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Background: This study aimed to investigate the impact of three-dimensional (3D)-printed guide plate-assisted percutaneous pedicle screw implantation on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. Methods: Overall, 162 patients who underwent MIS-TLIF at Tai'an City Central Hospital were retrospectively reviewed. The studied variables included operative time, volume of intraoperative blood loss, fluoroscopy time, postoperative drainage volume, visual analogue scale (VAS) score, Oswestry disability Index (ODI) score (preoperatively and at 2 weeks, 3 months, 6 months, and 12 months after surgery), and intervertebral fusion rate at 6 months after surgery. Results: The conventional group included 99 patients who underwent a conventional procedure, while the 3D printing group included 63 patients who underwent 3D-printed guide plate-assisted percutaneous pedicle screw implantation. The conventional group required more times of positioning needle punctures than the 3D printing group (22.2 ± 5.9 vs. 16.1 ± 4.9). The operation and fluoroscopy time were also longer in the former group (183.5 ± 51.1 min vs. 148.8 ± 40.3 min and 30.2 ± 5.9 s vs. 24.1 ± 4.9 s, respectively). In 3D printing group, lower back pain VAS scores and ODI scores at 2 weeks and 3 months after surgery were observed. There were no significant differences in terms of the volumes of intraoperative blood loss; postoperative lower limb pain VAS scores; and interbody fusion rate (P > 0.05). Conclusion: The novel 3D-printed guide plate-assisted percutaneous pedicle screw implantation can achieve better amelioration of back pain and recovery of function. It also reduced the times of positioning needle puncture and fluoroscopy time during percutaneous screw placement surgery and reduced the duration of surgery. [ABSTRACT FROM AUTHOR]

Background: Cervical spondylosis (CS) is a prevalent disorder that can have a major negative impact on quality of life. Traditional conservative treatment has limited efficacy, and electroacupuncture (EA) is a novel treatment option. We investigated the application and molecular mechanism of EA treatment in a rat model of cervical intervertebral disk degeneration (CIDD). Methods: The CIDD rat model was established, following which rats in the electroacupuncture (EA) group received EA. For overexpression of IL-22 or inhibition of JAK2-STAT3 signaling, the rats were injected intraperitoneally with recombinant IL-22 protein (p-IL-22) or the JAK2-STAT3 (Janus kinase 2—signal transducer and activator of transcription protein 3) inhibitor AG490 after model establishment. Rat nucleus pulposus (NP) cells were isolated and cultured. Cell counting kit-8 and flow cytometry were used to analyze the viability and apoptosis of the NP cells. Expression of IL-22, JAK2 and STAT3 was determined using RT-qPCR. Expression of IL-22/JAK2-STAT3 pathway and apoptosis related proteins was detected by Western blotting (WB). Results: EA protected the NP tissues of CIDD rats by regulating the IL-22/JAK2-STAT3 pathway. Overexpression of IL-22 significantly promoted the expression of tumor necrosis factor (TNF)-α, IL-6, IL-1β, matrix metalloproteinase (MMP)3 and MMP13 compared with the EA group. WB demonstrated that the expression of IL-22, p-JAK2, p-STAT3, caspase-3 and Bax in NP cells of the EA group was significantly reduced and Bcl-2 elevated compared with the model group. EA regulated cytokines and MMP through activation of IL-22/JAK2-STAT3 signaling in CIDD rat NP cells. Conclusion: We demonstrated that EA affected apoptosis by regulating the IL-22/JAK2-STAT3 pathway in NP cells and reducing inflammatory factors in the CIDD rat model. The results extend our knowledge of the mechanisms of action underlying the effects of EA as a potential treatment approach for CS in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of adult spinal deformity (ASD) has increased in recent years. Patients often have to live for a prolonged period from the onset of the condition, up until the need for surgical treatment. Self-management plays a crucial role in disease progression and prognosis. Objectives: This project aimed to promote evidence-based practices for the self-management of patients with ASD. Methods: This project was guided by the JBI Evidence Implementation Framework project and was conducted in the orthopedic department of a tertiary care hospital in China. A baseline audit was conducted to evaluate current practice against best practice recommendations. Barriers were identified and, after the implementation of improvement strategies, a follow-up audit was conducted to assess project effectiveness. Results: A comparison between the baseline and follow-up audits revealed a significant increase in nurses' compliance with best practices (rising from 0%–64% to 97.7%–100%) in the following areas: improved health promotion behaviors by nurses in self-management of ASD patients; acquisition and application of communication skills with patients; increased availability of educational materials in the ward; and establishment of conservative treatment follow-up instructions for patients. For patients, the Visual Analog Scale of pain decreased from (2.72 ± 1.67) to (1.90 ± 1.14), the Oswestry Disability Index decreased from (49.96 ± 16.49) to (39.83 ± 18.97), self-management behaviors improved from (10.84 ± 4.31) to (19.52 ± 6.31), and maximum isometric muscle strength in the standing position increased from (179.48 ± 91.18)N to (250.03 ± 91.50)N, all with statistically significant improvements (p <0.05). For nurses, the knowledge questionnaire score improved from (34.83 ± 24.16) to (82.00 ± 11.11) (p <0.05). Conclusions: This project helped ASD patients improve self-management, alleviated their clinical symptoms, and improved nurses' knowledge of best practices. Future audits will be conducted to review long-term project outcomes. http://links.lww.com/IJEBH/A193 [ABSTRACT FROM AUTHOR]

A randomized, controlled clinical trial was conducted from 2022 to 2023 at a hospital specializing in Traditional Chinese Medicine in Shanghai. A total of 564 participants were allocated into control and intervention groups in order to determine the effectiveness of Shujing Tongdu massage on patients with chronic lesions or spinal disorders. No significant differences were observed in baseline characteristics between the groups; age, gender and condition type were all distributed in a comparable manner. Following the implementation of Shujing Tongdu massage therapy twice weekly for the duration of 12 weeks, intervention group exhibited noteworthy enhancements. Significantly, rate of lesion healing achieved in the intervention group increased by 30%, while it merely improved by 10% in the control group. The intervention group exhibited decrease in pain intensity from 6.5 to 4.2, whereas control group demonstrated comparatively smaller reduction from 6.7 to 6.0. Range of motion in the intervention group increased substantially from 45 to 60 degrees, whereas it increased from 44 to 46 degrees in the control group. In the intervention group, Quality of Life scores increased from 50 to 75, exceeding the increase of 58 in the control group. There was significant rise in the Mental Well‐being Index for intervention group, from 60 to 80, in contrast to rise of 64 from 62 in the control group. Statistically significant outcomes were determined, establishing the massage therapy's efficacy. Mild discomfort and muscle soreness were the most frequent adverse effects in the intervention group, whereas vertigo was more prevalent in the control group. Based on the findings of this research, Shujing Tongdu massage therapy effectively promoted wound healing and mitigated symptoms associated with spinal disorders, indicating its potential as the supplementary therapeutic modality in clinical environments. [ABSTRACT FROM AUTHOR]

Background: Compared with Caucasians, East Asians have a lower incident of back pain, lower prevalence and severity of osteoporotic vertebral fracture and lumbar spine degeneration. Aim: This study compares radiographic spine degeneration features of older Chinese women (as an example of East Asians) and older Italian women (as an example of Caucasians) with a focus on the thoracic spine. Methods: From two population-based epidemiological studies conducted in Hong Kong, China and Rome, Italy, 297 pairs (mean age: 73.6 years) age-matched older community women's lateral spine radiographs were sampled. Existence (or absence) of seven degeneration features were assessed including: (1) hyper-kyphosis, (2) disc space narrowing (T3/T4 ~ T11/T12), (3) osteoarthritic (OA) wedging (T4 ~ T12), (4) generalised osteophyte formation (T4 ~ T12); (5) acquired short vertebrae (T4 ~ T12), (6) Schmorl node (T4 – L5), (7) disc calcification (T4–L5). Results: Italian women were more likely to have hyper-kyphosis (53.4% vs 25.6%), disc space narrowing (34.4% vs. 17.2%), OA wedging (6.4% vs. 0.67%), Schmorl node (19.5% vs. 4.4%, all P < 0.001). However, there was no statistically significant difference in osteophyte formation (7.7% vs. 9.4%, P > 0.1) and acquired short vertebrae (8.0% vs. 10.4%, P > 0.1). Disc calcification was uncommon among both Chinese and Italians. Discussion and conclusion: For the first time, this study documented a lower prevalence of a number of thoracic spine degeneration features among Chinese. This study further affirms the concept of a generally healthier spine in older Chinese relative to older Caucasians. The observed differences may reflect a foundational background influence of genetic predisposition that represents an important line of future research. [ABSTRACT FROM AUTHOR]

Background: Numerous complications of lumbar fusion surgery have been reported, with adjacent segment disease (ASD) being one of the most important. Few studies describe the effect of sagittal, horizontal screw angles and distance of pedicle screw apex to superior endplate on the incidence of ASD in lumbar spine. The purpose of this retrospective study is to evaluate the hypothesis that unsatisfactory pedicle screw insertion positions would increase the likelihood of ASD. Methods: Outpatients with lumbar spinal stenosis underwent posterolateral lumbar fusion at L4-S1 with a least 2-year follow-up were studied. ASD at L3–L4 was defined as a condition in which intervertebral disk narrowing, posterior vertebral opening, and vertebral slippage progress at the last follow-up in comparison with the postoperative. Independent t test was performed to compare data between two groups; Spearman analysis was performed to analyze the relationship between two continuous variables. Multivariate binary logistic models were performed to identify the independent risk factors of ASD. The receiver operating characteristic (ROC) curve was performed to measure model discrimination and Hosmer–Lemeshow (H–L) test was used to measure calibration. ROC curve evaluated the discrimination ability of sagittal screw angle and distance in predicting incidence of ASD. Results: Patients in ASD group exhibit higher incidence of osteoporosis, higher Visual analogue scale (VAS), Oswestry disability index (ODI), bigger sagittal screw angle, shorter distance of pedicle screw apex to superior endplate than those in non-ASD group (p < 0.05). VAS, ODI at the last follow-up were positively correlated with Pfirrmann grade of L3–4 disk and sagittal screw angle, while negatively correlated with distance of screw apex to superior endplate (p < 0.05). Multivariate binary logistic model indicated that follow-up time (odds ratio [OR] 1.637, 95% confidence interval [CI] 1.186–2.260), distance of screw apex to superior endplate (OR 0.150, 95% CI 0.067–0.336), sagittal screw angle (OR 2.404, 95% CI 1.608–3.594) were statistically significant. The models showed great discrimination and calibration. The area under the curve of ASD identified by sagittal angle and distance was 0.895 and the cut-off values were 5.500° and 6.250 mm, respectively. Conclusion: Sagittal screw angle and distance of screw apex to superior endplate were significantly associated with the risk of ASD. [ABSTRACT FROM AUTHOR]

Objective: The association between the single-nucleotide polymorphisms (SNPs) rs28742109, rs12955018, rs987850, rs8093805, rs12965084 and rs145497186 related to gene named NADH dehydrogenase [ubiquinone] flavoprotein 2 (NDUFV2) and lumbar disc degeneration (LDD) was preliminary investigated in a small sample size. Methods: A total of 46 patients with LDD and 45 controls were recruited at Qilu Hospital of Shandong University, and each participant provided 5 mL peripheral venous blood. NA was extracted from the blood of each participant for further genotyping. The frequency of different genotypes in the case group and control group was determined, and analysis of the risk of LDD associated with different SNP genotypes was performed. The visual analogue scale (VAS) scores of the patients' degree of chronic low back pain were calculated, and the relationship between VAS scores and SNPs was analysed. Results: After excluding the influence of sex, age, height, and weight on LDD, a significant association between SNP rs145497186 related to NDUFV2 and LDD persisted (P = 0.006). Simultaneously, rs145497186 was found to be associated with chronic low back pain in LDD populations. Conclusion: NDUFV2 rs145497186 SNP could be associated with susceptibility to LDD and the degree of chronic low back pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Because of its excellent biomechanical advantages, pedicle screw of subaxial cervical spine is widely used in various cervical spine diseases caused by trauma, tumors and deformities. How to improve the accuracy of nail placement and reduce postoperative complications has been hotspots in the research of the placement technology of the pedicle screw of subaxial cervical spine. OBJECTIVE: To review relevant domestic and foreign articles, to review the related anatomical characteristics of the placement technology of the pedicle screw of subaxial cervical spine, the biomechanical characteristics of pedicle screw of subaxial cervical spine and the research on the screw placement technology in and outside China, and to analyze the advantages and disadvantages of each placement technology. METHODS: Relevant articles in PubMed, Web of Science, CNKI, Wanfang and other databases were searched using “cervical, pedicle” in English, and “cervical vertebrae, pedicle” in Chinese as search terms. Related Chinese articles published from January 2015 to December 2020 and related English articles published in the past 5 years were searched. Finally, 52 articles were included, including 22 Chinese articles and 30 English articles. RESULTS AND CONCLUSION: (1) Regarding the thickness and strength of the cortex, the inner wall of the pedicle was higher than that of the outer wall. The abduction angle of the pedicle gradually decreased from C3-C7. The shape of the pedicle was similar to an ellipsoid. The distance between the upper edge of the pedicle and the upper nerve root gradually increased from C3-C7, and the distance between the lower edge of the pedicle and the inferior nerve root gradually decreased from C3-C7. The anterior lateral wall of the pedicle was close to the vertebral artery; and the anterior medial wall of the pedicle was close to the epidural sinus. (2) The penetrating force of the inner wall of the pedicle was greater than the other three side walls. In terms of direct extraction force, pedicle screws were superior to intervertebral foraminal screws and lateral mass screws. In terms of fatigue extraction force, pedicle screws and intervertebral foraminal screws were better than lateral mass screws. (3) At present, screw placement in posterior route pedicle on subaxial cervical spine mainly included freehand screw placement, computer-assisted screw placement, 3D printing guide-assisted screw placement, and surgical robot-assisted screw placement. However, various screw placement techniques have certain drawbacks. In the future, freehand screw placement technology will still be the mainstream of the subaxial cervical pedicle placement technology. With the improvement of technical level and the support of artificial auxiliary equipment, artificial intelligence assisted screw placement technology will become the future development direction. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: With the increase in life expectancy, a large number of patients with osteoporosis (OP) are undergoing spine surgery, which may adversely affect the surgical success rate. The prevalence of OP varies in different regions, and no data are available that represent the prevalence of OP among Chinese patients over 50 years of age who are undergoing spine surgery. It was the first multicenter study to assess OP in these patients. Aiming to obtain comprehensive data, this study combined bone mineral density (BMD) measurements and visual radiography assessment (VRA) to analyze the prevalence of OP in patients aged > 50 years who underwent spine surgery.Methods: Data from 1,856 patients aged over 50 years undergoing spine surgery who resided in northern, central, and southern China were reviewed between 2018 and 2019. Based on the perioperative BMD and X-ray data, we calculated the prevalence of OP in this special population according to sex, age, and spine degenerative disease.Results: A total of 1,245 patients (678 females and 567 males) were included in the study. The prevalence of OP diagnosed by BMD was 52.8 % in females and 18.7 % in males. When we combined with BMD and VRA, the prevalence of OP increased from 52.8 to 65.9 % in females and from 18.7 to 40.6 % in males. Although OP was more severe in females than in males, a significant difference in the rate of vertebral fracture (VF) was not observed between females and males with a normal BMD and osteopenia (females vs. males: aged 50-59 years, P = 0.977; 60-69 years, P = 0.302; >70 years, P = 0.172). Similarly, no significant difference in the vertebral fracture rate was observed within different age groups of patients with a normal BMD and osteopenia (females: P = 0.210; males, P = 0.895). The incidence of OP in patients with degenerative scoliosis was higher than that in the remaining patients (females: 63.6 % vs. 42.4 %, P = 0.018; males: 38.9 % vs. 13.8 %, P = 0.004).Conclusions: A high prevalence of OP was identified in patients aged > 50 years undergoing spine surgery, especially in patients whose primary diagnosis was degenerative scoliosis. BMD and VRA evaluations should be included in the clinical routine for these patients prior to surgery. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Spinal metastases have unique epidemiological features and treatment methods. Unfortunately, the relative scarcity of spinal metastases has limited the widespread development of descriptive epidemiological studies, especially in Asian countries. The purpose of this study was to describe the epidemiological characteristics of patients with metastatic spinal tumors in China between 2007 and 2019. From January 2007 and July 2019, data on patients with spinal metastases were collected from five cancer centers in China, and demographic characteristics, primary tumor types, segments and numbers of vertebral lesions, disease-related scores, and treatment methods were reviewed. A total of 2228 patients with spinal metastases were reviewed in this study, including 1279 male patients and 949 female patients, and the male to female ratio was 1.35: 1. More than half of patients developed metastatic diseases between the ages of 50 years and 69 years (64%). Overall, lung cancer (824 cases, 37%) was the most common primary tumor type and the most common level of spinal involvement was multi-level of metastases (860 cases, 39%). 705 patients (32%) had undergone surgical treatments, 1028 patients (46%) had undergone radiotherapy for metastatic vertebrae, and 855 patients (38%) had received systemic treatments. The age, primary tumor type, number of involved vertebrae, Frankel grade, and spinal instability neoplastic score would affect the surgical decision-making. This study provides insight into the epidemiological characteristics of spinal metastasis and health care service utilization in spinal metastasis patients in China. ICD-10: International Classification of Disease, Tenth Revision; VAS: Visual Analogue Scale; KPS: Karnofsky Performance Status; SINS: Spinal Instability Neoplastic Score; SOSG: Spine Oncology Study Group; MRI: Magnetic Resonance Imaging; CT: Computed Tomography; ECT: Emission Computed Tomography. [ABSTRACT FROM AUTHOR]

Purpose: To summarize the scope of nomenclature and measurement methods used to document endplate defects in the health sciences literature.Methods: The scoping review followed the York framework and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The databases of PubMed, Scopus, Embase and CINAHL were searched using key terms. Screening and selection were conducted by two independent reviewers. A standardized, pilot-tested form was used for extracting data, which were analyzed descriptively.Results: The review included 211 studies, originating from 29 countries, with the USA (18.8%) and China (12.26%) as leading contributors. Thirty-four different terms for structural endplate defects were reported, but were never defined in most studies (65%). Of the 34 different terms used, some appeared to represent the same phenomenon, while the same terms were occasionally defined differently between studies. Schmorl's nodes were most commonly investigated (n = 99 studies) and defined similarly across studies, with the main difference relating to whether the indentation (node) was required to have a sclerotic margin. There were also similarities in definitions for endplate sclerosis. However, there was great variability in the definitions of other terms, such as lesions, irregularities, abnormalities, erosions and changes.Conclusion: With the possible exception of Schmorl's nodes, we lack a common language for effectively communicating structural endplate findings. This review provides a foundation and impetus for standardizing terminology and core measures to improve communication and synthesis of the growing body of endplate research to advance related knowledge. These slides can be retrieved under Electronic Supplementary Material (paragraph). Then process the ppt slide as graphical image. [ABSTRACT FROM AUTHOR]

Background Context: Although the roles of Modic Changes (MCs) and disc degeneration in back pain remain controversial, clues from cadaveric studies suggest that lumbar vertebral endplate lesions may be important in back pain. Endplate lesions can be detected on magnetic resonance (MR) images as various endplate defects, including focal, corner, and erosive defects. Yet, the clinical significance of such endplate defects remains unknown.Purpose: To determine the prevalence and distribution patterns of lumbar vertebral endplate defects and their associations with back pain in a population-based sample.Study Design: Cross-sectional study.Patient Sample: Subjects were randomly selected from a typical community in Hangzhou Eastern China, regardless of back pain status.Outcome Measures: Each subject underwent a structured interview and lumbar MR imaging. Back pain history, including today, over the past 4 weeks, 12 months, and lifetime, were acquired. Endplate defects, MCs, and disc degeneration were evaluated on MRIs. Age, gender and body mass index (kg/m2), as well as lifetime exposures, including smoking history, riding in motorized vehicles and associated vibration, and occupational physical demands were assessed.Methods: Descriptive statistics were used to depict prevalence and distribution patterns of endplate defects in the lumbar spine. Logistic regressions were used to examine associations of endplate defects with back pain. The research grant was obtained from the National Natural Science Foundation of China (115,000 USD), Key Platform Project of the Health Department of Zhejiang Province (14,000 USD), Technology Program of Traditional Chinese Medicine Department of Zhejiang Province (21,000 USD), and 2015 Qianjiang Talent Program of Zhejiang Province (7,000 USD) toward this work. There is no conflict to disclose.Results: There were 478 subjects (53.3±14.4 years, range 20-88 years) studied. Endplate defects presented in 301 (63.0%) subjects and 842 (16.0%) endplates. The presence of endplate defects, but not MCs and disc degeneration, was associated with lifetime back pain (odds ratio=1.64, p=.026) in multivariate analyses. Focal and erosive endplate defects were associated with lifetime back pain history (odds ratio=1.74-2.23, p<.05 for both), whereas all three types of defects were associated with intensity of worst back pain over the past 12 months (Coef=5.84-7.19, p<.05 for all).Conclusions: Endplate defects are common findings on lumbar MRIs in adults. Specific types of endplate defects were associated with back pain history. Endplate defects may be an independent risk factor for back pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spinal sagittal imbalance caused by degenerative changes or iatrogenic factors in the elderly can cause symptoms such as anteversion and low back pain (LBP). There are different and conflicting opinions about the relationship between the degree of lumbar lordosis and functional status of patients with chronic low back pain (CLBP). OBJECTIVE: This study aimed to determine the relationships among the lumbar lordosis index, sacral horizontal angle, and CLBP in the elderly. METHODS: Subject data were collected from Lishui City, Zhejiang Province, China, using cluster sampling according to the background information provided by national physical fitness monitoring. The 207 subjects were urban and rural individuals, 60–69 years old. Radiographs were evaluated according to a standardized protocol. The lumbar lordosis index and sacral horizontal angle were recorded. Data on the prevalence and functional status of CLBP were collected through field investigations. Statistical correlations between the radiographic parameters and the prevalence and functional status of CLBP measurements were evaluated. RESULTS: No significant difference was observed in the sacral horizontal angles among the subjects with and without CLBP; however, the lumbar lordosis index of CLBP subjects was significantly higher than that of those without CLBP (P = 0.028) and showed a significant association with CLBP (P = 0.013). Neither the sacral horizontal angle nor the lumbar lordosis index showed significant correlations with the Oswestry Disability Index in CLBP subjects. CONCLUSIONS: The lumbar lordosis index, but not the sacral horizontal angle, was significantly associated with CLBP in the subjects. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the quantity and quality of articles in the field of full-endoscopic spine surgery (FESS) from different countries and assess characteristics of worldwide research productivity.Methods: Articles published from 1997 to July 23, 2018, were screened using the Web of Science database. All studies were assessed for the following parameters: the number of total publications, h-index, contribution of countries, authors, journals, and institutions.Results: A total of 408 articles were identified between 1997 and 2018. Between 1997 and 2017, the number of published articles tended to increase by 41 times. The largest number of articles was from China (30.15%), followed by South Korea (28.68%), the USA (13.97%), Germany (9.31%), and Japan (4.90%). The highest h-index was found for articles from South Korea (23), followed by the USA (18), Germany (16), China (11), and Japan (7). The highest number of articles was published in World Neurosurgery (12.50%), followed by Pain Physician (10.29%), Spine (6.62%), European Spine Journal (4.66%), and Journal of Neurosurgery: Spine (4.17%). Wooridul Spine Hospital published the largest number of articles (10.29%), followed by Tongji University (5.88%), University of Witten/Herdecke (5.39%), Brown University (5.15%), and Third Military Medical University (3.43%).Conclusions: The number of articles published in the field of FESS has increased rapidly in the past 20 years. In terms of quantity, China is the most contributive country based on the number of publications. High-quality papers as measured by h-index and the large quantity is from South Korea (second only to China). These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Purpose: Given the aging Chinese population and the inevitable degenerative process of the spine, more elderly patients with spinal degenerative disease (SDD) are surgical candidates, placing a significant burden on health care resources. Few studies have investigated recent trends in hospital admissions and procedures for SDD in China. This study aimed to identify the trends, if any, in the number of surgical procedures undertaken for SDD in a large patient cohort. Materials and methods: This retrospective cohort analysis used data from inpatient medical records at Peking University Third Hospital between 2003 and 2016. Descriptive statistical analysis, regression models, and a Holt–Winters seasonal model were used to analyze trends. Results: Altogether, 38,676 surgery records from 37,897 SDD patients who had undergone surgical treatment were included in our study, among whom 49.60%, 47.81%, and 2.59% were treated because of cervical, lumbar, and thoracic degenerative disease, respectively. There was an increasing trend for spinal surgery performance with an increasing mean age at surgery, from 50.65 years of age in 2003 to 55.29 years in 2016. We also revealed interesting seasonal variation in our study – that is, most of the spinal procedures were performed during the winter and spring months. Conclusion: Our study showed a significantly increasing surgical workload for addressing SDD in China. Both the public and the health care system should be aware of this increase in chronic degenerative disease in the aging population. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective clinical series.Objective: To investigate the clinical features and the risk factors for recurrent lumbar disc herniation (rLDH) in China.Summary Of Background Data: rLDH is a common cause of poor outcomes after lumbar microdiscectomy surgery. Risk factors for rLDH are increasingly being investigated. However, results in these previous studies were not always consistent.Methods: Between June 2005 and July 2012, 321 consecutive patients with single-level LDH, who underwent surgery, were enrolled in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group) and compared their clinical parameters and preoperative radiologic parameters. The relationships between the variables and rLDH were evaluated by univariate analysis and multiple logistic regression analysis.Results: There was significant difference between groups in sex (P = 0.003), age (P = 0.003), current smoking (P = 0.004), body mass index (BMI) (P = 0.04), occupational lifting (P < 0.001), trauma history (P = 0.04), procedures (P = 0.04), herniation type (P = 0.006), disc height index (DUI) (P = 0.04), facet orientation (FO) (P = 0.04), facet tropism (FT) (P = 0.04), and sagittal range of motion (from) (P = 0.04). By putting these differences in logistic regression analysis, it showed that being male, young age, current smoking, higher BMI, herniation type (transligamentous extrusion), surgical procedures (bilateral laminectomy or total laminectomy), heavy works, undergoing a traumatic event, a large from, a high DUI, a large FT, and a small FO significantly related with rLDH.Conclusion: Based on our data, sex, age, current smoking, BMI, occupational lifting, trauma, surgical procedures, herniation type, DUI, FO, FT, and from showed a significant correlation with the incidence of rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: The prevalence of cervical block vertebrae is unknown. Furthermore, there is no consensus on the cause of adjacent segment degeneration (ASD) after cervical fusion.Questions/purposes: (1) What is the incidence of cervical block vertebrae? Is there a gender difference? (2) Among cervical block vertebrae cases, is ASD related to age and segment? And what is the specific relationship? (3) What are the imaging findings and characteristics of this disease?Patients and Methods: We retrospectively diagnosed cervical block vertebrae cases with bony fusions in any segments of the cervical spine without intervertebral fusion surgery of 33,762 patients reported from 2006 to 2011 in north China. Then the X-ray of the obtained cases were observed and counted. The primary outcome was incidence of ASD according to age and segment. The secondary outcome measures were C2-7 angle in fusion (single segment fusion of lower cervical vertebra) and control groups (randomly selected cases of non-fusion), Cobb's angle of fusion segments, and curvature of each lower cervical segment in the control group.Results: A total of 218 cervical block vertebrae cases were found, with a incidence of 0.65%, and C2-3 represented the highest number of fusion segment cases. There were no significant differences in the incidence by sex. Varying degrees of degeneration in the adjacent segment was present in 112 cases (51.4%). The incidence of ASD increased with age, with the ASD growth rate reaching its peak at the age of 51-60 years (55.08%). Cervical curvature shows no significant difference between patients with cervical block vertebrae and normal individuals. The segmental curvature was lower in the fusion group than in the control group, with statistical significance achieved in fusion segments located in C4-5, C5-6, and C6-7, but not C3-4.Conclusions: Fusion segments located in C4-5, C5-6, and C6-7 are more prone to ASD than C3-4. The incidence of ASD in patients with vertebral fusion increases with age.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: No effective constructs were available in mainland China to assess the whole spine function. The SFI was developed to evaluate spinal function based on the concept of a single kinetic chain concept for whole spine. The SFI has been translated to Spanish and Turkish with accepted psychometric properties. It is imperative to introduce the SFI in mainland China and further to explore the measurement properties.Methods: The English versions of the SFI was cross-culturally translated according to international guidelines. Measurement properties (content validity, construct validity and reliability) were tested in accordance with the COSMIN checklists. A total of 271 patients were included in this study, and 61 participants with neck pain and 64 participants with back pain paid a second visit three to seven days later. Confirmatory factor analysis (CFA) and principal factor analysis (PCA) were applied to test the factor structure. The Functional Rating Index (FRI), Neck Disability Index (NDI), Oswestry Disability Index (ODI), SF-12 and a Visual Analogue Scale (VAS) were employed to evaluate the construct validity. Cronbach's alpha and an intra-class correlation coefficient (ICC) were calculated for internal consistency and reproducibility.Results: The means score of SC-SFI was 63.60 in patients with spinal musculoskeletal disorders. A high response rate was acquired (265/271). No item was removed due to abnormal distribution or low item-total correlation. Results of CFA did not support that one-factor structure was in goodness of fit (CMIN/DF = 3.306, NNFI = 0.687, CFI = 0.756, GFI = 0.771 and RMSEA = 0.092). Yet, PCA suggested a one-factor structure was the best, accounting for 32% of the total variance. For structural validity, the SC-SFI correlated highly with the FRI, NDI, ODI, and PF, BP in SF-12 (r = 0.661, 0.610, 0.750, 0.709, 0.605, respectively). All the a priori hypotheses were verified. The Cronbach's alpha for the SC-SFI was 0.91, and ICC was 0.96 (95% CI, 0.94-0.98). Bland-Altman plot also confirmed excellent test-retest reliability.Conclusions: The SFI has been culturally adapted into SC-SFI with remarkable clinical acceptance, excellent internal consistency, reproducibility, and construct validity when applied to patients with spinal musculoskeletal disorders. The results of current study suggest that SC-SFI can be applied by physicians and researchers to measure whole-spine functional status in mainland China. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study.Purpose: To explore the risk factors for reintubation after airway obstruction following anterior cervical surgery.Study Background: Anterior cervical surgery is an effective surgical therapy for cervical spine disorders. As the anterior approach is adopted more frequently, some rare postoperative complications come under the spotlight, among which, airway obstruction is extremely detrimental. However, the risk factors and the pathogenesis of the airway obstruction still remain unknown. Therefore, finding out the incidence rate and the risk factors of airway obstruction after anterior cervical surgery weighs significantly on preventing airway obstruction.Methods: We retrospectively analyzed the history and follow-up data of 774 patients who underwent anterior cervical surgery during January 2007 and June 2016. The patients were divided into two groups according to the occurrence of airway obstruction complication. Patients' age, sex, smoking history, drinking history, the presence of diabetes, body mass index (BMI), course of disease, surgical method, the location of the surgical segment, operation duration and the number of surgical segments were recorded and analyzed. Univariate analysis was conducted for the foregoing factors which might associate with concurrent airway obstruction, to screen out statistically significant factors, followed by a multivariate logistic regression analysis to analyze the relationship between these factors and the incidence rate of reintubation for airway obstruction after anterior cervical surgery.Results: 14 of 744 patients developed postoperative airway obstruction followed by reintubation, which makes the incidence rate of 1.81% (14/774) for patients having airway obstruction after anterior cervical surgery. Among the 14 patients, 12 (85.7%) developed airway obstruction within 48 h after surgery, and 2 (14.3%) postoperative showed delayed airway obstruction in 9-11d after surgery. All of them had reintubation. The results of univariate analysis showed that there were statistically significant differences in age, smoking history, body mass index (BMI), surgical method, the location of the surgical segment, operation duration and the number of surgical segments between the two groups (P < 0.05). Multivariate logistic regression analysis showed that age (OR = 2.038, 95% CI = 1.045-4.012), smoking (OR = 1.502, 95% CI = 1.012-2.375), BMI (OR = (OR = 1.807, 95% CI = 1.126-2.842), operation duration (OR = 2.503, 95% CI = 1.580-3.966), surgical method (OR = 3.386, 95% CI = 1.036-3.625), the location of the surgical segment (OR = 2.391, 95% CI = 1.085-5.159) and the number of surgical segments (OR = 2.512, 95% CI = 1.564-3.768) were the risk factors for airway obstruction and reintubation after anterior cervical surgery (P < 0.05).Conclusions: Age, smoking, obesity, the number of surgical segments, surgical method and surgical segment location are the important factors which may induce airway obstruction after anterior cervical surgery and therefore led to the decision of reintubations. [ABSTRACT FROM AUTHOR]

Objective: To construct and validate a model to predict responsible nerve roots in lumbar degenerative disease with diagnostic doubt (DD).Methods: From January 2009-January 2013, 163 patients with DD were assigned to the construction (n = 106) or validation sample (n = 57) according to different admission times to hospital. Outcome was assessed according to the Japanese Orthopedic Association (JOA) recovery rate as excellent, good, fair, and poor. The first two results were considered as effective clinical outcome (ECO). Baseline patient and clinical characteristics were considered as secondary variables. A multivariate logistic regression model was used to construct a model with the ECO as a dependent variable and other factors as explanatory variables. The odds ratios (ORs) of each risk factor were adjusted and transformed into a scoring system. Area under the curve (AUC) was calculated and validated in both internal and external samples. Moreover, calibration plot and predictive ability of this scoring system were also tested for further validation.Results: Patients with DD with ECOs in both construction and validation models were around 76 % (76.4 and 75.5 % respectively).Risk Factors: more preoperative visual analog pain scale (VAS) score (OR = 1.56, p < 0.01), stenosis levels of L4/5 or L5/S1 (OR = 1.44, p = 0.04), stenosis locations with neuroforamen (OR = 1.95, p = 0.01), neurological deficit (OR = 1.62, p = 0.01), and more VAS improvement of selective nerve route block (SNRB) (OR = 3.42, p = 0.02).Validation: the internal area under the curve (AUC) was 0.85, and the external AUC was 0.72, with a good calibration plot of prediction accuracy. Besides, the predictive ability of ECOs was not different from the actual results (p = 0.532).Conclusions: We have constructed and validated a predictive model for confirming responsible nerve roots in patients with DD. The associated risk factors were preoperative VAS score, stenosis levels of L4/5 or L5/S1, stenosis locations with neuroforamen, neurological deficit, and VAS improvement of SNRB. A tool such as this is beneficial in the preoperative counseling of patients, shared surgical decision making, and ultimately improving safety in spine surgery. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study.Objective: The aims of this study were to evaluate the radiographic and clinical outcomes of Bryan cervical disc arthroplasty at 10-year follow-up.Summary Of Background Data: Cervical arthroplasty is a new technique for treating degenerative cervical disease. Previous reports have shown that cervical arthroplasty with Bryan disc gained good clinical outcomes at 4- to 6-year follow-up.Methods: Clinical outcomes and dynamic x-ray examination were evaluated at baseline and at final follow-up.Results: Thirty-three patients with complete clinical and radiographic data were included in this study. The mean follow-up period was 120.5 months (116-130 months). Twenty-five patients underwent single-level arthroplasty and 7 underwent arthroplasty at 2 levels. One patient underwent arthroplasty at 3 levels. Eight of the 33 patients presented with radiculopathy and 25 patients with myelopathy. The 42 levels of surgery included C3/4 (3 levels), C4/5 (7 levels), C5/6 (26 levels) and C6/7 (6 level). The mJOA score of the 25 patients with myelopathy was 11.8 at the baseline and 15.9 at the final follow-up. No patient suffered from adjacent segment disease. Two patients received revision surgeries at the index level for recurrent radiculopathy caused by osteophyte formation and heterotopic ossification. On x-ray examination, the range of motion at the operated level was 7.8 degree at the baseline and 4.7 degree at the final follow-up. Heterotopic ossification was observed in 29 (69.0%) levels and heterotopic ossification of Grade 4 was observed in 14 levels. Adjacent segment degeneration was observed in 30 (47.6%) levels.Conclusion: Cervical arthroplasty using Bryan cervical disc prosthesis resulted in fine clinical outcomes in this study. Heterotopic ossification was common after Bryan disc arthroplasty, which decreased the range of motion.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background Context: Modic changes (MC) are bone marrow lesions on magnetic resonance imaging (MRI), suggestive of being associated with low back pain (LBP). Data on determinants of MC and their association with disc degeneration and other spinal phenotypes, as well as that of LBP, rely mostly on small-scale patient populations and remain controversial.Purpose: This study addressed the potential determinants of MC and their association with disc degeneration and LBP among Southern Chinese.Study Design/setting: A cross-sectional, population-based study was carried out.Patient Sample: This study consisted of 2,449 Southern Chinese volunteers.Methods: Sagittal T2-weighted MRIs of the lumbar spine were assessed for the presence of MC and other spinal phenotypes (eg, disc degeneration, disc displacement, Schmorl nodes) in all individuals. Subjects' demographics, occupation, lifestyle, and clinical profiles were assessed.Results: The overall prevalence of MC was 5.8% (n=141), which increased with advancing age. Modic changes predominantly occurred at the lowest two lumbar levels (83%). In the multivariate analyses, only the presence of disc displacement and a higher disc degeneration score were associated with MC at the upper lumbar levels (L1/L2-L3/L4) (p<.01). The presence of MC at the lowest two lumbar levels (L4/L5-L5/S1) were associated with age, the presence of Schmorl nodes, disc degeneration or displacement, and historical lumbar injury (p<.01). Subjects who were both smokers and overweight or obese had increased likelihood of MC in the lower spine (OR: 2.18; 95% CI: 1.10-4.30). The presence of MC at the lower lumbar levels were associated with historical LBP (OR: 1.93; 95% CI: 1.05-3.54) and with severity and duration of symptoms (p<.05).Conclusions: Based on one of the largest MRI studies to assess lumbar MC, we noted that MC were associated with both disc degeneration and the presence and severity of LBP. Determinants and association of MC with disc degeneration and clinical symptoms in the upper versus the lower lumbar spine were different. Our study further stresses the significance of MC as important imaging phenotypes associated with LBP. [ABSTRACT FROM AUTHOR]

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Objective: In recent years, Cage/SyCages or titanium mesh cages with interbody fusion have become a common surgical treatment for patients with cervical spondylosis and traumatic lesions. However, numerous complications have been reported, including hardware failure or breakage, which necessitate reoperation, and complications at the bone graft site. To improve upon the existing traditional titanium mesh cage, we designed a new pterygo-shaped titanium mesh cage (PTMC). Methods: We designed a biomechanical study to assess the relative rigidity provided by the PTMC system using cadaveric cervical spine models. Early outcome assessments of patients undergoing anterior cervical decompression and stabilization with the described technique also were performed. Eight fresh human cadaver spine segments from C1 to C7 were loaded nondestructively with pure moments in a nonconstraining testing apparatus to induce flection, extension, lateral bending, and axial rotation, whereas angular motion was measured optoelectronically. Results: The biomechanical results indicated that the PTMC provided effective stabilization for the unstable cervical segments in the eight cadavers ( P < 0.01). Device displacement, prolapse, or collapse did not occur after surgery in any of the 27 adult patients that were followed postoperatively for 24-30 months (average 27.4 months). Conclusions: The PTMC exhibited excellent biomechanical performance. It provided immediate stabilization and also avoided device displacement, prolapse, or collapse. Moreover, harvesting of iliac bone was not required. [ABSTRACT FROM AUTHOR]

Strong associations between the polymorphisms of anthrax toxin receptor 2 (ANTXR2) and interleukin-1 receptor 2 (IL-1R2) and ankylosing spondylitis (AS) were identified through genome-wide scan by Australo-Anglo-American Spondyloarthritis Consortium very recently. However, the data are restricted to Caucasian patients in only the above report, and no replication study in other ethnic groups is published. Our study addresses this relationship in Chinese Han population. A cohort of 200 AS patients who satisfied the modified New York criteria and 200 ethnically matched healthy controls were recruited. All subjects were genotyped for rs4333130 of ANTXR2 and rs2310173 of IL-1R2. Genotyping was performed using the Sequenom MassARRAY system based on the chip-based matrix-assisted laser desorption ionization time-of-flight mass spectrometry platform. No association was observed between AS and ANTXR2 or IL-1R2 in present study, indicating that the polymorphisms in the ANTXR2 and IL-1R2 gene may not be regarded as major contributors to AS susceptibility in Chinese Han population. We also assumed that IL-1β might not be the key factor in the immunogenesis of AS. [ABSTRACT FROM AUTHOR]

Instrumentation of anterior vertebral body screws has become an important approach for treatment of unstable fracture or curvature of the spine, but little attention has been paid to the starting point of placing the screws and variability of the rib head position. We analyzed the variability of rib head position in a Chinese population in terms of the spinal canal and vertebral body using computed tomography (CT). Images from transverse CT scan of the T4-TI 2 vertebral bodies of 30 normal individuals were 3D reconstructed, and analyzed for measurement of parameters, which included: 1 ) distance between the left (or right) anterior border of the rib head and the posterior (or anterior) margin of the vertebral body [L(R )ARHP(A)VB], 2) left (or right) transverse dimension [L(R)TD], 3) left (or right) posterior (or anterior) safe angle [L(R)P(A)SA], and 4) distance between the inferior border of the left (or right) rib head and the superior (or inferior) end-plate in the sagittal plane [IL(R)RHS(1)EP]. The ARHPVB, PSA, and IRHIEP gradually decrease, but ARHAVB, TD, ASA, and IRHSEP gradually increase from T4 to TI2, indicating that the position of the rib head changes from a more anterior position to a more posterior position and from a more superior position to a more inferior position as the number of the vertebra increases. Our study has provided comprehensive reference guide for accurate and sate instrumentation of vertebral body screws in treating related spine diseases. [ABSTRACT FROM AUTHOR]

The article presents a study that assesses the risk factors, prevalence, prognostic and clinical features associated with tuberculosis spondylitis to that of pyogenic spondylitis in Southern China. The study is undertaken through a retrospective review of all infective spondylitis cases presented from January 2004 to July 2008 in a tertiary referral center. Results of the study show that staphylococcus aureus is the most commonly isolated infective agent connected with pyogenic spondylitis.

The aim of this study was to investigate the association of the B27 subtypes with ankylosing spondylitis (AS) in the Wuhan population of China. We selected 317 HLA-B27-positive individuals (145 controls and 172 patients with ankylosing spondylitis). The B27 subtypes were characterized using a PCR-SSP method. Six B27 subtypes were determined: B*2702, 03, 04, 05, 06 and B*13. HLA-B*2704 and HLA-B*2705 were the two high frequency genotypes in controls and patients. Compared with the controls, the AS patients had high frequency of B*2704 (patients 69.2% vs. controls 53.8%) and low frequency of B*2705 (patients 23.8% vs. controls 33.1%). B*2703 was detected in 10 (5.8%) patients and in 13 (8.9%) controls. B*2702, 06 and B*2713 were relatively rare. Our results show that the allele conferring risk to AS in the Wuhan population of China was B*2704 and B*2705. B*2704 is strongly associated with AS. [ABSTRACT FROM AUTHOR]

Abstract The HLA-B27 subtypes have a varied racial and ethnic prevalence throughout the world. However, the association of B27-subtypes with ankylosing spondylitis (AS) in the mainland China is unknown. To determine the association of B27-subtypes with AS in the Mainland Chinese Han population, a total of unrelated 153 patients with AS were enrolled in a large case-control association study, and 1545 unrelated, healthy, ethnically matched blood donors were included as controls. The genotyping of B27 and its subtypes was performed using the polymerase chain reaction with sequence specific primers (PCR-SSP). A total of 130 (84.97%) AS patients and 61 (3.95%) healthy controls were B27 positive. Three B27-subtypes, B*2704, B*2705 and B*2710, were further identified, of which both B*2704 and B*2705 were strongly AS associated. B*2710 was only detected in one AS patient and two other healthy controls. Considering only B27-positive cases and controls, a statistically different frequency of B27-subtypes was observed, with an over-representation of B*2704 ( P = 0.018). B*2704 was clearly more strongly associated than B*2705 with AS [odds ratio (OR ) = 2.4, P = 0.011]. Furthermore, a combined analysis including three previous studies of B27-subtype distributions in Chinese AS cases confirmed the stronger association of B*2704 with AS than B*2705 (OR = 2.5, P = 0.00094). [ABSTRACT FROM AUTHOR]

Background: Anterior cervical discectomy and fusion (ACDF) has been widely used in cervical spondylosis, but adjacent segment degeneration/disease (ASD) was inevitable. Cervical total disc replacement (TDR) could reduce the stress of adjacent segments and retard ASD in theory, but the superiority has not been determined yet. This analysis aimed that whether TDR was superior to ACDF for decreasing adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). Methods: A meta-analysis was performed according to the guidelines of the Cochrane Collaboration with PubMed, EMBASE, Cochrane Library and CBM (China Biological Medicine) databases. It included randomized controlled trials (RCTs) that reported ASDeg, ASDis, and reoperation on adjacent segments after TDR and ACDF. Two investigators independently selected trials, assessed methodological quality, and evaluated the quality of this meta-analysis using the grades of recommendation, assessment, development, and evaluation (GRADE) approach. Results: Eleven studies with 2632 patients were included in the meta-analysis. The overall rate of ASD in TDR group was lower than ACDF group (OR = 0.6; 95% CI [0.38, 0.73]; P < 0.00001). Both the incidence of ASDeg and the reoperation rate were statistically lower in the TDR group than in the ACDF group (OR = 0.58, P < 0.00001; OR = 0.52, P = 0.01, respectively). Subgroup analysis was performed according to the follow-up time and trial site; the rate of ASDeg was lower in patients underwent TDR no matter the follow-up time, and TDR tended to increase the superiority across time. The rate of ASDeg was also lower with TDR both in the USA and China (P < 0.0001, P = 0.03, respectively). But the cost-effectiveness result might be prone to neither of the two surgery approaches. According to GRADE, the overall quality of this meta-analysis was moderate. Conclusions: TDR decreased the rates of ASDeg and reoperation compared with that of ACDF, and the superiority may become more apparent over time. We cautiously and slightly suggest adopting TDR according to the GRADE but may not believe it excessively. [ABSTRACT FROM AUTHOR]

The author discusses the introduction of minimally invasive spine surgery (MISS) on October 2003 in China. It is the procedure that treat the spinal condition of the body which involve pillars including microsurgical techniques, imaging or navigation techniques, and implants. The concept and techniques of MISS develop throughout with help of surgeons direct communication.