Correlation between direction of pedicle screw and restoration of lumbar degenerative scoliosis in degenerative lumbar spondylolisthesis: a retrospective study.

Background: Inferior clinical outcomes have been reported in patients with degenerative lumbar spondylolisthesis (DLS) accompanied by lumbar degenerative scoliosis, but little attention has been paid to its radiologic assessment or preoperative planning. The aim of this study was to analyze the effect of transforaminal lumbar interbody fusion on patients with DLS and lumbar degenerative scoliosis and explore the surgical aspects benefiting the restoration of lumbar degenerative scoliosis. Methods: All patients with DLS and lumbar degenerative scoliosis undergoing single-level unilateral transforaminal lumbar interbody fusion surgery between July 1, 2015, and April 30, 2021, were screened in this retrospective cohort study. Clinical outcomes including visual analog scale (VAS), Oswestry disability index (ODI), and radiographic parameters of sagittal and coronal alignment, cage spatial locations, and angle of pedicle screw (parallel, cranial, and caudad angle) were assessed. Coronal asymmetry was demonstrated by the intervertebral height difference between the medial and lateral margins of indexed intersegmental space. The correlations between Δintervertebral height difference (postoperative intervertebral height difference-preoperative intervertebral height difference) and radiographic parameters and clinical outcomes were analyzed by univariable, multivariable, mediation, and correlation analyses. Significance was set at a bilateral P<0.05. Results: A total of 57 included patients were followed up for a minimum of 1 year. Reduction of VAS, ODI, and improvement of radiographic parameters were found after surgery. The cranial angle of the lower pedicle screw positively correlated with Δintervertebral height difference restoration (b=0.54; standard error=0.11; P<0.001). Conclusions: Transforaminal lumbar interbody fusion surgery appears to be an effective approach to improving the radiographic and clinical outcomes of patients with DLS and lumbar degenerative scoliosis. The cranial direction of the lower pedicle screws in single-level unilateral transforaminal lumbar interbody fusion surgery may be associated with a better postoperative restoration of lumbar degenerative scoliosis.

Modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures.

PURPOSE: To investigate the surgical effects of modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCF). METHODS: From April 2013 to October 2017, a total of 53 patients with thoracolumbar OVCF were treated with controllable balloon percutaneous kyphoplasty (C-PKP). Peri-operative parameters including days from injury to operation, operation time, injected cement volume, cement leakage and complications were collected. Visual analogue scale (VAS) and Cobb angle before and after operation were applied to evaluate surgical effects. Moreover, a total of 53 cases treated with traditional balloon of percutaneous kyphoplasty were retrospectively analyzed and compared with C-PKP in above parameters. RESULTS: C-PKP achieved significant fewer events of cement leakage (type C) than that of traditional PKP (5/53 vs 13/53, p < 0.01). The patients were followed up for 10.8 ± 4.2 months; VAS and Cobb angle of the injured vertebra in both two groups at three days and final follow-up were significantly improved compared with that before surgery (p < 0.05), while there were no significant differences between the two groups regarding the VAS and Cobb angle at corresponding time points (p > 0.05). CONCLUSIONS: C-PKP technology is a safe and efficient way for the treatment of thoracolumbar OVCF, and it can reduce cement leakage.

Transplantation of bone marrow-derived mesenchymal stem cells rescues partially rachitic phenotypes induced by 1,25-Dihydroxyvitamin D deficiency in mice.

To determine whether the transplantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) can improve the 1,25(OH)2D deficiency-induced rachitic phenotype, 2×106 BM-MSCs from wild-type mice or vehicle were transplanted by tail vein injection into mice deficient in 1,25(OH)2D due to targeted deletion of 1α(OH)ase (1α(OH)ase-/-). Our results show that 1α(OH)ase mRNA was expressed in the BM-MSCs derived from wild-type mice, and was detected in long bone, kidney and intestine from BM-MSC-transplanted 1α(OH)ase-/- recipients. Serum calcium, 1,25(OH)2D3 levels and body weight were significantly increased in BM-MSC-transplanted 1α(OH)ase-/- recipients compared to vehicle-treated 1α(OH)ase-/- mice. Skeletal mineralization improved in 1α(OH)ase-/- recipients as demonstrated by BMD measurement, micro-CT analysis and von Kossa staining of undecalcified sections. Expression levels of type I collagen, osteocalcin, bone sialoprotein and vitronectin and the size of calcified nodules were decreased in BM-MSC cultures from 1α(OH)ase-/- mice compared with those from wild-type mice, however, these parameters were increased in those from BM-MSCs-transplanted 1α(OH)ase-/- recipients compared with those from vehicle-treated 1α(OH)ase-/- mice. This study indicates that donor BM-MSCs cells can relocate to multiple tissues where they synthesize 1α(OH)ase and produce 1,25(OH)2D that contributes to the improvement of serum calcium and skeletal mineralization. Results from this study suggest that BM-MSC transplantation may provide a therapeutic approach to treatment of pseudovitamin D-deficiency rickets.

[Fingertip replantation with anastomosis of palm vein and retaining the nail].

OBJECTIVE: To study the replantation methods and clinical results of amputated fingertip. METHODS: From October 2007 to June 2011, 18 fingers of 13 cases were replanted with anastomosis of palm vein and retaining the nail, including 9 males and 4 females,with an average age of 26 years old ranging from 17 to 45 years old. The time from injury to therapy was from 30 min to 5 h, time of broken finger ischemia was from 1.5 to 7 h. All broken fingers were preservation under normal temperature. RESULTS: All fingers were survived, no vascular crisis happened. All cases were followed up from 3 to 24 months with an average of 14 months. The length and shape of replanted fingers were similar to that of the healthy side. The new nails were smooth, the function was perfect,the sense of pain and touched sensation had been recovered. Their two-piont discriminations ranged from 3 to 6 mm with an average of 5 mm. According to the assessment standard of Chinese Medical Association of Hand Surgery, the results were excellent in 14 cases, good in 3 cases, poor in 1 case. CONCLUSION: Fingertip replantation with anastomosis of palm vein and retaining the nail is regained satisfactory appearance and function of the digits with a high survival rate.

[Posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems].

OBJECTIVE: To observe the clinical effect of a occipitocervical fixation systems using C(2) pedicle screws and plates. METHODS: An occipitocervical fixation system was designed. Since June 2001 to March 2003, 38 patients with instability of atlantoaxial joint underwent reconstructive surgery using this systems. Twenty-four patients were associated with congenital occipitalization. The pedicle screws were inserted into C(2) pedicles in the direction as its axis. The occipitocervical plate was slightly bent to fit the occipital contour and fixed onto the occiput. Hyperflexion alignment of the occipitoatlantoaxial complex was corrected by application of extensional force created by tightening of the nut on the pedicle screws. The autogenous cancellous bones were grafted between the occiput and the axis. RESULTS: In this series, neither vertebral artery nor spinal cord was injured. 36 of 38 cases were followed up for an average of 18 months, all cases achieved solid bony fusion. No implant failure was found. CONCLUSIONS: Occipitocervical reconstruction by the combination of C(2) pedicle screws and occipitocervical plate systems can provide sufficient correction of malalignment in the occipitoatlantoaxial region and achieve high fusion rate.