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Intervertebral disk (IVD) degeneration (IVDD) can cause various spinal degenerative diseases. Cumulative evidence has indicated that IVDD can result from inflammation, apoptosis, autophagy, biomechanical changes and other factors. Currently, lack of conservative treatment for degenerative spinal diseases leads to an urgent demand for clinically applicable medication to ameliorate the progression of IVDD. Resveratrol (3,5,4'-trihydroxy-trans-stilbene), a polyphenol compound extracted from red wine or grapes, has shown protective effects on IVD, alleviating the progression of IVDD. Resveratrol has been demonstrated as a scavenger of free radicals both in vivo and in vitro. The antioxidant effects of resveratrol are likely attributed to its regulation on mitochondrial dysfunction or the elimination of reactive oxygen species. This review will summarize the mechanisms of the reactive oxygen species production and elaborate the mechanisms of resveratrol in retarding IVDD progression, providing a comprehensive understanding of the antioxidant effects of resveratrol in IVD.

Background Delayed meningeal cyst (DMC) is a rare complication after spinal surgery that is often ignored by clinicians, and its in-depth research is infrequent. In particular, no consensus has been reached about its surgical treatment. We found that patients with a DMC failed after conservative treatment, epidural blood patch, subarachnoid drainage, and initial attempts to eliminate the meningeal cyst. Therefore, we introduce the application of a paraspinal muscle flap repair under a microscope for the treatment of DMC. Methods In this study, 13 patients who were repaired by a paraspinal muscle flap under a microscope for DMC from January 2007 to January 2017 were retrospectively reviewed. Their ages were 18-68 years old (mean age 48.7 years). The course of the disease ranged from 3 weeks to 28 months after the operation for the primary disease, with an average of 10.6 months. Length >5 cm was called a large DMC and length >8 was called a giant DMC. By analyzing the effect of surgical treatment, we summarized the treatment experience of DMC and evaluated the risk factors for the formation of DMC. Results All patients were treated with paraspinal muscle flap repair under a microscope, and they healed well after the operation. There was no cerebrospinal fluid leakage or other operation-related complication. The mean follow-up was 16.5 months. Reexamination of the spine MRI showed no recurrence of the DMC. Conclusions The application of paraspinal muscle flap under a microscope combined with glue, bedrest, and CSF drain, was an effective option for the patients with DMC.

Purpose In our present study, we aimed to investigate (1) whether cervical facet degeneration (FD) affects the clinical functional scores of patients with cervical radiculopathy after single-segment anterior cervical discectomy fusion (ACDF) and (2) whether FD affects the sagittal parameters of the cervical spine. Methods A total of 120 enrolled patients who underwent single-segment ACDF for radiculopathy with more than 2 years of follow-up were classified into two groups based on whether the preoperative mean FD was greater than or less than the mean FD grading score: mild FD group (mean score ≤ 2, n = 102) or severe FD group (mean score > 2, n = 48). Sagittal alignment changes and clinical functional scores were compared between the 2 groups. The relevant factors for FD were identified using multivariate logistic regression. Results Age, duration of symptoms, disc height and interfacet distance were independently associated with preoperative FD (age: P P = 0.020; disc height: P P = 0.045). Compared with the mild FD group, the preoperative VAS (neck pain) score and NDI of the severe FD group were also higher, and the improvement of neck symptoms was better during the follow-up period. However, all clinical scores and radiographic parameters showed no significant differences during the 2-year follow-up. Additionally, no significant differences in the sagittal parameter changes were presented. Conclusion Patients with severe FD tended to experience more severe neck pain before surgery and greater improvement of neck symptoms at the follow-up visit. However, 2-year clinical efficacy and sagittal alignment after ACDF may not be markedly affected by preoperative FD severity. ACDF is considered to be a good choice for patients with radiculopathy, especially for patients with severe FD.

Background To study the impact of changes in spino-cranial angle (SCA) on sagittal alignment and to investigate the relationship between SCA and Neck Disability Index (NDI) scores after laminoplasty (LP) Material and methods In total, 72 patients with multilevel cervical spondylotic myelopathy (MCSM) after laminoplasty (LP) were retrospectively enrolled. Based on the optimal cut-off values of preoperative SCA, patients were classified into low SCA and high SCA groups. Radiographic data were measured, including spino-cranial angle (SCA), T1-slope (T1s), C2–7 lordosis (CA), T1s minus CA (T1sCA), and C2–7 sagittal vertical axis (cSVA). JOA and NDI scores were both applied to assess postoperative and follow-up clinical efficacy. Pearson correlation coefficient and linear regression analysis were respectively calculated between radiographic data and between SCA and NDI. Results The preoperative SCA was significantly correlated with T1s (r = − 0.795), CA (r = − 0.857), and cSVA (r = 0.915). A receiver operating characteristic (ROC) curve model predicted a threshold of SCA (value of 85.2°). At the follow-up period, patients with lower SCA had a higher T1s and CA and a lower cSVA, simultaneously accompanied by greater △T1s, △CA, and △cSVA. The linear regression model demonstrated that SCA in the higher group was positively correlated with NDI, and patients with higher SCA had worse NDI scores (pre: p p p = 0.003) and greater changes of NDI (post: p p = 0.002). Conclusion SCA may be a good predictor of evaluating sagittal balance and planning surgery. Changes in sagittal alignment in the low SCA group were affected more easily, and a higher SCA was associated with worse quality of life. Laminoplasty could be a good choice for patients with lower SCA.

O-arm computer navigation-assisted technology (OACNAT) has been widely used in the treatment of thoracic ossification of ligamentum flavum (TOLF) in recent years, but there are few in-depth studies on the safety and effectiveness of this approach. The purpose of this study was to investigate the clinical effect of accurate surgical treatment for TOLF with OACNAT.From January 2010 to January 2018, the clinical data of 64 patients with TOLF who underwent laminectomy and internal fixation in the Third Hospital of Hebei Medical University were retrospectively reviewed. The patients were divided into group A (with OACNAT, n = 33) and group B (without OACNAT, n = 31) according to the application of OACNAT during the operation. The possible operation-related variables, imaging results, and clinical effects were compared between the 2 groups.In terms of demographics, there were no significant differences between group A and group B in age, sex, body mass index, smoking, drinking, heart disease, hypertension and diabetes (P0.05). In terms of operation-related variables, imaging results, and clinical efficacy, there were significant differences in operation time, wound length, postoperative modified Japanese Orthopaedic Association (JOA) score, JOA score improvement rate, accuracy of screw placement, number of intraoperative fluoroscopy procedures, and cerebrospinal fluid leakage between group A and group B (P0.05). There were no significant differences in other variables between the 2 groups (P0.05). In contrast to group A, in group B, 2 patients had incorrect segmental localization, 3 patients had residual ossified ligamentum flavum after the operation, and 1 patient had postoperative neurologic impairment. On further analysis, compared with group B, group A had a shorter operation time, more accurate screw placement, fewer fluoroscopy procedures, higher JOA score improvement rate, and lower incidence of complications.The use of OACNAT accurately located the position, size, shape, and boundary of ossification of the ligamentum flavum during the operation, which could guide accurate decompression and improve the accuracy of pedicle screw placement. This approach not only reduced the incidence of incorrect segmental localization and incomplete or excessive decompression but also reduced the risk of related complications and improved the accuracy, safety, and effectiveness of the operation.

Background Endplate defects are commonly seen in patients with lumbar degenerative disease. However, little is known about the presence of endplate defects in patients with degenerative spondylolisthesis (DS). In the present study, we have introduced a classification system for endplate defects in patients with DS using routine magnetic resonance imaging findings and explored the correlative factors. Methods Endplate defects were classified into 3 major categories (rim defects, focal defects, and erosive defects) and 5 subtypes (anterior type, posterior type, arc type at the anterior rim, notch type, and Schmorl's nodes). The incidence rates of the endplate defects were compared between the slippage and nonslippage levels. The correlations between the endplate defects and age, sex, disc degeneration, Modic changes (MCs), body mass index, slippage segment, and slippage degree were analyzed. Results Endplate defects were present in 47.43% of the endplates in DS. The most common endplate defects were rim defects. The occurrence of endplate defects, especially anterior defects, was more common at the slippage levels. Endplate defects were associated with age and closely related to MCs and the severity of disc degeneration. The slippage degree, slippage segment, body mass index, and sex differences were not associated with endplate defects in our study. The results obtained using this novel classification system were stable and consistent. Conclusions The results from the present study have shown that the novel radiological classification system of endplate defects is reliable. Endplate defects were associated with slippage but not with the slippage degree or slippage segment differences in DS. The correlation between endplate defects and age and between MCs and disc degeneration were important features on the magnetic resonance imaging scans of patients with DS.

To evaluate the efficacy of locking stand-alone cage (LSC) compared with anterior plate construct (APC) in anterior cervical discectomy and fusion (ACDF). A comprehensive literature search was carried out in PubMed, Embase, Web of Science, and Cochrane Library to screen randomized controlled trials (RCTs) that directly compared LSC with APC in ACDF. The Cochrane Collaboration’s tool was used for assessment of study quality. Data were analyzed with the Review Manager 5.3 software. A total of seven RCTs were included. The results revealed no significant differences between LSC and APC in ACDF regarding the fusion rate, Japanese Orthopaedic Association score, visual analogue scale score, neck disability index score, hospital stay, subsidence rate, cervical lordosis, segmental Cobb angle, and disc height. However, LSC was associated with a significantly shorter operation time, less blood loss, lower overall incidence of dysphagia, and lower adjacent-level ossification (ALO) rate compared with APC. In summary, LSC is not only a safe and effective device for ACDF but also has the advantages of significantly reduced operation time, blood loss, overall incidence of dysphagia, and ALO rate over APC. Therefore, LSC is a better alternative than APC for the patients undergoing ACDF procedures.

To determine the incidence of DVT and to evaluate the risk factors of DVT under LMWH prophylaxis in patients with thoracolumbar fractures caused by high‑energy injuries postoperatively. A total of 534 patients from January 2016 to November 2019 were included in this retrospective study. Medical record data, including demographic data, perioperative variables, and laboratory results, were collected. LMWH prophylaxis was used for DVT in all the patients. The incidence and risk factors of DVT after surgery were identified by logistic regression analysis and receiver operating characteristic (ROC) curve analysis. The overall incidence of postoperative DVT was 18.91% (101/534). Three patients (0.56%) had proximal DVT and ninety-eight (18.35%) patients had distal DVT. The incidence of postoperative DVT in patients with thoracic fractures was 26.80% and 15.50% with lumbar fractures. The multivariate analysis showed that six risk factors increased the incidence of postoperative DVT, including advanced age, decreased lower extremity motor, blood transfusion, duration of bed rests, fibrinogen (FIB), and D-dimer. The ROC analysis indicated that the diagnostic value of D-dimer was highest whose area under the ROC curves (AUC) value was 0.754. Despite LMWH prophylaxis, the risk of postoperative DVT is still very high, especially in thoracic fracture. Advanced age, decreased lower extremity motor, blood transfusion, duration of bed rests, FIB, and D-dimer are risk factors for DVT. Moreover, the diagnostic value of D-dimer is the highest among these factors.

PURPOSE Our research was designed to analyse the postoperative clinical results of patients suffering from single-segment thoracic ossification of the ligamentum flavum (TOLF) combined with dural ossification (DO) who underwent posterior laminar decompression and internal fixation.METHODS This retrospective research included thirty-two patients who underwent surgery for ossifying the ligamentum flavum in the thoracic spine between January 2016 and January 2020. Patients were fallen into one group included patients with evidence of DO during surgery, and the other group included patients without evidence of DO. We assessed and compared general clinical characteristics and health-related outcomes before surgery and during follow-up.RESULTS The DO group had a longer operation duration, more blood loss, and longer hospital stay (operation time: 94.75±6.78 min vs. 80.00±10.13 min, p0.05).CONCLUSIONS Thoracic myelopathy because of ossifying a single thoracic ligamentum flavum is uncommon. Posterior laminectomy and internal fixation combined with intraoperative resection of the ossified ligamentum flavum and dura is an efficient and relatively safe method for treating TOLF with DO, which can provide satisfactory results. Moreover, DO had no significant effect on postoperative neurological recovery and health-related quality of life scores.

Background Our research was designed to decide whether the application of C2 pars screws is an alternative choice for patients with OPLL involving the C2 segment. Methods A total of 40 patients who underwent cervical laminectomy with fusion (LF) from C2 to C6 for OPLL were reviewed. Among them, C2 pedicle screws were placed in 23 patients, who were the pedicle group, and C2 pars screws were placed in 17 patients, who were the pars group. The screw placement and vertebral artery (VA) anatomy presented by standard CT. General clinical characteristics and health-related outcomes were evaluated and compared preoperatively and during the follow-up period. Results The Pars group tended to have a shorter operation duration and less blood loss than the pedicle group (operation time: 115.29 ± 28.75 vs 133.48 ± 26.22, p = 0.044; blood loss: 383.53 ± 116.19 vs 457.83 ± 145.45, p = 0.039). Operation time and blood loss were both independently related to the pars group (operation time: OR = 0.966, p = 0.021; blood loss: OR = 0.993, p = 0.046). The idealization and acceptability of C2 screws in the pars group exceeded those in the pedicle group (100% vs 91.3%). However, no statistically obvious variation in the included complications or health-related outcomes between the pedicle and pars groups was observed. Conclusion In the treatment of patients with OPLL involving the C2 segment, the application of C2 pars screws is an alternative choice, which is not only safer but also reduces the amount of blood loss, shortens the operation time and obtains a more ideal screw placement.

Patients with degenerative lumbar spondylolisthesis (DLS) often suffer from years of low back pain (LBP) due to instability of the lumbar spine and the reduction of disc height. Since January 2016, we have performed oblique lateral interbody fusion (OLIF) on 154 patients. Among these, 56 patients who suffered from DLS underwent OLIF with stand-alone cages. Forty-two patients with a follow-up time that exceeded 1-year were enrolled for this study. The forty-two patients were followed up for at least one year. Operation segments ranged from L3-4 to L4-5. All the patients were with 1-level fusion. The mean postoperative ventral-disc height and dorsal-disc height increased significantly compared with preoperative (P<0.05). A significant postoperative increase was also observed in the mean operative segmental lordotic angle and the whole lumbar lordotic angle (P<0.05). Compared with preoperative, the postoperative VAS significantly decreased with no significant increase in the VAS in the last follow-up. The LBP was significantly relieved. The mean postoperative VAS of LBP decreased significantly compared with the preoperative ((1.6 ± 0.8) vs. (7.8 ± 0.8)). Postoperative complications included psoas major abscess and intervertebral space infection (1/56). Except for one patient whose cage subsided during the last follow-up, the other patients had good cage position. The one whose cage collapsed complained no symptoms including LBP. OLIF with stand-alone cages should be considered as a safe and effective option which can effectively alleviate LBP for the treatment of DLS.

After spine surgery, venous thromboembolism (VTE) is not uncommon in aged patients. This study investigates time-to-event risk factors of postoperative VTE based on medical records of aged patients (age≥60 yr) between January 2013 and December 2018. All participants had undergone lower extremity ultrasonography pre- and postoperatively at the first, second, fourth, eighth, and twelfth weeks. Mann-Whitney U tests and chi-square tests were used for univariate analyses, and Cox regression was utilized for multivariate analyses. A total of 1620 cases were recruited, VTE group (N=382, 23.6%) and non-VTE group (N=1238, 76.4%), aged 67 (IQR 11) years and 65 (IQR 6) years, respectively. The univariate analyses indicated significant differences between the VTE and non-VTE groups regarding advanced age, VTE history, hypertension, fusion, hospital stay, FIB, HDL, D-dimer, and TC (all P

Intervertebral disc degeneration (IVDD) is the main pathological basis of spinal degenerative diseases, and aberrant apoptosis of nucleus pulposus cells (NPCs) is the main cellular process that causes IVDD. In our previous studies, 17β‑estradiol (E2) was demonstrated to protect rat NPCs from interleukin‑1β (IL‑1β)‑induced apoptosis via the PI3K/Akt signaling pathway. However, the downstream signaling pathway of PI3K/Akt is currently unclear. The present study aimed to explore the signaling pathways that are downstream of the PI3K/Akt pathway, including mTOR, NF‑κB and glycogen synthase kinase‑3β (GSK‑3β). Annexin V/propidium iodide double staining was used to determine the incidence of apoptosis. Cell Counting kit‑8 and MTS assays were used to determine the proliferation and viability of NPCs, respectively. Cellular binding was evaluated using a cell‑collagen binding assay. Western blotting was used to determine the protein expression levels of mTOR, NF‑κB and GSK‑3β, and their phosphorylation levels, as well as the expression levels of active caspase‑3. The results revealed that IL‑1β induced NPC apoptosis and increased the early apoptotic rate of NPCs. However, E2 reduced the early apoptosis of NPCs induced by IL‑1β. In addition, E2 suppressed the decrease in cell viability and binding ability caused by IL‑1β cytotoxicity. Western blotting revealed that E2 also reduced the expression of activated caspase‑3, and increased the expression of activated mTOR. As a specific inhibitor of mTOR, rapamycin effectively attenuated the effects of E2. These findings indicated that E2 protected NPCs against apoptosis via activation of the mTOR/caspase‑3 pathway.

Objectives This study aimed to investigate the effect factors associated with the postoperative dissatisfaction of patients undergoing open-door laminoplasty for cervical OPLL. Methods In this study, 194 patients, who underwent open-door laminoplasty for cervical OPLL from January 2009 to January 2016, were retrospectively reviewed. The Patient Satisfaction Index (PSI) was collected at discharge, 6 months, 1 year, and the last follow-up. According to the PSI, patients were divided into satisfied group and dissatisfied group. The possible effect factors included demographic variables and surgery-related variables. Results At discharge, 42 (21.6%) patients were in the dissatisfied group, as compared to the satisfied group, the hospitalization cost, hospital stay, postoperative depression, the axial neck pain, delayed wound healing, and VAS-neck had significant statistical differences. At 6-month follow-up, 25 (12.9%) patients were in the dissatisfied group. The axial neck pain and JOA score had significant statistical differences between the two groups, and no significant differences were found between the two groups in other items. At 1 year with 18 (9.3%) dissatisfied patients and last follow-up with 14 (7.2%) dissatisfied patients, the JOA score and symptom recurrence had significant statistical differences. For further analysis, the dissatisfied patients with axial neck pain at 6 months were significantly higher than that at other terms and the JOA score of the two groups increased gradually with prolonging of restoration years but compared with the dissatisfied group, the JOA scores were obviously better in the satisfied group at the last follow-up. Conclusions Overall, to patients undergoing open-door laminoplasty for cervical OPLL, hospitalization cost and neck pain might be mainly associated with patient dissatisfaction at the early and middle recovery. Patient dissatisfaction at the long-term treatment outcome might be mainly associated with the low improvement rate of JOA score and symptom recurrence.

Objectives The aim of this study was to explore the prevalence and risk factors for axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery. Methods In this study, 88 patients, who underwent multilevel anterior cervical decompression with fusion surgery from January 2012 to January 2017, were retrospectively reviewed. Based on the postoperative axial neck pain, the patients were classified into two groups: axial pain group and no axial pain group. The patients were followed up 3 weeks, 3 months, and 1 year after cervical anterior surgery for the early- and long-term clinical evaluation. The possible effect factors included demographic variables (age, sex, BMI, smoking, drinking, heart disease, hypertension, diabetes, preoperative kyphosis, preoperative axial neck pain, preoperative JOA scores, and ODI) and surgery-related variables (surgical option, vertebral lesions, spinal canal stenosis rate, superior fusion segment, presence of intramedullary high signal intensity). Results The prevalence of axial neck pain was 27.3% (24 cases of 88). Our results showed that preoperative axial neck pain (62% vs 23%, P

Background:Endplate abnormalities in cervical spine were closed related to pre- and post-operative symptoms, and might lead to a certain complication. However, the related researches are few, and the associations between endplate abnormalities and clinical outcomes need more evidence. Correlations between endplate abnormalities and pre- and post-operative cervical sagittal parameters also remain unknown. The purpose of this study was to explore endplate abnormalities in cervical spondylotic myelopathy, and to find potential associations of endplate abnormalities with preoperative cervical sagittal parameters, disc degeneration and symptoms, and clinical outcomes after ACDF.Method:We enrolled 65 patients (34 males, 31 females) who were diagnosed with CSM and were subjected to single-level ACDF with a Zero-P implant at our hospital from 2015 to 2018. The patients were divided into two groups according to whether the endplate was abnormal.We conducted a retrospective study to compare the clinical and radiological results among the two groups.Results:The average age in endplate abnormality group was higher than it in no abnormality group (P

Background To explore the clinical effect of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF. Methods A retrospective study was conducted on the clinical data of 142 patients with TOLF and laminectomy who underwent spine surgery at XXX Medical University from January 2003 to January 2018. According to whether the laminectomy was combined with instrumentation, the patients were divided into two groups: group A (laminectomy alone (LA), n = 77) and group B (laminectomy with instrumentation (LI), n = 65). Comparisons of possible influencing factors of demographic variables and operation-related variables were carried out between the two groups. In this study, the clinical effects of LA and LI in the treatment of TOLF were discussed. Thus, we explored the clinical effect of LA and LI in the treatment of TOLF. Results In terms of demographics, there was a statistically significant difference in BMI between group A and group B (P 0.05). In terms of preoperative symptoms, there was a significant difference in gait disturbance, pain in the LE, and urination disorder between group A and group B (P 0.05). In terms of operation-related variables, there was a significant difference in the preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, operation time, pre-mJOA, post-mJOA at 1 year, and leakage of cerebrospinal fluid between group A and group B (P 0.05). The preoperative average JOA score of group A was 6.37 and that of group B was 5.19. In group A, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.87, 8.23 and 8.26, respectively, and the average JOA score improvement rate was 32.79 %, 38.32 and 38.53 %, respectively. In group B, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.74, 8.15 and 8.29, respectively, and the average JOA score improvement rate was 39.15 %, 46.86 and 47.12 %, respectively. Conclusions Currently, there is no consensus on whether instrumentation is needed after laminectomy for TOLF. We found that for patients with a long duration of gait disturbance, urination disorder, preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT less than 60 %, and shape on the sagittal MRI being beak and low, pre-mJOA had better clinical effects after LI as compared to those after LA, and the incidence of perioperative complications was lower.

Background To explore the relationship between spino cranial angle (SCA) and loss of cervical lordosis (LOCL), and to determine whether SCA has the ability to predict LOCL for patients with cervical myelopathy. Methods A total of 68 consecutive patients with cervical myelopathy who received laminoplasty (LAMP) were selected to the current study. C2–C7 lordosis was defined as a representation of the cervical alignment. Alignment change > 0° was considered LOCL. Multiple linear regression analysis was applied to evaluate the association between LOCL and various sagittal parameters at preoperative, such as SCA, CL, T1s and cSVA. Linear regression analysis was applied to evaluate the relationships between LOCL and preoperative SCA in each subgroup. Results Patients were assigned to three groups depending on the quartile of preoperative SCA. The first quarter of patients were defined as the low SCA group, the last quarter were defined as the high SCA group and the middle half were defined as the middle SCA group. There was no statistically significant difference in age, sex and the type of OPLL among the three groups. Patients in the low SCA group showed more cervical lordosis before surgery and more LOCL after LAMP (p r = − 0.857, p r = − 0.515, p = 0.034). However, there was no significant correlation between preoperative SCA and LOCL in the middle SCA group (r = 0.027, p = 0.881). Conclusions Patients with lower SCA had more lordosis preoperatively and performed more LOCL after LAMP at 2 years of follow-up. Both too high or low preoperative SCA were negatively correlated with the degree of LOCL, while when the SCA fluctuates in a suitable range, it is easier to compensate for the changes of cervical sagittal alignment.

Background To analyze the impact of spino cranial angle (SCA) on alteration of cervical alignment after multi-level anterior cervical discectomy fusion (ACDF) and explore the relationship between SCA and health-related quality of life (HRQOL) scores. Material and methods In total, 49 patients following multi-level ACDF for multi-level cervical spondylotic myelopathy (MCSM) with more than 2 years follow-up period were enrolled. Radiographic data including SCA were measured. Receiver operating characteristics (ROC) curve analysis was applied to confirm the optimal cut-off values of SCA for predicting sagittal balance. Patients were divided into two groups on the basis of the cut-off value of preoperative SCA. Correlation coefficients were analyzed between SCA and HRQOL scores. Results Optimal cut-off values for predicting sagittal balance was SCA of 88.6°. Patients with higher SCA, no matter preoperatively, postoperatively and at follow-up, got lower T1-Slope (T1s), C2–C7 lordosis angle (CA) and higher △SCA (pre vs post: p = 0.036, pre vs F/U: p = 0.022). Simultaneously, pre-SCA, post-SCA, and F/U-SCA in the high SCA group were positively correlated with the pre-NDI, post-NDI, and F/U-NDI scores respectively (pre: p < 0.001, post: p = 0.015, F/U: p = 0.003). However, no correlation was performed in the low SCA group. Conclusion An excessive SCA can be considered to cause poorer clinical outcomes at preoperative and better correction after surgery. The SCA could be used as a new reference value to determine sagittal balance parameters of the cervical spine and to assess the quality of life.

Aim To investigate the effect of 17β-Estradiol (E2) on intervertebral disc degeneration (IVDD) and the related mechanism. Materials and methods Immunohistochemistry was used to detect the expression of estrogen receptor β (ERβ) within intervertebral discs of humans and rats. After that, rat IVDD model was established by needle puncture and bilateral ovariectomy. Then, the serum E2 level was detected by enzyme linked immunosorbent assay, and the degree of IVDD was evaluated by X-ray, magnetic resonance imaging, hematoxylin and eosin staining, and Safranin O-Fast Green staining. Finally, we used immunohistochemistry and immunofluorescence staining to determine the effect of E2 on nuclear factor kappa-B (NF-κB) signal pathway both in vivo and in vitro. Key findings We identified that IVDD was associated with lower levels of ERβ and ERβ levels were inversely correlated with IVDD. The histological staining and radiological results showed that E2 supplement could alleviate IVDD progression. Additionally, immunohistochemistry staining demonstrated that E2 could inhibit nucleus pulposus cell (NPC) apoptosis, matrix metalloproteinases (MMPs) synthesis, and degradation of extracellular matrix (ECM) by inhibiting the activation of NF-κB signal pathway. Furthermore, immunofluorescence staining showed that the above effects of E2 on the NF-κB signal pathway could be blocked by the estrogen receptor antagonist ICI182780 in vitro. Finally, inhibition of NF-κB signal pathway by BAY11-7082 could reduce MMPs synthesis and ECM degradation of NPCs. Significance Collectively, these findings indicated that E2 could effectively ameliorate IVDD by inhibiting NPC apoptosis via inhibition of NF-κB signal pathway.

The purpose of our study was to analyze and compare the spino cranial angle (SCA) in patients with degenerative cervical spondylolisthesis (DCS) and asymptomatic controls and to determine whether SCA could help diagnose DCS.We enrolled 50 patients diagnosed with DCS (4.3%) from among 1168 patients and the same number of asymptomatic participants as the control group by using cervical radiographs. Both groups underwent cervical radiographs and computed tomography at the same time. Various sagittal parameters were measured on computed tomography in a standardized supine position and compared with the asymptomatic control group. The Spearman correlation coefficient was applied to test the correlation among the sagittal parameters in the DCS group. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to determine whether SCA could help predict DCS.Fifty patients were enrolled in the DCS group, and 50 asymptomatic participants were included in the control group. The SCA was significantly lower for the DCS group than for the control group (76.84 ± 7.48 degrees vs. 82.47 ± 8.06 degrees, P0.001), and the T1 slope (T1s) was significantly greater for the DCS group than for the control group (27.29 ± 7.84 degrees vs. 22.28 ± 6.43 degrees, P = 0.001). Except for SCA and T1s, no other parameters showed significant differences. The SCA on the computed tomography scan was significantly correlated with the values of the T1s (r = -0.890, P0.001), cervical lordosis (r = -0.437, P = 0.002), C2-C7 sagittal vertical axis (r = 0.397, P = 0.004), and thoracic inlet angle (r = -0.565, P0.001). Multivariate logistic regression analysis and receiver operating characteristic curve analysis showed that both a lower SCA and a higher T1s could be risk factors for DCS, and an SCA of79.1 degrees demonstrated significant diagnostic value for the detection of DCS.Patients in the DCS group had a lower SCA and a higher T1s. Both a lower SCA and a higher T1s could be risk factors for DCS, and an SCA of79.1 degrees demonstrated significant diagnostic value for the detection of DCS.

While many studies have explored the association between paravertebral muscle (PVM) change and low back pain/lumbar spinal stenosis, little is known about PVM change in adult degenerative scoliosis (ADS). The present study explored the PVM change in ADS and investigated its association with bony structural parameters. We evaluated 78 patients in ADS without radiculopathy (ADS group) and 65 healthy persons without degenerative lumbar diseases (control group). Percentage of fat infiltration area (%FIA) of multifidus muscle at L1 to S1 disk level was measured by MRI, using ImageJ software. Lumbar scoliosis Cobb’s angle, lumbar lordotic angle, lateral vertebral translation, and apical vertebral rotation were recorded in ADS group, and relationship between PVM change and these factors was analyzed. In the control group, the mean %FIA of multifidus muscle was not significantly different between the bilateral sides at all levels (P > 0.05). In the ADS group, the mean %FIA was significantly higher on the concave side than the convex side at all levels (P

Background This study investigated the clinical effect of laminectomy plus pedicle screw fixation in treating thoracolumbar intradural extramedullary schwannomas. Material/Methods Between October 2011 and May 2017, 57 patients undergoing resection of thoracolumbar schwannomas were retrospectively identified and included in the study. Based on the surgical procedures used, all participants were assigned to either the laminectomy-only group (n=33) or the combination group (laminectomy plus pedicle screw fixation, n=24). All participants were followed up for over 2 years. In the laminectomy, the spinal process, vertebral laminae, and bilateral upper articular processes of the surgical segments were completely resected and the lower articular processes were reserved. For further analysis, we evaluated the pain levels using visual analogue scale (VAS) score. The assessment of neurological function was performed with Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI). The comparisons of Cobb angle changes were carried out pre-surgery and post-surgery. Results The demographic data were well matched between the laminectomy-only group and combination group, without significant differences (P>0.05). After surgery, both surgical procedures achieved significant improvement in VAS score, ODI, and JOA score (P0.05). The postoperative change in Cobb angle indicated a significant difference in the laminectomy-only group, but not in the combination group (P

This is a meta-analysis to compare the results between laminoplasty and laminectomy followed by fusion for the patients with multilevel cervical compressive myelopathy. An extensive search of literature was performed in MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), cervical lordosis (C2–7), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0. A total of 23 studies comprising 774 and 743 patients treated with laminoplasty and laminectomy followed by fusion, respectively, were included in the final analysis. The pooled analysis showed that there was no significant difference in preoperative JOA scores [P = 0.89], postoperative JOA scores [P = 0.13], JOA scores improvement rate [P = 0.27], preoperative CCI [P = 0.15], postoperative CCI [P = 0.14], preoperative VAS [P = 0.41], postoperative VAS [P = 0.52], preoperative cervical lordosis (C2–7) [P = 0.46], postoperative cervical lordosis (C2–7) [P = 0.67], total complications [P = 0.07], axial pain [P = 0.94], and blood loss [P = 0.51]. However, there were significant difference in operation time (WMD = −19.57 [−32.11, −7.02], P = 0.002) and C5 palsy (OR = 0.26 [0.15, 0.44], P

Exogenous H2 S donor, sodium hydrosulfide (NaHS), can influence the bleomycin-induced pulmonary fibrosis by attenuating the epithelial-mesenchymal transition (EMT) of alveolar epithelial cells, but whether NaHS affects paraquat (PQ)-induced EMT and the molecular mechanisms remain unclarified. The aim of the present study is to examine the effect of exogenous NaHS on PQ-induced EMT in human alveolar epithelial cells (A549 cells) and assess if this effect occurs through regulating transforming growth factor (TGF)-β1/Smad2/3 signaling pathway. The expressions of endogenous H2 S producing enzymes, namely cystathionine β-synthase, cystathionine γ-lyase and 3-mercaptopyruvate sulfur transferase, were detected by reverse transcription-polymerase chain reaction and western blotting. The induced EMT was assessed by morphological and phenotypic characterizations, and the protein level of E-cadherin and vimentin were detected by western blotting. To investigate the effect of NaHS on PQ-induced EMT and potential mechanism, A549 cells were pretreated with NaHS before incubating with PQ and then evaluated by morphological changes, cell migration ability, the expression of EMT markers and TGF-β1/Smad2/3 signaling pathway related proteins. PQ significantly downregulated the expression levels of cystathionine β-synthase and cystathionine γ-lyase, but not 3-mercaptopyruvate sulfur transferase, in a time-dependent manner in A549 cells. Exogenous NaHS could significantly retard PQ-induced morphological changes and cell migration ability. Furthermore, exogenous NaHS significantly upregulated the expression of E-cadherin, whereas it downregulated the expression of vimentin. In addition, exogenous NaHS could also significantly attenuates PQ-induced TGF-β1, phosphorylated Smad2/3 proteins expression, which induced by PQ in a time-dependent manner. This study provides the first evidence that exogenous NaHS attenuates PQ-induced EMT and migration of human alveolar epithelial cells through regulating the TGF-β1/Smad2/3 signaling pathway.

This study was aimed to further explore whether estradiol (E2) had protective effects on intervertebral disc degeneration (IVDD) in a rat model.Forty, three-month-old female Sprague Dawley (SD) rats were randomly divided into four groups: Sham, Ovariectomy (OVX), E2 and ICI182780 (ICI). Sham group only underwent the resection of a bit fat; OVX group underwent bilateral ovariectomy; E2 group was treated with E2 based on OVX; ICI group was treated with E2 and pretreated ICI182780 (inhibitor of the estrogen receptor) based on OVX. Radiography, hematoxylin and eosin (HE) staining, immunohistochemistry (IHC), western blot and quantitative real-time PCR (qRT-PCR) were applied to detect the apoptosis characteristics of intervertebral disc cells.Radiographs showed marked intervertebral disc narrowing and HE staining showed typical apoptosis characteristics of intervertebral disc cells in OVX, which were reversed by E2. Furthermore, the results of IHC, Western blot and qRT-PCR revealed that OVX-induced IVDD was protected by E2 through decreasing the expression of caspase-3 and intracellular matrix metalloproteinases (MMPs), including MMP-3 and MMP-13, while increasing the expression of collagen Type II. All of the detected effects of E2 were abolished after treatment with ICI182780.17β-E2 inhibits IVDD by down-regulating MMP-3 and MMP-13 and up-regulating collagen Type II in a rat model.

// Si-Kai Liu 1, * , Yan-Li Song 1, * , Wen-Yuan Ding 1, 2 , Da-Long Yang 1 , Lei Ma 1 and Si-Dong Yang 1 1 Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei Province, China 2 Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, 050051, Hebei Province, China * These authors have contributed equally to this work Correspondence to: Wen-Yuan Ding, email: dingwyster@126.com Si-Dong Yang, email: sidongyang@hebmu.edu.cn Keywords: intervertebral disc degeneration; elderly patients; lower-limb rehabilitation gymnastics; orthopedic nursing; postoperative rehabilitation Received: September 16, 2017 Accepted: November 13, 2017 Published: November 28, 2017 ABSTRACT Objectives: The purpose of this study was to explore the effect of systematic lower-limb rehabilitation training in elderly patients undergoing lumbar fusion surgery due to serious degenerative intervertebral disc diseases. Results: At the 1st week after surgery, clinical rehabilitation effect in intervention group was better regarding lower-limb muscle strength, lower-limb DVT, VAS score, and ODI, as compared with control group (all p < 0.05). During the first two weeks after surgery, satisfaction rate in intervention group was higher than that in control group. However, there was no significant difference at last follow-up after surgery when comparing intervention group to control group. Materials and Methods: We retrospectively collected medical records of elderly patients (aged ≥ 60 yrs) undergoing lumbar fusion surgery between 01/2013 and 01/2015 in our department. Some of the identified patients randomly underwent postoperative systematic training of lower-limb rehabilitation gymnastics (intervention group, n = 240), the others not (control group, n = 300). During postoperative period, intervention group received lower-limb rehabilitation gymnastics treatment for 3 months, but control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month. Clinical outcomes were evaluated by scoring lower-limb muscle strength, detecting lower-limb deep venous thrombosis (DVT), visual analogue scale (VAS) score, lumbar JOA score, Oswestry disability index (ODI) questionnaire, and performing satisfaction survey. Conclusions: In early postoperative stage, systematic lower-limb rehabilitation training can effectively speed up the recovery, beneficial to reducing lower-limb DVT and increasing patient satisfaction rate.

Introduction Evidence regarding whether the polyaxial pedicle screws at the upper instrumented vertebrae (UIV) are superior to monoaxial pedicle screws in prevention of proximal junctional kyphosis (PJK) is not clear. The aim of this study was therefore to explore the influence of different types of pedicle screws at UIV on the incidence of PJK. Methods We reviewed retrospectively 242 patients surgically treated with instrumented segmental posterior spinal fusion at a minimum of 4 motion segments. Polyaxial pedicle screws were used at UIV in 125 patients (polyaxial group), and monoaxial pedicle screws were used at UIV in 117 patients (monoaxial group). According to the occurrence of PJK at final follow-up, patients in both the polyaxial and monoaxial groups were then divided into 2 subgroups: PJK and no proximal junctional kyphosis (NPJK). To investigate the risk factors of PJK, 2 categorized variables were analyzed statistically: 1) patient characteristics: age, sex, body mass index (BMI), bone mineral density (BMD), sagittal vertical axis (SVA), thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis (LL), pelvic incidence, pelvic tilt, and sacral slope. 2) Surgical variables: Changes of radiographic parameters include the SVA, thoracic kyphosis, thoracolumbar junctional, LL, pelvic incidence, pelvic tilt, sacral slope, pedicle-upper end plate angle, the number of instrumented levels, and the most proximal and distal levels of the instrumentation. Results PJK was developed in 26 of 117 patients (22.2%) in the monoaxial group and 30 of 125 patients (24.0%) in the polyaxial group. Until the final follow-up, there was no significant difference in the incidence of PJK (χ2 = 0.107, P = 0.734) between the monoaxial and polyaxial groups. There was no significant difference in patient characteristics and surgical variables between the 2 groups, except the proximal junctional angle change ( P = 0.031). In the monoaxial group, there were no significant differences in patient characteristics between the PJK and NPJK subgroups, except BMI ( P = 0.042) and BMD ( P = 0.037). There were no significant differences in change of radiographic parameters, except SVA change ( P = 0.036), proximal junctional angle change ( P = 0.029), LL change ( P = 0.025), and lower instrumented vertebrae location ( P = 0.036). Multivariate logistic regression analysis revealed that obesity, osteoporosis, lower instrumented vertebra at sacrum, and LL change >10 degrees were independently associated with PJK. In the polyaxial group, there were no significant differences in patient characteristics between the PJK and NPJK subgroups, except BMI ( P = 0.032) and BMD ( P = 0.040). There were no significant differences in change of radiographic parameters between the PJK and NPJK subgroups, except P-UP angle ( P = 0.037) and lower instrumented vertebrae location ( P = 0.017). Multivariate logistic regression analysis revealed that obesity, osteoporosis, and lower instrumented vertebra at sacrum were independently associated with PJK. Conclusions Polyaxial pedicle screws at UIV is not superior to monoaxial pedicle screws in prevention of PJK. Obesity, osteoporosis, and lower instrumented vertebra at sacrum are risk factors for PJK in all the patients. Excessive LL reconstruction is the unique risk factor of PJK when monoaxial pedicle screws were used at UIV.

STUDY DESIGN This was a retrospective study. OBJECTIVE Severe osteoporotic vertebral compression fractures with kyphotic deformity are difficult to treat. The objective of this study was to investigate the clinical efficacy of posterior vertebral column resection (PVCR) combined with bone cement augmentation of pedicle screw fixation in the treatment of severe vertebral compression fractures with kyphotic deformity. SUMMARY OF BACKGROUND DATA The data of patients with a severe vertebral compression fracture and kyphotic deformity treated at our university between October 2013 and October 2017 were retrospectively reviewed. MATERIALS AND METHODS All patients underwent PVCR combined with bone cement augmentation of pedicle screw fixation and anterior column reconstruction. The operative time, intraoperative blood loss, postoperative complications, and screw stability at the last follow-up in all patients were documented. The clinical benefits were evaluated by the Visual Analog Scale (VAS) score, Oswestry Dysfunction Index (ODI), Japanese Orthopedic Association (JOA) scores, and Frankel classification. RESULTS The mean Cobb angle, sagittal vertical axis, VAS score, JOA score, and ODI were 48.5±6.9 degrees, 44.0±5.7, 6.5±1.5, 11.2±2.7, and 59.0±5.7 before surgery, respectively. The average follow-up period was 28.7±3.2 months. The Frankel grade in 5 patients with neurological impairment improved from D to E after surgery. The average Cobb angles for kyphotic deformity, sagittal vertical axis, VAS score, JOA score, and ODI were 9.5±3.8 degrees, 18.3±3.5, 2.6±1.2, 20.5±3.6, and 20.7±4.0, respectively, at the last follow-up (all P

Background. In this study, it was aimed to investigate the clinical rehabilitation effect of lower-limb training on the patients that undergo oblique lumbar interbody fusion (OLIF) procedures. Methods. The eligible participants undergoing OLIF procedures between 01/2017 and 07/2019 were identified. All the patients underwent one-segment fusion operation (L3-4 or L4-5). Based on whether the participants received postoperative rehabilitation training, they were divided into two groups: intervention group and control group. Postoperatively, the participants in the intervention group were trained with lower-extremity rehabilitation exercise and maintained for three months. All participants got reexamined at the first postoperative week, the second postoperative week, the first postoperative month, and the third postoperative month (last follow-up). Comparisons were made in terms of the lower-extremity muscle force, visual analogue scale (VAS) score, lumbar JOA score, Oswestry disability index (ODI), the incidence of deep venous thrombosis (DVT), and patient satisfaction. Results. Seventy-seven participants in the intervention group (32 males and 45 females) and 82 in the control group (39 males and 43 females) were incorporated in this study. The median age of the participants was 57 years (39∼73) in the intervention group and 54 years (35∼71) in the control group. No statistical significance between the two groups was found (P>0.05). ODI score was less in the intervention group as compared to the control group in the first week after surgery (P=0.029). VAS and JOA scores were better in the intervention group in the first two weeks after surgery (P<0.05). DVT incidence in the intervention group was lower than the control group at final follow-up (P=0.037). Both group participants have achieved good grading in muscle force rehabilitation but no significant differences between the two groups. Additionally, satisfaction was higher in the intervention group than the control group. Conclusions. In summary, postoperative lower-extremity rehabilitation exercise can effectively accelerate patients’ health recovery from the OLIF surgery and increase their satisfaction.

Background Cervical sagittal parameters were closely related with clinical outcomes after multi-level ACDF. Our purpose was to evaluate the clinical outcomes and cervical sagittal parameters in patients with MCSM after ACDF and to identify the risk factors of poor clinical outcomes. Material and methods ACDF was performed in 89 patients with MCSM. Based on average JOA recovery rate, patients were divided good-outcome group (group GO) and poor-outcome group (group PO). The cervical sagittal parameters including Cobb angle, SVA, T1S, cranial tilt and cervical tilt were measured. Multivariate logistic regression was used to identify risk factors. Results Fifty-four patients (60.67%) were divided into group GO, while 35 patients (39.33%) were divided into group PO. Cobb angle, SVA and T1S was corrected from preoperative average 11.80° ± 9.63°, 23.69 mm ± 11.69 mm and 24.43° ± 11.78° to postoperative average 15.08° ± 9.05°, 18.79 mm ± 10.78 mm and 26.92° ± 11.94° respectively (p p = 0.008) and △SVA (p = 0.009) showed significantly statistical differences between two groups. Longer symptom duration, lower preoperative JOA score, smaller △Cobb angle and larger △SVA were identified as risk factors of poor clinical outcomes. Conclusion Multi-level ACDF is an effective surgical method to treat patients with MCSM. However, long duration of preoperative symptoms, lower preoperative JOA score, smaller △Cobb angle and larger △SVA are risk factors for poor outcomes in patients with MCSM after ACDF. Sagittal parameters should be paid attention to in surgery.

To investigate the association between Modic changes (MCs) and endplate sclerosis; and to investigate the effect of MCs and endplate sclerosis on cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone.We included 78 inpatients who underwent OLIF stand-alone from August 2015 to August 2017. All patients underwent computed tomography (CT) and magnetic resonance imaging. The presence and the types of MCs were assessed. Endplate sclerosis was evaluated from sagittally reconstructed CT images. Cage subsidence was evaluated at the 1-, 3-, 6-, and 12-month follow-up.Of 78 patients, 92 discs underwent OLIF without posterior instrumentation; 32 of 92 (34.8%) had MCs. Type I, II, and III MCs were seen in 10 (10.9%), 19 (20.7%), and 3 (3.2%) endplates, respectively. Among 32 endplates with MCs, 10 (31.3%) showed evidence of sclerosis on CT images, including 2 of 10 endplates (20%) with type I MCs, 5 of 19 (26.3%) with type II, and 3 of 3 (100%) with type III. Among 60 endplates without MCs, 5 (8.3%) showed evidence of sclerosis. Cage subsidence rate in the no-MCs group was higher than that in the MCs group (P 0.01). We found only 1 case of cage subsidence in the MCs group (n = 32), which was classified as MCs type I, whereas 6 cases of cage subsidence were observed in the no-MCs group (n = 60). Hounsfield unit ratios for sclerotic and no-sclerotic endplates were 2.2 ± 0.3 and 1.1 ± 0.1, respectively. No subsidence of cage was found in the sclerotic endplates group (n = 15), whereas 7 cases of cage subsidence were found in the no-sclerotic group (n = 77).MCs associated with endplate sclerosis can prevent cage subsidence in OLIF stand-alone.

This study was designed to investigate the clinical efficacy of laminectomy with instrumented fixation in treatment of adjacent segmental diseases following anterior cervical corpectomy and fusion (ACCF) surgery. Between January 2008 and December 2015, 48 patients who underwent laminectomy with instrumented fixation to treat adjacent segmental diseases following ACCF surgery, were enrolled into this study. The patients were followed up at least 2 years. Pain assessment was determined by visual analogue scale (VAS) score and Neck Disability Index (NDI) score; neurological impairment was evaluated by Japanese Orthopaedic Association (JOA) score; and radiographic parameters were also compared. All comparisons were determined by paired t test with appropriate Bonferronni correction. VAS score preoperatively and at last follow-up was 5.28 ± 2.35 vs 1.90 ± 1.06 (P vs 14.5 ± 1.1 (P vs 10.6 ± 5.8 (P

Nickel compounds are known to be common environmental and occupational carcinogens which also promote the migration of lung cancer cells. However, the molecular mechanism yet remains to be clarified. Hydrogen sulfide (H2S) is involved in cancer biological processes. However, the exact effect and functionality of H2S on nickel, towards the promotion of the migration ability of lung cancer cells, remains to be unknown. In this study, we have found that the nickel chloride (NiCl2) treatment significantly downregulates the protein levels of endogenous H2S enzyme cystathionine β-synthase (CBS), cystathionine γ-lyase (CSE) and 3-Mercaptopyruvate sulfurtransferase (3-MST). A correlation between NiCl2-induced epithelial-mesenchymal transition (EMT) and the migration ability of lung cancer A549 cells has been observed. Exogenous H2S donor, sodium hydrogen sulfide (NaHS) (100 μmol/L), can reverse NiCl2-induced EMT as well as the migration ability of A549 cells. NiCl2 treatment is able to upregulate the protein level of transforming growth factor-β1 (TGF-β1), p-Smad2, p-Smad3, p-JNK, p-ERK and p-P38 in a time-dependent fashion, indicating that both TGF-β1/Smad2/Smad3 and mitogen-activated protein kinase (MAPK) signaling cascades (a non-Smad pathway) may play essential roles in NiCl2-dependent EMT as well as cell migration of human lung cancer cells. Furthermore, exogenous NaHS alleviates the NiCl2-induced EMT and the migration ability of A549 cells only by regulating TGF-β1/Smad2/Smad3, rather than the MAPK, signaling pathway. These results indicate that the exogenous administration of NaHS might be a potential therapeutic strategy against nickel-induced lung cancer progression.

Exogenous H

To analyse the incidence and risk factors associated with proximal junctional kyphosis (PJK) following spinal fusion, we collect relative statistics from the articles on PJK and perform a meta-analysis.An extensive search of literature was performed in PubMed, Embase, and The Cochrane Library (up to April 2015). The following risk factors were extracted: age at surgery, gender, combined anterior-posterior surgery, use of pedicle screw at top of construct, hybrid instrumentation, thoracoplasty, fusion to sacrum (S1), preoperative thoracic kyphosis angle (T5-T12)40°, bone mineral density (BMD) and preoperative to postoperative sagittal vertical axis (SVA difference)5 cm. Data analysis was conducted with RevMan 5.3 and STATA 12.0.A total of 14 unique studies including 2215 patients were included in the final analyses. The pooled analysis showed that there were significant difference in age at surgery55 years old (OR 2.19, 95 % CI 1.36-3.53, p = 0.001), fusion to S1 (OR 2.12, 95 % CI 1.57-2.87, p 0.001), T5-T1240° (OR 2.68, 95 % CI 1.73-4.13, p 0.001), low BMD (OR 2.37, 95 % CI 1.45-3.87, p 0.001) and SVA difference5 cm (OR 2.53, 95 % CI 1.24-5.18, p = 0.01). However, there was no significant difference in gender (OR 0.98, 95 % CI 0.74-1.30, p = 0.87), combined anterior-posterior surgery (OR 1.55, 95 % CI 0.98-2.46, p = 0.06), use of pedicle screw at top of construct (OR 1.55, 95 % CI 0.67-3.59, p = 0.30), hybrid instrumentation (OR 1.31, 95 % CI 0.92-1.87, p = 0.13) and thoracoplasty (OR 1.55, 95 % CI 0.89-2.72, p = 0.13). The incidence of PJK following spinal fusion was 30 % (ranged from 17 to 62 %) based on the 14 studies.The results of our meta-analysis suggest that age at surgery55 years, fusion to S1, T5-T1240°, low BMD and SVA difference5 cm are risk factors for PJK. However, gender, combined anterior-posterior surgery, use of pedicle screw at top of construct, hybrid instrumentation and thoracoplasty are not associated with PJK.

Background The aim of this study was to explore the clinical efficacy of unilateral pedicle screw fixation with bone graft (UPSFB) in treating single-segment lumbar degenerative diseases (LDD), as compared to bilateral pedicle screw fixation with bone graft (BPSFB) or with cage (BPSFC). Material/Methods Medical records were retrospectively collected between 01/2010 and 02/2015 in Longyao County Hospital. According to surgical methods used, all patients were divided into 3 groups: UPSFB group, BPSFB group, and BPSFC group. Clinical outcomes were evaluated by blood loss, blood transfusion, duration of operation, hospital stay, postoperative complications, interbody fusion rate, reoperation rate, medical expenses, patient satisfaction survey, and JOA score. Results Ninety-five patients were included and underwent 2.5-year follow-up, with 7 patients lost to regular follow-up. As compared to the BPSFB group and BPSFC group, the UPSFB group had less blood loss and less blood transfusion, as well as shorter hospital stay (p0.05). Conclusions As compared to BPSFB and BPSFC, UPSFB has the same reliability and effectiveness in treating single-segment LDD with unilateral radicular symptoms in a single lower extremity, with the additional advantage being less expensive.

BACKGROUND Clinically, percutaneous vertebroplasty (PVP) is frequently applied to treat osteoporotic vertebral compression fracture (OVCF). It is believed that new compression fractures are more likely to occur adjacent to the PVP-treated segment, typically within 1 month after PVP. The purpose of this study was to investigate risk factors for adjacent vertebral compression fractures (AVCF) after PVP in patients with OVCF after menopause. MATERIAL AND METHODS Between Jun 2012 and Dec 2016, 412 patients were initially identified. We enrolled 390 patients in this study, and 22 were lost to follow-up. The medical records of the patients were retrospectively collected. Patients were followed up for at least 6 months, with an average follow-up period of 18 months. The potential risk factors investigated in this study included age, duration of menopause (DoM), preoperative vertebral compression, number of preoperative vertebral fractures (NPVF), bone mineral density (BMD), surgical approach (unilateral or bilateral), anesthesia methods, bone cement dose, complications (including COPD), and anti-osteoporosis treatment. Logistic regression analysis was used to determine the risk factors. RESULTS Sixty-eight patients were observed to have suffered from AVCF after PVP at the last follow-up. Univariate analysis showed that age, DoM, NPVF, BMD, COPD, and anti-osteoporosis treatment were the potential variables associated with the onset of AVCF (all P

BACKGROUND Not all patients with spinal cord compression due to cervical spondylotic myelopathy (CSM) have clinical symptoms and signs. The aim of this study was to investigate and compare the imaging findings in asymptomatic and symptomatic patients with CSM with mild to moderate cervical spinal cord compression. MATERIAL AND METHODS A retrospective clinical study included 68 patients. Group A (n=30) had no symptoms and signs; group B (n=38) had symptoms and signs of cervical myelopathy. The age, sex, body mass index (BMI), history of steroid treatment, duration of symptoms, number of spondylotic cervical segments, Torg ratio, range of motion (ROM), incidence of cervical segmental instability, overall curvature of the cervical spine, direction of spinal cord compression, and spinal cord magnetic resonance imaging (MRI) signal intensity were compared. RESULTS For groups A and B, the Torg ratio was 90.3% and 83.6% (P

Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58–4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05–3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26–0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.

Levofloxacin, a fluoroquinolone, is a widely-used and effective antibiotic. However, various adverse side effects are associated with levofloxacin. The purpose of this study was to further explore the effects of levofloxacin on rat nucleus pulposus cells (NPCs). Inverted phase-contrast microscopy, flow cytometry and caspase-3 activity assays were used and revealed that serum deprivation induced apoptosis, which was markedly increased by levofloxacin in a dose-dependent manner. Simultaneously, levofloxacin decreased cell binding to type II collagen (COL2). Thus, levofloxacin-induced apoptosis exhibits characteristics of anoikis, the process by which cell death is triggered by separation from the extracellular matrix, which contains COL2. Furthermore, real-time quantitative RT-PCR was used to further confirm that levofloxacin downregulates COL2 expression in a dose-dependent manner. At last, western blot was used to find that levofloxacin increased the ratio of Bax/Bcl-2 and active caspase-3 in a dose-dependent manner. Levofloxacin therefore increases the effects of serum deprivation on anoikis by downregulating COL2 in rat NPCs in vitro via Bax/Bcl-2/caspase-3 pathway. This research provides a novel insight into the mechanisms of levofloxacin-induced toxicity and may potentially lead to a better understanding of the clinical effects of levofloxacin, especially in terms of intervertebral disc degeneration.

To evaluate the clinical outcome of two different surgical treatments in treating degenerative scoliosis. Forty patients with degenerative scoliosis hospitalized in our department from June 2010 to June 2012 were selected. They were randomly divided into two groups. The first group was performed on the points with nerve or spinal compression for decompression, bone grafting, and short-segmental fixation in situ; The second group was treated with sufficient decompression, long-segmental fixation, and short-segmental fusion to operate orthopedic on scoliosis in three dimensions. All patients completed the follow-up period for more than 1 year, with the average of 18 months. Bone grafting fusion was achieved in all of the patients. The second group showed significantly better result in remission rate of postoperative pain and ODI improvement rate than the first group. Long-segmental internal fixation orthopedic is a better surgical option for patients with degenerative scoliosis to achieve sufficient decompression and three-dimensional orthopedic; therefore, it is a better solution for biomechanical reconstruction of spine.

Levofloxacin has been reported to have cytotoxicity to chondrocytes in vitro. And 17β-estradiol has been widely studied for its protective effects against cell apoptosis. Based on apoptotic cell model induced by levofloxacin, the purpose of this study was to explore the mechanism by which 17β-estradiol protects rat nucleus pulposus cells from apoptosis. Inverted phase-contrast microscopy, flow cytometry, and caspase-3 activity assay were used to find that levofloxacin induced marked apoptosis, which was abolished by 17β-estradiol. Interestingly, estrogen receptor antagonist, ICI182780, and functional blocking antibody to α2β1 integrin, both prohibited the effect of 17β-estradiol. Simultaneously, levofloxacin decreased cellular binding ability to type II collagen, which was also reversed by 17β-estradiol. Furthermore, western blot and real-time quantitative PCR were used to find that integrin α2β1 was responsible for estrogen-dependent anti-apoptosis, which was time-response and dose-response effect. 17β-estradiol was proved for the first time to protect rat nucleus pulposus cells against levofloxacin-induced apoptosis by upregulating integrin α2β1 signal pathway.

Rationale: Kümmell's disease is defined as delayed traumatic vertebral collapse disease in which patients develop a kyphosis after asymptomatic minor spinal trauma. Both anterior approach and posterior approach have been reported, however, there is no standard treatment for Kümmell's disease. Patient concerns: We described a successful modified posterior vertebral column resection in a patient with Kümmell's disease. A 65-year-old woman reported persistent back pain for almost three months. Diagnoses: Kümmell's disease was diagnosed based on computer tomography (CT) and magnetic resonance imaging (MRI). Interventions: Modified posterior vertebral column resection combined with short-segment fixation was designed to treat this disease. Outcomes: The procedure was successful without any complications. Patient reported that symptoms were obviously improved in one week after operation. Lessons: Modified posterior vertebral column resection combined with short-segment fixation is an effective treatment option for Kümmell's disease.

BACKGROUND The aim of this study was to evaluate the clinical efficacy of modified posterior vertebral column resection (MPVCR) in treating osteoporotic Kummell disease. MATERIAL AND METHODS Between January 2013 and January 2015, 10 patients who were diagnosed with Kummell disease underwent MPVCR treatment, and their medical records were retrospectively collected. Every patient had follow-up for at least one year, with an average of 15 months. Clinical efficacy of MPVCR treatment was evaluated by kyphotic Cobb's angle, Oswestry disability index (ODI) and visual analogue scale (VAS) score. RESULTS Data analyses showed that operation time was 188.39±30.8 minutes, and blood loss was 860±130 mL with 600±200 mL of blood transfusions. VAS score decreased significantly after MPVCR surgery (p

The purpose of this study was to explore incidence and risk factors of adjacent segment disease (ASD) following posterior decompression and instrumented fusion for degenerative lumbar disorders, and hope to provide references in decision making and surgical planning for both spinal surgeon and surgically treated patients. By retrieving the medical records from January 2011 to December 2013 in our hospital, 237 patients were retrospectively reviewed. According to the occurrence of ASD at follow up, patients were divided into 2 groups: ASD and N-ASD group. To investigate risk values for the occurrence of ASD, 3 categorized factors were analyzed statistically: Patient characteristics: age, sex, body mass index (BMI), bone mineral density (BMD), duration. Surgical variables: surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, intraoperative superior facet joint violation. Radiographic parameters: preoperative lumbar lordosis, preoperative angular motion at adjacent segment, preoperative adjacent segment disc degeneration, preoperative paraspinal muscle degeneration. Postoperative ASD was developed in 15 of 237 patients (6.3%) at final follow up. There was no statistically significant difference between the 2 groups in patient characteristics of age, sex composition, BMD, duration, while the BMI was higher in ASD group than that in N-ASD group. There was no difference in surgical variables of surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, while intraoperative superior facet joint violation was more common in ASD group than that in N-ASD group. There was no difference in radiographic parameters of preoperative lumbar lordosis, preoperative paraspinal muscle degeneration, while preoperative adjacent segment disc degeneration were more severe in ASD group than that in N-ASD group. The Logistic regression analysis revealed that, BMI >25 kg/m2, preoperative disc degeneration, and superior facet joint violation were independently associated with ASD. In conclusion, higher BMI, preoperative disc degeneration at adjacent segment and intraoperative superior facet joint violation are risk factors for ASD. Patients who are overweight or obesity and with preoperative disc degeneration at adjacent segment should be fully informed the risk of ASD. For surgeons, it is essential to prevent superior facet joint violation in pedicle screw insertion procedure.

To explore incidence and risk factors of postoperative adjacent segment degeneration (ASD) following anterior decompression and instrumented fusion for degenerative disorders of the cervical spine.Medical records from January 2005 to September 2011 of 283 patients were retrospectively reviewed. Patients were divided into 2 groups based on occurrence of ASD at follow-up: ASD group and no ASD group. To investigate risk for occurrence of ASD, 3 sets of factors were analyzed statistically: patient characteristics, surgical variables, and radiographic parameters.Postoperative ASD developed in 68 of 283 patients. There was no statistically significant difference between the 2 groups in patient characteristics or the surgical variables of surgical strategy, surgical time, and blood loss. The number of patients receiving 2-level spinal fusion was higher in the ASD group. Upper instrumented vertebra at C5 was more common in the ASD group. There was no difference between groups in all but 1 of the radiographic parameters; the plate-to-disc distance was much smaller in the ASD group. Logistic regression analysis revealed that upper instrumented vertebra at C5, plate-to-disc distance3.0 mm, and 2-level anterior cervical fusion were independently associated with ASD.Patients with degenerative disorders of the cervical spine who receive 2-level cervical fusion and with upper instrumented vertebra at C5 are at high potential risk of ASD.

Kyphosis may occur after arthroplasty as the result of the disc insertion angle and overmilling; however, few studies have described techniques to avoid these factors. We investigated whether modified techniques of Bryan cervical disc arthroplasty can prevent adverse outcomes. Twenty patients (control group) underwent surgery using techniques described in the Bryan disc product monograph (Medtronic Sofamor Danek, Minneapolis, MN, USA). Twenty-nine patients (investigation group) underwent surgery using a modified technique which included changes in disc insertion angle, reducing overmilling of the endplates, ensuring the anterior borders of the two halves of the prosthesis were at the same horizontal line, and accurately fitting the prosthesis. Disability and pain were assessed using self-administered questionnaires and the change in functional spinal unit (FSU) angle between the two groups was also compared. Both groups demonstrated statistically significant improvement compared with preoperative values for the following functional outcomes measures. The mean neck pain Visual Analog Scale (VAS) scores before surgery were 73.45 (control) and 74.53 (investigation); at the 2-year follow-up these scores were 22.1 and 14.79 (p = 0.0013), respectively. After surgery, 14 of 20 patients in the control group developed a tendency toward kyphosis of the FSU in the neutral position (range = –9°–13°, mean = –1.1 °± 5.05). Conversely, none of the 29 patients in the investigation group developed kyphosis of the FSU in the neutral position (range = 0–10°, mean = 3.79° ± 2.90) (p = 0.0007). There was no statistically significant difference between the groups regarding preoperative and postoperative scores with the exception of neck pain VAS and FSU angle changes. There were no intraoperative complications, vascular or neurologic complications, spontaneous fusions, or device failures or explantations.

Objective: To identify an appropriate surgical approach for the management of cervical cord injury with ossification of the posterior longitudinal ligament. Methods: A retrospective study of 25 cases of cervical cord injury with ossification of the posterior longitudinal ligament was performed. Two cases were classified as Frankel grade A, three as grade B, fourteen as grade C, and six as grade D. Treatment procedures consisted of anterior decompression with instrumentation (twelve patients), posterior decompression (eight patients), and combined anterior and posterior decompression (five patients). Results: There were no iatrogenic injuries of great vessels, trachea, esophagus or spinal cord. All patients were followed up for 15–86 months (average, 38.3 months). All segment with anterior fixation attained solid fusion, without implants loosening or breakage. No reclosed open-door was found after posterior laminoplasty. Twenty-one patients improved by one to two Frankel grades. The patients with complete spinal cord injury achieved no neurologic recovery, but did experience relief of upper limb pain or numbness. Conclusion: The surgical outcomes of cervical cord injury with ossification of the posterior longitudinal ligament were satisfactory. It is important to select a suitable surgical approach according to the findings on radiological imaging and the clinical characteristics and general condition of the patients.