Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: Systematic Review and Meta-Analysis.

BACKGROUND: Many retrospective studies of pedicle screw placement have revealed that intraoperative navigation systems provide higher accuracy rates and safety than do free-hand techniques. The accuracy of various image-guided navigation systems has been studied; however, differences have not been well defined due to the lack of adequate evidence-based comparative studies. OBJECTIVE: A meta-analysis was conducted to focus on the variation in pedicle screw insertion among 3 navigation systems: a 3-dimensional fluoroscopy-based navigation system (3D FluoroNav), a 2-dimensional fluoroscopy-based navigation system (2D FluoroNav), and a conventional computed tomography navigation system (CT Nav). METHODS: We screened for comparative studies on different pedicle screw insertion navigation systems published through January 2017 using the Cochrane Library, Ovid, Web of Science, PubMed, and EMBASE databases. RESULTS: From 125 papers that were identified, 10 articles were finally chosen. The present comparative study included 8 retrospective clinical studies, 1 prospective clinical trial, and 1 randomized controlled cadaveric study. The prevalence rate of pedicle violation in the 3D FluoroNav group was significantly lower than the rates of the 2D FluoroNav group (relative risk [RR] 95%, confidence interval [CI]: 0.16-0.61, P < 0.01) and the CT Nav group (RR 95%, CI: 0.42-0.90, P = 0.01), and the rate of the CT Nav group was significantly lower than that of the 2D FluoroNav group (RR 95%, CI: 0.29-0.81, P < 0.01). CONCLUSION: Significant differences exist among CT Nav, 3D FluoroNav, and 2D FluoroNav. Our review suggests that 3D FluoroNav may be superior to the other 2 methods in reducing pedicle violation and that clinicians should consider 3D FluoroNav as a better choice.

Accuracy of a patient-specific template for pedicle screw placement compared with a conventional method: a meta-analysis.

INTRODUCTION: Accurate placement of pedicle screws in spine surgery is a challenge for surgeons. Patient-specific template techniques have the potential for improving the accuracy of screw placement. The target of this analysis was to investigate differences in terms of accuracy of pedicle screw insertion between patient-specific template assistance and the conventional free-hand method for reconstruction of spinal stability. MATERIALS: The Cochrane Library, Ovid, Web of Science, PubMed, EMBASE and CNKI database were searched until February 2017 for a systematic review, and several comparative studies were screened for comparisons of accuracies of pedicle screw insertion with patient-specific assistance and conventional methods. Primary outcomes extracted from papers that met the selection criterion were expressed as odds ratios for dichotomous outcomes with a 95% confidence interval. A χ 2 test and I 2 statistics were used to evaluate heterogeneity. RESULTS: A total of ten RCTs and two prospective cohort studies were finally chosen for the analysis of accuracy rates. Study quality was assessed using the Cochrane Collaboration's Tool and Newcastle-Ottawa Quality Assessment Scale. There were obvious differences between them, and the accuracy rate of screw implantation among a patient-specific template assistance set was statistically significantly higher than the conventional free-hand set (OR 95% CI 3.78-6.41, P < 0.01); in vitro: OR 95% CI 3.93-7.42, P < 0.01; in vivo: OR 95% CI 2.49-6.44, P < 0.01. CONCLUSIONS: The template-assisted technique is superior to the conventional method for the reduction of pedicle violation. The template-assisted technique is a promising technique that should be considered as another available navigation tool for surgeons to improve the accuracy of pedicle screw placement. As an available technique for emerging applications in spine surgeries, this technique will face challenges but ultimately prove successfully.

The in vitro and in vivo effects of microRNA-133a on intervertebral disc destruction by targeting MMP9 in spinal tuberculosis.

AIMS: We aim to investigate the role of microRNA-133a (miR-133a) in intervertebral disc destruction by targeting MMP9 in spinal tuberculosis (TB). MAIN METHODS: Rabbit models with spinal TB were established and assigned to the blank, miR-133a mimic, miR-133a inhibitor and negative control (NC) groups. Primary notochordal cells were extracted and separately transfected with miR-133a mimics, miR-133a inhibitor, miR-nonsense sequence control (NC), si-NC and si-MMP9. QRT-PCR and Western blot assay were used to detect the expression of MMP-9, Collagen I, Collagen II and Collagen-X. Gelatin Zymography was performed to detect MMP9 activity. Immunohistochemistry was used to detect the expression of Collagen I, Collagen II and Collagen-X proteins. Osteoclast morphology and the number of osteoclast cells were observed after Tartrate resistant acid phosphatase staining. KEY FINDINGS: MMP9, Collagen-X and Collagen I expression and MMP9 activity were higher while the expression of Collagen II was lower in the miR-133a mimic group than the miR-NC group. MMP9, Collagen-X Collagen I and MMP9 activities were lower and Collagen II expression was higher in the miR-133a inhibitor group than the miR-NC group. Compared with the si-NC group, the si-MMP9 group showed increased Collagen II expression but decreased expression of MMP9, Collagen-X and Collagen I and MMP9 activity. A reduced amount of osteoclast cells exhibited in the miR-133a mimic group while an increased number was seen in the miR-133a inhibitor group compared to the blank group. SIGNIFICANCE: MiR-133a could inhibit Collagen degradation by down-regulating MMP-9 expression to attenuate the destructive effects of spinal TB on intervertebral disc.

Long Noncoding RNA CRNDE Promotes Multiple Myeloma Cell Growth by Suppressing miR-451.

It has been determined that long noncoding RNAs (lncRNAs) are identified as a potential regulatory factor in multiple tumors as well as multiple myeloma (MM). However, the role of colorectal neoplasia differentially expressed (CRNDE) in the pathogenesis of MM remains unclear. In this study, we found that the CRNDE expression level, in MM samples and cell lines, is higher than that in the control detected by real-time qPCR, which is also closely related to tumor progression and poor survival in MM patients. Knockdown of CRNDE significantly inhibits the proliferative vitality of MM cells (U266 and RPMI-8226), induces cell cycle arrest in the G0/G1 phase, and promotes apoptosis. After being transfected with siRNA, miR-451 expression observably increases. Bioinformatics analysis and luciferase assay reveal the interaction by complementary bonding between CRNDE and miR-451. Pearson's correlation shows that CRNDE is negatively correlated to miR-451 expression in human MM samples. Subsequently, miR-451 inhibitor rescues the inhibited tumorigenesis induced by CRNDE knockdown. Our study illustrates that lncRNA CRNDE induces the proliferation and antiapoptosis capability of MM by acting as a ceRNA or molecular sponge via negatively targeting miR-451, which could act as a novel diagnostic marker and therapeutic target for MM.

Posterior atlantoaxial fixation: a review of all techniques.

BACKGROUND CONTEXT: Posterior atlantoaxial fixation is an effective treatment for atlantoaxial instability. Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. However, there is no article reviewing all the posterior atlantoaxial fixation techniques yet. PURPOSE: The aim was to review the evolution and advancements of posterior atlantoaxial fixation. STUDY DESIGN: This was a literature review. METHODS: The application of all posterior fixation techniques in atlantoaxial stabilization, including wiring techniques, interlaminar clamp fixation, transarticular fixation, screw-plate systems, screw-rod systems, and hook-screw systems, are reviewed and discussed. Recent advancements on the novel technique of atlantoaxial fixation are described. The combination of the C1 and C2 screws in screw-rod systems are described in detail. RESULTS: All fixation techniques are useful. The screw-rod system appears to be the most popular approach. However, many novel or modified fixation methods have been introduced in recent years. CONCLUSIONS: Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. The wiring technique and interlaminar clamps technique have fallen out of favor because of the development of newer and superior fixation techniques. The C1-C2 transarticular screw technique may remain the gold standard for atlantoaxial fusion, whereas screw-rod systems, especially the C1 pedicle screw combined with C2 pedicle/pars screw fixation, have become the most popular fixation techniques. Hook-screw systems are alternatives for atlantoaxial fixation.

[Characteristic and surgical treatment of cervicothoracic spine fracture].

OBJECTIVE: To discuss the clinical characteristic and surgical treatment of cervicothoracic spine fracture complicated with spine cord injury. METHODS: Thirty-eight patients with cervicothoracic fracture and spine cord injury were retrospectively analyzed from January 1998 to January 2007. There were 29 males and 9 females with an average age of 36.4 years ranging from 18 to 58 years. All patient suffered from pain and limitation of motion on cervicothoracic junction. According to American Spinal Injury Association (ASIA) grades, 4 cases were in grade A, 13 cases in grade B, 10 cases in grade C, 7 cases in grade D and 4 cases in grade E. All patients were treated with anterior decompressed, bone graft and Zephir plate fixation in cervicothoracic spine. RESULTS: All patients were followed up for 1 to 10 years, the mean followed up time was 4.5 years. And all patients got complete bone fusion within 4 to 6 months postoperatively. There were no pull-out and breakage of screws or plates. Spinal cord functional recovery improved on average 3.8 degree according AISA standard. Two patients appeared transient hoarse voice after surgery, the symptoms were alleviated from 3 to 6 months after operation. Seven patients were complicated with Horner syndrome preoperatively, and the symptoms were disappeared after operation. CONCLUSION: The clinical situation of cervicothoracic spine fracture with spine cord injury is complicated. And anterior decompressed, bone graft and internal fixation performed on cervicothoracic spine fracture can achieve an efficient and safe clinical outcome.

One-stage anterior release and reduction with posterior fusion for treatment of irreducible atlantoaxial dislocation.

OBJECTIVE: To analyze the approach and feasibility of one-stage anterior release and reduction with posterior fusion for irreducible atlantoaxial dislocation. METHODS: Ten male and 6 female patients, with an average age of 36 years, including 13 patients with old trauma, 2 with rheumatoid disease, and 1 with os odontoideum were studied. Anterior release and reduction was performed in the supine position. The atlas and vertebra dentate were fixed posteriorly and fused by one stage. RESULTS: All patients were followed up from 15 to 40 months (mean, 23 months), and all gained anatomic reduction and bone fusion. Six months postoperatively, the Japanese Orthopaedic Association (JOA) score of the 12 patients with cord symptoms had improved from 8.3 preoperatively to 13.9, with a mean improvement of 87.5%. CONCLUSION: Treatment of irreducible atlantoaxial dislocation with one-stage anterior release and reduction with posterior fusion is a reliable method.

[The application of lumbar discography in the diagnosis and treatment of the discogenic low back pain].

OBJECTIVE: To investigate the diagnostic value of lumbar discography in discogenic low back pain and the effects of intervertebral fusion surgery. METHODS: Forty-five cases with 101 discs underwent discography, 360 degree fusion manipulation were performed on 18 discography abnormal cases, 27 cases were treated conservatively. Discography, MRI and provocative pain were observed and all the cases were followed up. RESULTS: Twenty-one cases showed positive provocative pain (21/45, 47%), and 21 discs of 101 were concordant discography (21/101, 21%). All cases were followed up for an average 16 months (15 to 23 months), the satisfactory rate was 83% (15/18) in the surgery group and 41% (11/27) in the conservative group. CONCLUSIONS: It is concluded that the discography is moderately sensitive in the diagnosis of discogenic low back pain. Furthermore, the short term follow-up reveals that operative group has better pain relief than conservative group.