Impact of Elevated Body Mass Index on Surgical Outcomes for Patients Undergoing Cervical Fusion Procedures: A Systematic Review and Meta-Analysis.

To investigate whether high body mass index (BMI) had adverse effects on the postoperative outcomes for patients who underwent anterior or posterior cervical fusion procedures. A literature search were conducted in PubMed, Embase, and Web of Science. Comparative or controlled studies that examined the influences of high BMI on postoperative outcomes after cervical fusion procedures were included. Using a fixed-effect model or random-effect model, the effects of high BMI were determined by weight mean difference (WMD) with 95% confidence interval (95% CI) or risk ratio (RR) with 95% CI. A total of seven studies were included in this meta-analysis. The pooled estimate showed that high BMI was associated with longer hospital stay (WMD = 1.61 days, 95% CI: 0.51, 2.71; P = 0.004), longer surgical time (WMD = 4.55, 95% CI: 1.04, 8.07; P = 0.011), higher mortality rate (RR = 3.01, 95% CI: 2.75, 3.29; P < 0.001), and higher postoperative rates of cardiac complication (RR = 1.30, 95% CI: 1.11, 1.52; P = 0.001), deep venous thromboembolism (RR = 2.29, 95% CI: 1.36, 3.86; P = 0.002), and wound complication (RR = 1.69, 95% CI: 1.26, 2.28; P < 0.001). However, there was no significant differences between high and normal BMI groups in terms of Neck Disability Index (WMD = 1.49, 95% CI: -2.34, 5.32; P = 0.447), SF-36 Mental Component Score (MCS) (WMD = -0.87, 95% CI: -2.09, 0.35; P = 0.164), overall complications (RR = 1.18, 95% CI: 0.80, 1.76; P = 0.399), central nervous system (CNS) complications (RR = 0.68, 95% CI: 0.17, 2.76; P = 0.586), pulmonary complications (RR = 1.46, 95% CI: 0.87, 2.46; P = 0.150), and septic complications (RR = 0.87, 95% CI: 0.32, 2.38; P = 0.785).High BMI seemed to be associated with longer hospital stay, surgical time, and higher postoperative complication rates compared to normal BMI. Therefore, high BMI patients should be counseled carefully regarding the risk of postoperative complications and surgical outcomes after cervical fusion procedures.

Efficacy of Vertebroplasty in Short-Segment Pedicle Screw Fixation of Thoracolumbar Fractures: A Meta-Analysis.

BACKGROUND Short-segment pedicle screw instrumentation provides superior outcomes in treating thoracolumbar fractures. Nevertheless, the effect of intermediate screws on the outcome of short-segment instrumentation at the fracture level has not been specifically analyzed. We performed an update meta-analysis of the effect of additional vertebroplasty on the outcome of short-segment instrumentation to determine the role of screws for patients with fractured vertebra. MATERIAL AND METHODS A systematic literature search was conducted, updated to January 2019, in terms of the efficacy of additional vertebroplasty on the outcome of short-segment instrumentation at the fracture level. After rigorous quality review, we extracted the data from qualified clinical studies. We further analyzed odds ratios (ORs) of the endpoints of interest based on the included trials. RESULTS Compared with the control group, short-segmental fixation combined with intermediate screws restored Cobb angle (P<0.001) and reduced anterior vertebral height compression (P=0.001). However, our results did not reveal statistically significant differences in operative time (P=0.28) or estimated blood loss (P=0.23). A statistically significant difference was observed in mean hospital stay (P=0.02). CONCLUSIONS Reinforcement with fracture-level screw combination can help stabilize the fractures and restore the anatomy. Nevertheless, additional trials and studies with longer follow-ups and on larger populations are warranted to confirm the current findings.

An updated meta-analysis of clinical outcomes comparing minimally invasive with open transforaminal lumbar interbody fusion in patients with degenerative lumbar diseases.

BACKGROUND & AIMS: Open-transforaminal lumbar interbody fusion (O-TLIF) is regarded as the standard (S) approach which is currently available for patients with degenerative lumbar diseases patients. In addition, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has proposed and gradually obtained popularity compared with O-TLIF procedures due to its beneficial outcomes in minimized tissue injury and quicker recovery. Nonetheless, debates exist concerning the use of MI-TLIF with its conflicting outcomes of clinical effect and safety in several publications. The purpose of the current study is to conduct an updated meta-analysis to provide eligible and systematical assessment available for the evaluation of the efficacy and safety of MI-TLIF in comparison with O-TLIF. METHODS: Publications on the comparison of O-TLIF and MI-TLIF in treating degenerative lumbar diseases in last 5 years were collected. After rigorous reviewing on the eligibility of publications, the available data was further extracted from qualified trials. All trials were conducted with the analysis of the summary hazard ratios (HRs) of the interest endpoints, including intraoperative and postoperative outcomes. RESULTS: Admittedly, it is hard to run a clinical RCT to compare the prognosis of patients undergoing O-TLIF and MI-TLIF. A total of 10 trials including non-randomized trials in the current study were collected according to our inclusion criteria. The pooled results of surgery duration indicated that MI-TLIF was highly associated with shorter length of hospital stay, less blood loss, and less complications. However, there were no remarkable differences in the operate time, VAS-BP, VAS-LP, and ODI between the 2 study groups. CONCLUSION: The quantitative analysis and combined results of our study suggest that MI-TLIF may be a valid and alternative method with safe profile in comparison of O-TLIF, with reduced blood loss, decreased length of stay, and complication rates. While, no remarkable differences were found or observed in the operate time, VAS-BP, VAS-LP, and ODI. Considering the limited available data and sample size, more RCTs with high quality are demanded to confirm the role of MI-TLIF as a standard approach in treating degenerative lumbar diseases.

Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: A meta-analysis.

OBJECTIVE: To contrast the effects and complications in unilateral and bilateral percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures in elderly patients. METHODS: Multiple databases were adopted to search relevant studies, and the articles eventually satisfied the criteria were included. All the meta-analyses were conducted with the Review Manager 5.2. To estimate the quality of each article, risk of bias table was performed. RESULTS: Finally, 627 patients were enrolled in 9 studies and ultimately met the eligibility criteria. The unilateral and bilateral surgical samples were 314 and 313, respectively. The meta-analysis showed no significant difference in Visual Analog Scale/Score (VAS) (MD = -0.05, 95% confidence interval [CI] [-0.24, 0.13], P = .57), Oswestry Disability Index (ODI) score (MD = 0.03, 95% CI [-0.57, 0.62], P = .93) and cement leakage (OR = 1.00, 95% CI [0.67, 1.50], P = 1.00) between unilateral group and bilateral group. The surgery time of unilateral PVP is much less than that of bilateral PVP (MD = -8.42, 95% CI [-13.17, -3.66], P = .0005). Patients with bilateral PVP surgery have been injected more cement than patients with a unilateral surgery (MD = -2.56, 95% CI [-2.79, -2.33], P <.00001). CONCLUSION: This study demonstrated unipedicular approach is the preferred surgical technique for treatment of osteoporotic vertebral fracture (OVF) compared with bilateral PVP since unipedicular approach injects less cement and cost less surgery time.

Comparison of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolithesis: A Meta-Analysis.

Aim: Both posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) are the frequently-used techniques to treat lumbar spondylolithesis. The aim of this meta-analysis is to compare the safety and effectiveness between these two methods. Materials and Methods: The multiple databases were used to search for the relevant studies, and full-text articles involved in the comparison between PLIF and PLF were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Results: Finally, 11 relevant studies were eventually satisfied the included criteria. The meta-analysis suggested that there was no significant difference of the clinical outcome, fusion rate, complication rate and blood loss (RR = 1.07, 95%CI [0.97, 1.17], P = 0.16; RR = 0.84, 95%CI [0.49, 1.45], P = 0.54; RR = 1.07, 95%CI [0.95, 1.21], P = 0.25; SMD = 0.24, 95%CI [-0.50, 0.98], P = 0.52; respectively). No publication bias was observed in this study (P > 0.05). Conclusions: Both these two procedures provide excellent outcomes for patients with spondylolisthesis. There was no significant difference of clinical outcome, complication rate, fusion rate and blood loss between PLIF and PLF techniques.

Association between Physical Activity and Telomere Length in a North Chinese Population: A China Suboptimal Health Cohort Study.

Several studies have demonstrated an association between physical activity and telomere length; however, the association remains inconsistent. A cross-sectional study consisting of 588 participants (375 females, median age of 33.8 years) was carried out to investigate the association between telomere length and physical activity in a general population from North China. The results show that relative telomere length is not significantly different in participants in the northern Chinese population with different levels of physical activity, either in the model only adjusted for age (F = 2.127, P = 0.120) or in the model adjusted for demographics and lifestyle (F = 1.227, P = 0.294). The gender-stratified analysis also produced insignificant results. Our study confirmed a non-significant association between physical activity and telomere length in the northern Chinese population, which adds to the inconsistent association between physical activity and telomere length across different ethnic populations.

One or Two Drains for the Treatment of Surgical Site Infections After Lumbar Spine Surgery.

BACKGROUND: Optimal drainage after débridement for treating postoperative surgical site infection (SSI) is controversial. We compared single-tube drainage with double-tube drainage. METHODS: We retrospectively analyzed 1125 patients with lumbar degenerative disease who underwent lumbar surgery. Postoperative SSI was diagnosed in 26 patients, and these patients were divided into 2 groups: single-tube drainage group (1 drain) and double-tube drainage group (2 drains). RESULTS: The 26 adult patients (17 women and 9 men) with postoperative SSI after lumbar surgery (26/1125 [2.3%]) were treated with débridement. There were no significant differences in patient age, sex, body mass index, mean number of pedicle screws, operative time, amount of bleeding, and drainage between the 2 groups. There were no significant differences between groups in administration of antibiotics (P > 0.05). Bacterial cultures were routinely performed in all 26 cases of SSI; 80.7% (21/26) of patients had a positive culture. Staphylococcus species, including predominantly S. aureus, methicillin-resistant S. aureus, and S. epidermidis, were the most common pathogens, followed by Escherichia coli, Acinetobacter, Klebsiella pneumoniae, and Enterococcus faecalis. There were no significant differences in drainage efficiency between the 1 drain and 2 drains groups (P > 0.05). CONCLUSIONS: There were no significant differences between the 1 drain and 2 drains groups in surgery-related and patient-related risk factors, pathogenic bacteria and antibiotic therapy, laboratory tests results, or drainage efficiency and time. However, patients in the 1 drain group exhibited better clinical outcome and shorter hospital stay.

Association between the SUMO4 M55V Polymorphism and Susceptibility to Type 2 Diabetes Mellitus: A Meta-analysis.

OBJECTIVE: The aim of this study is to determine whether the SUMO4 M55V polymorphism is associated with susceptibility to type 2 diabetes mellitus (T2DM). METHODS: A meta-analysis was performed to detect the potential association of the SUMO4 M55V polymorphism and susceptibility to T2DM under dominant, recessive, co-dominant (homogeneous and heterogeneous), and additive models. RESULTS: A total of eight articles including 10 case-control studies, with a total of 2932 cases and 2679 controls, were included in this meta-analysis. The significant association between the SUMO4 M55V polymorphism and susceptibility to T2DM was observed in the dominant model (GG + GA versus AA: OR = 1.21, 95% CI = 1.05-1.40, P = 0.009), recessive model (GG versus GA + AA: OR = 1.29, 95% CI = 1.07-1.356, P = 0.010), homozygous model (GG versus AA: OR = 1.41, 95% CI = 1.06-1.56, P = 0.001), and additive model (G versus A: OR = 1.18, 95% CI = 1.08-1.29, P = 0.001), and marginally significant in the heterozygous model (GA versus AA: OR = 1.16, 95% CI = 0.98-1.36, P = 0.080). In subgroup analyses, significant associations were observed in the Chinese population under four genetic models excluding the heterozygous model, whereas no statistically significant associations were observed in the Japanese population under each of the five genetic models. CONCLUSION: The meta-analysis demonstrated that the G allele of the SUMO4 M55V polymorphism could be a susceptible risk locus to T2DM, mainly in the Chinese population, while the association in other ethnic population needs to be further validated in studies with relatively large samples.

Association of the insulin-like growth factor-1 single nucleotide polymorphisms rs35767, rs2288377, and rs5742612 with osteoporosis risk: A meta-analysis.

BACKGROUND: Insulin-like growth factor-1 (IGF-1) plays an important role in the regulation of bone formation and mineralization. We aimed to perform a meta-analysis to assess the association of three IGF-1 single nucleotide polymorphisms (SNPs) rs35767, rs2288377, and rs5742612 with osteoporosis risk. METHODS: A systematic search of PubMed, Web of Science, Embase, Medline, Scopus, CNKI, and Wanfang databases was conducted. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using a fixed effects model. RESULTS: Four Chinese case-control studies with a total of 2807 participants were included in this meta-analysis. The results revealed an association between rs35767 and osteoporosis risk in all study subjects (women and men) in dominant (OR 1.32, 95% CI 1.13-1.53, P < .001), recessive (OR 1.73, 95% CI 1.35-2.21, P < .001), homozygote (OR 1.89, 95% CI 1.46-2.45, P < .001), and allelic (OR 1.31, 95% CI 1.18-1.47, P < .001) models. Subgroup analysis according to gender showed that rs35767 was associated with osteoporosis risk in women under dominant (OR 1.29, 95% CI 1.08-1.54, P = .005), recessive (OR 1.59, 95% CI 1.19-2.12, P = .002), homozygote (OR 1.73, 95% CI 1.28-2.34, P < .001), and allelic (OR 1.28, 95% CI 1.12-1.47, P < .001) models. Meta-analysis did not find associations of rs2288377 and rs5742612 with osteoporosis risk. There was no evidence of between-study heterogeneity and publication bias. CONCLUSION: Our results suggest that rs35767 is associated with osteoporosis risk in Chinese, whereas there is no association of rs2288377 and rs5742612 with osteoporosis risk.

[Characteristics of vascular morphology and vascular endothelial growth factor in patients with osteoarthritis and rheumatoid arthritis].

OBJECTIVE: To study the differences in vascular morphology and vascular endothelial growth factor (VEGF) of early knee osteoarthritis and rheumatoid arthritis and to evaluate whether VEGF mRNA and VEGF protein expression correlate with disease activity and vascular morphology. METHODS: VEGF mRNA and VEGF protein in OA and RA synovium were detected by means of in situ hybridization and immunohistochemistry. Vascular morphology was assessed by arthroscopy. The level of VEGF protein expression of synovium was evaluated to make sure whether it was correlated with disease activity and macroscopic observation by arthroscopy. RESULTS: Significant differences of VEGF mRNA and protein expression were found in synovium lining layer region, perivascular region and sub-lining region between OA and RA. The correlations were found between VEGF expression in sub-lining region and erythrocyte sedimentation rate (ESR) in OA, in synovium lining layer and the counts of platelet in RA, in sub-lining region and C-reaction protein (CRP) in RA. The correlation was found between VEGF expression and synovium lining layer, between VEGF expression and synovial hypertrophy in sub-lining region in OA; The expression of VEGF in synovium lining layer in RA demonstrated its correlation with vascular morphology, tortuous vessels, and vascular density. CONCLUSION: There is differential VEGF mRNA/VEGF protein expression between OA and RA in each layer of synovial membrane. This phenomenon may be responsible for the pathogenic mechanisms of osteoarthritis and rheumatoid arthritis.

Increasing incidence of brain and nervous tumours in urban Shanghai, China, 1983-2007.

BACKGROUND: Wide use of cellular telephones has given rise to concerns about adverse health effects, especially in the brain, which might caused by the low power microwave-frequency signal transmitted by the antennas on handsets. Subscribers to cellular telephone services increased from mid-1990s in Shanghai; time trends in brain and nervous tumour after 2000 may supply information about possible associations between tumour risk and cellular telephones use. METHODS: We investigated time trends in the incidence of brain and nervous tumour in urban Shanghai, from 1983 to 2007, applying joinpoint regression models to analyze the annual incidence rates and to predict future trends. RESULTS: from 1983 to 2007, the age-adjusted incidence rate of brain and nervous tumours increased gradually by 1.2% per year (95% confidence interval [CI] = 0.4% to 1.9%) among men and 2.8% per year (95% CI =2.1 to 3.4) among women. Age-adjusted incidences of brain and nervous tumours in urban Shanghai for 2020 were estimated to 7.4 and 10.9 per 100,000 person-years. CONCLUSION: The study did not support an association between cellular telephone use and increased risk of brain and nervous tumours. However, considering the increasing incidence rate of brain and nervous tumours now and in the future, in addition to the high prevalence of mobile phone exposure in the population and worldwide, assessment of longer follow-up time trends in brain tumour incidence rates is warranted.

[Assessment of flexibility in adolescent idiopathic scoliosis by curved planar reformation using multi-slice spiral CT scanning].

OBJECTIVE: To investigate the role of curved planar reformation (CPR) using multi-slice spiral CT scanning to evaluate the coronal and sagittal plane in scoliosis so as to affirm the features of supine coronal and sagittal plane in idiopathic scoliosis. METHODS: Thoracic and lumbar spine multi-slice spiral CT scanning was undertaken on 45 patients with adolescent idiopathic scoliosis (AIS), all female, age 10 - 18. CPR was used to reconstruct the spine coronal and sagittal planes respectively. The values of main curve and compensate curve Cobb angles were obtained and compared with those obtained by X-ray films. RESULTS: The average CPR coronal main curve Cobb angle was smaller by 10.17 degrees than that obtained by standing position film. The average CPR coronal compensate curve Cobb angle was smaller by 6.97 degrees than that obtained by standing position film. For scoliosis coronal flexibility assessment, fulcrum-bending method offered better surgical correction result than other methods. Only the post-operational Cobb angle was different between the 10 - 14 year-old group and 15 - 18 year-old group. Bending film showed differences in correction rate and flexibility rate between the main thoracic group and main lumbar/thoracolumbar group. The correction rate and flexibility rate of main curve and compensate curve of the 10 - 14 year-old group were significantly higher than those of the 15 - 18 year-old group. In the sagittal plane, the CPR thoracic kyphotic angle (T5-T12) and upper thoracic curve kyphosis of the main thoracic group were both smaller than those of the main lumbar/thoracolumbar group. The CPR thoracic kyphotic angle (T5-T12) of the 10 - 14 year-old group was significantly smaller than that of the 15 - 18 year-old group. Correlation analysis showed that the CPR main curve flexibility and bending film flexibility were positively corrected with the surgical correction rate. CONCLUSION: CPR using multi-slice spiral CT scanning is able to obtain multiple three-dimensional assessment by one scanning and is helpful in scoliosis curve type diagnosis and scoliosis 3D analysis.

[Surgical treatment for posterior malleolus fracture of external rotation].

OBJECTIVE: To evaluate a surgical technique and outcome and illustrate its important of open reduction and internal fixation for fractures of posterior malleolus. METHODS: From Jan. 2004 to Jan. 2008, 25 cases were treated with open reduction and internal fixation involving 17 males and 8 females with an average age of 34 years (ranged from 21 to 67 years old). According to Lauge-Hansen classification: 13 cases of type pronation-external rotation (IV), 7 and 5 cases of type supination-external rotation (III and IV). Twenty cases were treated with screw, 5 cases were treated with gypsum. To evaluate the outcome of operation with X-ray. RESULTS: After seven months to three years followed-up, clinic therapeutic effect of each patient was evaluated according to the Leeds scoring system, the results were excellent in 21 cases and good in 2. As compared with the uninjured side on the evaluation of the activity range of ankle joint, there were no significant difference in back-extend and plantar flexion. CONCLUSION: In order to obtain ankle joint satisfactory result, open reduction and rigid internal fixation must be adopted in the fracture of posterior malleolus.

[Vertebra morphology measurement in adolescent idiopathic scoliosis population].

OBJECTIVE: To measurement the vertebra morphology using multi-planar reformations method of multi-slice spiral CT (MSCT) in AIS girls, and To compare with age and gender-matched controls in order to affirm the morphology results of abnormal development of the anterior and posterior elements in AIS. METHODS: Thoracic and lumbar spine multi-slice spiral CT was undertaken on 52 girls with AIS between the age of 10 and 18 years from June 2004 to May 2008 in Peking Union Medical College Hospital and Beijing Shijitan Hospital, and 54 age and gender-matched non-IS controls. Multiple measurements (including the anterior column and posterior column) of each thoracic and lumbar vertebra were obtained using the 3D-MPR technique. The patients and control were divided into 10-14 years old group and 15-18 years old group. The corresponding vertebral anterior height, vertebral posterior height, transverse distance, vertebra central width, vertebra anterior-posterior distance, area of pedicle, pedicle height, pedicle width, and upper-lower facet distance were compared. RESULTS: Compared with the controls, the 10-14 years old group girls' spine had longer anterior column height, relative shorter posterior column (there are difference from thoracic 2-11 and lumbar 1-3, P < 0.05), relative longer anterior-posterior vertebral distance, vertebral wedging changes in vertebral, distinct vertebral and pedicle asymmetry on the concave and convex side, and upper-lower facet distance asymmetry on the concave and convex side. The difference between the anterior and the posterior column ratio was significantly different from that in the controls (P < 0.01). But there hadn't the same difference in 15 - 18 years old group. CONCLUSIONS: There are differences in coronal plane vertebra wedging changes in AIS patient. There are high vertebra height, relative shorter posterior column, relative longer anterior-posterior vertebral distance, and relative slender vertebra in 10 - 14 years old AIS patients. This may lead to the initial and progression of scoliosis.

Simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kyphoscoliosis.

OBJECTIVE: To evaluate the efficacy of simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra. METHODS: Twenty-one consecutive cases with congenital kyphoscoliosis, which were 8 males and 13 females, underwent one-stage operation of anterior hemivertebra resection and posterior instrumentation. All of the hemivertebra were fully-segmented. The average age at surgery was 11.4 (range, 1.5-16) years old. RESULTS: The average follow-up was 23 (range, 6-50) months. The average Cobb's angle of the coronal curve was 51.4 degrees (30 degrees - 120 degrees) before surgery, 16.9 degrees (0 degree - 54 degrees) after surgery, and 19.5 degrees at latest follow-up. The angle of segmental kyphosis was 37.1 degrees (0 degree - 95 degrees) before surgery and 16.1 degrees (0 degree - 48 degrees) after surgery, and 18.2 degrees at latest follow-up. Apical translation was improved from 4.7 cm to 1.9 cm. The average fusion segments were 4.8 (range, 2-10) segments. Complication included pressure sore in one case, pedicle cutting by pedicle screw in one case and elongation of the curve in one case. There was no obvious pseudarthrosis, decompensation, and kyphosis deformity aggravation at latest follow-up. CONCLUSION: One-stage hemivertebra resection has a good result in the surgical treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra, and may shorten fusion levels if performed at an earlier age.