Systemic Inflammatory Markers and Clinical Outcomes of Open versus Biportal Endoscopic Transforaminal Lumbar Interbody Fusion.

Purpose: The purpose of this study is to preliminarily assess the change in perioperative systemic inflammatory markers and clinical outcomes between open TLIF and BE-TLIF procedures. Patients and Methods: In total, 38 patients who underwent single-level lumbar fusion surgery (L4-5 or L5-S1) were retrospectively reviewed. 19 patients were treated by the BE-TLIF technique, while the other patients were managed using open TLIF. The perioperative serum C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), and platelet/lymphocyte ratio (PLR) of the two groups were compared to determine if there was a statistical difference. Meanwhile, clinical evaluations were conducted to assess various factors including operative duration, estimated blood loss (EBL), drainage catheter stay, length of hospitalization, visual analogue scale (VAS), and Oswestry disability index (ODI) scores. Results: The perioperative analysis revealed that BE-TLIF cases experienced a longer operative duration than open TLIF cases (open TLIF: 138.63 ± 31.59 min, BE-TLIF: 204.58 ± 49.37 min, p < 0.001). Meanwhile, the EBL showed an increased trend in the BE-TLIF group (260.7 ± 211.9 mL) in comparison with the open TLIF group (200.9 ± 211.9 mL) (p =0.485). In terms of systemic inflammatory markers, the mean postoperative CRP, NLR, LMR, and PLR were lower in the BE-TLIF group than in the open TLIF group, although these differences were not statistically significant (p > 0.05). The VAS and ODI scores in both groups were significantly improved after surgery (p < 0.05). Conclusion: There was no significant difference found between BE-TLIF and open TLIF in terms of systemic inflammatory markers, and clinical outcomes. Overall, BE-TLIF can be considered a viable choice for lumbar canal decompression and interbody fusion for less invasion. It is worth noting that BE-TLIF does have a longer operation time, indicating that there is still potential for further improvement in this technique.

[Comparative analysis of unilateral biportal endoscopic discectomy, percutaneous endoscopic lumbar discectomy, and fenestration discectomy in treatment of lumbar disc herniation].

Objective: To investigate the effectiveness of unilateral biportal endoscopic discectomy (UBED), percutaneous endoscopic lumbar discectomy (PELD), and traditional fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). Methods: The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed. They were divided into FD group (160 cases), PELD group (86 cases), and UBED group (101 cases) according to operation methods. There was no significant difference in gender, age, surgical level distribution, disease duration, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between groups ( P>0.05). The operation time, hospitalization stay, treatment cost, and incidence of surgery-related complications were recorded and compared between groups. The patients' pain and functional recovery were evaluated by VAS score and ODI before and after operation. Results: The operation time of FD group was significantly shorter than that of PELD group and UBED group, and the hospitalization stay was significantly longer than that of PELD group and UBED group ( P<0.05); there was no significant difference between PELD group and UBED group ( P>0.05). The treatment cost in UBED group was significantly higher than that in PELD group, and in PELD group than in FD group ( P<0.05). All the patients were followed up 6-24 months, with an average of 14.6 months. VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation ( P<0.05). At 1 day after operation, VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group ( P<0.05), but there was no significant difference between PELD group and FD group ( P>0.05). There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation ( P>0.05). The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group ( P<0.05), and there was no significant difference between FD group and UBED group ( P>0.05). Incidence of surgery-related complications in FD group (20.0%) was significantly higher than that in PELD group (12.8%) and UBED group (6.9%), and PELD group was significantly higher than UBED group ( P<0.05). All the incision infection occurred in FD group (12 cases), symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group. Conclusion: UBED, PELD, and FD have similar effectiveness on lower extremity pain in early LDH. Compared with FD, UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.

Periosteum and development of the tissue-engineered periosteum for guided bone regeneration.

BACKGROUND: Periosteum plays a significant role in bone formation and regeneration by storing progenitor cells, and also acts as a source of local growth factors and a scaffold for recruiting cells and other growth factors. Recently, tissue-engineered periosteum has been studied extensively and shown to be important for osteogenesis and chondrogenesis. Using biomimetic methods for artificial periosteum synthesis, membranous tissues with similar function and structure to native periosteum are produced that significantly improve the efficacy of bone grafting and scaffold engineering, and can serve as direct replacements for native periosteum. Many problems involving bone defects can be solved by preparation of idealized periosteum from materials with different properties using various techniques. METHODS: This review summarizes the significance of periosteum for osteogenesis and chondrogenesis from the aspects of periosteum tissue structure, osteogenesis performance, clinical application, and development of periosteum tissue engineering. The advantages and disadvantages of different tissue engineering methods are also summarized. RESULTS: The fast-developing field of periosteum tissue engineering is aimed toward synthesis of bionic periosteum that can ensure or accelerate the repair of bone defects. Artificial periosteum materials can be similar to natural periosteum in both structure and function, and have good therapeutic potential. Induction of periosteum tissue regeneration and bone regeneration by biomimetic periosteum is the ideal process for bone repair. CONCLUSIONS: Periosteum is essential for bone formation and regeneration, and it is indispensable in bone repair. Achieving personalized structure and composition in the construction of tissue engineering periosteum is in accordance with the design concept of both universality and emphasis on individual differences and ensures the combination of commonness and individuality, which are expected to meet the clinical needs of bone repair more effectively. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: To better understand the role of periosteum in bone repair, clarify the present research situation of periosteum and tissue engineering periosteum, and determine the development and optimization direction of tissue engineering periosteum in the future. It is hoped that periosteum tissue engineering will play a greater role in meeting the clinical needs of bone repair in the future, and makes it possible to achieve optimization of bone tissue therapy.

The Dual Effect of Abnormal Serum Uric Acid on Intervertebral Disc Degeneration.

An abnormal serum uric acid (SUA) level is associated with many diseases. To our knowledge, there is no research on the association between SUA and intervertebral disc degeneration (IDD). The purpose of this study was to determine the relationship between SUA and IDD. From June 2011 to July 2020, 691 patients undergoing surgery for lumbar disc herniation (LDH) were included in the LDH group, and 684 patients who underwent endoscopic surgery for knee trauma were included in the non-LDH group. We examined the baseline characteristics of all these patients and divided the SUA level into 10 groups according to the percentiles in males, females, and the total population. Subsequently, the relationship between the SUA level and IDD was further analyzed. There was no statistically significant difference in the baseline characteristics of the two groups (p > 0.05). Among the 10 groups, the LDH rate was higher at both lower and higher SUA levels. In multiple logistic regression analysis, after adjustment for age, sex, body mass index, smoking, and drinking, when the SUA level was <20% or >80%, compared with 60-80%, the odds ratio (OR) and 95% confidence interval (CI) of LDH of the total population were 1.821 (1.125-2.946) and 1.701 (1.186-2.438), respectively, and in the males, they were 1.922 (1.169-3.161) and 2.800 (1.766, 4.439), respectively. In females, when the SUA was <20%, there was a higher LDH rate (OR = 1.951, 95% CI 1.091-3.486). The present study suggests that there is a U-shaped relationship between SUA and IDD, being particularly prominent among male. Lower and higher SUA level may be risk factors for IDD.

Minocycline ameliorates osteoporosis induced by ovariectomy (OVX) and iron accumulation via iron chelation, bone metabolism regulation and inhibition of oxidative stress.

OBJECTIVE: To investigate the effect and mechanism of minocycline on iron accumulation-related postmenopausal osteoporosis. METHODS: The present study established a rat model of ovariectomy (OVX), gave rats ferric ammonium citrate (FAC) and treated them with minocycline, then examined the severity of osteoporosis and iron metabolism in rats. To further explore the mechanism, osteoblasts were treated with FAC and minocycline, then their effects on cell viability, apoptosis, alkaline phosphatase (ALP) activity, bone metabolism proteins, iron metabolism proteins, and oxidative stress in osteoblasts were measured. RESULTS: In the animal study, OVX significantly decreased the serum estradiol level. Both OVX and FAC significantly increased the serum ferritin and tibial iron level, which was significantly decreased by minocycline (P < 0.05). Minocycline significantly increased the ratio of BV/TV, Tb.Th and Tb.N (P < 0.05), and the levels of BALP, BGP and CTX, but decreased the levels of TRAP and ratio of RANKL/OPG (P < 0.05 compared to OVX+FAC group). In the cell study, minocycline significantly decreased the cellular iron accumulation and induced cell death and apoptosis (P < 0.05). Minocycline significantly increased the ALP activity, the expression of Collagen I, Osteocalcin and OPG (P < 0.05). Minocycline significantly decreased the expression of Ferritin and hepcidin, and increased the expression of FPN) (P < 0.05). It also significantly decreased the cellular MD) and protein carbonyl level and RO) intensity, but increased the levels of SO) and GP) (P < 0.05). CONCLUSION: Minocycline ameliorated osteoporosis induced by OVX and iron accumulation. The mechanism may involve iron chelation, regulation of bone and iron metabolism, and inhibition of oxidative stress.

Facet joint parameters which may act as risk factors for chronic low back pain.

BACKGROUND: Facet orientation (FO) and facet tropism (FT) are two important structural parameters of lumbar facet joint. The purpose of this study was to evaluate the association between facet joint parameters and chronic low back pain (LBP). METHODS: From June 2017 to January 2019, a total of 542 cases were enrolled in this study. There were 237 males and 305 females with a mean age of 35.8 years (range 18~59 years). All the cases were divided into a LBP group (LBP group) and a non-LBP group (N-LBP group) in this study. We compared their clinical parameters and facet joint parameters between two groups. RESULTS: The LBP group was composed of 190 male and 252 female, whose ages ranged from 17 to 59 years (35.6 ±7.9 y). The N- LBP group was composed of 47 male and 53 female, whose ages ranged from 18 to 59 years (35.9 ± 7.5 y). Of these parameters, BMI (P = 0.008) and FT (P = 0.003) at all three levels were found to be significantly associated with incidence of chronic LBP (P < 0.05), but FO were only found to be significant at L3-L4 level and L5-S1 level (P < 0.05). Logistic regression analysis showed that high BMI and large FT were significant risk factors for chronic LBP (P < 0.05), and FT were found to might be independent risk factors for chronic LBP. CONCLUSION: FT may play a more important role in the pathogenesis of chronic LBP.

Evaluation of Degenerative Lumbar Scoliosis After Short Segment Decompression and Fusion.

The objective of this study was to investigate short segment decompression of degenerative lumbar scoliosis (DLS) and the efficiency of fusion treatment.After DLS surgery, the patients were retrospectively reviewed using the VAS (visual analog scale) and ODI (Oswestry Disability Index) to assess clinical outcomes. All patients underwent posterior lumbar decompressive laminectomy, pedicle screw internal fixation, and posterolateral bone graft fusion surgery. Radiographic measurements included the scoliotic Cobb angle, the fused Cobb angle, the anterior intervertebral angle (AIA), the sagittal intervertebral angle (SIA), and lumbar lordosis angle. The relationships between these parameters were examined by bivariate Pearson analysis and linear regression analysis.Preoperatively, the Cobb angle at the scoliotic segment was 15.4°, which decreased to 10.2° immediately following surgery (P < 0.05). The AIA significantly increased by the last follow-up (4.4 ± 3.4) compared with pre- and postoperative values (2.5 ± 2.8 and 2.2 ± 2.4, respectively; P < 0.05). However, the scoliotic Cobb angle and the AIA did not correlate with the VAS or ODI scores. At the final follow-up, no patients had pseudoarthrosis or internal instrumentation-related complications.Short fusion surgical treatment results in limited DLS correction, with correction loss over time. The AIA between the upper adjacent segment and proximal fused vertebra continues to increase postoperatively, which does not exacerbate clinical symptoms, as reflected by the low reoperation rates for repairing degeneration at adjacent levels.

Comparative Study of Modified Posterior Operation to Treat Kümmell's Disease.

The present study aimed at examining the curative effect of modified posterior operation on treatment of Kümmell's disease. About 30 patients of Kümmell's disease with complete image and clinical data treated during June 2004 to July 2013 were conducted with anterior and posterior approaches, respectively. Kyphotic Cobb angle, fractured vertebra wedge angle, and the anterior and posterior heights of fractured vertebra were all measured through x-ray before and after operation, and the pain visual analog scale (VAS) was determined for evaluating the effect of operations. The injury and restoration of neurological function were assessed using Frankel classification. Patients in group A were treated with anterior operation, whereas group B was posterior operation. Postoperatively, VAS score, kyphotic Cobb angle, anterior vertebra height, and pathologic vertebra wedge angle were all significantly improved in patients with Kümmell's disease receiving modified posterior operation (group B). Similar results were also observed in patients with anterior operation. The improvement of VAS and correction rate of kyphotic Cobb angle indicated equivalent effects of posterior and anterior operations. Meanwhile, alleviated neurological function damage was observed in 2 groups. Relevant factor analysis illustrated that there was no significant correlation of the severity and improvement rate of pain symptoms with age, medical history, anterior and posterior vertebra heights, kyphotic Cobb angle, and pathological vertebra wedge angle. Compared with traditional anterior approach, modified posterior operation, adopting transpedicular vertebral body grafting combined with vertebral pedicle screw fixation, could produce equivalent effects on kyphosis correction, pain relief, and improvement of neurological function in patients with Kümmell's disease.

Down-regulation of microRNA152 is associated with the diagnosis and prognosis of patients with osteosarcoma.

Potential values of microRNA152 (miR-152) as a serum diagnostic and prognostic biomarker have not been determined in human osteosarcoma. By detecting the expression of miR-152 among 80 osteosarcoma patients, 20 periostitis patients and 20 healthy individuals using qRT-PCR, we aimed to explore the clinical significance of miR-152 in osteosarcoma patients. The expression of miR-152 was significantly decreased in patients with osteosarcoma compared to patients with periostitis (P<0.01) and healthy controls (P<0.01). The relationship between clinicopathologic characteristics and miR-152 was analyzed by chi-square test. The outcome indicated that miR-152 might be linked with the development of osteosarcoma. Moreover, the receiver operating characteristic (ROC) curve was performed to estimate the diagnostic value of miR-152. The result demonstrated that miR-152 might be a promising diagnostic marker of osteosarcoma with an AUC of 0.956, combing with 92.5% specificity and 96.2% sensitivity. The relationship between miR-152 and overall survival of osteosarcoma patients was analyzed by Kaplan-Meier curve and log rank test. As a result, the survival time of patients with low miR-152 expression was significantly shorter than those with high miR-152 expression (P<0.001). Then Cox regression analysis was used to estimate the prognostic value of miR-152 in osteosarcoma. The outcomes showed that low miR-152 expression (P=0.004) might be a potential independent prognostic marker for osteosarcoma patients. These findings suggested that down-regulation of miR-152 could be considered as a predictor for diagnosis and prognosis of osteosarcoma patients.

Association between CTLA-4 gene polymorphism and ankylosing spondylitis: a case-control study.

AIMS: The aim of our study was to evaluate the association between CTLA-4 polymorphisms (+49A/G, -318C/T and CT60A/G) and ankylosing spondylitis (AS) susceptibility. METHODS: A total of 120 AS cases and healthy controls, matched on the age and gender, were enrolled in the study. Polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) were used to determine the gentypes of +49A/G, -318C/T and CT60A/G polymorphisms. Genotype distribution in control group was assessed by Hardy Weinberg Equilibrium (HWE) test. Odds ratio (OR) with 95% confidence interval (95% CI) were adopted to evaluate the relationship of CTLA-4 polymorphisms and AS susceptibility. RESULTS: In our study, genotype distribution of the three polymorphisms in control group was consistent with the HWE (P > 0.05). The genotype analysis showed that AA genotype of + 49A/G polymorphism could increase the risk for AS (OR=2.357, 95% CI=1.127-4.930). Moreover, the frequency of A allele was also presented as a risk factor for AS. Additionally, AA genotype and A allele of CT60A/G appeared to be related with AS susceptibility (OR=2.610, 95% CI=1.047-6.510; OR=1.751, 95% CI=1.160-2.641). However, the T allele of -318C/T appeared to be a protective factor for AS (OR=0.383, 95% CI=0.228-0.643). CONCLUSION: In summary, there existed significant association between CTLA-4 gene polymorphisms and increased or decreased risk for AS.

TNF-α and IL10 polymorphisms interaction increases the risk of ankylosing spondylitis in Chinese Han population.

AIMS: The target of this article was to reveal the role of tumor necrosis factors α (TNF-α) and Interleukin-10 (IL10) gene polymorphisms in ankylosing spondylitis (AS) development and explore the interaction between these two gene polymorphisms. METHODS: The genotyping of gene polymorphims was conducted using ABI Taqman assay method in 84 AS patients and 92 healthy people. Hardy-Weinberg equilibrium (HWE) was checked in the control group and the genotypes and alleles difference were compared with χ(2) test. Odds ratio (OR) with 95% confidence interval (CI) was calculated to identify the strength of association between gene polymorphism and disease. Meanwhile, multifactor dimensionality reduction (MDR) method was used to analysis the interaction between gene polymorphisms. RESULTS: The genotypes CG+CC of the minor allele in IL10 rs1878672 in cases was obviously higher frequency than the controls (P=0.03) and the minor allele C was also associated with the increased risk of AS, compared with G allele (OR=2.05, 95% CI=1.08-3.89). Rs3024490 in IL10 also showed a significant correlation to the onset risk of AS (GG vs. TT: OR=3.03, 95% CI=1.04-8.87; G vs. T: OR=1.70, 95% CI=1.08-2.68). What's more, there was the interaction between TNF-α rs3093662 and IL10 rs3021094, rs3024490 polymorphisms in AS. CONCLUSIONS: IL10 rs1878672 and rs3024490 polymorphisms obviously increase the susceptibility to AS, but not TNF-α rs3093662. Both IL10 and TNF-α polymorphisms may affect the onset of AS.

Genetic analysis of TNFST15 variants in ankylosing spondylitis.

AIMS: The purpose of this study was to explore the role of TNF-like ligand 1A (TL1A) gene (TNFST15) polymorphisms (rs3810936, rs7848647, and rs6478109) in the generation of ankylosing spondylitis (AS). METHODS: Polymerase chain reaction (PCR) and sequencing were used to conduct the genotyping of TNFSF15 polymorphisms in 113 AS patients and 120 healthy persons as the case and control groups. The frequencies comparison was performed by chi-square or t test between the two groups. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated to represent the correlation between TNFSF15 polymorphism and AS. Besides, genotypes distribution of the former in controls was checked by Hardy-Weinberg equilibrium (HWE). RESULTS: There was statistically significant difference in AS patients and controls based on family history. Among TNFSF15 polymorphisms, only TT genotype frequency of rs3810936 in cases was obviously high, compared with the controls (P=0.04), the results indicated that TT was a high-risk genotype (OR=2.31, 95% CI=1.03-5.20). However, both of rs6478109, rs7848647 polymorphisms didn't show any association with AS. CONCLUSION: Rs3810936 of TNFSF15 were related to the risk of AS and we should pay more attention to the role of TNFSF15 polymorphisms in the pathogenesis of AS in the future.

[Association study of WNT3A gene polymorphisms with the susceptibility to congenital scoliosis in a Chinese Han population].

OBJECTIVE: To investigate whether the polymorphisms of WNT3A gene are associated with congenital scoliosis (CS) and its various clinical phenotypes in a Chinese Han population. METHODS: A total of 127 CS patients admitted into PUMC were enrolled into this case-control study between October 2005 and September 2007. There were 55 boys and 72 girls with a mean age of 12.90 years old. Another 127 scoliosis-free control subjects at the same hospital during the same study period were frequency-matched with regards to age (± 3 years) and gender. Genomic DNA was extracted by QIAamp DNA Blood Mini Kit from peripheral blood leukocytes of each subject who had signed informed consent. Based on the genotypic data from the International HapMap project, the main functional single nucleotide polymorphisms (SNPs) were initially selected. The patients in the case group were classified into different clinical phenotypes according to vertebral defect type, location of deformity, extent of developmental disruption, combined rib malformations and neural canal deformity. The genotying of all selected SNPs was performed by SNPstream technology (Beckman Coulter SNPstream). All data of SNPs with polymorphism were processed by the association analysis based on a single SNP and between phenotypes and SNPs. And the pairwise linkage disequilibrium was calculated in the control population by Haploview 4.1 software. RESULTS: The SNP1 (rs964941) and SNP2 (rs752107) of WNT3A were genotyped. There was no linkage disequilibrium between two SNPs. No association was observed between SNP1 and SNP2 genotypes or allele polymorphisms and risk of CS and various clinical phenotypes (P > 0.05). CONCLUSIONS: The genetic variants of WNT3A gene may not be associated with the susceptibility to CS and various clinical phenotypes of CS in Chinese Han population.

[Clinical results of posterolateral fusion in treating lumbar low-grade spondylolisthesis].

OBJECTIVE: To analyze the clinical outcomes and losses of correction for posterolateral fusion on low-grade lumbar spondylolisthesis. METHODS: From October 2001 to July 2008, 37 patients with a mean age of 60.1 years (range, 27 - 88 years) with low-grade lumbar spondylolisthesis treated with posterolateral fusion, including 9 males and 28 females, were reviewed retrospectively. The clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI). The fusion status and loss of correction were assessed using plain radiographs and CT. RESULTS: All the 37 patients had got complete follow-up for 14 - 96 months (average 36.4 months); post-operative reduction rate was 76.4%, and 34 patients (91.9%) showed loss of correction with a mean loss rate 5.8% (range, -3.0% - 25.8%). The percentage of slip of pre-operative, post-operative and final follow-up indicated significant difference (P < 0.05)compared with each other; post-operative intervertebral disc height indicated significant difference in comparison with that of pre-operatively and at final follow-up (P < 0.05); lumbar lordosis angle at final follow-up showed significant difference when compared with that of pre-operatively and postoperatively (P < 0.05); VAS and ODI at final follow-up indicated significant difference in contrast to that of pre-operative (P < 0.05). Upon final follow-up, the complications were found in 2 cases who presented degenerative scoliosis at 15 and 17 months after the surgery, in 1 case with cranial adjacent segment retrolisthesis at the 14 months after the surgery, in 1 case with cut-out and breakage of screws at the 24 months after the surgery, and in 1 case with postoperative infection which were cured after debridement. CONCLUSIONS: For mid-term follow-up of low-grade lumbar spondylolisthesis, posterolateral fusion shows loss of correction in most cases, but presents good clinical outcome and fusion rate.

[Radiological evaluation of intervertebral angles on short-segment fusion of degenerative lumbar scoliosis].

OBJECTIVE: To analyze the radiological change of intervertebral angles after the short-segment fusion of degenerative lumbar scoliosis. METHODS: From January 2001 to May 2007, 28 patients (mean age 62 years old) with degenerative lumbar scoliosis, including 6 male and 22 female, were reviewed retrospectively. The average vertebra number in the lumbar curve were 4.8, ranging from 3 to 6. All the patients underwent posterior decompressive laminotomy, pedicle screw fixation, and posterolateral fusion. The fusion levels were within the curve in all the cases (mean 3.3 vertebrae), without exceeding the end vertebrae. All the patients took standing lumbar antero-posterior and sagittal radiological images pre and post-surgery and upon follow up. The coronal scoliosis Cobb angle, anterior and sagittal intervertebral angles of upper adjacent segment of proximal fused vertebra were measured. The following aspects were also evaluated such as bone graft fusion and complications. RESULTS: Follow up period of 25-97 months, average 50 months; post-operative scoliosis Cobb angle average correction rate was 33.7%, final follow up average correction loss was 3.7 degrees , pre-operative and final follow up results compared with post-operative indicated significant difference (P < 0.05); final follow-up antero-posterior proximal upper fusion segment intervertebral angle compared with pre-operative and postoperative presenting significant difference (P < 0.05). Upon final follow up, all cases did not present pseudo-arthrosis or internal instrumentation related complications. CONCLUSION: For degenerative lumbar scoliosis, short-segment fusion can produce limited correction on antero-posterior proximal upper fusion segment intervertebral angle and cannot stop its aggravation.

The association analysis of TBX6 polymorphism with susceptibility to congenital scoliosis in a Chinese Han population.

STUDY DESIGN: A case-control association study was conducted to investigate the genetic etiology for congenital scoliosis (CS) in a Chinese Han population. OBJECTIVE: To identify whether TBX6 polymorphisms are associated with susceptibility to CS in a Chinese Han population. SUMMARY OF BACKGROUND DATA: CS is a 3-dimensional deformity of the spine, resulting from defection of normal vertebral development. Although there are many types of defects observed in CS, all result from abnormal formation and segmentation of the vertebral precursors, called somites. Developmental studies in animal models have identified many genes regulating somite formation and segmentation. T-box factor, TBX6, is a prerequisite for somite segmentation in vertebrates. In mouse TBX6 knockouts, the phenotypes are similar with that of some human birth defects, such as CS, raises the possibility that TBX6 gene may be a potential susceptibility gene for CS, so we investigated the relations between TBX6 polymorphisms and CS. METHODS: Two known single-nucleotide polymorphisms (SNPs) of TBX6 gene were genotyped among 254 Chinese Han subjects (127 CS patients and 127 controls with matched sex and age) by GenomeLab SNPstream genotyping system. The 2 markers (the only tagging SNP and a functional SNP) with minor allele frequency above 5% were analyzed by the allelic and genotypic association analysis, the genotype-phenotype (CS patients were divided into type I 31 cases [failure of formation], type II 46 cases [a failure of segmentation], and type III 50 cases [mixed defects]) association analysis, and the haplotype analysis. RESULTS: The single SNP analysis showed allele frequency of rs2289292 (exon 8, the only tagging SNP) and rs3809624 (5' untranslated region) demonstrated significant difference between CS cases and controls (P = 0.017 and P = 0.033). No SNP was found to be correlated with clinical phenotype. Moreover, the 2 makers (rs2289292 and rs3809624) in TBX6 gene were found to be in strong linkage disequilibrium (D' = 1.0; gamma = 0.984; 95% confidence interval, 0.96-1.0; LOD = 57.48) in the controls. Both global haplotype analysis and individual haplotype analysis showed that the haplotype of SNP1/SNP2 showed significant association with the disease (P = 0.017), G-A haplotype was more frequently observed in controls than in cases (odds ratio, 0.71; 95% confidence interval, 0.51-0.99). CONCLUSION: This is the first report on SNPs of TBX6 gene in CS that suggests genetic variants of TBX6 gene is associated with CS and may play an important role in mediating susceptibility to developing CS in the Chinese Han population.

[Association study of SIM2 gene polymorphisms with susceptibility to congenital scoliosis in a Chinese Han population].

OBJECTIVE: To investigate whether polymorphisms of SIM2 gene are associated with congenital scoliosis (CS) in a Chinese Han population. and explore the relationship of between polymorphisms of SIM2 and clinical phenotypes of CS. METHODS: A case-control design was employed in this study. A total of 127 patients (55 boys, 72 girls, mean age 12.90 y/o) diagnosed with CS admitted at Peking Union Medical College (PUMC) Hospital were enrolled between October 2005 and September 2007. The scoliosis-free control subjects (127 cases) at the same hospital during the same study period were frequency-matched to the cases on age (+/- 3 years) and gender. Genomic DNA was extracted by QIAamp DNA Blood Mini Kit from peripheral blood leukocytes of each subject who had signed informed consent. Based on genotype data from the International HapMap project, the main functional single nucleotide polymorphisms (SNPs) initially were selected. Case group were classified into different clinical phenotypes according to vertebral defect type, location of deformity, extent of developmental disruption, combined rib malformations and neural canal deformity. Genotying of all selected SNPs was done by SNPstream technology (Beckman Coulter SNPstream). All the data of SNPs with polymorphism were analyzed by association analysis based on a single SNP, the association analysis between phenotypes and SNPs. And pairwise linkage disequilibrium was calculated in the control population using Haploview 4.1 software. RESULTS: SNP1 (rs2073601), SNP2 (rs2073417) and SNP3 (rs2051397) of SIM2 are genotyped. SNP2 and SNP3 in linkage disequilibrium. No association (P > 0.05) is observed between SNP1, SNP2 and SNP3genotypes/allele polymorphisms and risk of CS and different clinical phenotypes. CONCLUSION: Genetic variants of SIM2 gene may not be associated with the susceptibility to CS and different clinical phenotypes of CS in Chinese Han population.

[Assessment of curve flexibility in adolescent idiopathic scoliosis before operation].

OBJECTIVE: To compare the effects in assessing the curve flexibility of the adolescent idiopathic scoliosis (AIS) and predicting the outcomes of operation among different radiological techniques: supine lateral bending (SB), traction (Tr), and fulcrum bending radiographs. METHODS: 68 consecutive AIS patients, all with the single-curve types Ia/Ib/Ic according to the PUMC classification, divided into 4 groups according to the magnitude of Cobb's angle: moderate thoracic curve (n = 19, 40 degrees < Cobb's angle < or = 60 degrees ), severe thoracic curve (n = 13, Cobb's angle > 60 degrees ), moderate lumbar curve (n = 28, 35 degrees < Cobb's angle < or = 60 degrees ), and severe lumbar curve(n = 8, Cobb's angle > 60 degrees ) who were treated surgically underwent preoperative radiological evaluation including standing anteroposterior and lateral Tr, SB, and fulcrum bending radiographs. COBB angle was measured and the flexibility ratio was determined on each radiograph. The amounts of correction obtained by all radiographic methods were compared with the amount of surgical correction. RESULTS: The post-operative Cobb's angle of the moderate thoracic curve group was 9 degrees , not significantly different from that by fulcrum bending radiograph (P = 0.076), but significantly different from those by the other methods (both P < 0.01). The post-operative COBB angle of the severe thoracic curve group was 40 degrees , significantly different from all the radiographs before operation (all P < 0.01). The post-operative Cobb's angle of the moderate lumbar curve group was 4 degrees , significantly different from those by fulcrum bending and Tr radiographs (both P < 0.01) and that by SB (P = 0.013). The post-operative Cobb's angle of the severe lumbar curve group was 24 degrees , significantly different from those of anteroposterior and Tr radiograph (both P < 0.01) and those of fulcrum-bending and SB radiographs (P = 0.021 and P = 0.011). In the moderate thoracic curve group the operation correction rate was not significantly different from the flexibility rate by fulcrum-bending radiograph (P = 0.111), and was significantly different from the flexibility rates by SB and Tr radiographs (P = 0.011 and P = 0.000). In the severe thoracic curve group the operation correction rate was significantly different from the flexibility rates by different kinds of radiograph (all P = 0.111). In the moderate lumbar curve group the operation correction rate was significantly different from the flexibility rates by different kinds of radiograph (P < 0.111 or P = 0.019). In the severe lumbar curve group the operation correction rate was significantly different from the flexibility rates by different kinds of radiograph (P < 0.01 or P = 0.017). CONCLUSION: Fulcrum-bending radiography can better assess the flexibility and correction rate of thoracic curves in AIS, however, it can only predict those in moderate thoracic curves. Fulcrum-bending radiograph and SB radiograph are similar in predicting the flexibility in lumbar curves.