Gray Matter Abnormalities in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Voxel-Based Morphometry Studies.

BACKGROUND: Numerous studies utilizing voxel-based morphometry (VBM) have documented gray matter (GM) alterations in patients with chronic low back pain (CLBP) compared to healthy controls. However, the inconsistency in GM abnormalities observed across different studies has hindered their potential application as objective neuroimaging biomarkers or therapeutic targets. To address this issue, we conducted a comprehensive meta-analysis of VBM studies to identify robust GM differences between CLBP patients and healthy controls. METHODS: The databases including PubMed, Embase, and Web of Science were systematically searched from January 2000 to September 2022 to identify eligible neuroimaging studies. In this coordinate-based meta-analysis of VBM studies, the Seed-based d Mapping with Permutation of Subject Images method was used to quantitatively assess regional differences in GM between CLBP patients and healthy controls. RESULTS: Thirteen VBM studies, involving a total of 574 CLBP patients and 1239 healthy controls, were included in the meta-analysis. The findings revealed that CLBP patients exhibited increased GM in the left striatum and left postcentral gyrus and decreased GM in the left superior frontal gyrus, left cerebellum, right striatum, left insula, and right middle occipital gyrus compared to healthy controls. The jackknife sensitivity analysis confirmed the robustness of these neuroimaging findings. CONCLUSIONS: This study provides new insights into potential treatment strategies for CLBP and identifies neuroimaging biomarkers for pain chronification. These findings highlight the importance of considering regional GM abnormalities in the development of clinical interventions for CLBP.

[Analysis of clinical effects and risk factors of short implant followed up for 7-9 years].

PURPOSE: To evaluate the long-term clinical efficacy of short implants and analyze the influencing factors of the survival rate. METHODS: A total of 178 patients who received implant therapy in the Department of Stomatology, the Fourth Affiliated Hospital of Nanchang University from January 2010 to December 2014 were selected, including 334 short implants of Bicon (implant length ≤6 mm). The basic condition, restoration design, short implant survival rate and complications were observed and analyzed. SPSS 24.0 software package was used for data analysis. RESULTS: The average follow-up time of short implants was 96±17 months. During the observation period, 20 implants failed, 1 implant had mechanical complications and 6 implants had biological complications. Based on the analysis of implants and patients, the long-term cumulative survival rate of short implants was 94.0%(over 5 years survival rate was 96.4%) and 90.4% respectively. There was no significant difference between the survival rate of short implants and the patient's gender, age, whether to use special operation and the type of jaw teeth(P＜0.05). Smoking and periodontitis were risk factors for failure of short implants(P＜0.05).The difference of short implant survival rate between short implants restoration with combined crowns and single crowns was statistically significant(P＜0.05). The survival rate of short implant in mandible was higher than that in maxilla(P＜0.05). CONCLUSIONS: Under the standards clinical program and operation, short implant can be used to shorten the implant restoration cycle and avoid complicated bone augmentation which can achieve good long-term clinical effect. Short implant should be used to strictly control the risk factors that affect the survival of short implant.

SESN1 is a FOXO3 effector that counteracts human skeletal muscle ageing.

Sarcopenia, a skeletal muscle disorder in which loss of muscle mass and function progresses with age, is associated with increased overall frailty, risk of falling and mortality in the elders. Here, we reveal that SESN1 safeguards skeletal muscle from ageing downstream of the longevity gene FOXO3, which we recently reported is a geroprotector in primate skeletal muscle. Knockdown of SESN1 mimicked the human myotube ageing phenotypes observed in the FOXO3-deficient human myotubes, whereas genetic activation of SESN1 alleviated human myotube senescence. Of note, SESN1 was identified as a protective secretory factor against muscle atrophy. Administration of recombinant SESN1 protein attenuated senescence of human myotubes in vitro and facilitated muscle regeneration in vivo. Altogether, we unveil a key role of SESN1 downstream of FOXO3 in protecting skeletal muscle from ageing, providing diagnostic biomarkers and intervention strategies for counteracting skeletal muscle ageing and related diseases.

Surgical treatment of sacral fractures following lumbosacral arthrodesis: Case report and literature review.

Sacral fractures following posterior lumbosacral fusion are an uncommon complication. Only a few case series and case reports have been published so far. This article presents a case of totally displaced sacral fracture following posterior L4-S1 fusion in a 65-year-old patient with a 15-year history of corticosteroid use who underwent open reduction and internal fixation using iliac screws. The patient was followed for 2 years. A thorough review of the literature was conducted using the Medline database between 1994 and 2014. Immediately after the revision surgery, the patient's pain in the buttock and left leg resolved significantly. The patient was followed for 2 years. The weakness in the left lower extremity improved gradually from 3/5 to 5/5. In conclusion, the incidence of postoperative sacral fractures could have been underestimated, because most of these fractures are not visible on a plain radiograph. Computed tomography has been proved to be able to detect most such fractures and should probably be performed routinely when patients complain of renewed buttock pain within 3 mo after lumbosacral fusion. The majority of the patients responded well to conservative treatments, and extending the fusion construct to the iliac wings using iliac screws may be needed when there is concurrent fracture displacement, sagittal imbalance, neurologic symptoms, or painful nonunion.

[Analysis of sagittal parameters about senior thoracolumbar proximal junctional kyphosis after lumbar long segment fusion].

OBJECTIVE: To explore the radiographic risk factors of senior thoracolumbar proximal junctional kyphosis (PJK) after lumbar long segment fusion. METHODS: From January 2009 to December 2011, the PJK group enrolled 9 patients who satisfied the following criteria: being older than 60 years, having lumbar fusion operation no less than 4 levels, upper instrumented vertebrae being L1 or L2, emerging PJK in 2-year follow-up, and the control group enrolled 10 matched patients without PJK. Their sagittal parameters including sagittal vertical axis, thoracic kyphosis, lumbar lordosis, upper instrumented vertebral angle, pelvic incidence, sacral slope, pelvic tilt, lumbo-pelvic lordosis on full length spine lateral film were measured, the oswestry disability index (ODI ) scores of the two groups in the last follow up recorded, and the parameters and ODI scores of two groups compared. RESULTS: The phenomena of PJK emerged average 7.9 months post-operation. The patients' lumbar lordosis reduced and compensatory pelvic appeared backward obviously after PJK emerged. Compared with the control group, lumbar lordosis, pelvic radius-T12 (PR-T12), upper instrumented vertebral angle were small in the PJK group, suggesting more severe lumbar pelvic imbalance. The ODI scores of the PJK group and contral group were 40.6 ± 15.9 and 21.5 ± 15.0 respectively, and the difference was significant. CONCLUSION: PJK after lumbar long segment fixation of elderly patients can aggravate the sagittal imbalance and reduce functional scores. The operator should pay great attention to restoring the lumbo-pelvic lordosis.

[Retrospective study of complication of interspinous implants for degenerative lumbar disease].

OBJECTIVE: To summarize and analyze the complications of interspinous implants for degenerative lumbar disease. METHODS: From September 2007 to September 2011, 177 cases with degenerative lumbar diseases were treated with interspinous implants. There were 99 male patients and 78 female patients, the average age was 44.5 years (26 - 71 years). According to the application interspinous dynamic stabilization system type were divided into the Wallis group (136 cases) and Coflex group (41 cases). The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers, lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score. The radiological results including segmental lodosis and segement movement degree were assessed by lumbar X ray and dynamic X ray. Summarize and analyze the complications both during operation and post operation. Quantitative datas were compared by paried-samples t test and complication rate was compared by χ(2) test. RESULTS: There were 168 cases had completed follow-up and the average time was 34.7 months (3 - 50 months). In the final follow-up, lumbar pain VAS, lower limber pain VAS, lumbar JOA score and Prolo functional score were better than pre-operation (t = 10.7, 7.9, 13.4 and 8.8, P < 0.01). Segment lodosis angles was 14° ± 4° which was less than pre-operation 19° ± 4° (t = 9.4, P < 0.01).Segment movement degree was larger in Coflex group (12.6° ± 3.1°) than in Wallis group (9.7° ± 2.7°) (t = 8.6, P < 0.05). Complication rate was 10.7% (18/168), which of Wallis group was 6.2% (8/130) and Coflex group was 26.3% (10/38) (χ(2) = 12.5, P < 0.01). In Wallis group, there were 3 cases with dura tear and cerebrospinal fluid leakage, 1 case with nerve root injury and foot drop, 2 cases with spacer breakage when implantation and change the implants and 2 cases with recurrence of lumbar disc herniation. In Coflex group, there was 1 case with dura tear and cerebrospinal fluid leakage, 2 cases with mild displacement post operation, 1 case with debridement for aseptic wound exudates, 1 case with implant removal for breakage 1 week post operation, 4 cases with recurrence of lumbar disc herniation and 1 case with lumbar disc herniation 6 months post operation of lumbar stenosis. CONCLUSIONS: The application of interspinous implants for degenerative lumbar diseases is effective and relative safe, but would suffer from the risk of complications.

[Clinical characteristics and reoperation of symptomatic adjacent segment degeneration postoperation of lumbar fusion].

OBJECTIVE: To evaluate the clinical characteristics and reoperation of symptomatic adjacent segment degeneration postoperation of lumbar fusion. METHODS: In the study, 28 cases of symptomatic adjacent segment degeneration postoperation of lumbar fusion from May 2007 to April 2012 were retrospectively reviewed,with an average age of (64.3±8.7) years. The mean period between reoperation and primary fusion surgery was (47.5±30.8) months. Symptomatic adjacent segment degeneration located in cephalic segments in 12 cases, in caudal segments in 14 cases and in both segments in 2 cases. Of all the 28 patients, 12 suffered from lumbar stenosis, other 13 from lumbar disc herniation and still other 3 from both lumbar stenosis and disc herniation, of whom 11 were together with segment instability. Localization diagnoses of 19 cases were clear and other 9 received diagnostic nerve root block. The cases were divided into two groups by the type of reoperation,of which 8 cases were in adjacent degenerative segment nonfusion group and the other 20 cases in adjacent degenerative segment fusion group. The clinical results were assessed by lumbar pain visual analog score (VAS) and lower limber pain VAS,lumbar Japanese Orthopedic Association (JOA) score and Prolo functional score before operation and in the final follow-up. RESULTS: In adjacent degenerative segment nonfusion group, the average operation time was (86.3±17.1) min and average blood volume was (125.0 ±37.8) mL of reoperation and 1 case with dural injury; and in adjacent degenerative segment fusion group, the average operation time was (201.6 ±71.0) min and average blood volume was (313.6±218.9) mL of revision surgery and 4 cases with dural injury. The average follow-up period was 25.5 months. In the final follow-up,lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 2.4±1.2, 2.8±1.4,23.5±4.2 and 8.2±1.5,which were better than preoperation 5.5±2.9, 6.8±2.5, 13.7±5.2 and 4.3±2.1, P<0.001; lumbar pain VAS, lower limber pain VAS,lumbar JOA score and Prolo functional score of adjacent degenerative segment nonfusion group were 3.3±1.9, 3.1±1.2, 22.2±4.4 and 7.7±1.6, which were better than preoperation 5.4±2.7, 7.0±2.4, 13.0±5.6 and 3.9±1.9, P<0.001.In the final follow up, lumbar pain VAS of adjacent degenerative segment nonfusion group was better than that adjacent degenerative segment fusion group(P=0.028). CONCLUSION: Symptomatic adjacent segment degeneration postoperation of lumbar fusion is difficult for diagnosis and treatment. Appropriate reoperation could get the good results.

[Biomechanical study of interspinous fixational effect on the stiffness of adjacent segments].

OBJECTIVE: To discuss the effect of interspinous fixation (Wallis) on the stiffness of adjacent segments by biomechanical measurements. METHODS: The surgical segments of all 23 patients were L4/5 lumbar disc herniation with or without lumbar stenosis. Thirteen patients (experimental group) underwent interspinous (Wallis) fixation, and ten patients (control group) underwent PLIF. L3/4 and L5/S1 segmental stiffness and displacement were measured by a spine stiffness gauge (SSG) device during surgery when the vertebral plate was exposed or during spinal decompression or internal fixation. RESULTS: Stiffness of adjacent segments L3/4 and L5/S1 showed no significant difference between the L4/5 segment decompression and the exposure of the vertebral plate. After interspinous (Wallis) fixation of L4/5, the stiffness of the cephalad adjacent segment L3/4 was (45.8 ± 10.7) N/mm, which was 20.5% more than that after exposure of the vertebral plate (P=0.025); After L4/5 PLIF, the stiffness of L3/4 was (35.3 ± 10.7) N/mm and was decreased by 12.4% less than that after exposure of the vertebral plate (P=0.033). The stiffness of the cephalad adjacent segment L3/4 after fixation in the Wallis group was significantly higher than that of the PLIF group (P=0.037). CONCLUSION: After interspinous (Wallis) fixation, the stiffness and the stability of the cephalad adjacent segment increased. The interspinous fixation system (Wallis) has a protective effect on cephalad adjacent segments.

[Prevention for venous thromboembolism prophylaxis after spinal surgery].

OBJECTIVE: To investigate the efficacy and safety of venous thrombus embolism (VTE) prophylaxis according to risk stratifications after spinal surgery. METHODS: From June 2008 to June 2009, we separated 298 spinal patients who had different VTE risk factors into low-, medium- and high-risk groups for 22 cases, 48 cases and 228 cases respectively. Physical prevention measures such as thigh-length thromboembolic deterrent stockings (TEDS) and pneumatic sequential compression device (PSCD) were used in low- and medium-risk groups. In high-risk groups, low molecular weight heparin(LMWH) was applied in addition to physical prevention measures. Lower limb vascular doppler ultrasonography was used to monitor thrombosis pre- and postoperatively. Simultaneously the occurrences of epidural or wound hematoma, mucosal bleeding, thrombocytopenia caused by low molecular heparin and nerve damage caused by extradural hemorrhage were monitored. RESULTS: Among the 298 cases of patients with spinal surgery, DVT occurred in 23 cases, the incidence of DVT was 7.7%. There were 0, 2 and 21 patients with positive findings of deep vein thrombosis on duplex ultrasonograph respectively in low-, medium- and high-risk groups. There was no case of PE. All DVT was thrombosis in calf which was distal to the knee. There was no clinical symptom of VTE. The DVT needed no therapy. The vein with thrombosis was recanalized 3 months after operation. No case caught epidural or wound hematoma, mucosal bleeding, thrombocytopenia caused by low molecular heparin or nerve damage caused by extradural hemorrhage. CONCLUSION: Individual VTE prophylaxis was taken according to risk stratifications. No VTE of clinical value or no complications from prophylaxis happened. So our prophylaxis is effective and safe. But more prospective, case-control studies are needed to assess the efficacy and safety of VTE prophylaxis.

[Retrospective study of combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases].

OBJECTIVE: To assess the efficacy and safety of combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases. METHODS: From September 2007 to September 2008, 16 cases with degenerative lumbar diseases were treated with combined application of interspinous process fixation system and rigid fixation system. The clinical results were assessed by VAS of pain of lumbar and lower limbs, lumbar JOA score and Prolo functional score. The radiological results including implant position (interspinous process, pedicle screws and plates), spinous process fracture, segmental range of motion (the non-fusion fixation segment, and the intermediate segments between fused and non-fused segments) which were assessed by lumbar static and dynamic X rays. RESULTS: All 16 cases obtained an average follow-up of 17.6 months. At final follow up, lumbar VAS, lower limbers VAS, lumbar JOA score and Prolo functional score were significant improved than those of pre-operation (lumbar VAS: 1.9 +/- 1.4 vs. 4.5 +/- 3.1; lower limbs VAS: 1.7 +/- 1.2 vs. 6.3 +/- 2.9; lumbar JOA score: 22.8 +/- 3.3 vs. 12.5 +/- 4.7; Prolo functional score: 8.3 +/- 1.2 vs. 4.0 +/- 2.3). Range of motion of the non-fusion fixation segment was (9.8 +/- 4.2) degrees and that of the intermediate segments between fused and non-fused segments was (13.2 +/- 3.5) degrees . CONCLUSIONS: Combined application of interspinous process fixation system and rigid fixation system for degenerative lumbar diseases provides a new idea to avoid the multi-segment fusion fixation and pertinent potential problems. Short-term clinical results are successful.

[Distant pain after thoracolumbar compressive fracture].

OBJECTIVE: To retrospectively analyze the causes and treatment of distant pain after thoracolumbar compressive fracture. METHODS: The investigators retrospectively analyzed 14 cases of thoracolumbar compressive fracture with distant pain, observed the pain region and its relationship with thoracolumbar compressive fracture and administered the treatment of pain. RESULTS: There were 14 cases of thoracolumbar compressive fracture with lumbar sacral pain whose painful region were located in paravertebral muscles (n = 6), near iliac crest (n = 5) and in hypochondrium (n = 3). Five and 7 cases of pain disappeared after vertebroplasty and local injection respectively and 2 cases were relieved with analgesics. Eighteen patients with thoracolumbar vertebrae fractures (T11-L2) were fixed with short segment pedical screw fixation, the instrumentation removed at 1 year post-operation and their Cobb's angle and trauma vertebra height measured from 0.5 - 2 years after instrumentation removal. CONCLUSION: The cause of distant pain after thoracolumbar compressive fracture maybe be related with radiating pain resulting from irritated nerves in the vertebral fracture region or distant soft tissue pain. A timely pain treatment can relieve the patients' symptoms.

[Hydrology and pollution characteristics of urban runoff: Beijing as a sample].

The purpose of this study is identification and characterization of hydrological process of urban runoff, as well as concentration variation of pollutants in it. Samples were collected in 4 rainfall events in Beijing from Jun. 2006 to Aug. 2006. Hydrology and pollution of the rainfall-runoff process were analyzed on roof and road. Study results show that the shapes of hydrological curves of runoff, despite for a 5 - 20 min delay and a milder tendency, are similar to rainfall curves. Runoff coefficients of roof are 0.80 - 0.98, while 0.87 - 0.97 of road. Event mean concentrations (EMC) of pollutants are influenced by build-up and wash-off features, which leads to a higher concentration in road runoff than in roof runoff. Major pollutants that excess the water quality standards are COD, TN, and TP. Evident correlations (> 0.1) are found between pollutants. Correlation with particles are higher for COD and SO4(2-) (> 0.5), while lower for nutrients (<0.5). First flush effects (FFE) are found and affected by several factors, such as pollutant variety, types of land covers, and rainfall intensity. FFE are found more intense in SS, more frequently in road runoff, and more difficult to form for COD and nutrients with low rainfall intensity. Therefore, control of first period of runoff would be an effective approach for runoff management in Beijing.

[Surgical treatment of cervical spondylotic amyotrophy].

OBJECTIVE: To investigate the clinical characteristics and treatment of cervical spondylotic amyotrophy. METHODS: 9 cervical spondylotic amyotrophy patients and 15 cervical radiculopathy, myelopathy spondylosis patients were included in this study. Their clinical manifestation, MRI image results and treatment were analysis. Of 9 cervical spondylotic amyotrophy patients, 7 cases were done with cervical discectomy, 2 cases were done with combined cervical anterior and posterior operation; of 15 radiculopathy, myelopathy spondylosis patients, 12 cases were done with cervical discectomy, 3 cases were done with combined cervical anterior and posterior operation. RESULTS: Cervical spondylotic amyotrophy patients were followed up 6-36 months, muscle power of 9 patients were improved markedly, muscle power of 6 patients were improved from grade II preoperation to grade IV-V postoperation after operation 6 months, relief rate is 75%-100%, that of 2 patients were improved from grade III preoperation to grade IV-V postoperation, relief rate is 50% and 100% respectively, that of 1 patient (multiple segments) were improved from grade I preoperation to grade III postoperation, relief rate is 50%; 8 patients were followed up over 12 months, muscle power of 7 patients were improved to grade V, relief rate is 100%, that of 1 patient were improved to grade IV, relief rate is 80%. Cervical radiculopathy, myelopathy spondylosis patients were followed up 12-36 months, muscle power of 15 patients were improved respectively, muscle power of 15 patients were improved from grade II-IV preoperation to grade III-V postoperation after operation 6 months, relief rate is 20%-100%, all 15 patients were followed up over 12 months, muscle power of 11 patients were improved to grade V, relief rate is 100%, that of 3 patient were improved to grade IV, relief rate is 20%-50%, that of 1 case keep unchanged. CONCLUSION: Cervical spondylotic amyotrophy is a rare type of cervical spondylotic disorder, it is easily misdiagnosed because it is confused with motor neuron disease. MRI and electromyography can help to diagnose. The mechanism of cervical spondylotic amyotrophy maybe is that compression of anterior horn of spinal cord or ischemic injury of spinal cord. Surgical treatment can help to improve muscle power, prognosis of single segment is better than that of multiple segments.

[Influence factors of adjacent segment degeneration after instrumented lumbar fusion].

OBJECTIVE: To investigate the influence factors of adjacent segment degeneration (ASD) after instrumented lumbar fusion. METHODS: Thirty-three patients who had undergone an instrumented lumbar fusion from March 1998 to May 2002 were reviewed. The incidence, age, position, radiographic characteristics and clinical manifestations of ASD were studied. Then the relations between "floating fusion" and ASD were compared, the range of fusion and ASD and investigated the incidences of different adjacent segments. RESULTS: The mean follow-up period for the patients was 4 years and 7 months (24 - 82 months). Adjacent segment degeneration mainly occurred in patients older than 60. Ten patients (10%) were found to have radiographic characteristics of ASD. Nine of the ten patients had ASD at cranial segments. Using "floating fusion" or not did not show difference in the risk of ASD. There was a trend of more ASDs after long-segment fusion than short-segment fusion. As an adjacent segment, L(2)/L(3) had a high risk of ASD, while L(5)/S(1) had a much lower risk. CONCLUSIONS: The cranial segment has a higher degeneration risk than the caudal segment. If L(2)/L(3) has degenerative appearance and has chance to be the adjacent segment, we'd better fuse it. If there is no evidence of obvious degeneration, L(5)/S(1) should not be fused. During instrumented lumbar fusion, long-segment fusion should be avoided if possible.