Comparison of Intraoperative Endplate Injury between Mini-Open Lateral Lumbar Interbody Fusion (LLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) and Analysis of Risk Factors: A Retrospective Study.

OBJECTIVE: The study aimed to compare the incidence of intraoperative endplate injury in patients who underwent Transforaminal interbody fusion (TLIF) and mini-open lumbar interbody fusion (LLIF) surgery. The independent risk factors related to endplate injury in LLIF procedure were analyzed. METHODS: A total of 199 patients who underwent LLIF (n = 106) or TLIF (n = 93) surgery from June 2019 to September 2021 were reviewed. The endplate injury was assessed by postoperative sagittal CT scan. A binary logistic analysis model were used to identify independent risk factors related to LLIF endplate injury based on univariate analysis. RESULTS: There was an obvious difference in the occurrence of intraoperative endplate injury between LLIF (42/106, 39.6%) and TLIF group (26/93, 28%), although it did not reach the significant level. L1 CT value (OR = 0.985, 95% CI = 0.972-0.998), cage position (OR = 3.881, 95% CI = 1.398-10.771) and height variance (OR = 1.263, 95% CI = 1.013-1.575) were independent risk factors for endplate injury in LLIF procedure. According to the cage settlement patterns, there 5 types of A to E. The severity of the facet joint degeneration was positively related to the occurrence of endplate injury. CONCLUSIONS: The incidence of intraoperative endplate injury is higher in LLIF than in TLIF procedures. Low bone quantity, cage posterior position and larger height variance are risk factors to induce endplate injury in LLIF surgery. The facet joint degeneration may be related to severe endplate injuries and even fractures.

Retracted: Expression and Mechanism of Interleukin 1 (IL-1), Interleukin 2 (IL-2), Interleukin 8 (IL-8), BMP, Fibroblast Growth Factor 1 (FGF1), and Insulin-Like Growth Factor (IGF-1) in Lumbar Disc Herniation.

This manuscript has been retracted due to concerns regarding the authorship and the credibility of the study.Reference:Zhengkuan Xu, Xiaopeng Zhou, Gang Chen. Expression and Mechanism of Interleukin 1 (IL-1), Interleukin 2 (IL-2), Interleukin 8 (IL-8), BMP, Fibroblast Growth Factor 1 (FGF1), and Insulin-Like Growth Factor (IGF-1) in Lumbar Disc Herniation. Med Sci Monit, 2019; 25:984-990. DOI: 10.12659/MSM.911910.

Effect of miRNA-146a-mediated TLR4 Signal Pathway on the Pain of Lumbar Disc Herniation.

The current experiment was carried out to explore the effect of the miR-146a-mediated TLR4 signaling pathway on the lumbar disc herniation pains. For this aim, a total of 32 rats were divided randomly into 4 groups - the blank group (Group C), Model group (M), miR-146a overexpression group (agomiR-146a group) and negative control group (NC group), with 8 rats in each group. Rats in Group M were prepared for the construction of lumbar disc herniation models, while those in the agomiR-146a group or NC group, in addition to the model construction, would receive the intrathecal injection of agomiR-146a or agomiRNA-146a NC. Thereafter, a series of tests were performed for rats, including the mechanical pain test and heat pain test to measure the pain threshold, RT-PCR to detect the expression of miR-146a, and the transcription of TLR4, IRAK1, TRAF6, IL-6 and TNF-α, Western blot to determine the expression of IRAK1 and TRAF6 and ELISA to determine the expression of IL-6 and TNF-α. Results showed that as compared to the blank group, rats in Group M were more sensitive to the pains, presenting with declines in the thresholds in the pain, and upregulation in the TRL4 signaling pathway (TLR4, IRAK1 and TRAF6) and pro-inflammatory factors, including IL-6 and TNF-α. In comparison with Group M, intrathecal injection of agomiR-146a relieved the pains, with significant upregulation of miR-146a and downregulation of TLR4, IRAK1, TRAF6, IL-6 and TNF-α. Then upregulation of miR-146a could reduce the activity of the TLR4 signaling pathway and the release of pro-inflammatory factors, which may be a potential strategy for the treatment of lumbar disc herniation.

[Corrigendum] Identification of the key genes and long non­coding RNAs in ankylosing spondylitis using RNA sequencing.

Following the publication of the above paper, the authors wish to publish a Corrigendum to account for a necessary change in the authorship on the paper. Dr Xiaopeng Zhou requested that his name be removed from the paper on account of having left the research group for personal reasons, and given that he only participated in a part of the translation work in this study. The other authors have acceded to his request; therefore, the revised authors' names on this paper, together with their affiliations, are as follows: ZHENGKUAN XU, HAO LI, QIXIN CHEN and GANG CHEN, Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China. The authors are grateful to the Editor of International Journal of Molecular Medicine for allowing them the opportunity to publish this Corrigendum, and apologize for any inconvenience caused. [the original article was published in International Journal of Molecular Medicine 43: 1179­1192, 2019; DOI: 10.3892/ijmm.2018.4038].

The effect of sarcopenia in the clinical outcomes following stand-alone lateral lumbar interbody fusion.

BACKGROUND: Sarcopenia has been found to affect the postoperative outcomes of lumbar surgery. The effect of sarcopenia on the clinical outcomes in patients who underwent stand-alone lateral lumbar interbody fusion (LLIF) has not yet been examined. OBJECTIVE: To investigate whether sarcopenia affects the Oswestry Disability Index (ODI) and visual analog scale (VAS) score for back pain following single-level stand-alone LLIF. METHODS: Patients who underwent a single level stand-alone LLIF for lumbar diseases were retrospectively investigated. Sarcopenia was defined according to the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. Patients were divided into the sarcopenia (SP) and non-sarcopenia (NSP) group. Univariate analysis was used to compare with regards to demographics and clinical outcomes. Multivariate logistic regression was performed to elucidate factors predicting poor clinically improvement. RESULTS: Sixty-nine patients were enrolled, with 16 and 53 patients in the SP and NSP group respectively. In the SP group, patients were much older (P= 0.002), their body mass index was significantly lower (P< 0.001), the percent of women was higher (P= 0.042), and the skeletal muscle mass index (SMI) (P< 0.001) and gait speed were much lower (P= 0.005). The postoperative ODI scores were much higher and the improvement rate was much lower (both P< 0.001) in the SP group, whereas VAS scores for back pain showed no difference between the two groups. SMI and gait speed had a moderate and weak correlation with the final ODI score, respectively. Low SMI and low gait speed were independently associated with poor clinical outcomes at the final follow-up. CONCLUSIONS: Sarcopenia impacts the final clinical outcomes of stand-alone LLIF for lumbar diseases. Low SMI and low gait speed were negative impact factors for the clinical improvement after stand-alone LLIF.

Inhibited microRNA-494-5p promotes proliferation and suppresses senescence of nucleus pulposus cells in mice with intervertebral disc degeneration by elevating TIMP3.

It has been unraveled that microRNAs (miRNAs) played crucial roles in processes of human diseases, while the role of miR-494-5p in intervertebral disc degeneration (IDD) remains scarcely studied. We aimed to investigate the mechanisms of miR-494-5p in IDD with the involvement of tissue inhibitor of metalloproteinase 3 (TIMP3). Expression of miR-494-5p and TIMP3 in IDD clinical specimens was assessed. The IDD models were established by needle punching, which were then injected with low expression of miR-494-5p or TIMP3 overexpression lentivirus to observe their effects on pathology and apoptosis in IDD mice. The nucleus pulposus cells were isolated and, respectively, treated with miR-494-5p inhibitor or TIMP3 overexpression plasmid to determine the viability, apoptosis, and senescence in vitro. Furthermore, the expression of Aggrecan, Col-2, Caveolin-1, and SA-ß-gal in nucleus pulposus cells in vitro were measured. The target relation between miR-494-5p and TIMP3 was determined. An increased expression of miR-494-5p and a decreased expression of TIMP3 were found in IDD. Downregulation of miR-494-5p or overexpression of TIMP3 could relieve pathology and suppress nucleus pulposus cell apoptosis in IDD mice, as well as promote the viability and attenuate the apoptosis and senescence of nucleus pulposus cells from IDD mice. Moreover, inhibition of miR-494-5p or overexpression of TIMP3 upregulated Aggrecan and Col-2 expression while downregulated Caveolin-1 and SA-ß-gal expression, and TIMP3 was the target gene of miR-494-5p. Results of this study indicated that the degradation of miR-494-5p ameliorates the development of IDD by elevating TIPM3, which may provide new targets for IDD treatment.

Does Lateral Lumbar Interbody Fusion Decrease the Grading of Lenke-Silva Classification and Determine the Optimal Fusion Level in Severe Adult Degenerative Scoliosis?

OBJECTIVE: To testify whether lateral lumbar interbody fusion (LLIF) decreases the Lenke-Silva classification grading and determines the optimal fusion level in adult degenerative scoliosis (ADS) of global imbalance. METHODS: Thirty-seven patients with ADS of level V and VI based on Lenke-Silva classification were included. After the first-stage LLIF, patients received reassessment and were divided into group A (the Lenke-Silva classification grading changed) and group B (the grading was unchanged). Posterior fixation was performed according to the reassessment. The demographic, operative, radiographic, and clinical data were compared between the 2 groups. RESULTS: Twenty-five patients of level V and 12 patients of level VI were included, with a mean follow-up of 29.6 months. After first-stage LLIF, the Lenke-Silva classification grading changed in 22 patients (group A), with the remaining 15 patients unchanged (group B). There were significant differences in preoperative Lenke-Silva classification grading, use of anterior column realignment and hyperlordotic cage and high-grade cage subsidence between the 2 groups. The posterior fusion levels in the second surgery were less and the rate of fusion to thoracic spine region was lower in group A. The visual analog scale and Oswestry Disability Index were significantly improved and restorations of coronal and sagittal balance were found at the latest follow-up in both groups. CONCLUSIONS: LLIF decreased the Lenke-Silva classification grading and determined the optimal fusion level in patients with severe ADS. Change of Lenke-Silva classification may be associated with preoperative Lenke-Silva classification grading, use of anterior column realignment, and hyperlordotic cage.

DUSP19 mediates spinal cord injury-induced apoptosis and inflammation in mouse primary microglia cells via the NF-kB signaling pathway.

Objective: Spinal cord injury (SCI) is a common injury that seriously threatens human health. NF-κB may be involved in the secondary injury of SCI that is mediated by inflammation and aggravates damage. Our study was aimed to investigate the role of NF-κB signaling in DUSP19-mediated cleaved Caspase-3 expression and the release of inflammatory factors in vivo and in vitro.Materials and Methods: DUSP19 mRNA expression and the content of IL-6 and IL-8 in patients with traumatic SCI (TSCI) were measured by real-time PCR and ELISA, respectively. The levels of p-NF-κBp65, NF-κBp65 and cleaved Caspase-3 expression and the concentrations of IL-6 and IL-8 were measured by western blotting and ELISA, respectively.Results: Patients with TSCI showed lower DUSP19 expression and higher concentration of IL-6 and IL-8 compared with healthy controls. DUSP19 overexpression inhibited p-NF-κBp65 level, cleaved Caspase-3 expression, and production of IL-8 and IL-6 in the mice induced by TSCI. DUSP19 silencing increased p-NF-κBp65 level, cleaved Caspase-3 expression, and concentration of IL-6 and IL-8 in mouse primary microglia cells. DUSP19 overexpression had an inverse effect. Importantly, DUSP19 silencing and overexpression mediated p-NF-κBp65 level, cleaved Caspase-3 expression, and concentration of IL-6 and IL-8 in mouse primary microglia cells were reversed by NF-κB inhibitor pyrrolidine dithiocarbamate (PDTC) and NF-κB activator 12-myristate 13-acetate (PMA), respectively.Conclusion: These results suggested that DUSP19-mediated SCI-induced apoptosis and inflammation via NF-κB signaling and might therefore serve as a potential therapeutic target for SCI.

Reassessment System and Staged Surgical Strategy with Minimally Invasive Techniques for Treatment of Severe Adult Spinal Deformities.

OBJECTIVE: We determined the feasibility of minimally invasive surgery for severe adult spinal deformities and proposed a reassessment system and staged minimally invasive surgical strategy. METHODS: We treated 53 patients from June 2016 to August 2017 using a reassessment system and a staged surgical strategy with minimally invasive techniques for minimally invasive spinal deformity surgery, class III. Patients with scoliotic apex vertebrae above L1-L2 or spontaneous fusion of the facet joints were excluded. The reassessment system was applied. The first stage involved multisegmental lateral lumbar interbody fusion and anterior column realignment (ACR), and the second stage involved posterior minimally invasive surgery. The pre- and postoperative visual analog scale scores, Oswestry disability index, surgical data, and radiographic images were collected. The major and minor complications were recorded. RESULTS: All the patients were followed up for 11.5 months (range, 6-20). Lateral lumbar interbody fusion was performed in 168 segments, of which 113 had ACR. The average sagittal correction angle of each ACR segment was 15.6° ± 6.3° (range, 7°-28°). The correction rate of the Cobb angle for lumbar scoliosis after first stage was 55.4%, and the total correction rate was 75.6%. The lumbar lordosis-pelvic index mismatch was improved from -32.8° ± 14.9° to -2.5° ± 9.4°, reaching the sagittal matching state of the lumbar spine. CONCLUSIONS: A reassessment system and minimally invasive staged surgery for severe adult spinal deformity can achieve good clinical outcomes and deformity correction and might have the advantage of decreasing unnecessary iatrogenic injury.

Expression and Mechanism of Interleukin 1 (IL-1), Interleukin 2 (IL-2), Interleukin 8 (IL-8), BMP, Fibroblast Growth Factor 1 (FGF1), and Insulin-Like Growth Factor (IGF-1) in Lumbar Disc Herniation.

BACKGROUND The expression and mechanism of IL-1, IL-2, IL-8, BMP, FGF1, and IGF-1 in Sprague-Dawley (SD) rats with lumbar disc herniation were investigated. MATERIAL AND METHODS Immunohistochemical methods were applied to identify IL-1, IL-2, IL-8, BMP, FGF1, and IGF-1. PI3K, AKT protein, and mRNA expression were detected and analyzed by Western blot analysis. We selected 30 healthy SD rats and divided them into 2 groups to construct an animal model that was validated by immediate CT scanning. Cartilage tissues from the lumbar disc herniation (experimental) group and control group were obtained and compared. RESULTS The expression of BMP was not significantly different between the control group and the experimental group (P>0.05). FGF1: There was no significant difference in the expression of FGF1 (P>0.05) between the control group and the experimental group. Compared with the control group, the expression of IGF-1 in the experimental group was significantly higher (P<0.05); the expression of IL-1 in the experimental group was significantly higher (P<0.05); and the expression of IL-2 in the experimental group was also significantly higher (P<0.05). There was no significant difference in IL-8 between the experimental group and the control group (P>0.05). The expression levels of PI3K and AKT protein and mRNA were significantly higher than those in healthy controls (P<0.05). CONCLUSIONS After lumbar disc herniation occurred, the IGF-1 was first activated; the PI3K/AKT signaling pathway was later activated, which resulted in the expression of IL-1 and IL-2 inflammation-related factors being increased.

Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review.

Traumatic incarceration of the small bowel accompanied by vertebral fractures and dislocation is rare and usually misdiagnosed until laparotomy. This report presents a rare case of jejunum entrapment between lumbar spine fractures. A 43-year-old man was clamped between two railway tracks on the upper abdomen and lower back. Following ineffective conservative treatment, he underwent a laparotomy due to the development of guarding and rebound tenderness. Loss of vitality of the jejunal loop, which was incarcerated between the L3 and L4 vertebrae, was observed. The necrotic bowel was removed and end-to-end anastomosis was performed. When his condition was stable, anterior and posterior lumbar fixation surgery was performed. The patient had no abdominal complications and lower limb nerve function deficiency during the follow-up period. A review of the literature since 1979 on incarceration of the bowel associated with lumbar fracture and dislocation identified 12 cases: five patients showed persistent neurological symptoms, but none of the patients died as a result of their injuries. It should be borne in mind that patients with hyperextension or flexion-distraction injury of the lumbar spine could show symptoms of intestinal obstruction and bowel incarceration. Enhanced computed tomography or magnetic resonance imaging will be helpful for diagnosis.

Effects of IGFBP3 gene silencing mediated inhibition of ERK/MAPK signaling pathway on proliferation, apoptosis, autophagy, and cell senescence in rats nucleus pulposus cells.

OBJECTIVE: Disc degeneration is the common life-threatening disease characterized by flank pain. The gene expression of insulin-like growth factor binding protein 3 (IGFBP3) is increased in patients with disc degeneration, however, its mechanism is still unknown. This study aimed to investigate the influence of IGFBP3 gene silencing mediated inhibition of extracellular signal-related kinase (ERK)/mitogen-activated protein kinase (MAPK) signaling on proliferation, apoptosis, autophagy, and cell senescence in rats nucleus pulposus (NP) cells. METHODS: The expression of IGFBP3 in disc NP of patients was assessed by real-time PCR (RT-PCR) and western blot. RT-PCR, transwell assay, immunohistochemical staining, SA-ß-Gal staining, and western blot were performed to explore the molecular mechanism of IGFBP3 in NP cell migration and invasion. RESULTS: In this study, IGFBP3 was highly expressed in disc NP of patients. With RT-PCR, transwell assay, immunohistochemical staining, SA-ß-Gal staining, and western blot, downregulated IGFBP3 could inhibit NP cells' migration and invasion by targeting the ERK/MAPK signaling pathway. CONCLUSION: Our findings revealed that the inhibition of the ERK/MAPK pathway was mediated by IGFBP3 silencing that had effects on proliferation, apoptosis, autophagy, and cell senescence. Furthermore, our findings suggested the underlying mechanism of disc degeneration.

Identification of the key genes and long non­coding RNAs in ankylosing spondylitis using RNA sequencing.

Ankylosing spondylitis (AS) is an insidious and debilitating form of arthritis that involves the axial skeleton, and its etiology and pathogenesis remain unclear. In the present study, three patients with AS and three normal controls from our hospital were enrolled. RNA sequencing and bioinformatics analysis were performed in order to identify the differentially expressed (DE) mRNAs (DEmRNAs) and DE long non­coding RNAs (DElncRNAs) between the patients with AS and normal controls. Construction of an AS­specific protein­protein interaction network, a weighted DElncRNA­DEmRNA co­expression network and functional annotation of the DEmRNAs co­expressed with DElncRNAs was performed. Nearby cis­targeted DEmRNAs or DElncRNAs were identified by searching for DEmRNAs that were transcribed within 100­kb up­ or downstream of DElncRNAs. Based on the Gene Expression Omnibus datasets GSE25101 and GSE73754, the expression of selected DEmRNAs and DElncRNAs were verified using published RNA sequencing data from blood samples, and receiver operating characteristic analysis of selected DEmRNAs was performed. Compared with the normal controls, 1,072 DEmRNAs and 372 DElncRNAs in the patients with AS were identified. Caspase recruitment domain family member 11 and DNA methyltransferase 1 have great diagnostic value for AS. MSTRG.8559 and LINC00987 were also identified as two hub DElncRNAs. The T­cell receptor signaling pathway was a significantly enriched pathway of the DEmRNAs co­expressed with DElncRNAs in patients with AS. In conclusion, the present study identified the key DEmRNAs and DElncRNAs in AS, which provides novel information for understanding the pathogenesis of AS and developing potential biomarkers for AS.

Does the Access Angle Change the Risk of Approach-Related Complications in Minimally Invasive Lateral Lumbar Interbody Fusion? An MRI Study.

OBJECTIVE: To investigate the potential risk of approach-related complications at different access angles in minimally invasive lateral lumbar interbody fusion. METHODS: Eighty-six axial magnetic resonance images were obtained to analyze the risk of approach-related complications. The access corridor were simulated at different access angles and the potential risk of neurovascular structure injury was evaluated when the access corridor touching or overlapping the corresponding structures at each angle. Furthermore, the safe corridor length was measured when the corridor width was 18 and 22 mm. RESULTS: When access angle was 0°, the potential risk of ipsilateral nerve roots injury was 54.7% at L4-L5. When access angle was 45°, the potential risk of abdominal aorta, contralateral nerve roots or central canal injury at L4-L5 was 79.1%, 74.4%, and 30.2%, respectively. The length of the 18mm-wide access corridor was largest at 0° and it could reach 44.5 mm at L3-L4 and 46.4 mm at L4-L5. While the length of the 22 mm-wide access corridor was 42.3 mm at L3-L4 and 44.1 mm at L4-L5 at 0°. CONCLUSION: Changes in the access angle would not only affect the ipsilateral neurovascular structures, but also might adversely influence the contralateral neural elements. It should be also noted to surgeons that alteration of the access angle changed the corridor length.

Facet angle and its importance on joint violation in percutaneous pedicle screw fixation in lumbar vertebrae: A retrospective study.

This is a retrospective study of case records. The aim of this study was to investigate the relationship between the facet angle (FA) at the pedicle level and facet joint violation (FJV) in percutaneous pedicle screw fixation (PPSF) in lumbar vertebrae.Current PPSF technique has a high facet violation rate than open surgery, and the relationship of FJV and FA has not been studied.Retrospective imaging analysis was conducted for 115 cases who underwent PPSF from December 2013 to November 2016 by the same group of surgeons using the same technique, in the spine surgery center of our hospital. The FA at the pedicle level was measured by computed tomography, and diagnosis and evaluation of FJV grade were performed postoperatively. The effect of the variant FA and lumbar segment (L1-L5) on FJV, and the correlation between FA and the FJV and FJV grade in PPSF were evaluated.A total of 476 percutaneous pedicle screws were included: 144 L1, 136 L2, 64 L3, 72 L4, and 60 L5 screws, with a total FJV rate of 30.46% (145/476). The FJV rate was 28.78% in upper lumbar group with 344 screws (99/344), and 34.85% in lower lumbar group with 132 screws (46/132). There was no significant difference between groups with regards to FJV rate, and age, sex, or BMI index. Evaluation of variant FA and lumbar segment on FJV rate indicated that FJV rate increased dramatically when FA >35 degree; however, FJV rate was not significantly related to the lumbar segment. There was a positive correlation between FA and FJV rate, as well as FA and FJV grade.There was a positive correlation between the increase of the FA at the pedicle level, and the FJV rate and FJV grade. The FJV risk increased remarkably when the FA was >35 degree.

Efficacy of Laminoplasty in Patients with Cervical Kyphosis.

BACKGROUND The efficacy of laminoplasty in patients with cervical kyphosis is controversial. The purpose of this study was to investigate the impact of the initial pathogenesis on the clinical outcomes of laminoplasty in patients with cervical kyphosis. MATERIAL AND METHODS A total of 137 patients with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) underwent laminoplasty from April 2013 to May 2015. The patients were divided into the following 4 groups: lordosis with CSM (LC), kyphosis with CSM (KC), lordosis with OPLL (LO), and kyphosis with OPLL (KO). The clinical outcome measures included the visual analogue scale (VAS) and modified Japanese Orthopedic Association (mJOA) scores, the range of motion (ROM), and the cervical global angle (CGA). RESULTS The mean VAS and mJOA scores improved significantly in all groups after surgery. The changes in VAS and mJOA scores were significantly smaller, and the JOA recovery rate was significantly lower, in the KC group than in the LC and KO groups. The mean change in the CGA was greatest in the KC group (>8° towards kyphosis). The preoperative ROM was negatively correlated with the change in CGA and the JOA recovery rate in the KO and KC groups. CONCLUSIONS We found that laminoplasty is suitable for patients with cervical lordosis and those with mild cervical kyphosis and OPLL, but is not recommended for patients with kyphosis and CSM, particularly those with a large ROM preoperatively.

Computer Simulation of Two-level Pedicle Subtraction Osteotomy for Severe Thoracolumbar Kyphosis in Ankylosing Spondylitis.

BACKGROUND: Advanced ankylosing spondylitis is often associated with thoracolumbar kyphosis, resulting in an abnormal spinopelvic balance and pelvic morphology. Different osteotomy techniques have been used to correct AS deformities, unfortunnaly, not all AS patients can gain spinal sagittal balance and good horizontal vision after osteotomy. MATERIALS AND METHODS: Fourteen consecutive AS patients with severe thoracolumbar kyphosis who were treated with two-level PSO were studied retrospectively. All were male with a mean age of 34.9 ± 9.6 years. The followup ranged from 1-5 years. Preoperative computer simulations using the Surgimap Spinal software were performed for all patients, and the osteotomy level and angle determined from the computer simulation were used surgically. Spinal sagittal parameters were measured preoperatively, after the computer simulation, and postoperatively and included thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence, pelvic tilt (PT), and sacral slope (SS). The level of correlation between the computer simulation and postoperative parameters was evaluated, and the differences between preoperative and postoperative parameters were compared. The visual analog scale (VAS) for back pain and clinical outcome was also assessed. RESULTS: Six cases underwent PSO at L1 and L3, five cases at L2 and T12, and three cases at L3 and T12. TK was corrected from 57.8 ± 15.2° preoperatively to 45.3 ± 7.7° postoperatively (P < 0.05), LL from 9.3 ± 17.5° to -52.3 ± 3.9° (P < 0.001), SVA from 154.5 ± 36.7 to 37.8 ± 8.4 mm (P < 0.001), PT from 43.3 ± 6.1° to 18.0 ± 0.9° (P < 0.001), and SS from 0.8 ± 7.0° to 26.5 ± 10.6° (P < 0.001). The LL, VAS, and PT of the simulated two-level PSO were highly consistent with, or almost the same as, the postoperative parameters. The correlations between the computer simulations and postoperative parameters were significant. The VAS decreased significantly from 6.1 ± 1.9 to 2.0 ± 1.1 (P < 0.001). In terms of clinical outcome, 10 cases were graded "excellent" and 4 cases were graded "good." CONCLUSION: Two-level PSO using a preoperative computer simulation is a feasible, safe, and effective technique for the treatment of severe thoracolumbar kyphosis in AS patients with normal cervical motion.

Idiopathic intracranial hypertension occurred after spinal surgery: report of two rare cases and systematic review of the literature.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a relatively rare syndrome of increased intracranial pressure of unknown etiology. It is characterized by cerebrospinal fluid (CSF) opening pressure more than 250 mmH2O, with normal cranial imaging and CSF content. IIH occurred after spinal surgery is extremely rare. METHODS: We present two IIH cases occurred after spinal surgery and conduct a systematic review of articles reporting IIH occurred after spinal surgery. RESULTS: The first patient underwent a posterior decompression and fixation for cervical fractures. IIH symptoms appeared 3 days postoperatively and gradually resolved with appropriate medication. The second patient underwent posterior spinal fusion with segmental instrumentation for congenital scoliosis. IIH symptoms appeared 5 days postoperatively and the patient died due to the irreversible intracranial hypertension although underwent intensive care and treatment. The literature review revealed that there were only five cases of IIH occurred after spinal surgery reported till date. CONCLUSIONS: IIH occurred after spinal surgery is relatively rare; the diagnosis is based upon exclusion of other diseases. IIH should be kept in mind in patients underwent spinal surgery as it could develop into irreversible intracranial hypertension.