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Grade 3 obesity could potentially increase postoperative complications after spinal fusion surgery. However, the relationship between prior bariatric surgery (BS) and postoperative complications after spinal fusion surgery is not well-established. Inpatient hospital admissions from the Nationwide Inpatient Sample. Patients with a primary procedure of spinal fusion surgery discharged between 2006 and 2014 were identified. In-hospital outcomes included postoperative complications, mortality, cost, and length of stay were compared between patients with prior BS and grade 3 obesity. A total of 3,132,192 patients who underwent elective spinal fusion surgery were identified. There were 33,936 (1.1%) patients with a diagnosis of prior BS. The prevalence of prior BS increased significantly from.1% in 2006 to 1.5% in 2014. Compared with patients with grade 3 obesity, patients with prior BS were younger, more likely to be female, had less co-morbidities, and higher proportion of cervical surgery. Multivariable analysis indicated that patients with prior BS had lower risk of overall complications (odds ratio [OR]:.44; 95% confidence interval [CI]:.38–.49), neurologic (OR:.55; 95%CI:.35–.84), respiratory (OR:.30; 95%CI:.23–.37), cardiac (OR:.38; 95%CI:.24–.60), gastrointestinal (OR:.61; 95%CI:.44–.84), urinary and renal (OR:.34; 95%CI:.26–.44), venous thromboembolism (OR:.35; 95%CI:.19–.63), wound-related complications (OR:.67; 95%CI:.53–.85), and in-hospital mortality (OR:.12; 95%CI:.02–.88). Prior BS was also related to 13% shorter length of stay and 2% lower cost. Among patients undergoing spinal fusion surgery, prior BS is associated with lower complications, in-hospital mortality, and healthcare utilization. BS might mitigate risk of worse outcomes associated with grade 3 obesity after spine fusion surgery. [ABSTRACT FROM AUTHOR]

We sought to introduce an anterior surgical technique for cervical ossification of posterior longitudinal ligament (OPLL) extending to C2. A total of 29 patients with multilevel OPLL extending to C2 underwent surgery from January 2016 to January 2019. The rationale of our surgical technique is to transect the ossified ligament at the level of C2/3, dividing OPLL into 2 parts. OPLL behind the C2 vertebra is reserved as "focus exclusion," and OPLL below C2 is performed anterior controllable antedisplacement and fusion. Neurologic condition was evaluated using the Japanese Orthopaedic Association scoring system and its improvement ratio. Radiologic assessment included type and extent of OPLL, occupying rate, thickness and length of ossified mass, and curvature of spinal cord. Surgery- and implant-related complications were recorded. The mean Japanese Orthopaedic Association score increased from 9.4 to 15.8 points at last follow-up, with a significant improvement (P < 0.01). The mean preoperative length of the ossified mass behind C2 was 15.4 mm, and its thickness was 2.2 mm, with no significant progression at last follow-up (15.3 mm and 2.2 mm, P > 0.05). There was also no statistical difference in OPLL thickness at the largest occupying rate level between preoperation and last follow-up (7.4 mm vs. 7.3 mm, P > 0.05). Four patients presented with cerebrospinal fluid leakage, 1 with screw displacement, and 1 with dysphagia. For patients with cervical OPLL extending to C2, exclusion of ossified ligaments behind C2 combined with anterior controllable antedisplacement and fusion below C2 is an effective and alternative technique. [ABSTRACT FROM AUTHOR]

To evaluate outcomes of sagittal reconstruction of the atlantoaxial lateral mass complex using a modified intra-articular cage fusion technique for treating degenerative atlantoaxial instability. Data from 15 patients with degenerative atlantoaxial instability were retrospectively reviewed. All patients underwent posterior reduction and intra-articular fusion with a cage filled with local autologous bone. Atlantodental interval values on plain radiography in flexion before and after surgery were recorded. Bone fusion was evaluated on computed tomography reconstruction, and bone fusion time was recorded. Lateral atlantoaxial joint space height before and after surgery was measured on coronal computed tomography reconstruction. Japanese Orthopaedic Association score and visual analog scale score for neck pain before surgery and at final follow-up were compared. Mean follow-up time was 40.7 ± 13.4 months. All patients achieved good reduction and solid bone fusion at follow-up. Mean fusion time was 4.4 ± 1.1 months. Atlantodental interval decreased from 8.6 ± 1.5 mm preoperatively to 1.9 ± 0.5 mm at final follow-up (P < 0.05). Lateral atlantoaxial joint space height significantly improved from 1.7 ± 0.5 mm preoperatively to 4.7 ± 0.3 mm at final follow-up (P < 0.05). Japanese Orthopaedic Association score significantly improved from 14.9 ± 1.5 preoperatively to 16.7 ± 0.6 at final follow-up (P < 0.05). Visual analog scale score for neck pain markedly decreased from 4.5 ± 1.8 preoperatively to 0.5 ± 0.6 at final follow-up (P < 0.05). Posterior reduction and intra-articular cage fusion with a C2 nerve root preservation technique is effective in treatment of degenerative atlantoaxial instability. Satisfactory reconstruction of the sagittal alignment and the height of atlantoaxial complex can be achieved. [ABSTRACT FROM AUTHOR]

Ankylosing spondylitis (AS) and osteoporosis (OP) are both prevalent illnesses in spine surgery, with OP being a possible consequence of AS. However, the mechanism of AS-induced OP (AS-OP) remains unknown, limiting etiologic research and therapy of the illness. To mine targetable medicine for the prevention and treatment of AS-OP, this study analyzes public data sets using bioinformatics to identify genes and biological pathways relevant to AS-OP. First, text mining was used to identify common genes associated with AS and OP, after which functional analysis was carried out. The STRING database and Cytoscape software were used to create protein–protein interaction networks. Hub genes and potential drugs were discovered using drug–gene interaction analysis and transcription factors–gene interaction analysis. The results of text mining showed 241 genes common to AS and OP, from which 115 key symbols were sorted out by functional analysis. As options for treating AS-OP, protein–protein interaction analysis yielded 20 genes, which may be targeted by 13 medications. Carlumab, bermekimab, rilonacept, rilotumumab, and ficlatuzumab were first identified as the potential drugs for the treatment of AS-OP, proving the value of text mining and pathway analysis in drug discovery. [ABSTRACT FROM AUTHOR]

Objective To evaluate differences in radiologic and functional outcomes between C1–C2 posterior temporary fixation (PTF) and cephalocervicothoracic cast fixation for type III odontoid fractures. Methods Data from 13 patients who underwent PTF and 13 cases who underwent cephalocervicothoracic cast fixation due to fresh type III odontoid fractures were reviewed retrospectively. All patients with fracture healing underwent a functional computed tomography scan at the final follow-up to evaluate the range of motion in C1–C2 rotation. Functional outcomes were evaluated in the form of visual analog scale for neck pain, neck stiffness, patient satisfaction, and Neck Disability Index. The outcomes were compared between the 2 groups. Results At the final follow up, all 26 patients achieved healing of their fractures. There were no complications associated with either treatment. The left-to-right ranges of motion of C1–C2 rotation were 41.9° ± 11.9° in the PTF group and 43.5° ± 12.0° in the cephalocervicothoracic cast fixation group. There was no statistical difference between the 2 groups regarding the C1–C2 rotation angle ( P > 0.05). There also were no significant differences between 2 groups in functional outcomes evaluated by visual analog scale for neck pain, neck stiffness, Neck Disability Index, and patient satisfaction (all P > 0.05). Conclusions The outcomes of PTF and cephalocervicothoracic cast fixation were comparable in the treatment of type III odontoid fractures. For type III odontoid fractures that cannot be managed by nonoperative fixation or anterior screw fixation, PTF may be the treatment of choice, because it spares the motion of the C1–C2 complex. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical outcomes of our experience with the unilateral C2 translaminar screw technique and evaluate its feasibility as an alternative or salvage of the pedicle screw. Methods Eleven consecutive adult patients with atlantoaxial instability who underwent hybrid fixation techniques using unilateral translaminar screw combined with contralateral C2 pedicle screw and bilateral C1 LMS via posterior arch from January 2010 to December 2013 were retrospectively investigated. The surgical techniques and treatment procedures were described, and clinical symptoms, neurologic function, and imaging appearance were evaluated. Results The average age in our series was 40.9 years. No vascular or neurologic injuries occurred. No hardware failure or breach of C2 lamina or pedicle was observed in postoperative radiographs or computed tomography scans. Good bone union was achieved in all patients. There were no cases of screw pullout or pseudarthrosis. Conclusions Patients with variant vertebral artery or osseous anomaly are good candidates for the hybrid translaminar screw technique as an alternative to or salvage of C2 pedicle screw. [ABSTRACT FROM AUTHOR]

Some atlantoaxial rotatory fixations (AARFs) cannot be classified according to the Fielding and Hawkins classification. This study aimed to introduce a new subtype of AARF (type IIIa AARF) with a C1 anterior displacement >5 mm, but with one lateral mass being displaced anteriorly and another posteriorly. Data from 10 cases of AARF with anterior C1 displacement of >5 mm were retrospectively reviewed. The exclusion criteria were as follows: 1) type I, II, or IV AARF according to the Fielding and Hawkins classification; 2) cases caused by trauma, tumor, or infection; 3) AARF with os odontoideum or odontoid fracture; and 4）age ≥18 years. Imaging features were analyzed. The atlanto-dental interval was measured to evaluate C1 anterior displacement. Three cases that did not match type III AARF were classified under type IIIa AARF. They had the following common imaging features: 1) atlanto-dental interval of >5 mm, being similar to type III AARF; 2) one lateral mass of C1 displaced anteriorly and the other posteriorly (the most important feature distinguishing the type from type III AARF in which both C1 lateral masses displaced anteriorly); and 3) C1-C2 separation angle (mean 44.2 ± 2.9°) being larger than that in type III AARF. AARF with anterior C1 displacement of >5 mm, but with one lateral mass displaced anteriorly and the other posteriorly, was defined as type IIIa AARF. It should not be confused with type III AARF because these 2 types differ in biomechanics and imaging parameters. [ABSTRACT FROM AUTHOR]

To verify the effectiveness of anterior retropharyngeal release followed by posterior open reduction using long arm reduction screws combined with intra-articular fusion with a cage filled with the local autologous bone for treating fixed Type III atlantoaxial rotatory fixation (AARF). Data from 6 children with fixed AARF were retrospectively reviewed. All patients underwent anterior retropharyngeal release followed by posterior open reduction using long-arm reduction screws combined with intra-articular fusion with a cage filled with local autologous bone. Outcomes were measured using the atlantodental interval value, the Japanese Orthopedic Association score and visual analog scale for neck pain. Patient age, sex, operation time, blood loss, and bone fusion time were recorded. Complications related to the operation were also recorded. All patients achieved complete reduction and solid bone fusion at follow-up. The atlantodental interval dropped to 2.1 ± 0.5 mm after the operation from a preoperative score of 15.3 ± 3.1 mm (P < 0.05). Japanese Orthopedic Association score significantly improved from a preoperative score of 15.3 ± 0.5 to 17 ± 0 at the final follow-up (P < 0.05). Visual analog scale for neck pain markedly decreased from preoperative 4.5 ± 1.0 to 0.2 ± 0.4 at the final follow-up (P < 0.05). No complication related to the surgical approach or instrumentation was observed. One-stage anterior retropharyngeal release followed by posterior open reduction combined with intra-articular cage fusion is effective in treating chronic fixed type III AARF. [ABSTRACT FROM AUTHOR]

Atlantoaxial dislocation (AAD) is classified into reducible AAD and irreducible AAD (IRAAD). Anterior or posterior releasing followed by occipitocervical/atlantoaxial fusion is often performed for IRAAD, but is technically demanding. This study aimed to evaluate the results of the posterior open reduction technique without releasing the atlantoaxial joint in the treatment of potentially reducible AAD (PRAAD) caused by transverse ligament laxity in patients with rheumatoid arthritis (RA). Data from 38 RA patients who experienced PRAAD due to transverse ligament laxity were retrospectively reviewed. They all underwent posterior open reduction and fusion without releasing the atlantoaxial joint. Outcomes were evaluated by using atlantodental interval, modified Japanese Orthopedic Association scores, Nurick grade, Neck Disability Index, and visual analog scale score for neck pain. All the patients achieved solid bone fusion at follow-up. The mean atlantodental interval was reduced to 5.6 ± 0.7 mm and 2.1 ± 0.5 mm after traction and operation, respectively, from a preoperative score of 8.2 ± 0.6 mm (P < 0.05). Compared with the respective preoperative values, the mean modified Japanese Orthopedic Association score and Nurick grade were significantly increased at the final follow-up (both P < 0.05), whereas the Neck Disability Index and visual analog scale score for neck pain were significantly decreased (both P < 0.05). AAD with partial reduction after skeletal traction for 48 hours should be defined as PRAAD, not IRAAD. Open reduction with a C1–C2 pedicle screw-rod system can be safely and effectively applied in the treatment of PRAAD due to transverse ligament laxity in patients with RA. [ABSTRACT FROM AUTHOR]

A retro-odontoid pseudotumor (ROP) is commonly associated with atlantoaxial instability or rheumatoid arthritis. However, ROP in the absence of atlantoaxial instability or rheumatoid arthritis, which is termed idiopathic ROP (IROP), is a rare condition. The pathomechanisms and optimal treatment strategies for IROP remain controversial. The aim of the present study was to evaluate the radiographic and clinical characteristics of IROP patients and to assess the efficiency of atlantoaxial/occipitocervical fusion on IROP regression. Data from 5 patients diagnosed with IROP were retrospectively reviewed. Posterior atlantoaxial or occipitocervical fixation and fusion were performed in 4 patients and C1 posterior arch resection alone in 1 patient. The patients' features, surgical procedures, and complications were recorded. The retro-odontoid soft tissue thickness was measured on preoperative and postoperative magnetic resonance imaging to evaluate IROP regression. The mean follow-up time was 37 months. ROP regression was achieved in patients who received atlantoaxial/occipitocervical fusion, but not for the patient with C1 posterior resection alone. There were no observed neurovascular complications associated with surgery. IROP was related to a restricted range of motion of the subaxial spine. Upper cervical fixation is an optional treatment that produces IROP regression over time. By contrast, direct removal of the IROP is unnecessary. [ABSTRACT FROM AUTHOR]

Objective To investigate the role of lumbosacral transitional vertebra (LSTV) in the pathogenesis of adolescent lumbar disc herniation (ALDH) and the association between LSTV type and the herniation level of ALDH. Methods This study was a retrospective case-control analysis of roentgenographic images. All adolescent patients who received surgical treatment for L4/5 or L5/S1 single level lumbar disc herniation in our department from 2010 to 2015 were eligible for the ALDH group. All adolescent patients admitted to our hospital during the same period and who had ever undergone a plain anteroposterior radiologic examination of the abdomen and met the inclusion criteria that ensured the absence of any spinal disorders were selected into the control group. The anteroposterior lumbar or abdomen roentgenograms were collected to identify the LSTV. The incidence of LSTV in the ALDH group and the control group were compared. Among the ALDH group, the association between LSTV type (sacralization or lumbarization) and the herniation level of ALDH were evaluated. Results A total of 80 adolescent patients were included in the ALDH group and 92 asymptomatic adolescents were included in the control group. LSTV was found in 24 patients (30%) in ALDH group compared with 7 patients (7.6%) in the control group ( P < 0.001; odds ratio, 5.2; 95% confidence interval 2.1, 12.9). Among the adolescent patients with sacralization, the L4/5 disc herniation was significantly more common than L5/S1 (81.3% vs. 18.7%; P = 0.019). Conclusions The LSTV is associated with LDH in adolescents and the sacralization of L5 may contribute to the L4/5 disc herniation in adolescent patients. [ABSTRACT FROM AUTHOR]

Objectives To analyze whether multifidus degeneration has a relationship with degenerative lumbar spinal stenosis (LSS). Materials and Methods Clinical data of 40 patients with LSS were analyzed retrospectively. Moreover, 40 healthy people were selected as controls. Subjects of both groups underwent a 1.5-T lumbar spinal magnetic resonance imaging scan in our hospital, and then the multifidus muscularity, fatty infiltration ratio, and bilateral asymmetry at L4/5 level on magnetic resonance imaging were measured with ImageJ software to analyze and compare the multifidus parameters between the 2 groups. Results Compared with the control group, the multifidus muscularity was lower, fatty infiltration ratio was greater, and muscle asymmetry was more significant at the L4/5 level in patients with LSS, and the difference between the 2 groups was statistically significant. Conclusions Multifidus degeneration, including reduced volume, increased fatty infiltration, and bilateral muscle asymmetry, has an association with LSS. [ABSTRACT FROM AUTHOR]

Hydrogel is a kind of hemostatic agent with good application prospect. However, the water molecules on the wound made the hydrogel less adhesive to wet wound tissue. Herein, the carboxymethyl chitosan (CMCS)/oxidized dextran (OD)/γ-polyglutamic acid (γ-PGA) hydrogel was prepared using a double-barreled syringe for hemostasis of diffuse and incompressible wound bleeding. The hydrogel formation was based on the intramolecular lactam bonds, intermolecular amide bonds, and Schiff base bonds. In the hydrogel, the super hydrophilic γ-PGA could drain the surface moisture of the wound and create a local dry environment for enhanced surface adhesion. In vivo study showed that the CMCS/ODex/γ-PGA hydrogel possesses a good biosafety and biodegradability. Interestingly, the CMCS/ODex/γ-PGA hydrogel exhibited excellent hemostatic abilities in dynamic humid environment and resisted a high blood pressure of 238 mmHg, which exceeds the threshold systolic blood pressure of healthy adults (i.e. , 120 mmHg). Together with the antibacterial and reactive nitrogen species scavenging activities, this study is expected to provide a new method to design the wet-surface adhesives for the efficient hemostatic application. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective To develop modified finite element models to simulate degenerative lumbar scoliosis (DLS) based on the normal lumbar spine model and to investigate the facet joint force of the DLS. Methods A 3-dimensional finite element model of a normal lumbar spine was modified to simulate 3 different Cobb angles conditions (12.3°, 22.2°, and 31.8°). The stresses on the facet joint were calculated on both sides (right and left) of the each vertebra. Changes of stress and asymmetry in contact forces between facet joints in the development of DLS were quantitatively analyzed to better understand the development of DLS and the biomechanical forming mechanism. Results The results show that asymmetric responses of the facet joint forces exist in various postures and that such effect is amplified with larger curve. When the Cobb angle was smaller, the convex side of the facet joints suffered larger force. When the Cobb angle was larger than 20°, the concave side of the facet joints suffered larger force. In the axial-rotation cases, the facet joint compression is less often located on the ipsilateral side than the contralateral side at the same level. Conclusions With the asymmetric loading, facet joints compressive deformation appears on the concave side, and it decreases in the effect of the facet joints to limit the vertebral rotation and listhesis. Asymmetric loading on facet joint contact forces accelerates asymmetry in the lumbar spine. [ABSTRACT FROM AUTHOR]

Objective To compare the results of anterior cervical discectomy and fusion (ACDF) combined with anterior cervical foraminotomy (ACF) and standalone ACDF for the treatment of cervical spondylotic radiculopathy (CSR). Methods The data of 24 consecutive patients who underwent ACDF combined with ACF for significant bony foraminal stenosis were reviewed. The clinical outcomes, including visual analog scale (VAS) scores for neck pain and arm pain and Neck Disability Index, were evaluated by questionnaires. Radiologic outcomes as manifested by C2-7 angle and surgical segmental angle were recorded. The outcomes were compared with outcomes of standalone ACDF for CSR secondary to posterolateral spurs. Results At the final follow-up evaluation, all patients obtained bone fusion. No patient developed adjacent segment disease. Operative time was longer and blood loss was more in the ACDF combined with ACF group than in the ACDF group (all P < 0.05). However, in both groups, the neck VAS score, arm VAS score, and Neck Disability Index were significantly reduced postoperatively (all P < 0.05). The segmental curve and C2-7 lordosis were significantly improved postoperatively (all P < 0.05). There was no significant difference between the 2 groups in clinical and radiologic outcomes ( P > 0.05). Conclusions For CSR with foraminal stenosis secondary to significant bony pathology that cannot be managed with standalone ACDF, ACDF combined with ACF is an effective and safe treatment strategy. [ABSTRACT FROM AUTHOR]

Objective To evaluate the acute stability of a novel integrated C1 laminar hook (H) combined with a C1–C2 transarticular screw (TAS) with established techniques. Methods A novel integrated C1 laminar hook was tested. Seven human cadaveric cervical spines (C0–C3) were used. The range of motion (ROM) of C1–C2 during flexion-extension, lateral bending, and axial rotation were recorded. The specimens were tested under the following conditions: intact, destabilized (using a type II odontoid fracture model), and destabilized but with internal fixation. The following screw systems were used: bilateral C1–C2 TAS combined with the Gallie (G) technique (TAS+G), C1–C2 TAS combined with a novel integrated C1 laminar hook (TAS+H), C1 lateral mass screw and C2 pedicle screws (C2PS+C1LMS), and novel integrated C1 laminar hook combined with C2 pedicle screws (C2PS+H). The TASs were always inserted after the C2PSs. The C2PS+C1LMS and C2PS+H tests were performed alternatively, as were the TAS+G and TAS+H tests. Results All fixation constructs greatly improved acute atlantoaxial stability, with no significant difference among TAS+H, TAS+G, and C2PS+C1LMS (all P > 0.05). C2PS+H showed the greatest C1–C2 ROM in axial rotation, significantly different from TAS+G, C2PS+C1LMS, and TAS+H fixation models (all P < 0.05). However, there were no significant differences between C2PS+H and the other 3 models in flexion-extension and lateral bending (all P > 0.05). Conclusions The TAS+H technique can achieve acute stability comparable to that with the TAS+G technique for treating C1–C2 instability. The C2PS+H is a promising alternative, although it provides less stability in axial rotation than TAS+G, TAS+H, or C2PS+C1LMS. [ABSTRACT FROM AUTHOR]

Objective To evaluate the outcome of posterior open reduction and interlaminae compression fusion using a screw-rod system combined with a structural iliac bone graft in the treatment of atlantoaxial dislocation (AAD) secondary to os odontoideum. Methods A retrospective study was performed on 24 patients with AAD secondary to os odontoideum. All cases were with partial reduction after skeletal traction. Intraoperative open reduction and fixation were performed with a posterior screw-rod system, followed by interlaminae compression of an autologous iliac bone graft for fusion. The modified atlanto-dental interval (MADI) was measured to assess the degree of dislocation before traction, after traction, and postoperatively. Japanese Orthopaedic Association (JOA) score, Nurick scale score, visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI) score, and neck stiffness were used to evaluate functional outcomes. Results The mean duration of follow-up was 43.0 ± 24.0 months. All patients achieved relief of symptoms and solid bone fusion. There were no complications associated with instrumentation and operation. At the final follow-up, the average MADI was reduced to 2.0 ± 0.8 mm (pretraction: 9.2 ± 1.1 mm; post-traction: 6.6 ± 0.7 mm; P < 0.001). The neck stiffness was significantly relieved ( P < 0.001), and function of the spinal cord manifested by the JOA score and Nurick scale score significantly improved (all P < 0.001). The NDI score and VASSNP markedly decreased (all P < 0.001). Conclusions Intraoperative open reduction and interlaminae compression fusion using a posterior screw-rod system combined with a structural iliac bone graft is a safe and effective procedure for AAD secondary to os odontoideum. [ABSTRACT FROM AUTHOR]