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• Administration of LMWH before surgery did not increase the risk of perioperative bleeding. • The study revealed a prevalence of preoperative DVT of 8.0% in patients with spinal metastasis. • Preoperative D-dimer may not be a perfect predictor of preoperative DVT for patients with spinal metastasis. S pine surgeons should weigh the risks of anticoagulants against their benefits in preventing deep venous thrombosis (DVT), as they may increase the risk of bleeding. Spinal metastasis patients undergoing decompression with fixation are at a high risk for DVT, which may occur preoperatively. Therefore, anticoagulants should be administered preoperatively. This study aimed to evaluate the safety of the administration of anticoagulants in treating spinal metastasis patients with preoperative DVT. Therefore, we prospectively investigated the prevalence of DVT in these patients. Patients who were diagnosed with preoperative DVT were included in an anticoagulant group. Subcutaneous low-molecular-weight heparin (LMWH) was administered. Patients without DVT were included in a non-anticoagulant group. Data on patient information, clinical parameters, blood test results, and bleeding complications were also collected. Moreover, the safety of anticoagulants was analyzed. The prevalence of preoperative DVT was 8.0%. None of the patients developed pulmonary thromboembolism. Furthermore, no significant differences in blood loss, drainage volume, hemoglobin levels, number of transfusions, or preoperative trans -catheter arterial embolization were observed between the two groups. None of the patients developed major bleeding. However, two patients experienced wound hematoma and one experienced incisional bleeding in the non-anticoagulant group. Therefore, LMWH is safe for spinal metastasis patients. Future randomized controlled trials should be conducted to evaluate the validity of perioperative prophylactic anticoagulation therapy in these patients. [ABSTRACT FROM AUTHOR]

We evaluate the clinical effects and radiological findings of the Wallis interspinous device (Zimmer, Warsaw, IN, USA) for the treatment of multi-segmental lumbar degenerative disease after a minimum 5 year follow-up period. A total of 26 adult patients underwent a primary discectomy followed by fixation of the segment with the Wallis interspinous device between December 2007 and August 2008. Twelve men and 14 women with an age range of 43 to 56 years (average: 47.6) were included. The visual analogue scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI), foraminal height (FH), anterior disc height (aDH) and posterior disc height (pDH), range of motion (ROM) and Pfirrmann grades were obtained and compared before and after surgery. The VAS and ODI significantly decreased postoperatively ( p < 0.05). The postoperative FH and pDH values increased significantly compared with the preoperative levels ( p < 0.01) and the increase in the FH and pDH values remained statistically significant during the follow-up period. There were no statistically significant changes in the aDH values before and after surgery ( p > 0.05). Also, there were no statistically significant changes in the ROM and Pfirrmann grade at the instrumented level and at the cephalad-adjacent segment ( p > 0.05). In our study, no patient underwent further surgery because of a re-prolapse or progression of index level degeneration or adjacent segment disease. The Wallis interspinous device was a useful alternative for treating multi-segmental lumbar degenerative disease and it offered a significant minimum 5 year symptom control. [ABSTRACT FROM AUTHOR]

Abstract: Adequate fixation of the opened laminar arch is the key indicator of a successful laminoplasty surgery; poor outcomes, including secondary narrowing of the spinal canal and a high risk of axial neck pain are possible when using a suturing method during conventional laminoplasty. Rigid fixation including spacers or bone struts yields satisfactory clinical outcomes. However, this approach is also associated with a longer surgical time and an increased risk of instrumentation dislodgement. Plate-only fixation with fusion was developed in our hospital to improve conventional laminoplasty; in addition, the supraspinous ligament is preserved in this procedure. We evaluated both the safety and efficacy of the procedure. Twenty-six patients with multilevel cervical degenerative disease were enrolled for selective open-door laminoplasty with miniplate fixation; autologous bone debris was placed on the hinge side to promote fusion, without bone struts on the open side. The Japanese Orthopedic Association (JOA) score, X-ray, three-dimensional CT scan and MRI were used for the pre- and postoperative evaluations. The mean follow-up period was 22months (range=12–34months), and all patients achieved osseous fusion within six months of the operation. Patients who underwent open-door laminoplasty showed an improvement in the JOA score of 60.7%; a 23.0% incidence of axial neck pain and a 3.2° loss of range of motion (ROM) were also observed. No instrumentation failure or clinical deterioration was observed in our study. Thus, open-door laminoplasty with miniplate fixation is a safe, simple surgery for multilevel cervical disease that has significant clinical efficacy. This approach can maintain the cervical ROM, reduce the incidence of postoperative axial neck pain, decrease surgical time and cost, and avoid complications related to fusion. [Copyright &y& Elsevier]

The aim of this study was to evaluate the influence factors of metagenomic next-generation sequencing (mNGS) negative results in the diagnosed patients with spinal infection. mNGS test was applied in a cohort of 114 patients with suspected spinal infection, among which 56 patients had a final diagnosis of spinal infection. mNGS achieved a sensitivity of 75.0% (95% CI, 61.6% to 85.6%) and a specificity of 84.5% (95% CI, 72.6% to 92.7%), using histopathology and culture results as reference. Diagnosed patients with a negative culture result had lower white blood cell account, percentage of neutrophilic granulocyte, C-reactive protein (all P<0.05) and relatively higher rate of prior antimicrobial treatment history (P=0.059). However, diagnosed patients with a negative mNGS result did not have such difference with mNGS-positive patients, suggesting that mNGS was not strictly limited by the above indicators, which presented the advantages of this technique from another point of view. [ABSTRACT FROM AUTHOR]

Background context Microcirculatory dysfunction of the sub-endplate is considered to reduce nutrient supply to the intervertebral disc (IVD); however, direct interruption or destruction of blood vessels in the bone marrow of the vertebrae body adjacent to the endplate has not yet been described, especially with regard to the calcification and ossification of the cartilaginous endplate occurring during IVD degeneration. Purpose The purpose of the study was to evaluate the causal relationship between IVD degeneration and blocking of the main blood supply gateway through the endplate. Study design/setting The study describes a new IVD degeneration model induced by ischemic sub-endplate. Patient sample A total of 40 Sprague-Dawley rats were included in the study group. Outcome measures To assess disc height, a radiograph was taken each month for 4 months. Changes in endplate, nucleus pulposus (NP), and annulus fibrosus (AF) were evaluated by histochemical and immunohistochemical staining to detect IVD degeneration. Methods Injection of 30 μL absolute ethanol into the IVD of rat tail at Co7/Co8 was used to induce injury. Controls were injected with 30 μL of phosphate-buffered saline into the IVD at Co8/Co9. Results In the ethanol-injected group, disc height gradually decreased and bone sclerosis developed in the endplate. In the NP, cell transformation occurred, changing from predominantly vacuolar cells to chondrogenic cells and eventually fibrocartilaginous cells, along with fibrosis of the NP. As degeneration progressed, the AF developed disordered morphology and rough lamellae, and eventually ruptures and fibrosis. The extent of degeneration increased gradually over time, while the wavy tidemark of the growth plate regressed, and eventually disappeared. Initially positive collagen type II staining gradually decreased on the ischemic side of the sub-endplate. Except at the 3-month time point, expression of collagen type II, aggrecan, and Sox-9 in NP decreased gradually as degeneration progressed, compared with the control group. Conclusions This model successfully reproduced IVD degeneration, which could be used for etiological studies on IVD degeneration and investigation of nutrient supply disturbance, and may provide a theoretical foundation for clinical intervention and therapy for IVD degeneration in the future. [ABSTRACT FROM AUTHOR]

Resorbable fixation systems have gained interest in orthopedics by avoiding secondary surgery and stress shielding, but lack of enough bioactivity. Herein, we fabricated resorbable and bioactive regenerated silk fibroin/gelatin (RSF/G) screws with dual physically and chemically crosslinked networks, which can control the release of Arg-Gly-Asp (RGD) peptide and bear pull-out and shear forces comparable to those of pure RSF and commercial poly (lactic-co-glycolic acid) devices under dry and wet conditions. The controllable swelling properties of the RSF/G screws support implantation although with the high hydrophilic gelatin. Compared to RSF screws, the RSF/G screws have better bioactivity and significantly promote cell proliferation, adhesion, spreading and osteogenic differentiation by RGD-integrin interactions via the focal adhesion kinase/extracellular signal-regulated (FAK/ERK) pathway. Eight weeks after implantation in rats, the RSF/G screws with magnetic resonance imaging(MRI) compatibility remained fixed with tight contact, less inflammatory reaction and more new bone formation compared with pure RSF screws. The results indicate great promise for the application of RSF/G screws in bone fracture fixation. • A double-crosslinked silk fibroin/gelatin (RSF/G) screw was fabricated with limited swelling and sufficient strength. • The RSF/G screws showed good biocompatibility and bioactivity for bone regeneration by RGD-integrin interactions. • The screws could promote bone formation with less inflammatory reaction in the rat femoral condyles. [ABSTRACT FROM AUTHOR]