[Comparative study of Kurokawa's double door laminoplasty and modified Kurokawa's double door laminoplasty for the treatment of cervical disorders].

OBJECTIVE: To observe and compare the medium-long-term efficacy of Kurokawa's and modified Kurokawa's double door laminoplasty for the treatment of cervical disorders. METHODS: A retrospective analysis was performed to compare the outcomes and complications between two kinds of operations on 172 cases from January 2002 to December 2010, including 106 cases of cervical spondylotic myelopathy, 52 cases of cervical stenosis, 21 cases of cervical ossification of the posterior longitudinal ligament. Patients were divided into two groups according to two surgical methods: traditional group, including 51 male and 18 female patients, with mean age of (56 ± 18) years (35-76 years); modified group, including 75 male and 28 female patients, with mean age of (58 ± 20)years (35-80 years). The two groups were comparable and compared according to different data using t test, χ(2) test and rank sum test. RESULTS: All patients were followed up continuously for (52 ± 33)months, 123 patients were followed up ≥ 2 years, 71 patients ≥ 5 years. All patients' Japanese Orthopaedic Association (JOA) score improved significantly at the latest follow-up(t = 3.420, P < 0.01); no significant difference between the patients' JOA score improvement rate of two groups. The postoperative incidence rate of axial symptoms in patients of modified group (3.9%) was significantly lower than the traditional group (14.5%) (χ(2) = 7.548, P < 0.05), and cervical intervertebral activity decreased in the modified group was better than the traditional group in the first 3 months postoperatively (27% ± 6% vs. 19% ± 4%,Z = 6.34, P < 0.05), but during the medium-long-term follow-up, no significant difference in the cervical intervertebral activity decreased between two groups. CONCLUSIONS: Medium-long-term efficacy of Kurokawa's and modified Kurokawa's double door laminoplasty is satisfied and reliable. Avoiding damaging of semispinalis cervicis insertion in spinous process of C2, the modified operation method can protect the extensor group of the neck muscle and reduce the incidence of postoperative axial symptoms better.

Serum levels of IL-33 is increased in patients with ankylosing spondylitis.

Interleukin-33 (IL-33) is implicated in rheumatoid arthritis with effects of promoting tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17) productions, which have been demonstrated to play a pivotal role in ankylosing spondylitis (AS). However, changes of IL-33 levels and its effects in AS have not been investigated. Eighty-nine and 178 healthy controls were included in the current study. Erythrocyte sedimentation rate, serum levels of C-reactive protein, IL-17, and IL-33 were determined. Effects of IL-33 on TNF-α and IL-6 productions were investigated. Effects of IL-33 on neutrophil migration were also evaluated. Serum levels of IL-33 were elevated in AS patients. Moreover, IL-33 was significantly higher in active AS patients according to Bath Ankylosing Spondylitis Disease Activity Index. IL-33 concentrations in serum were positively correlated with TNF-α and IL-17 levels (IL-33 and TNF-α, r = 0.54, P < 0.01; IL-33 and IL-17, r = 0.47, P < 0.01). IL-33 dose-dependently enhanced TNF-α and IL-6 productions by peripheral blood mononuclear cells (PBMCs) responding to lipopolysaccharide. IL-33 induced neutrophil migration only in higher doses (≥10 ng/ml). Serum levels of IL-33 were elevated in AS patients. IL-33 may play a role in AS development via enhancing TNF-α production by PBMCs and inducing neutrophil migration.

Transpedicular fixation in management of thoracolumbar burst fractures: monosegmental fixation versus short-segment instrumentation.

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVE: To compare the clinical and radiologic late results of monosegmental transpedicular fixation versus short-segment pedicle instrumentation (SSPI) in management of thoracolumbar burst fractures and evaluate the efficacy of monosegmental transpedicular fixation. SUMMARY OF BACKGROUND DATA: SSPI (1 level above and 1 below the fracture level) are accepted by many surgeons as an accepted technique for the treatment of thoracolumbar burst fractures. To preserve more motion segments, some authors have advocated monosegmental pedicle instrumentation (MSPI). The recent developments showed that MSPI yielded good clinical results; however, there were no report about comparison of clinical outcome between monosegmental and biosegmental transpedicular fixation in management of thoracolumbar burst fractures. METHODS: Eighty-five patients with thoracolumbar burst fractures fulfilling the inclusion criteria were included in the study. The patients were randomized by a simple method into 2 groups. Group 1 were treated with monosegmental transpedicular fixation (n = 47), and group 2 were treated with biosegmental transpedicular fixation (n = 38). Clinical (Low Back Outcome Score and Oswestry Disability Index) and radiologic (load-sharing classification index, sagittal index, and percentage of anterior body height compression) outcomes were analyzed. RESULTS: The 2 groups were similar in age, follow-up period, and severity of the deformity and fracture. The postoperative and follow-up sagittal index, local kyphosis, percentage of anterior body height compression, and average correction loss in local kyphosis in both groups were not significantly different. The failure rate between the 2 surgical approaches was also not significantly different (group 1 = 6.38% and group 2 = 5.26%). Oswestry Disability Index improved in both groups by >25 points in a similar amount (P = 0.23). The average follow-up Low Back Outcome Score was 74.9 and 60.2 for group 1 and group 2, respectively (P = 0.033). CONCLUSION: In conclusion, radiologic parameters demonstrated that both MSPI and SSPI are the effective and reliable operative techniques for selected thoracolumbar burst fractures. MSPI shortened the operative time and decreased the amount of blood loss significantly and, thus, offered better clinical results. Nevertheless, long-term studies are supposed to be performed to support the outcomes.