Time Trends in the Incidence of Spinal Pain in China, 1990 to 2019 and Its Prediction to 2030: The Global Burden of Disease Study 2019.

BACKGROUND: With increasing life expectancy in China, the associated burden of low back and neck pain (spinal pain) on the healthcare system increases, posing a substantial public health challenge. This study aimed to investigate trends in spinal pain incidence across China from 1990 to 2019 and to predict incidence trends between 2020 and 2030. METHODS: Data were derived from the Global Burden of Disease Study (GBD) 2019. The annual percentage change (APC) and average annual percentage change (AAPC) between 1990 and 2019 were calculated using Joinpoint regression analysis. The effects of age, period, and cohort on spinal pain were estimated by an age-period-cohort model. An autoregressive integrated moving average (ARIMA) model was used to forecast incidence trends from 2020 to 2030. RESULTS: From 1990 to 2019, the age-standardized incidence rate (ASIR) of low back pain (LBP) significantly decreased in both male and female subjects, while the ASIR of neck pain (NP) slightly increased regardless of sex. Joinpoint regression analysis showed that the incidence rates of LBP decreased in all age groups, and incidence rates of NP increased after 45 years old among men and women. The age effects showed that the relative risks (RR) of LBP incidence increased with age, and the group aged 40-49 years had the highest RR for NP incidence, regardless of sex. Period effects showed that the risk of NP continuously increased with increasing time periods, but not in LBP. The cohort effect showed a continuously decreasing trend in later birth cohorts. The prediction results of the ARIMA model show that the ASIR of NP in both male and female subjects in China shows an increasing trend in the next 10 years, and the ASIR of LBP increased in male but decreased in female subjects. CONCLUSION: Spinal pain has remained a major public health burden over the past 30 years in China and will likely increase further with population aging. Therefore, spinal pain should be a priority for future research on prevention and therapy, and is especially critical as the aging population increases in China.

[Treatment of giant cell tumor of bone around knee joint with three-dimensional printing personalized prosthesis].

OBJECTIVE: To investigate the short-term effectiveness of three-dimensional (3D) printing personalized prosthesis in the treatment of giant cell tumor of bone around knee joint. METHODS: A clinical data of 9 patients with giant cell tumor of bone around knee joints and met the inclusive criteria between May 2014 and August 2017 was retrospectively analysed. There were 4 males and 5 females, with an average age of 35.8 years (range, 24-50 years). The lesion located at the distal femur in 4 cases and at the proximal tibia in 5 cases. The disease duration was 5-25 months (mean, 12.9 months). According to Campanacci grading, there were 2 patients of grade Ⅰ and 7 of grade Ⅱ. The 3D printing personalized prosthesis was designed based on the CT scanning and 3D reconstruction prepared before operation. All patients were treated with the tumor resection and 3D printing personalized prosthesis reconstruction. The radiological examination was taken to observe the tumor recurrence and the Musculoskeletal Tumor Society 1993 (MSTS93) score was used to evaluate the knee function. RESULTS: All operations were successful and all incisions healed by first intention without early complications. All patients were followed up 24-40 months (mean, 31.2 months). At last follow-up, no complication such as pain, pathological fracture, prosthesis loosening, or tumor recurrence occurred. The MSTS93 score was 20-29 (mean, 24.7). The knee function was rated as excellent in 6 cases and good in 3 cases, with the excellent and good rate of 100%. CONCLUSION: For giant cell tumor of bone around knee joint, 3D printing personalized prosthesis has the advantages of bio-fusion with host bone, mechanical stability, good joint function, and ideal short-term effectiveness. But the middle- and long-term effectiveness still need to be further observed.

Radiation Exposure and Operation Time in Percutaneous Endoscopic Lumbar Discectomy Using Fluoroscopy-Based Navigation System.

OBJECTIVE: This study evaluated radiation exposure and operation time of percutaneous endoscopic lumbar discectomy (PELD) by using a fluoroscopy-based navigation system for access and localization. METHODS: Eighty-six PELDs performed by a single surgeon were retrospectively analyzed. Patients were separated into 2 groups: group A (using a three-dimensional [3D]-printed navigation instrument and fluoroscopy-based navigation system) and group B (with conventional fluoroscopy and standard instrumentation). The operation, fluoroscopy, and total access time were collected, as well as fluoroscopy and access times. RESULTS: The operative time for group A was 59 minutes (standard deviation [SD], 6 minutes) and 106 minutes (SD, 15 minutes) in group B (P < 0.001). In group A, fluoroscopy was used an average of 5 times (SD, 0.7) and 29 times (SD, 8) in group B (P < 0.001). The fluoroscopy time was 9 minutes (SD, 2 minutes) in group A and 40 minutes (SD, 8 minutes) in group B (P < 0.001). The number of access attempts was 1.3 (SD, 0.5) in group A and 8 (SD, 2 times) in group B (P < 0.001). The total access time was 11 minutes (SD, 2 minutes) in group A and 28 minutes (SD, 5 minutes) in group B (P < 0.001). CONCLUSIONS: PELD using the fluoroscopy-based navigation system showed lower operative, fluoroscopy, and access time compared with conventional techniques. In addition, fewer fluoroscopy images and access attempts were made in the navigation group. These data suggest that this novel technique reduces fluoroscopy and operation time and may reduce risks of repeated surgical access attempts.

Effect of computer navigation-assisted minimally invasive direct lateral interbody fusion in the treatment of patients with lumbar tuberculosis: A retrospective study.

The benefits of navigation-assisted technologies are not entirely understood. Therefore, this study aimed to examine the outcomes of patients with lumbar tuberculosis who received computer navigation-assisted minimally invasive direct lateral interbody fusion (DLIF).This was a retrospective study of 33 patients with lumbar tuberculosis who underwent minimally invasive DLIF at the Department of Spine and Orthopedics of Guigang People's Hospital (Guangxi, China) between January 2015 and December 2016. The patients were pathologically diagnosed as lumbar tuberculosis and grouped into the navigation-assisted fluoroscopy (NAV; n = 18) and non-navigation-assisted fluoroscopy (non-NAV; n = 15) groups. X-ray exposure and operation times were assessed in all patients.All surgical procedures were successfully completed. No case was converted into open surgery. The NAV group had longer surgical preparation time but shorter operation time compared with the non-NAV group (both P <.01). Total operation time showed no significant difference between the 2 groups (P = .1). The time of radiation exposure in the non-NAV group was longer compared with that of the NAV group (53.2 ±â€Š9.9 vs 13.5 ±â€Š2.6 s; P <.01). There were no significant differences regarding intraoperative blood loss, postoperative drainage volume, length of hospital stay, bone fusion and complications between the 2 groups (all P >.05).Computer navigation-assisted minimally invasive DLIF could significantly reduce intraoperative radiation exposure, with no increase in total operation time.

Minimally invasive direct lateral interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosisMini-DLIF for the thoracic and lumbar spinal tuberculosis.

BACKGROUND: To investigate the clinical efficacy of minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosis. METHODS: From January 2013 to January 2016, 35 cases with thoracic and lumbar spinal tuberculosis received direct lateral approach debridement, interbody bone grafting, and interbody fusion. Of the 35 cases, 16 patients were male and 19 were female and the median age was 55.2 (range 25-83). The affected segments were single interspace, and the involved vertebral bodies included: 15 cases of thoracic vertebrae (1 cases of T5/6, 2 cases of T6/7, 4 cases of T7/8, 3 cases of T8/9, 5 cases of T9/10) and 20 cases of lumbar spine (2 cases of L1/2, 6 cases of L2/3, 6 cases of L3/4, 6 cases of L4/5). After MIDLIF operation, all the patients received medication of four anti-tubercular drugs for 12 to18 months. RESULTS: The patients were followed up for 7 to 40 months with an average of 18.5 months. The visual analogue scale (VAS) at the last follow-up was 2.8 ± 0.5, which was significantly different from the preoperative VAS (8.2 ± 0.7). After MIDLIF, there was 5 cases occurred with transient numbness in one side of the thigh or inguinal region, and 10 cases suffered from flexion hip weakness. All the bone grafts were fused within 6~ 18 months (average of 11.5 months) after the operation. CONCLUSION: Minimally invasive lateral approach interbody fusion technology have the advantage of less injury and quick recovery after surgery, which is the effective and safe treatment for thoracic and lumbar spinal tuberculosis.

[APPLICATION OF DIRECT LATERAL INTERBODY FUSION FOR LUMBAR DEGENERATIVE DISEASES].

OBJECTIVE: To investigate the effectiveness of direct lateral interbody fusion (DLIF) for lumbar degenerative diseases. METHODS: A retrospective study was done on 25 cases of lumbar degenerative diseases treated with DLIF between May 2013 and May 2014. There were 15 males and 10 females with an average age of 61.4 years (range, 36-78 years), including 14 cases of lumbar disc herniation, 2 cases of degenerative lumbar scoliosis, 3 cases of lumbar spondylolisthesis, and 6 cases of lumbar instability with spinal stenosis. The disease duration was 8 months to 20 years (mean, 5.7 years). The involved segments included L4, 5 in 10 cases, L3, 4 in 6 cases, L2, 3 in 2 cases, L2-4 in 2 cases, L3-5 in 3 cases, and L2-5 in 2 cases. The operation time, intraoperative bleeding volume, postoperative hospitalization time, and complications were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) criteria were used to assess the effectiveness; X-ray film and CT were used to evaluate the bone fusion. RESULTS: The mean operation time was 105?minutes (range, 85-155 minutes), and mean intraoperative bleeding volume was 158 mL (range, 80-300?mL). The postoperative hospitalization time was 2-5 days (mean, 3.2 days). All incisions healed by first intension. There was no complication of wound infection, vascular injuries, or intraoperative visceral injuries. All cases were followed up 24.6 months on average (range, 18-30 months). Four cases had iliopsoas weakness, 5 cases had iliopsoas weakness and anterior thigh hypoesthesia, which disappeared within 6 months after operation. No retrograde ejaculation, Cage displacement, or loosening was found after operation. Full bony fusion was observed in 20 segments and partial bony fusion in 12 segments. The mean bony fusion time was 10.8 months (mean, 6-18 months). The height of intervertebral space was significantly increased to (11.98±1.20)?mm at 2 days after operation and to (11.80±1.33) mm at last follow-up from preoperative (6.20±0.88) mm (P < 0.05), but no significant difference was found between at 2 days and last follow-up (P > 0.05). At last follow-up, VAS score was significantly decreased to 3.43±0.53 from preoperative 8.26±0.49 (t=26.275, P=0.000), and ODI was significantly decreased to 15.41%±3.91% from preoperative 40.80%±3.10% (t=22.902, P=0.000). CONCLUSIONS: DLIF is a safe and effective treatment for lumbar degenerative diseases, which has the advantages of less tissue damage, less blood loss, and fast rehabilitation.

[Lipase-catalyzed enantioselective ammonolysis of racemic phenylglycine methyl ester in organic solvent].

A novel reaction-enzymatic ammonolysis discovered in the mid of 1990s has been demonstrated to be a very promising alternative in the preparation of optically pure compounds. The effects of organic solvent, initial water activity, temperature and additives on lipase Novozym435-catalyzed enantioselective ammonolysis of racemic phenylglycine methyl ester were investigated systematically in this paper. Enzymatic reaction of ammonolysis showed higher activity and enantioselectivity than the corresponding reaction of hydrolysis and alcoholysis.