY OF BACKGROUND DATA: AOSF surgery is a classic surgical method for the treatment of odontoid fracture, but there are few studies that investigated its effect on in vivo biomechanics of the cervical spine. Postoperative biomechanical characters of the atlantoaxial joint (C1-C2) and the caudal adjacent segment (C2-C3) have yet to be clarified. METHODS: The study involved 14 patients subjected to a procedure of AOSF with lag screw. Subjects were matched with 14 healthy controls. All subjects underwent CBCT scanning of the cervical spine under seven functional positions. A 3D-3D registration was performed for each vertebra at each functional position to calculate the segmental motion characteristics. The ranges of motion (ROMs) of the C1-C2, C2-C3, and the overall cervical spine (C1-C7) for each of the functional positions were determined. RESULTS: The ROMs of the AOSF group were significantly (P < 0.05) smaller than the control group in flexion-extension positions for the C1-C2 (7.0°vs.11.0°), C2-C3 (3.7°vs.6.7°) and C1-C7 (43.3°vs.54.4°). The twisting ROM of the C1-C2 was 39.3° in the AOSF group and 65.7° in the control (P < 0.05), the bending ROM of the C2-C3 was 2.8° in the AOSF group and 8.9° in the control (P < 0.05). The twisting ROM of C1-C7 segment was 63.2° for the AOSF and 98.1° for the healthy control groups (P < 0.05). CONCLUSION: Although AOSF surgery reduced the flexion-extension ROMs of all investigated spinal segments, additionally, it reduced twisting ROMs of C1-C2 and C1-C7, but only lateral bending ROM of C2-C3, when compared with the control group. The data implied that the AOSF surgery would result in different biomechanics changes in the atlantoaxial segment and caudal adjacent segment. Longer-term follow-up studies of larger patient cohorts are necessary to evaluate the clinical outcomes of patients after the AOSF surgery.Level of Evidence: 3.

Recurrent giant cell tumour of the thoracic spine managed by total en bloc spondylectomy and denosumab therapy: a case report.

BACKGROUND: Giant cell tumour (GCT) of the bone is a rare, invasive benign bone tumour, which typically originates in the metaphyseal ends of long bones and rarely in the spine. Here, we report a rare case of recurrent GCT of the thoracic vertebra, which was managed by three-level total en bloc spondylectomy (TES) after denosumab therapy. CASE PRESENTATION: A 50-year-old woman presented with a 2-month history of progressive lower back pain. Magnetic resonance imaging revealed destruction of the T11 vertebra and a soft tissue mass. The patient underwent tumour resection. Computed tomography at the 2-year follow-up revealed relapse of the resected tumour, which had spread to the T12 vertebral body. Subsequently, denosumab therapy was administered to the patient for 1 year. The growth of the tumour was controlled, and its boundary line was clear. Thereafter, TES for the T10-T12 vertebrae was performed, and spinal reconstruction was completed through a one-stage single posterior approach. The patient's condition improved postoperatively, and no evidence of recurrence of GCT of the bone or spinal deformity was observed at the 32-month follow-up. CONCLUSIONS: Denosumab therapy contributed to tumour regression. Three-level TES may be an effective and feasible strategy for managing large recurrent GCTs of the spine after denosumab therapy.

Evaluation of MRI and CT parameters to analyze the correlation between disc and facet joint degeneration in the lumbar three-joint complex.

Lumbar 3-joint complex degeneration is a multifactorial, pathological process. Previous studies included insufficient quantitative analyses to prove the relationship between disc degeneration and facet joint osteoarthritis (OA). We assessed the correlation between intervertebral disc and lumbar facet joint degeneration using computed tomography (CT) and magnetic resonance imaging (MRI) parameters.A total of 152 participants who underwent conventional MRI and CT in the clinostat position were included in this study. The presence of lumbar disc degeneration was identified using the Pfirrmann grading system, and the presence of lumbar facet joint degeneration was identified using the Weishaupt grading system. Facet tropism was defined as a divergence more than 7° between the facet joint angles of both sides at the same segment. The intervertebral disc heights were also measured.Most facet joint OA probably appeared at the segment with intervertebral disc degeneration of more than grade III. Facet joint OA was significantly exacerbated with the progression of disc degeneration grade. The intervertebral height significantly decreased with the progression of facet joint degeneration grades, except for grades 0 and 1.Our current study found that each individual joint degeneration influences the other 2 in the lumbar 3-joint complex. Facet tropism was significantly associated with lumbar disc degeneration. Narrowing of the intervertebral disc height probably aggravates the facet joint degeneration further at the same level.

In vivo dynamic motion characteristics of the lower lumbar spine: L4-5 lumbar degenerative disc diseases undergoing unilateral or bilateral pedicle screw fixation combined with TLIF.

OBJECTIVE: To evaluate the short-term in vivo dynamic motion characteristics of the lower lumbar spine (L3-S1) after unilateral pedicle screw fixation (UPSF) or bilateral pedicle screw fixation (BPSF) combined with TLIF for treatment of L4-5 lumbar degenerative disc diseases (DDD). METHODS: Twenty-eight patients were recruited (13 UPSF, 15 BPSF). Each patient was CT-scanned to construct 3D models of the L3-S1 vertebrae. The dual fluoroscopic imaging system (DFIS) was then used to image the lumbar spine while the patient performed seven functional activities (upright standing, maximum extension, flexion, left-right twist, and left-right bend). The in vivo vertebral positions were reproduced using the 3D vertebral models and DFIS images. The ranges of motion (ROMs) of L3-4, L4-5, and L5-S1 segments were analyzed. RESULTS: At the index L4-5 segment, the primary ROM of left-right twist of the UPSF group (2.11 ± 0.52°) was significantly larger (p = 0.000) than the BPSF group (0.73 ± 0.32°). At the proximal adjacent L3-4 segment, the primary ROMs of left-right twist, and left-right bend of the UPSF group (2.16 ± 0.73°, 2.28 ± 1.03°) were significantly less (p = 0.003, 0.023) than the BPSF group (3.17 ± 0.88, 3.12 ± 1.04°), respectively. However, at distal adjacent L5-S1 segment, no significant difference was found between the two groups during all activities. CONCLUSIONS: The ROM in left-right twisting of UPSF group was significantly larger compared with BPSF group at the index level in the short term. The UPSF has less impact on the cranial adjacent level (L3-4) in left-right twisting and bending activities compared to the BPSF. The data implied that the UPSE and BPSF combined with TLIF would result in different biomechanics in the index and cranial adjacent segment biomechanics. Long-term follow-up studies are necessary to compare the clinical outcomes of the two surgeries.

Unilateral versus Bilateral Pedicle Screw Fixation Combined with Transforaminal Lumbar Interbody Fusion for the Treatment of Low Lumbar Degenerative Disc Diseases: Analysis of Clinical and Radiographic Results.

OBJECTIVE: To compare the clinical and radiographic results of unilateral pedicle screw fixation (UPSF) and bilateral pedicle screw fixation (BPSF) after unilateral transforaminal lumbar interbody fusion (TLIF) for the treatment of lumbar degenerative disc diseases (DDDs). METHODS: A total of 63 patients who underwent UPSF or BPSF combined with unilateral TLIF at L4-L5 or L5-S1 in our hospital between 2014 and 2016 were included in this analysis. The perioperative outcomes and radiographic results were recorded at preoperative and postoperative follow-up. Fusion rates were determined according to the Bridwell-Lenke grading system. Clinical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and lumbar Japanese Orthopedic Association score. RESULTS: According to the perioperative assessment, the duration of operation, intraoperative and postoperative blood loss, duration of pain medication use, and hospital costs were significantly (P < 0.0001) lower in the UPSF group compared with the BPSF group. After a mean follow-up of 24 months, both the UPSF and BPSF groups showed significantly (P < 0.05) maintained disc height and segmental lordosis of the surgical segment and achieved similar clinical outcomes at the final postoperative follow-up. The impact on the cranial adjacent vertebral level was significantly (P < 0.05) less in the UPSF group than the BPSF group in the short term. CONCLUSIONS: UPSF techniques with TLIF can attain similar clinical efficiency as BPSF techniques in treating single-level low lumbar DDD, but with fewer surgical injuries and at lower cost. BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. The long-term results require more study.