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Objective To report a rare case of spontaneous fusion (SF) following cervical disc arthroplasty (CDA), to review the related literature, and to propose a new measure to prevent it. Methods The course of a patient with SF is described here. The potential causes, risk factors, and preventive measure of SF after CDA published in previous studies have also been reviewed and discussed. Results A 63-year-old man presented with a 6-month history of progressive neck pain and developed left C-7 radiculopathy 4 years ago. Magnetic resonance imaging revealed disc herniation at the C6-C7 levels resulting in compression of the left C-7 nerve root. The patient underwent CDA at the C6-C7 levels, during which a PRESTIGE cervical disc device was implanted. He failed to follow-up regularly as recommended postoperatively because he was completely free from the pain in his neck and left upper limb. Four years later, he was readmitted with a 2-month history of occasional neck stiffness. Plain radiographs indicated complete radiographic fusion of the C6-C7 levels with trabecular bone bridging surrounding the cervical disc prosthesis, and dynamic imaging showed no motion. He was seen at regular follow-up visits for up to 60 months without special treatment, as his symptoms of neck stiffness were minor and his symptom has not worsened since then. Conclusion SF after CDA is a rare condition that can be attributed to patient- or prosthesis-related causes, and its risk factors are diverse. SF after CDA did not affect the patient's clinical outcome, and no special treatment was required for it. Practitioners should be aware of this rare complication and advise patients of the risks before performing CDA.

Background Lumbar disc herniation into the dural space is a very rare phenomenon of degenerative lumbar lesions in the elderly population, and its potential pathogenesis and natural course remain unclear. Case description We describe a rare case of intradural lumbar disc herniation. A 68-year-old man presented with progressive lower back pain and radiating pain and numbness in both legs for 3 years. Magnetic resonance imaging revealed a large herniated disc at L4-L5. Posterior discectomy and fusion of the L4-L5 was performed after conservative treatment failed. Intraoperatively, only minimal disc fragments in the epidural space were found after meticulous probing following laminectomy of the L4-L5 vertebrae. The dorsal dura mater was saturated, tense, and bulged at the L4-L5 levels; additionally, an intradural mass was palpable and confirmed by intraoperative ultrasonography. Subsequently, dorsal middle durotomy was performed. Upon opening the dural sac, a large cauliflower-like mass similar to nucleus pulposus tissue was found near the arachnoid membrane. The mass was dissociative and could be completely resected. The dorsal dural incisions were closed after careful exploration, followed by fixation and fusion of the L4-L5 levels. Pathological examination revealed disc tissue with central balloon-type cystic degenerative changes. The patient's lower back pain and radiating pain and numbness of both legs improved remarkably postoperatively, and he became asymptomatic at 3 months postoperatively. Conclusion Intradural lumbar disc herniation should be highly suspected when intraoperative findings are incompatible with findings from the preoperative imaging examination, and it could be further confirmed via intraoperative ultrasonography and pathological examination of the resected tissue from the dural space. Prompt surgery is recommended, and surgical results are usually favorable. We also reviewed the literature and discussed the potential pathogenesis, natural course, diagnosis, and treatment of intradural lumbar disc herniation.

Background: Fusion with a titanium mesh cage (TMC) has become popular as a conventional method after cervical anterior corpectomy, but postoperative TMC subsidence has often been reported in the literature. We designed a novel anatomic cervical TMC to reduce the postoperative subsidence rate. This finite element study aims to investigate the anti-subsidence performance of a novel anatomic TMC and provide a theoretical basis for clinical application. Methods: According to the test process specified in the ASTM F2267 standard, three-dimensional finite element analysis was used to compare the anti-subsidence characteristics of a traditional TMC (TTMC) and novel TMC (NTMC). Abaqus software was used for the mesh, and the modulus of elasticity, Poisson's ratio and other material coefficients of each part were input into the model. Solidworks software was used to establish the TTMC and NTMC models and construct the two three-dimensional finite element models of TMC subsidence testing mentioned above. Through analysis, the relationships between the stiffness of the intervertebral body fusion device (Kd) and the stiffness of the polyurethane foam blocks (Ks) of the TTMC and NTMC were derived, respectively. Results: After fitting the linear segment, the Kd values of the TTMC and NTMC were 37314 N/mm and 89124 N/mm, respectively. After calculation, the Ks values of the TTMC and NTMC were 653.83 N/mm and 995.95 N/mm, respectively. The Kp values of the TTMC and NTMC were calculated to be 665.5 N/mm and 1007.2 N/mm according to the formula. Conclusion: The reported novel anatomic titanium mesh cage (NTMC) significantly improved the anti-subsidence performance after ACCF, which was approximately 51.3% higher than that of the traditional titanium mesh cage.

In worldwide, osteoporosis has become one of the severe public health distress and over 200 million people get affected by tenderness and fissure during their life period. Vicenin-2 is a naturally occurring flavonoid glycoside present in Moringa oleifera, Peperomia blanda and Ocimum sanctum Linn with numerous biological activities. The present study aims to assess the effect of Vicenin-2 on ovariectomy-induced postmenopausal osteoporosis in female rats. Surgical removal of ovaries was achieved to institute the ovariectomy animal model. The ovariectomized (OVX) animals were alienated into four groups: Control, OVX alone (model), OVX with Vicenin-2 (5 mg/kg b.w), and OVX with Vicenin-2 (10 mg/kg b.w). Also, their consistent conduct remained managed intragastrically for about 12 weeks. OVX rats treated with Vicenin-2 effectually improved body mass, uterus index, lipid profiles, inflammatory markers, bone turnover markers and amplified the presence of calcium in the OVX rat serum. Vicenin-2 was found to suppress the actions of ACP, E2, and BGP in OVX rats. Besides, Vicenin-2 showed some adverse effects over histomorphometric percentage and histological studies, in which tabular thickness and area were restored in the control and Vicenin-2 managed OVX rats. PCR results of Alp, Runx 2, Osx showed diminished expressions in OVX rats whereas treatment with Vicenin-2 displays up-regulated expression of these genes. Through our study, we established that Vicenin-2 did not wield a detrimental upshot on the skeletal organization of OVX rats. Besides, we put forward that Vicenin-2 could be an excellent candidate to treat and manage bone related disease or disorders.

With the development of radiology and minimally invasive technology, vertebroplasty has become the mainstream treatment for Kummell’s disease. However, the catastrophic complication of bone cement displacement appears occasionally. We use robot-assisted pediculoplasty combined with vertebroplasty to avoid such complications. From January 2015 to January 2018, 87 patients suffering from thoracolumbar Kummell’s disease without neurological symptoms were treated by robot-assisted pediculoplasty combined with vertebroplasty. Pediculoplasty as a “bridge” allows the bone cement at the anterior edge of the vertebral body to be fixed in the vertebral body through the intrapedicular cement, which can effectively prevent bone cement displacement. The clinical efficacy was evaluated based on the statistical analysis results of vertebral body index (VBI), Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) at 3, 6, 12, 18, and 24 months after treatment. The average operation time was 85.23±10.48 min, and the average volume of cement injected was 4.97±0.66 ml. The patients’ preoperative VBI, Cobb angle, VAS and ODI scores were 62.01±11.32, 33.78±11.99°, 7.47±0.82, and 78.37±7.14, respectively. The postoperative measurements were 87.06±4.45, 16.57±6.46°, 2.89±0.95, and 46.91±8.44. At the last follow-up, the outcomes were 86.82±4.27, 16.72±6.22°, 1.75±0.69, and 20.48±4.48, respectively. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P

To compare the efficacy and safety of novel percutaneous minimally invasive pedicle screw fixation and traditional open surgery for thoracolumbar fractures without neurological deficit.Sixty adult patients with single thoracolumbar fracture between June 2014 and June 2016 were recruited in this study, randomly divided into open fixation group (group A) or minimally invasive percutaneous fixation group (group B). Clinical and surgical evaluation including surgery time, blood losses, radiation times, hospital stay, and complication were performed. The two groups of patients with pre-operative and last follow-up anterior height ratio of fracture vertebral, Cobb angle of fracture vertebral, and VAS score of back pain were compared.All patients completed valid follow-ups, with an average time period of 15.4 months (12-26 months). Group B achieved much better results in time of operation, intra-operative blood loss, and length of stay than group A (P 0.05). Group A was significantly better than group B in the times of radiation (P 0.05). The VAS score was significantly lower in group B than in group A at three days after the operation (P 0.05). There were no significant differences between the two groups in the anterior height ratio of fracture vertebral, Cobb angle, and VAS score in the last follow-up (P 0.05). No injured nerve or other severe complications occurred in both groups; one of the patients from group A had back and loin pain lasting for about one month, which resolved after analgesia and functional training. There was no significant difference between the two groups in incidence of complications.Novel percutaneous pedicle screws with angle reset function can achieve the same effect as traditional open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve injuries. Percutaneous minimally invasive pedicle screw fixation has the characteristics of shorter operative time, less bleeding, and less pain, but it needs more radiation times.

In spite of a variety of designs for the lumbar interbody fusion cage, there is no consensus on the optimal design so far. Different cage designs may cause different extent of X-ray exposure to visualize the cage positon intraoperatively. In this study, we retrospectively evaluated the X-ray exposure and clinical outcomes of the direction-changeable cage in transforaminal lumbar interbody fusion (TLIF). The patients were divided into the direction-changeable cage group (group A, n=79) and non-direction-changeable cage group (group B, n=84). Intraoperative implantation duration, cage position adjustment times, implantation fluoroscopy times, fluoroscopy exposure time of cage implantation, Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores were recorded before and after operation at the last follow-up. CT scanning was performed to evaluate lumbar fusion. All the patients underwent single-level TLIF and were followed up for 12 to 18 months. In the group A, intraoperative implantation duration, cage position adjustment times, implantation fluoroscopy times, and fluoroscopy exposure time of cage implantation were 6.7 ± 3.6 min, 1.2 ± 0.4 times, 2.5 ± 0.6 times, 7.84 ± 1.83 s, retrospectively. In the group B, these parameters were 11.5 ± 5.9 min, 2.6 ± 1.3 times, 5.8 ± 1.7 times, and 15.31 ± 5.16 s retrospectively, which were higher than those in the non-direction-changeable cage group with statistical significance (P0.05). Regarding to the complications, there were 4 cases (4.49%) in the group A, with 3 cases of non-union and 1 case of dural laceration. Eight cases (10.53%) showed complications in the group B, with 7 cases of non-union and 1 case of infection. There was a significant difference between the groups in terms of the complication rate (P

Percutaneous pedicle screw fixation (PPSF) has been a popular approach for treating thoracolumbar and lumbar fracture, and its relevant complications have been gradually recognized. This study aimed to summarize the complications of PPSF in treating thoracolumbar and lumbar fracture as well as the management and outcomes of the complications. We retrospectively analyzed the patients with thoracolumbar and lumbar fracture who were admitted to our department from February 2011 to February 2015 and underwent posterior PPSF. Information on demographics, medical comorbidities, radiographs, and treatment was obtained from hospital medical records and follow-up records. Main outcome indexes included adverse clinical and radiological outcomes during and after surgery. A total of 781 patients were included in this study. Forty-six patients (5.9%) presented with complications during or after surgery. The complications included intraoperative guide wire breakage, abdominal artery injury, spinal dura mater injury, postoperative pedicle screw misplacement, screw breakage, plug screw falling off, connecting rod loosening, poor reduction, and late infection. Among the 39 cases with postoperative complications, 14 underwent revision surgery, and the remaining patients underwent conservative treatment and presented good outcomes. PPSF is associated with the following complications: guide wire rupture, blood vessel injury, cerebrospinal fluid leakage, screw misplacement, poor reduction, failed internal fixation, and infection. A thorough preoperative evaluation, accurate operation, and timely and correct management of complications are critical to achieving satisfactory surgical outcomes.

Recurrent complex spinal tuberculosis accompanied by sinus tract formation is one of the most common and complex types of recurrent tuberculosis. To date, only very few studies have reported the strategies and effectiveness of surgical treatments on postoperative recurrent spinal tuberculosis accompanied by sinus tract formation. In this study, 21 recurrent patients out of 87 patients with complex spinal tuberculosis were reviewed. The data of the patients, including age, gender, existence of drug-resistant mycobacterium tuberculosis, postoperative standard chemotherapy, completeness of lesion debridement, reconstruction of the spinal stability, nutritional status, accompaniment by tuberculosis in other regions, timing of the operations, and areas of the lesions, were collected for single- and multiple-factor analyses. The clinical outcomes were evaluated by long-term follow-ups. The results showed that 7 factors were significantly associated with postoperative recurrence of complex spinal tuberculosis accompanied by sinus tract formation. This suggested that when we treat complex spinal tuberculosis, we should pay more attention to these seven indicators to avoid postoperative recurrence, and our clinical outcomes suggested that it is difficult to treat recurrent complicated spinal tuberculosis combined with sinus tract formation. The key for successful surgical treatment includes effective chemotherapy, radical debridement and proper reconstruction of spinal stability.

The aim of this study was to determine whether the serum level of irisin can be a candidate to predict the spinal metastasis in patients with breast cancer. In a cross-sectional study, 148 patients were recruited. Of those, 53 (35.8%) had spinal metastasis. The baseline characteristics were compared by status of spinal metastasis. Multiple logistic regression analysis was used to determine whether the serum irisin can be a candidate for predicting breast cancer to spinal metastasis. The correlation coefficient analysis was used to confirm the correlation between the serum irisin and lipid metabolic parameters and body mass index (BMI), respectively. The serum irisin was higher in patients without spinal metastasis (7.60 ± 3.80). Multivariable analysis showed that the serum irisin was protective to the presence of spinal metastasis in patients with breast cancer after adjustments of age and BMI (odds ratio, 0.873; 95% confidence interval, 0.764–0.999). Furthermore, there was a positive correlation between the serum irisin and BMI (r = 0.263). The patients with metabolisc syndrome (MetS) had a higher level in serum irisin. In addition, the higher numbers of MetS components were associated with higher serum irisin. Higher serum irisin can be a protective factor of spinal metastasis in patients with breast cancer. The BMI is positively associated with the serum level of irisin. Furthermore, patients with MetS tended to have a higher level of serum irisin.

Despite the diverse designs for the lumbar interbody fusion cage, there is no consensus on the optimal design to date. The current study aimed to compare the efficacy and complications associated with the direction-changeable and traditional lumbar cages for treating lumbar spondylolisthesis. We conducted a retrospective study including 109 patients with lumbar spondylolisthesis, who were admitted to our hospital from January 2013 to December 2014. The patients were divided into the direction-changeable (group A) and traditional (group B) lumbar cage group. All patients underwent single-level transforaminal lumbar interbody fusion and were followed up for 12 to 24 months. There were 52 cases in group A and 57 cases in group B. Surgery-related parameters, including operation time, bleeding volume, and hospitalization time, were recorded; there was no significant difference between the 2 groups regarding these parameters. The visual analog scale and Oswestry disability index at the last follow-up showed significant improvement compared with preoperative values in both groups (P .05). In group A, complications included 3 cases of nonunion (5.77%) and 1 case of cerebrospinal fluid leakage (1.92%). In group B, complications included 9 cases of nonunion (15.79%) and 1 case of postoperative infection (1.75%). There was a significant difference between both groups in terms of the nonunion rate and total complication rate (P

Type C3 thoracic fracture is a severe spinal injury, but one that is clinically rare, and there are few reports pertaining to the treatment of this type of fracture. No consensus has been achieved on the proper timing of spine fracture fixation; therefore, we focused on evaluating the surgical effects using a posterior approach and determining the influence of surgical timing on surgical outcomes.This was a retrospective cohort study of 36 cases of type C3 thoracic fracture in patients admitted to the hospital from April 2005 to October 2012, and who were divided into two groups according to the timing of surgery: early fixation (72 h) and late fixation (72 h). Surgical outcomes were analyzed based on surgery duration, intraoperative blood loss, intensive care unit and hospital stay, mortality rate, and complications.There were 13 patients in the early fixation group and 23 patients in the late fixation group. Patients were treated with posterior decompression, intervertebral titanium mesh support, pedicle screw fixation, and fusion. All fractures involved a single segment: T7/T8 (8 patients), T9/T10 (11 patients), and T11/T12 (17 patients). All injuries were classified as American Spinal Injury Association (ASIA) grade A. Patients underwent periodic follow-up over a period of 12-30 months (average, 22.5 months). One patient developed ascending myelitis and died of respiratory failure 1 month after early fixation, and two patients died of pulmonary infection after late fixation procedures. Other patients achieved bone fusion without improvement in ASIA grade. No statistically significant difference in parameters was observed between groups.Though type C3 thoracic fracture is one of the most severe spinal injuries, complete reduction and recovery of spinal stability can be achieved using a posterior approach. As clinical outcomes in this study were similar between early and late fixation procedures, early surgical intervention may not be helpful for improving neurologic recovery in type C3 thoracic fractures.

Background Destructive erosion of bone or osteolysis is a major complication of inflammatory conditions such as rheumatoid arthritis (RA), periodontal disease, and periprosthetic osteolysis. Natural plant-derived products have received recent attention as potential therapeutic and preventative drugs in human disease. Methods The effect of Angelica sinensis (AS) extract on RANKL-induced osteoclast differentiation was examined in this study. The osteoclast precursor cell line bone marrow macrophages (BMMs) was cultured and stimulated with RANKL followed by treatment with AS at several doses. Gene expression profiles of c-Fos, c-Jun, NFATc1, TRAP, and OSCAR were sequentially evaluated. Results AS extract inhibited RANKL-mediated osteoclast differentiation in BMMs in a dose-dependent manner without any evidence of cytotoxicity. AS extract strongly inhibited p38, ERK, JNK, p65 phosphorylation and I-κB degradation in RANKL-stimulated BMMs. AS extract also inhibited the mRNA expression of c-Fos, c-Jun, NFATc1, TRAP, and OSCAR in RANKL-treated BMMs. Moreover, RANKL-induced c-Fos, c-Jun and NFATc1 protein expression was suppressed by AS extract. Conclusions These results collectively suggested that AS extract demonstrated inhibitory effects on RANKL-mediated osteoclast differentiation in bone marrow macrophages in vitro, indicating that AS may therefore serve as a useful drug in the prevention of bone loss.

Type III Denis fracture of the sacrum is rare clinically, constituting approximately 16% of all sacral fractures. Because it is often complicated with neurologic injuries, treatment is crucial and difficult. Several surgical options are available for the treatment of type III Denis sacral fracture with lumbopelvic dissociation. The authors report 21 patients admitted to the hospital from February 2002 to May 2012 who had type III Denis sacral fracture combined with lumbopelvic dissociation. All of the patients were treated with posterior sacral lamina decompression, sacral nerve root decompression, fracture reduction, an integrated lumbopelvic internal fixation system, and posterolateral fusion. The authors recorded pre- and postoperative complications, fracture reduction, bone graft healing, and improvements in neurologic function, according to the Gibbons grading standard. The average surgical time was 190 minutes (range, 170–210), and the average amount of intraoperative bleeding was 960 mL (range, 930–1500). No intraoperative complications occurred. Twelve patients had complete recovery of neurologic function; 5 patients showed great improvement except for foot drop and impaired lower limb sensation; and 4 patients showed no improvement in lower limb, bladder, and rectum function. Gibbons grade decreased from an average of 3.43±0.51 before surgery to 1.76±1.09 at the last follow-up. Deep infections were noted in 2 cases, and in 1 case, vertebral screw loosening was observed 1 year postoperatively. Surgical reduction with lumbopelvic fixation is an ideal method for treating type III Denis sacral fracture with neurologic injury and lumbopelvic dissociation.

Background context Most atlas fractures can be effectively treated nonoperatively with external immobilization unless there is an injury to the transverse atlantal ligament. Surgical stabilization is most commonly achieved using a posterior approach with fixation of C1–C2 or C0–C2, but these treatments usually result in loss of the normal motion of the C1–C2 and C0–C1 joints. Purpose To clinically validate feasibility, safety, and value of open reduction and fixation using an atlas polyaxial lateral mass screw-plate construct in unstable atlas fractures. Study design Retrospective review of patients who sustained unstable atlas fractures treated with polyaxial lateral mass screw-plate construct. Patient sample Twenty-two patients with unstable atlas fractures who underwent posterior atlas polyaxial lateral mass screw-plate fixation were analyzed. Outcome measures Visual analog scale, neurologic status, and radiographs for fusion. Methods From January 2011 to September 2012, 22 patients with unstable atlas fractures were treated with this technique. Patients' charts and radiographs were reviewed. Bone fusion, internal fixation placement, and integrity of spinal cord and vertebral arteries were assessed via intraoperative and follow-up imaging. Neurologic function, range of motion, and pain levels were assessed clinically on follow-up. Results All patients were followed up from 12 to 32 months, with an average of 22.5±18.0 months. A total of 22 plates were placed, and all 44 screws were inserted into the atlas lateral masses. The mean duration of the procedure was 86 minutes, and the average estimated blood loss was 120 mL. Computed tomography scans 9 months after surgery confirmed that fusion was achieved in all cases. There was no screw or plate loosening or breakage in any patient. All patients had well-preserved range of motion. No vascular or neurologic complication was noted, and all patients had a good clinical outcome. Conclusions An open reduction and posterior internal fixation with atlas polyaxial lateral mass screw-plate is a safe and effective surgical option in the treatment of unstable atlas fractures. This technique can provide immediate reduction and preserve C1–C2 motion.