TGF-ß1 related inflammation in the posterior longitudinal ligament of cervical spondylotic myelopathy patients.

AIM: This study aimed to elucidate the pathogenesis of posterior longitudinal ligament (PLL) hypertrophy. METHODS: Cervical PLL specimens were collected from CSM patients during surgery (n = 30) and during routine autopsy (n = 14), and processed for histological examination (HE staining and Masson's Trichrome staining) and IHC (CD3, CD68, CD31, TGF-ß1 and collagen II). In addition, the mRNA expression of collagen I was detected in cervical PLL specimens from 16 CSM patients (n = 16) and from routine autopsy (n = 16) by RT-PCR. RESULTS: Obvious fibrosis, cartilage metaplasia and calcification were found in the cervical PLL of CSM patients. In the degenerated PLL, CD68(+) macrophages were frequently identified, CD3(+) T lymphocytes were occasionally found, and many newly generated small vessels were also present. In the degenerated PLL, of the number of TGF-ß1 positive cells increased markedly when compared with control group. IHC indicated TGF-ß1 was secreted by macrophages. RT-PCR showed a significantly lower mRNA expression of collagen I in the PLL of CSM patients as compared to control group. CONCLUSIONS: Macrophages are the major type of inflammatory cells involved in the cervical PLL degeneration, and TGF-ß1 is related to the cervical PLL degeneration. TGF-ß1 is mainly secreted by macrophages. Anti-inflammation may serve as an alternative non-surgical treatment and prophylactic strategy for PLL degeneration.

[Clinical outcomes of percutaneous kyphoplasty under local anesthesia for osteoporotic vertebral compression fractures].

OBJECTIVE: To analyze the clinical outcomes of percutaneous kyphoplasty under local anesthesia for osteoporotic vertebral compression fractures. METHODS: In this study, 76 elderly patients with osteoporotic vertebral compression fractures undergoing percutaneous kyphoplasty were followed up for 2-3.1 years. They were divided into 3 groups according to different ages: 60-69 yrs (A group), 70-79 yrs (B group) and 80- 91 yrs (C group). Pre- and post-operative and last follow-up evaluations were conducted. And the parameters of bone mineral density (BMD), kyphotic angle, change of visual analog scale (VAS), Oswestry disability index, average vertebral body height, complications and costs of hospitalization were recorded and analyzed. RESULTS: BMD decreased with advancing age and had statistical significance between three groups (P < 0.05). Three thoracic spine fractures and 6 lumbar spine fractures could not be detected with digital radiography and were observed only on magnetic resonance imaging (MRI). The pre-operative levels of visual analogue scale and Oswestry disability index increased in all groups.No statistical significance existed between A and B groups. But there was statistical significance between A or B and C groups (P < 0.05). Pre- and post-operative assessments showed that statistically significant improvements were found in visual analogue scale and Oswestry disability index in all groups (P < 0.05). And statistically significant improvements were found for the pre- and post-operative kyphotic angles and vertebral body heights in A, C group and B groups (P < 0.05). The sites for symptomatic leakage of cement included paravertebral vein (n = 2), intervertebral disc (n = 1) and paravertebral space (n = 2). Adjacent vertebral fracture occurred in 1 patient at 17 months and underwent percutaneous kyphoplasty. The mean operative duration was 28 minutes per vertebrae and the mean cost of hospitalization at RMB yuan 33 778. CONCLUSION: As a simple and safe procedure for osteoporotic vertebrae compression fractures, percutaneous kyphoplasty may relieve pain quickly, restore vertebral height, prevent further fractures and improve the patient's quality-of-life.

Management of postoperative instrumented spinal wound infection.

BACKGROUND: Wound infection following spinal instrumented surgery is a frequent complication. The optimal treatment of acute deep wound infection following spinal instrumentation fusion remains controversial because of variability in cohort identification, definition of an infection, and the instrument used to measure outcomes. This retrospective study evaluated the clinical curative effect for postoperative spinal infection after instrumented spine fusion with extensive debridement, or implant removal. METHODS: From January 2004 to October 2009, 851 patients were identified who underwent surgical treatment of spinal diseases. The medical records of patients who developed infections were reviewed in detail. RESULTS: Of 851 patients, 41 (4.9%) developed an infection. Thirty-three were acute, and eight were delayed. Acute infected cases were managed with antibiotic therapy, and aggressive debridement of the wound and soft tissues leaving all instrumentation in situ in all but one patient. The most common symptoms of acute infection included: posterior incisional drainage (26 of 33 patients), back pain (22 of 33 patients) and fever (13 of 33 patients). Among patients with delayed onset infection, five of eight patients had local pain, four of eight patients had incision drainage, and one patient had a prolonged period of intermittent fever. The most frequent causative organism for postoperative spinal infection following spine surgery is Staphylococcus aureus. Pseudarthrosis was noted in long-term follow-up in four of 41 patients. CONCLUSIONS: We recommend irrigation and debridement, no instrumentation removal, and, if necessary, repeat debridement followed by delayed primary closure for the treatment of acute deep infection with instrumentation.

[Risk factors for delirium of elderly patients undergoing hip fracture operation].

OBJECTIVE: To explore the causes for delirium of elderly patients after hip fracture operation. METHODS: A total of 68 cases of delirium were selected from 458 patients aged over 65 years undergoing hip fracture operation via spinal anesthesia from 2009 to 2011. There were 26 males and 42 females with an average age of 72.9 (66-98) years. Their clinical features, such as gender, operative duration, blood loss volume, saturation of arterial oxygen, were observed. After single factor risk analysis, multiple factor analysis was performed by binary Logistic regression. RESULTS: Delirium occurred at certain timepoints during the first postoperative days. The incidence of delirium was 14.9%. The Logistic stepwise regression analysis showed that significant differences existed between delirium and non-delirium in age (P = 0.042), operative duration (P = 0.042), blood loss volume (P = 0.027), hypoxemia (P = 0.019) and preoperative comorbidity (P = 0.029). CONCLUSION: The independent risk factors for postoperative delirium include age, operative duration, blood loss volume, preoperative comorbidity and hypoxemia.

Surgical treatment of adult idiopathic scoliosis: long-term clinical radiographic outcomes.

More adults are suffering from adult idiopathic scoliosis and seeking treatment for their spinal deformities. Adult idiopathic scoliosis can lead to painful spinal osteoarthritis, progressive deformity, spinal stenosis with radiculopathy, muscle fatigue from coronal and sagittal plane imbalance, and psychological effects with a visible deformity. Primary treatment of such conditions is conservative; however, some patients are resistant to conservative treatment or are not candidates for it, and they require surgery. Back pain is likely the most common indication for surgical treatment of scoliosis in adult patients. Pedicle screws offer 3-column purchase and a longer arm compared with hook placement on the lamina. This study is a retrospective analysis of a consecutive series of patients with adult idiopathic scoliosis who were treated with pedicle screw placement. Significant back pain relief and satisfaction can be achieved and maintained over the long term. Restoration of coronal and sagittal balance, or improvement thereof, was achieved in all patients with balance problems. This study clarified several important characteristics of adult scoliosis, and we believe that useful conclusions can be drawn regarding its surgical indications and strategies: (1) pedicle screw construct can gain effective results for treatment of adult idiopathic scoliosis due to its perceived superior power of correction; (2) younger patients present for surgery for different reasons than older patients (progressive deformity or pain); and (3) pain improvement is a more reliable outcome in older patients than younger patients, although younger patients rarely have severe pain symptoms.