Clinical impact and imaging results after a modified procedure of ACDF: a prospective case-controlled study based on ninety cases with two-year follow-up.

STUDY DESIGN: This is a prospective case-controlled study. BACKGROUND: To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). METHODS: Ninety patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores. RESULTS: A total of 90 patients were enrolled and the patients were divided into spread group (n = 48) and none-spread group(n = 42). Cage subsidence of (spread group vs none-spread group) was (0.82 ± 0.68 vs 0.58 ± 0.81) mm, (0.64 ± 0.77 vs 0.34 ± 0.46) mm, (0.48 ± 0.43 vs 0.25 ± 0.28) mm, and (0.45 ± 0.47 vs 0.17 ± 0.32) mm at 3 months, 6 months, 12 months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. CONCLUSIONS: The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the "natural height" of cervical vertebra, relieve immediate pain after surgery, and prevent rapid Cage subsidence and the loss of cervical curvature.

Anatomic study and clinical significance of the dorsal meningovertebral ligaments of the thoracic dura mater.

STUDY DESIGN: A dissection-based study of 18 embalmed thoracic specimens. OBJECTIVE: To investigate the properties and clinical significance of the dorsal meningovertebral ligaments of the thoracic dura mater. SUMMARY OF BACKGROUND DATA: Previously, we performed a comprehensive anatomic study on the dorsal meningovertebral ligaments in the lumbosacral and cervical regions, whereby we concluded that the ligaments were an anatomic factor leading to dural laceration and hemorrhage during flavectomy and laminectomy. Unfortunately, thus far, no systematic anatomic study has been undertaken to examine the dorsal meningovertebral ligaments of the thoracic dura mater. METHODS: Eighteen adult embalmed cadavers were studied, and the morphology, orientation, attachment site, and distribution traits of the dorsal meningovertebal ligaments were observed. In addition, the length, width, or diameter and thickness of the ligaments were measured using a Vernier caliper. Two meningovertebal ligaments were removed for histological examination. RESULTS: In the thoracic region, the dorsal meningovertebral ligaments anchored the dura mater to the lamina or ligamentum flavum. The meningovertebral ligaments displayed a relatively even distribution along the upper thoracic region (T1-T7) and a gradual increase in frequency in the lower thoracic region from T7 to T12. The meningovertebral ligaments protrude into the dura and correspondingly become an integral part of the dura. Some ligaments are accompanied by or are attached to blood vessels. Histological examination of the meningovertebral ligaments revealed fibrous connective tissue. CONCLUSION: The dorsal meningovertebral ligaments exist between the dural sac and ligamentum flavum or lamina in the thoracic spine. Based on their anatomic features, meningovertebral ligaments may be one potential cause for dural laceration and epidural hemorrhage. We propose that, during thoracic flavectomy and laminectomy, the meningovertebral ligaments should first be identified and properly handled, thereby minimizing the occurrence of relevant complications. LEVEL OF EVIDENCE: N/A.

miR-218 expression in osteosarcoma tissues and its effect on cell growth in osteosarcoma cells.

OBJECTIVE: To investigate the expression of miR-218 and its clinical significance in osteosarcoma tissues and explore its effect on proliferation and apoptosis in osteosarcoma cells. METHODS: miR-218 expression was detected in 76 samples of surgically resected osteosarcoma and matched normal tumor-adjacent tissues using quantitative reverse transcription polymerase chain reaction (qRT-PCR). MiR-218 was over-expressed by exogenous miR-218 plasmids in Saos-2 cells, and then BrdU cell proliferation assay and flow cytometry were used to determine cell proliferation and apoptosis. RESULTS: The expression of miR-218 in osteosarcoma tissues was significantly lower than those in normal tumor-adjacent tissues (t=8.735, P<0.001). MiR-218 expression in tumor tissues was significantly correlated with tumor size (χ(2)=5.380, P=0.020), clinical stage (χ(2)=6.692, P=0.010) and distant metastasis (χ(2)=4.180, P=0.041). MiR-218 was obviously over-expressed by exogenous miR-218 plasmids (t=19.42, P<0.001), and miR-218 overexpression significantly reduced cell proliferation (t=9.045, P<0.001) and induced apoptosis (t=12.38, P<0.001) in Saos-2 cells. CONCLUSIONS: The low-expression of miR-218 is correlated with the poor clinicopathological features in osteosarcoma. Moreover, miR-218 overexpression reduces cancer cell proliferation and induces apoptosis in Saos-2 cells, suggesting that miR-218 may play a key role in the progression of human osteosarcoma.