Search

Objective: To investigate the outcome of modified anterior cervical corpectomy and fusion(mACCF) without corpectomy C4 or C5 vertebral body in the treatment of four-level cervical spondylotic myelopathy (CSM). Methods: 34 consecutive patients suffered from 4 level cervical spondylotic myelopathy were definitely diagnosed from July 2013 to June 2017. All 34 patients were treated by mACCF and followed up at least 5 years. Of these 34 patients, the cervical cord compression was observed at disc levels C2–C6 with/without spinal stenosis in 15 patients, which were treated with corpectomy of C3 and C5 vertebrae and preservation of C4 vertebrae; the cervical cord compression was observed at disc levels C3–C7 with/without spinal stenosis in 19 patients. and were treated with corpectomy of C4 and C6 vertebrae and preservation of C5 vertebrae. Then the operation time, blood loss, bone graft fusion rate at the last follow-up, the improvement rate of JOA score and the cervical lordosis were collected for comparison. Results: all 34 patients are followed-up from 61 to 84 months, the mean follow-up time is 66.18±11.79 months; The mean operation time was 148.97±31.51min(range,115-192min), The average blood loss was 742.28±87.89ml(range,580-1080ml). All of 34 cases got bony union without complications such as subsidence of titanium mesh cage, displacement of plate or screw was found at last follow-up. The JOA score was (12.46±2.83) before the operation, got improvement to (15.28±2.17), (15.36±2.25) and (16.17±1.83) after operation 3 months,6months and at the last follow-up respectively. The mean improvement rate was 58.8%(3 months after operation), 61.8%(6 months after operation), and 62.9%(the last follow-up);The average cervical lordosis changed from（9.19±3.11）mm before the operation to（12.79±4.15）mm 3 months after operation and（13.11±3.19）mm at last follow-up; Postoperative complications including temporary hoarseness (2 patients), and C5 nerve root palsy (3patients), and improved after 2-week conservative treatments and had resolved completely at the 6-week follow up. Conclusions: This study demonstrated modified anterior cervical corpectomy and fusion preservation C4 or C5 vertebral body can achieve satisfactory outcome during short and medium-term follow-up in the treatment of 4-level CSM. In this series, neither signifcant subsidence of titanium mesh cage nor signifcant loss of cervical lordosis correction was seen, postoperative lateral radiograph of the cervical spine at last follow-up showing obtaintion of solid fusion.

Background This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS). Methods A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n = 25) and rigid systems (n = 15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

Cytoskeletal microtubule rearrangement and movement are crucial in the repair of spinal cord injury. Spastin plays an important role in the regulation of microtubule severing. Both spastin and collapsin response mediator proteins can regulate neurite growth and branching; however, whether spastin interacts with collapsin response mediator protein 3 (CRMP3) during this process remains unclear, as is the mechanism by which CRMP3 participates in the repair of spinal cord injury. In this study, we used a proteomics approach to identify key proteins associated with spinal cord injury repair. We then employed liquid chromatography-mass spectrometry to identify proteins that were able to interact with glutathione S-transferase-spastin. Then, co-immunoprecipitation and staining approaches were used to evaluate potential interactions between spastin and CRMP3. Finally, we co-transfected primary hippocampal neurons with CRMP3 and spastin to evaluate their role in neurite outgrowth. Mass spectrometry identified the role of CRMP3 in the spinal cord injury repair process. Liquid chromatography-mass spectrometry pulldown assays identified three CRMP3 peptides that were able to interact with spastin. CRMP3 and spastin were co-expressed in the spinal cord and were able to interact with one another in vitro and in vivo. Lastly, CRMP3 overexpression was able to enhance the ability of spastin to promote neurite growth and branching. Therefore, our results confirm that spastin and CRMP3 play roles in spinal cord injury repair by regulating neurite growth and branching. These proteins may therefore be novel targets for spinal cord injury repair. The Institutional Animal Care and Use Committee of Jinan University, China approved this study (approval No. IACUS-20181008-03) on October 8, 2018.

Objective To assess the biomechanical stability of unilateral pedicle screws (UPS) plus contralateral transfacetopedicular screws (TFPS) after transforaminal lumbar interbody fusion (TLIF) with two cages. Methods Range of motion (ROM) testing was performed in 28 fresh-frozen human cadaveric lumbar spine motion segments. The sequential test configurations included supplemental constructs after TLIF such as UPS, UPS plus contralateral TFPS and bilateral pedicle screws (BPS). All test specimens were fixated in the normal lordotic lignment, then mounted in a three-dimensional (3-D) motion testing machine and fixed to the load frame of a six degrees of freedom spine simulator. Each of the test constructs were subjected to three load–unload cycles in each of the physiologic planes generating flexion-extension, right-left lateral bending and right-left axial rotation load-displacement curves. Statistical analysis was performed on the ROM data. Comparison of data was performed by repeated-measures analysis of variance for independent samples followed by Bonferroni analysis for multiple comparison procedures. Results The ROMs for UPS, BPS and UPS plus TFPS fixation after TLIF were significantly smaller than those of the intact spine in all modes. The ROM for UPS plus TFPS fixation was between the largest for UPS and the smallest for BPS. The differences between ROMs of UPS and UPS plus TFPS were significant for both lateral bending and rotation. There were no significant differences between BPS and UPS plus TFPS in any mode. Conclusion Because the UPS construct provides the least stability, especially during lateral bending and rotation, it should be used prudently. After TLIF with two cages, UPS plus TFPS provides stability comparable to that of TLIF with BPS. It is thus an acceptable option in minimally invasive surgery.

Background: In this study, we evaluated the performance of a point-of-care device, the CoaguChek XS Plus system, in the determination of prothrombin time and international normalized ratio (INR) based on ISO17593: 2007 criteria in Taiwanese patients. The underlying clinical and genetic factors were also investigated. Methods: Fifty patients receiving warfarin therapy were enrolled in this study. The accuracy of the CoaguChek XS Plus system was evaluated with linear regression analysis and bias plot by comparing with the data measured using Sysmex CA-1500. The clinical and genetic factors that may have caused a bias of ΃ 0.5 INR were evaluated with Fisher's exact test. Results: From the 50 patients, 93 INR values were collected by each method. Linear regression analysis indicated a high correlation with r = 0.96, a slope of 1.05, and an intercept of - 0.14. Eight patients showed an INR bias ΃0.5 between the two methods. Only aspartate aminotransferase (AST) >34 U/L (3/8, 37.5% vs. 3/42, 7.1%; p = 0.044) and alanine aminotransferase (ALT) >36 U/L (3/8, 37.5% vs. 3/42, 7.1%; p = 0.044) were significantly different from each other. No differences were observed for hypoalbuminemia, elevated creatinine, anemia, and the polymorphisms of VKORC1 and CYP2C9. Conclusions: The CoaguChek XS Plus system presented results that were comparable with those obtained using laboratory CA-1500 method. Both methods fell within INR in the range of 2-4.5 defined by ISO17593:2007 and the clinically recognized therapeutic INR range of 2-3.5. Elevated AST and ALT levels might have interfered with the INR results.