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Background The purpose of the study was to investigate whether pelvic incidence (PI) will affect the occurrence of PJK in Lenke 5 AIS patients after correction surgery and try to explore a better surgical scheme based on PI. Methods Lenke 5C AIS patients that underwent correction surgery with a minimum of a 2-year follow-up were identified. Demographic and radiographic data were collected preoperatively, postoperatively, and at the final follow-up. The comparison between the PJK and the Non-PJK group was conducted and the subgroup analysis was performed based on the preoperative value of PI to investigate the potential mechanism of PJK. Clinical assessments were performed using the Scoliosis Research Society (SRS)-22 questionnaire. Results The mean preoperative Cobb angle of the TL/L curve was 53.4°±8.6. At the final follow-up, the mean TL/L Cobb angle was drastically decreased to 7.3°±6.8 (P 2 = 0.425, P = 0.514). For low PI patients, there is no significant difference where the UIV is located with regards to the TK apex between the PJK and Non-PJK subgroups (χ2 = 1.103, P = 0.401). For high PI patients, PJK was more likely to occur when UIV was cephalad to than caudal to the TK apex (31.25 % vs. 4.7 %, P = 0.038). There was no significant difference in the selection of LIV between the two groups. Conclusions There is no difference in the incidence of PJK between the Lenke 5 AIS patients with low PI (< 45°) and high PI (≥45°), but the main risk factor of PJK should be different. For patients with low PI, overcorrection of LL should be strictly avoided during surgery. For patients with high PI, the selection of UIV should not be at or cephalad to the apex of thoracic kyphosis to retain more mobile thoracic segments.

Background. The DNA repair enzyme poly(ADP-ribose) polymerase (PARP) is involved in DNA damage repair and cell death. However, the association between PARP’s biological activities and the immune microenvironment in hepatocellular carcinoma (HCC) is unclear. The present study will explore whether combining a PARP inhibitor with anti-PD1 might improve the anti-HCC impact and explain how it works. Method. The PARP inhibitor olaparib was screened out of 867 drugs through Cell Counting Kit 8 (CCK-8) assay. The expression of PARP was verified through the TCGA and TISIDB databases. The impacts exerted by PARP inhibitor olaparib to HCC cells were assessed via wound healing, Transwell, and proliferation assay. In vivo, experiments were performed in a C57BL/6 mouse model to evaluate the function of PARP inhibitor olaparib combination with anti-PD1 in HCC and mice tumors were further detected by immunohistochemically staining. Result. Olaparib was selected as the research object on the basis of drug screening. The results of the TCGA and Human Protein Atlas databases revealed that PARP was significantly upregulated in carcinoma cell cluster of HCC tissues compared to normal tissues. Higher expression of PARP showed a poorer prognosis based on Kaplan-Meier Plotter. qRT-PCR experiments confirmed that olaparib could increase PD-L1 expression through inhibiting miR-513 in HCC cells. In vivo, experiment confirmed that the combination of olaparib and anti-PD1 could enhance the immunotherapy effect of HCC. Conclusion. The present study reveals that inhibition of PARP potentiates immune checkpoint therapy through the miR-513/PD-L1 pathway in HCC and the combination of PARP inhibitor olaparib and anti-PD1 is beneficial to HCC therapy.

Background This study assesses performance and utility of motor evoked potentials and somatosensory evoked potentials during corrective surgery to thoracic tuberculosis with kyphosis (TTK), as well as corresponding risk factors. Methods Patients diagnosed with TTK and underwent TTK corrective surgery from 2012 to 2018 were included. Relevant Data were retrospectively collected. Measures of intraoperative neurophysiological monitoring (IONM) performance were calculated. A receiver operating characteristic (ROC) curve and area under ROC curve (AUC) were deployed to identify the diagnostic accuracy of potential recovery. Univariate and multivariate analysis were performed to determine risk factors correlated with IONM alerting. Results 68 patients were included. The mean age was 31.7±20.3 years (3-78 years). IONM alerting occurred in 12 surgeries (12/68, 17.6%), of which 6 were somatosensory evoked potential (SSEP) alerting, 2 motor evoked potential (MEP) alerting, and 4 combinations of both SSEP and MEP. There were 10 posterior vertebral column resections (PVCRs) and 2 pedicle subtraction osteotomies (PSOs) with 1.83±1.19 vertebra resected. Four (4/68, 5.89%) patients were identified with presence of postoperative neurological deficits (PNDs). Calculated measures of performance of MEP and SSEP were as follows: sensitivity of 0.75, specificity of 0.86, positive predictive value (PPV) of 0.25, and negative predictive value (NPV) of 0.98 respectively. The AUC of evoked potential recovery in diagnosing a PND was 0.884. On logistic regression analysis, sever kyphosis was determined as the independent risk factor for IONM alerting. Conclusions Multimodal IONM can benefit 66.7% participants from neural impingement under appropriate intervention after IONM alerting. Corrective surgery in TTK is at risk of spinal injury, especially in severe kyphosis requiring three-column osteotomy.

Objective The nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage is a novel biomimetic nonmetal cage, whereas the polyetheretherketone (PEEK) cage has been widely used for decades with excellent clinical outcomes. However, there has been no long-term comparison of these 2 cages in anterior cervical reconstruction. Methods This retrospective study included 98 patients who underwent single-level anterior cervical decompression and fusion (ACDF) from January 2009 to June 2011 with at least 7 years of follow-up; the PEEK cage was used in 51 patients (PEEK group), whereas the n-HA/PA66 cage was used in 47 (n-HA/PA66 group). The groups were compared regarding radiographic (cage subsidence, fusion status, cervical lordosis, and segmental sagittal alignment) and clinical (10-point visual analog scale and Japanese Orthopedic Association scores) parameters preoperatively, postoperatively, and at the final follow-up. Results The n-HA/PA66 and PEEK cages had similar fusion rates at the final follow-up (97.9% vs. 98.0%). The respective cage subsidence rates in the PEEK and n-HA/PA66 cage groups were 9.8% and 10.6%. There were no significant differences between the 2 groups in mean cervical lordosis, mean interbody height, segmental sagittal alignment, cervical lordosis, and 10-point visual analog scale and Japanese Orthopedic Association scores at the final follow-up. The n-HA/PA66 cages resulted in high fusion and low subsidence rates during long-term follow-up. Conclusions After single-level ACDF, the n-HA/PA66 cage showed similar radiographic fusion, subsidence rate, and clinical results compared with the PEEK cage during 7 years of follow-up. These results suggest that the n-HA/PA66 cage could be comparable with the PEEK cage for ACDF.

POEMS syndrome is a rare clonal plasma cell disease characterized by polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes. We report a rare case of neurological impairment in patients with concurrent cervical disc herniation and POEMS syndrome. A patient presented to a local hospital with C3/4 and C4/5 disc herniation, apparent spinal cord compression concomitant with neurological signs, and concurrent POEMS syndrome. Anterior cervical discectomy and fusion was performed. The limb numbness was only slightly alleviated, and 10 days postoperatively the patient complained of muscle weakness of the extremities and was referred to our hospital. The patients exhibited non-typical neurological signs and an enlarged liver and spleen that could not be explained. Electroneuromyography and immunofixation electrophoresis produced abnormal results. We diagnosed concurrent POEMS syndrome, for which drug therapy was prescribed. The patient’s symptoms receded. Patients presenting with cervical spondylopathy and non-typical neurological signs and symptoms or other systemic problems should be evaluated for the presence of concurrent disease and ruled out differential diagnoses.

Study Design Comparative study Objective To compare manual and deep learning-based automated measurement of Cobb angle in adolescent idiopathic scoliosis. Methods We proposed a fully automated framework to measure the Cobb angle of AIS patients. Whole-spine images of 500 AIS individuals were collected. 200 digital radiographic (DR) images were labeled manually as training set, and the remaining 300 images were used to validate by mean absolute error (MAE), Pearson or spearman correlation coefficients, and intra/interclass correlation coefficients (ICCs). The relationship between accuracy of vertebral boundary identification and the subjective image quality score was evaluated. Results The PT, MT, and TL/L Cobb angles were measured by the automated framework within 300 milliseconds. Remarkable 2.92° MAE, .967 ICC, and high correlation coefficient (r = .972) were obtained for the major curve. The MAEs of PT, MT, and TL/L were 3.04°, 2.72°, and 2.53°, respectively. The ICCs of these 3 curves were .936, .977, and .964, respectively. 88.7% (266/300) of cases had a difference range of ±5°, with 84.3% (253/300) for PT, 89.7% (269/300) for MT, and 93.0% (279/300) for TL/L. The decreased bone/soft tissue contrast (2.94 vs 3.26; P=.039) and bone sharpness (2.97 vs 3.35; P=.029) were identified in the images with MAE exceeding 5°. Conclusion The fully automated framework not only identifies the vertebral boundaries, vertebral sequences, the upper/lower end vertebras and apical vertebra, but also calculates the Cobb angle of PT, MT, and TL/L curves sequentially. The framework would shed new light on the assessment of AIS curvature.

Purpose We previously reported anterior release, posterior internal distraction, and subsequent spinal fusion (ARPIDF) for the correction of severe scoliosis with a satisfactory correction rate. However, surgical procedures were completed in 2–3 stages. Here we compare Cobb angle of ≥90° in scoliosis correction between a novel posterior multiple screws distraction reducer (MSDR) system and ARPIDF. Methods Thirty-six patients with severe scoliosis treated by MSDR or ARPIDF (n = 18 in both groups). We retrospectively analyzed and compared outcome measures between the two groups over a minimum follow-up duration of 2 years. The following variables were compared between the two groups: age at surgery, sex, etiology, flexibility of the main thoracic curve, number of fused segments and screws, operation time, estimated blood loss, hospitalization time, follow-up duration, various radiological parameters, complication rate, and Scoliosis Research Society-30 score. Results There were no significant between-group differences with respect to age, sex, etiology, flexibility of the main thoracic curve, number of fused segments and screws, and follow-up duration. Further, there was no significant difference in terms of preoperative, postoperative, and final follow-up findings of the radiographic data. However, the ARPIDF group had longer operation and hospitalization times and greater blood loss. In the ARPIDF group, 4 patient developed complications (infection, intraoperative neuromonitoring changes, transient dyspnea); none of these events occurred in the MSDR group. Conclusion The use of MSDR helped achieve greater scoliosis correction with a shorter operation time, lower blood loss, and lower complication rate than the use of ARPIDF. MSDR facilitates safer and easier correction of severe scoliosis without increasing surgical risk.

Background PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF). Methods Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia. Results Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA Conclusions PIA could be used as a predictor for postoperative dysphagia in patients undergoing OCF. Adjusting a PIA level higher than the preoperative PIA level could avoid dysphagia. For those who inevitably had decreasing PIA, preserving intraoperative PIA over 90° would help avert postoperative dysphagia. Trial registration This trial has been registered in the Medical Ethics Committee of West China Hospital, Sichuan University. The registration number is 762 and the date of registration is Sep. 9 th, 2019.

Background Previous studies have reported the progression of deformity in patients with adolescent idiopathic scoliosis after implant removal. However, for patients with congenital scoliosis, few studies have investigated the prognosis after implant removal. Methods We observed 24 patients with congenital scoliosis, who underwent implant removal, for at least 3 years. Radiographic parameters and demographic data were compared to evaluate whether implant removal would lead to deformity progression. Results Four of the 24 patients (16.7%) suffered correction loss and underwent revision surgery (RS). All correction losses occurred within 12 months of implant removal. The average curve of fixed segments (9.84° ± 7.22° to 16.42° ± 16.79°; P = 0.017) and kyphosis of fixed segments (10.46° ± 13.42° to 18.98° ± 25.99°; P = 0.03) increased significantly throughout the follow-up. After excluding patients who underwent RS, the changes in curve of fixed segments (9.10°–11.58°) and kyphosis of fixed segments (8.50°–9.24°) were all within the measurement error. The coronal and sagittal balance maintained during the follow-up. Through comparison, we thought that the younger age and lower Risser’s grade with larger scoliosis might be risk factors for correction loss. Conclusions Implant removal after fusion surgery for congenital scoliosis may present loss of correction and require RS, thus preserving implants is recommended. When removal of instrumentation is inevitable, parents and patients should be counseled for potential loss of correction and RS, and patients should be monitored for the progression of deformity.

Background: Curcumin is the major component of turmeric, which has an anticancer property in multiple cancers, including hepatocellular carcinoma (HCC). However, the mechanisms are still largely unclear. This research aims to assess the pharmacological function of curcumin and explore the potential microRNA (miRNA)-mRNA regulatory mechanism in curcumin-mediated HCC progression. Materials and Methods: Hep3B and Huh-7 cells were used for in vitro experiments. Cells were exposed to various doses of curcumin, and transfection was conducted using Lipofectamine 2000. Cell proliferation, migration, and invasion were examined using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide or transwell assay. The abundances of miR-21-5p and gender-determining region Y-related high-mobility group box 6 (SOX6) were examined using quantitative real-time polymerase chain reaction or Western blot. The relationship between miR-21-5p and SOX6 was analyzed through luciferase reporter analysis. Results: Curcumin repressed HCC cell proliferation, migration, and invasion. miR-21-5p level was decreased in curcumin-treated cells, and miR-21-5p overexpression reversed curcumin-mediated inhibition of HCC progression. SOX6 was targeted through miR-21-5p, and SOX6 restoration attenuated miR-21-5p-induced promotion of HCC progression. Moreover, curcumin exposure increased SOX6 expression through regulating miR-21-5p, and knockdown of SOX6 overturned curcumin-modulated suppression of HCC progression. Conclusions: Curcumin repressed proliferation, migration, and invasion of HCC cells by regulating miR-21-5p and SOX6, indicating the promisingly pharmacological effect of curcumin in HCC.

The treatment of congenital hemivertebrae in the upper thoracic region is challenging. The objective of this study was to investigate the outcomes of posterior hemivertebral resection for the upper thoracic region. Twenty-one patients diagnosed with upper thoracic congenital scoliosis were included. All of them received hemivertebral resection surgery via the posterior-only approach with at least 2 years of follow-up. The radiographic parameters and Scoliosis Research Society-22 score were analyzed. All the intraoperative and postoperative complications were recorded retrospectively. The segmental main curve was 35.9° before surgery and 7.0° at the last follow-up, with an average correction rate of 80.2%. The total main curve was 44.1° before surgery and 11.6° at the last follow-up, with an average correction rate of 73.9%. The caudal compensatory curve was corrected from 20.2° to 7.1°, with an average correction rate of 64.9%. The segmental kyphosis was corrected from 30.9° to 8.9°, with an average correction rate of 65.5%. The total Scoliosis Research Society-22 score significantly improved in all patients at the last follow-up, mainly resulting from the improvement of the self-image, mental health, and satisfaction domains. The following complications were found: one pedicle fracture, two malpositioned screws, one transient neurologic deficit, one implant failure, and four postoperative curve progressions. Although good radiographic deformity correction and clinical results were achieved after surgery, the incidence rate of complications was high at 42.9%; great care should be taken to prevent them, especially for postoperative curve progression (19.0%).

Background Spinal tuberculosis accounts for more than 50% of bone tuberculosis cases. This study compared clinical, radiological and functional outcomes between anterior and posterior approaches for treatment of middle or lower thoracic spinal tuberculosis in elderly patients. Methods We retrospectively examined middle or lower thoracic spinal tuberculosis (T5–T12) in patients over 65 years. All procedures included debridement, decompression, autologous bone graft and fixation. Surgical procedure, surgical duration, estimated blood loss during surgery and laboratory results were recorded. Pleural effusion volume, thoracic cavity volume, Oswestry Disability Index score, neurological status, radiological parameters and complication rate were evaluated. Results No significant difference was found in surgical duration, blood loss, kyphosis angle correction, loss of correction, thoracic cavity volume, or complication rate between the two groups (P > 0.05). Average postoperative pleural effusion volumes were 605.9 ± 209.5 mL (377–1074 mL) and 262.9 ± 228.1 mL (0–702.4 mL) in the anterior and posterior groups, respectively (P = 0.004). Average hospitalization durations were 26.4 ± 10.5 days (17–53 days) and 19.2 ± 5.0 days (14–30 days) (P = 0.04). Average postoperative serum albumin levels were 24.19 ± 3.84 g/L (19–29.5 g/L) and 28.24 ± 2.52 g/L (24.4–31.6 g/L) (P = 0.01). No relapse or reinfection was observed in either group at the final follow-up. Surgical revision was not required in either group. Conclusions Both anterior and posterior surgeries can be used to treat middle or lower thoracic spinal (T5-T12) tuberculosis in elderly patients. In general, the posterior approach might be superior, especially for patients with poor general health.

Background and aims Population-based studies suggest a strong association between the presence of nonalcoholic fatty liver disease (NAFLD) and an increased risk of urolithiasis. However, the available information on the association of the severity of NAFLD with urolithiasis is limited. We hypothesised a link between the severity of NAFLD and the risk of urolithiasis. Methods We recruited 1527 adult patients with NAFLD who completed a comprehensive health checkup. The severity of NAFLD was measured with AST to platelet ratio (APRI score). Logistic regression analysis was used to detect the association of APRI score with the risk of urolithiasis among NAFLD patients. ROC analysis was used to assess the diagnostic value of APRI score for identifying urolithiasis among NAFLD patients. Results Multivariate analysis showed three independent risk factors for urolithiasis: obesity (OR 2.06 95%CI 1.35-3.13), APRI score (OR 1.29 95%CI 1.05-1.59), and serum uric acid (OR 1.07 95%CI 1.05-1.09), suggesting an independent association between the noninvasive staging of liver fibrosis and the risk of urolithiasis in NAFLD patients. A three-variable model (obesity, APRI score, and serum uric acid) with an AUROC of 0.73 (95% CI 0.70-0.75) was significant in identifying urolithiasis. Conclusions The severity of NAFLD is associated with the risk of urolithiasis among NAFLD patients. Moreover, a three-variable model (obesity, APRI score, serum uric acid) could serve as a useful tool for identifying individuals at high risk for urolithiasis in these patients.

Background Context Many different correction methods have been reported to treat severe and rigid scoliosis. In the past, anterior and posterior spinal fusion (APSF), which included an anterior release followed by posterior instrumented fusion, was widely applied. In recent years, anterior/posterior vertebral column resection (APVCR) is used to treat severe and rigid scoliosis. Purpose We aimed to compare the clinical results of APSF and APVCR for severe and rigid scoliosis. Study Design This is a retrospective, one-center, institutional review board-approved study. Patient Sample A total of 48 patients with severe and rigid scoliosis treated by APSF or APVCR were enrolled. Outcome Measures Comparisons between groups were made regarding the following variables: age at surgery, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, follow-up duration, different radiological parameters, complication rate, and Scoliosis Research Society (SRS)-22 scores. Methods According to the operating technique, 48 patients with severe and rigid scoliosis were divided into two groups. In the first group, 26 patients were treated by APSF. In the second group, 22 patients were treated by APVCR. All patients had a minimum 2-year follow-up. The radiographic parameters as well as anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, complication rate, and demographic data were analyzed. Results There was no significant difference in age, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, and follow-up between the two groups. The APVCR group had longer operation and hospitalization time, and more blood loss. There was no significant difference in the preoperative main curve between the two groups, but the APVCR group had smaller main curve at postoperation and final follow-up, and higher correction rate at immediate postoperation and final follow-up. There was no significant difference in the preoperative, postoperative, and final follow-up thoracic kyphosis, and coronal and sagittal balance between the two groups. There was no significant difference in complication rate between the two groups. Analysis of the preoperative SRS-22 questionnaire revealed no difference between the two groups. At final follow-up, APSF and APVCR groups had similar scores in the function, pain, self-image, mental health, and satisfaction with the treatment domains. Conclusions Compared with APSF, treating severe and rigid scoliosis by APVCR means longer operation and hospitalization time, and more blood loss, but it allows better correction rate of main curve. Furthermore, SRS-22 questionnaire improvement scores were similar for both correction methods.

Dolomite is considered advantageous as bed material in fluidized bed gasification processes, due to its catalytic tar cracking and anti-sintering properties. However, in case of pressurized fluidized bed gasifiers, the use of dolomite is challenging. High temperature in the presence of steam favors the production of clean syngas due to the intensified cracking of tar in the presence of CaO, whereas it simultaneously increases the tendency of fragmentation of dolomite particles after full calcination. The present study was carried out to examine the influence of the properties of dolomite on the stability of dolomite in a pressurized fluidized bed gasifier, with the aim of determining criteria for dolomite selection. Glanshammar dolomite exhibited a better stability in the mechanical strength after calcination, compared to Sala dolomite. The corresponding change of micro-structure that occurred during dolomite chemical transformation was presented. The crystal pattern and Si distribution in the crystal lattice are the possible explanations for the superior performance of the Glanshammar dolomite compared to the Sala dolomite.

There are many different systems recommending upper instrumented vertebra (UIV) for Lenke type 2 adolescent idiopathic scoliosis (AIS), several of which suggest that all Lenke type 2 AIS patients should be fused to the second thoracic vertebra (T2). However, all previously proposed UIV selecting systems do not accurately predict postoperative shoulder balance. We investigated whether fusing to T2 could prevent postoperative shoulder imbalance and identified circumstances under which to fuse up to T2.We retrospectively collected all patients with typical Lenke type 2 AIS who received surgery by one spine surgeon in our hospital from 2010 to 2014. Lateral shoulder balance was assessed utilizing radiographic shoulder height difference (RSH), coracoid height difference (CHD), clavicle-rib intersection difference (CRID), and clavicle angle (CA). Medial shoulder balance was assessed by T1 tilt angle and first rib angle (FRA). Lateral shoulders were considered to be level if the absolute value of RSH was less than 10 millimeters. All patients were divided into two groups as follows: 1) T2 group: UIV of T2 (n=49); and 2) below-T2 group: UIV of T3 (n=24) or T4 (n=6). Patients were assessed before surgery and at final follow-up with a minimum follow-up duration of 24 months.Seventy-nine typical Lenke type 2 AIS patients were identified. Preoperative CHD and CA were significantly associated with postoperative lateral shoulder imbalance (both p=0.045), whereas the UIV level was not significantly associated with it. Both fusing to T2 and to below T2 could improve RSH (p0.001 and p=0.001, respectively). Fusing to T2 slightly worsened CHD, CRID, and CA at last follow-up (all p0.001), while fusing to below T2 improved these lateral shoulder balance parameters (p=0.042, p0.001, and p=0.007, respectively). For medial shoulder balance, fusing to below T2 worsened T1 tilt angle and FRA at last follow-up (p=0.025 and p0.001, respectively), while fusing to T2 effectively kept these medial shoulder parameters in balance. In addition, for patients with an elevated left border of T1, the T2 group had worse preoperative T1 tilt angle but gained better postoperative T1 tilt angle than the below-T2 group (p0.001 and p=0.040, respectively).Preoperative lateral shoulder balance, more so than the UIV level, can strongly influence postoperative lateral shoulder balance. Fusing to T2 can only effectively improve medial shoulder balance, not lateral shoulder balance (CHD, CRID, and CA). Moreover, a positive T1 tilt angle is an indicator for fusing to T2 to improve medial shoulder balance.

Objective One-stage posterior hemivertebral resection has been proven to be an effective, reliable surgical option for treating congenital scoliosis due to a single hemivertebra. To date, however, no studies of treating unbalanced multiple hemivertebrae have appeared. This study evaluated the efficacy and safety of one-stage posterior hemivertebral resection for unbalanced multiple hemivertebrae. Patients and methods Altogether, we studied 15 patients with unbalanced multiple hemivertebrae who had undergone hemivertebral resection using the one-stage posterior approach with at least 2 years of follow-up. Clinical outcomes were assessed radiographically and with the Scoliosis Research Society-22 (SRS-22) score. Related complications were also recorded. Results The mean Cobb angle of the main curve was 62.4° (46°–98°) before surgery and 18.2° (9°–33°) at the most recent follow-up (average correction 73.3%). The compensatory cranial curve was corrected from 28.5° (11°–52°) to 9.1° (0°–30°) (average correction 70.0%). The compensatory caudal curve was corrected from 31.6° (14°–54°) to 6.9°(0°–19°) (average correction 79.1%). The segmental kyphosis/lordosis was corrected from 41.1° (−40° to 98°) to 12.3° (−25° to 41°) (average correction 65.5%). The mean growth rate of the T1-S1 length in immature patients was 9.8 mm/year during the follow-up period. Health-related quality of life (SRS-22 score) had significantly improved. Complications include one wound infection and one developing deformity. Conclusion One-stage posterior hemivertebral resection for unbalanced multiple hemivertebrae provides good radiographic and clinical outcomes with no severe complications when performed by an experienced surgeon. Longer follow-up to detect late complications is obligatory.

Currently, polylactide is the most popular material used to made bioabsorbable cages but too-quick degradation and osteolysis around the cage have been reported in the literature. This study evaluated the fusion effect, biomechanical stability, and histologic characteristics of a novel bioabsorbable multiamino acid copolymer/nanohydroxyapatite/calcium sulfate (MAACP/n-HA/CS) interbody cage in a goat model of anterior cervical discectomy and fusion.A total of 24 goats underwent C3/C4 discectomy and fusion with 3 groups of intervertebral implants: MAACP/n-HA/CS cage group (n = 8), titanium cage group (n = 8), and autologous tricortical iliac crest bone group (n = 8). Disc space height and lordosis angle were measured pre- and postoperatively and after 4, 12, and 24 weeks. Range of motion (ROM) was evaluated through biomechanical testing. Histologic analysis was performed to evaluate fusion status and to detect any foreign body reactions associated with the bioabsorbable cages.At 12 and 24 weeks, disc space height in MAACP/n-HA/CS cage group was greater than that of titanium cage group and tricortical iliac crest group (P0.05). Lordosis angle in MAACP/n-HA/CS cage group and titanium cage group were lower than that of tricortical iliac crest group (P0.05). Biomechanical test showed that ROM did not differ significantly between MAACP/n-HA/CS cage group and titanium cage group, whereas the value of ROM in bone graft group was the largest. Histologic evaluation showed a better interbody fusion in the MAACP/n-HA/CS cage group than in the other 2 groups. MAACP/n-HA/CS cage surface degraded and was absorbed at 24 weeks. All MAACP/n-HA/CS cages showed excellent biocompatibility.MAACP/n-HA/CS cages can provide good fusion effect, enough biomechanical stability, and integrate closely with the surrounding bone.