Clinical outcomes of anterior correction and reconstruction for neurofibromatosis-associated severe cervical kyphotic deformity.

PURPOSE: To assess the clinical outcome of anterior correction and reconstruction for severe cervical kyphotic deformity due to neurofibromatosis type 1 (NF-1). METHODS: In this study, we reviewed a series of seven patients who underwent anterior procedures for correction of NF-1-associated cervical kyphotic deformity. After continuous preoperative skull traction, all patients received anterior corpectomy and fusion (ACCF), anterior discectomy and fusion (ACDF), or combined ACCF and ACDF for surgical correction and reconstruction. Pre- and postoperative local and global Cobb angles, correction rate, sagittal vertical axis (SVA), and T1-slope were assessed by X-ray. Japanese Orthopaedic Association (JOA) score, JOA recovery rate, visual analog scale (VAS), and Neck Disability Index (NDI) scores were recorded to assess the outcome. RESULTS: Kyphosis was corrected successfully in all patients in terms of local and global Cobb angles (P < 0.05), with a correction rates of 83.1% (range, 66.0 to 115.5%) and 88.6% (range, 61.1 to 125.0%), respectively. JOA scores of patients were improved from preoperative 10.4 (range, 6 to 14) to postoperative 15.4 (range, 14 to 17), with a recovery rate as 77.6% (range, 66.7 to 100%). NDI scores were reduced from preoperative 25.1 (range, 13 to 35) to postoperative 8.7 (range, 5 to 12). VAS scores were reduced from preoperative 7.0 (range, 4 to 9) to postoperative 2.3 (range, 1 to 3). CONCLUSION: This study has demonstrated that anterior correction and reconstruction is an alternative option for the treatment of NF-1-associated severe cervical kyphosis when deformity is localized, flexible, or fixed.

Effect analysis of anterior cervical operation for severe cervical kyphosis / 中华外科杂志

Objective@#To determine the feasibility and safety of anterior cervical decompression and fusion in severe cervical kyphosis treatment.@*Methods@#Totally 29 patients with severe cervical kyphosis(Cobb angle>50°) underwent anterior cervical decompression and fusion from June 2008 to May 2016 were studied retrospectively. There were 19 males and 10 females. The average age was 32.6 years ranging from 14 to 53 years. According to the etiology, 12 patients had iatrogenic deformity (11 had post-laminectomy cervical kyphosis, 1 had kyphosis due to anterior graft subsidence), 5 had neurofibromatosis, 4 had infective kyphosis, 8 had idiopathic cervical kyphosis. The curvature of cervical angle was measured by two-line Cobb method. The severity of cervical kyphosis was evaluated by kyphosis index (KI). Parameters including kyphosis levels, the apex of the kyphosis, C2-7 sagittal vertical axis(SVA) and T1 slope were also measured on lateral radiographs in the neutral position in each patient. The pre- and post-operative Japanese Orthopaedic Association(JOA) scores, visual analogue scale (VAS) of neek pain, neck disability index (NDI) and cervical alignment were compared. All patients were treated by skull traction. Motor evoked potential and somatosensory evoked potential were applied intraoperation as the spinal cord monitor.@*Results@#Skull traction was performed for an average of 6.3 days. The mean vertebral number in kyphotic region was 4.7. The average operation time was 155 minutes and blood loss was 135 ml. The preoperative C2-7Cobb angle was 46.6°±18.1° in average. It was reduced to 11.4°±6.4° in average after operation. The Cobb angle of operation region was 72.9°±19.6° in average before operation. It was reduced to 11.2°±6.4° in average after operation. The kyphosis region correction rate was 84.6%. The mean preoperative C2-7SVA changed from (3.8±14.6) mm to (12.6±7.8) mm postoperatively. The mean preoperative T1 slope changed from -10.6°±16.4° to 7.1°±14.9° postoperatively. The average postoperative C2-7 Cobb angle, Cobb angle of kyphosis region, KI, C2-7 SVA and T1 slope changed significantly compared with preoperation (F=12.700-218.200, all P<0.01). The average postoperative JOA, VAS and NDI scores improved significantly compared with preoperation (F=225.500, 217.900, 131.200, all P<0.01).@*Conclusion@#For severe cervical kyphosis, anterior correction is a safe and effective technique, sufficient decompression will be achieved.

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with unilateral pedicle screw fixation in treatment of one-level lumbar degenerative disease / 中华骨科杂志

Objective To explore the clinical and radiographic outcomes of minimally invasive transforarninal lumbar interbody fusion (MIS-TLIF) with unilateral pedicle screw fixation in treatment of one-level lumbar degenerative disease.Methods A total of 65 patients suffered from one-level lumbar degenerative disease between October 2009 and December 2011.They were divided into 2 groups according to different fixation ways.31 patients were given MIS-TLIF with unilateral pedicle screw fixation.The other 34 patients were given MIS-TLIF with bilateral pedicle screw fixation.Microscopic tubular retractor system (METRxMD) and Sextant system were used in all the procedures of treatment.The whole lumbar lordosis (WL),the segmnental lordosis (SL),fusion level disc space angle,lumbar scoliosis angle,and segmental scoliosis angle were measured pre and post operation according to standarded X-rays.The disc height index (DI) and the lumber curvature index (LI) were also evaluated.The Oswestry disability index (ODI) score and visual analog scale (VAS) pain score data were obtained from all the patients pre-operation and during each following-up procedure.Results All the patients were well followed up 18 months to 36 months(average 26.6 months).All the 65 patients were proved to achieve bone fusion in 12 months post-operation.The ODI and VAS scores post-operation improved significantly in each group,but showed no significant difference between the 2 groups.Likewise,there were no significant differences between the 2 groups in datas of WL,SL,fusion level disc space angle,lumbar scoliosis angle,segmental scoliosis angle,DI,and LI.But there was a positive linear correlation between the LI and WL in the 2 groups.Conclusion MIS-TLIF with unilateral pedicle screw fixation is as good as MIS-TLIF with bilateral pedicle screw fixation in patients of one-level lumbar degenerative disease.

Screening and identification of siRNA-mediated TNF-α expression in synovial cells of Human / 重庆医学

Objective To design and identify small interfering RNA (siRNA) targeting tumor necrosis factor‐α (TNF‐α) ex‐pression ,siRNAs were electroporated into synovial cells of Human to screen those which can effectively suppress TNF‐α expres‐sion .Methods Three TNF‐α specific double stranded siRNA were designed targeting different regions of TNF‐α mRNA(compared with negative control group) .RT‐PCR and Elisa were applied to detect TNF‐α ,mRNA expression and the secretion of TNF‐α in cell supernatant ,respectively .Results Two of the three customized TNF‐α siRNA could inhibit the expression of TNF‐α mRNA in synovial cells of Human (P< 0 .01) .At the same time ,the secretion of TNF‐α decreased in cell supernatant ,the difference was sig‐nificant statistically compared with the control group(P< 0 .01) .Conclusion TNF‐α siRNA can be successfully designed and syn‐thesized ,which can specifically and effectively suppress TNF‐α mRNA expression .

Weakness of the neck extensors, possible causes and relation to adolescent idiopathic cervical kyphosis.

Cervical kyphosis may be congenital, or occur as a result of laminectomy, post-traumatic deformity, infection, neuromuscular disorders such as muscular dystrophies, motor neuron disorders such as amyotrophic lateral sclerosis, tumor, and inflammation such as ankylosing spondylitis. Furthermore, adolescent idiopathic cervical kyphosis was defined as cervical kyphotic deformity of adolescent patient without any cause such as those previously described. As no standard values for "cervical kyphosis" could be found in the literature, many reported studies only report a subjective classification, "kyphotic, straight or lordotic". But this method had proven to be unreliable. Grob et al. defined "straight" for the global curvature as +4° to -4°, and lordotic and kyphotic as <-4° and >+4°, respectively. The etiology and pathogenesis of adolescent idiopathic cervical kyphosis remain little understood. Weakness of the neck extensors can result in "dropped head syndrome", a rare disorder characterized by weakness of neck extensor muscles causing an inability to extend the neck and resulting in a chin-on-chest deformity. The purpose of this paper is to propose a possible mechanical cause leading to the kyphotic deformity. We hypothesize that weakness of the neck extensors could be the initiating factor for adolescent idiopathic cervical kyphosis.

Adolescent idiopathic cervical kyphosis:grade and treatment / 中华骨科杂志

Objective To explore the appropriate treatment according to the grading system of adolescent idiopathic cervical kyphosis.Methods A retrospective study was performed in 115 adolescent patients with idiopathic cervical kyphosis.The patients were divided into 4 groups according to the magnitude of kyphosis.The initial Cobb angle of 4 groups were 12.7°±1.4° 25.4°±4.8°,47.2°±4.4° and 62.6°±5.7° respectively.The patients in group I were treated with the collar support for 4-8 weeks.The patients in group Ⅱ were treated with skull traction (3-5 kg) and then fixed by cranio-cervical-thoracic plaster.According to the angles between the tangents of posterior vertebral body at each level on lateral cervical radiograph in extension,the anterior fusion levels of the group Ⅲ and angles and range of osteotomy in the group Ⅳ were decided.In group Ⅳ,the patients were treated by two steps.The anterior release and posterior osteotomy were performed firstly.Then skull traction (1/10 body weight) was maintained in order to correct the deformity for 7-10 days,fusion and anterior fusion with autologous bone graft and internal fixation was completed.Results Post-operative radiograph showed that Cobb angle were -5.5°±2.0°,-8.2°±6.1°,-4.5°±6.6° and -2.9°±7.9° in Ⅰ-Ⅳ group after treatment.The deformed appearance of the patients improved significantly.A improvement neck pain and neurologic function were found in all patients.Post-operative MRI showed that physiological curve of the cervical spine was restored,and the cerebrospinal fluid line was clear in the previous kyphosis area.Conclusion Adolescent idiopathic cervical kyphosis has specific characteristics.Surgical strategy is determined by the severity of deformity.