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OBJECTIVE The correlation between the spinopelvic type and morphological characteristics of lumbar facet joints in patients with degenerative lumbar spondylolisthesis (DLS) was investigated. METHODS One hundred forty-two patients with L4 DLS were enrolled (DLS group), and 100 patients with lumbar disc herniation without DLS were selected as the control group (i.e., non–lumbar spondylolisthesis [NL] group). Morphological parameters of L4–5 facet joints and L4–5 disc height and angle were measured on 3D reconstructed CT images; namely, the facet joint angle (FJA), pedicle–facet joint angle (PFA), facet joint tropism, and facet joint osteoarthritis (OA). The L4 slip percentage, sacral slope, and lumbar lordosis were measured on radiographs. Patients in the DLS and NL groups were divided into 4 subgroups according to Roussouly classification (types I, II, III, and IV). RESULTS In the DLS and NL groups, as the spinopelvic type changed from type II to type IV, the facet joint morphology showed a gradual sagittal orientation in the FJA, a gradual horizontal orientation in the PFA, a gradual severity in OA, and a gradual increase in the slip percentage, but changes were completely opposite from type I to type II. Additionally, compared with the NL group, the facet joint morphology in the DLS group had more horizontal orientation in PFA, more sagittal orientation in the FJA, and the facet joint tropism and OA were more severe. CONCLUSIONS Facet joint morphology was correlated with spinopelvic type in the slip segment of DLS. Facet joint morphology was part of the joint configuration in different spinopelvic types, not just the result of joint remodeling after DLS. Moreover, morphological changes of the facet joints and DLS interacted with each other. Additionally, morphological remodeling of the facet joints in DLS played an important role in spinal balance and should be taken into consideration when designing a surgical approach.

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

Study Design Retrospective Radiographic Review. Objectives The purpose of this study was to investigate the correlation between the sacral slope (SS) and pedicle morphological parameters of the fourth lumbar vertebra in degenerative lumbar spondylolisthesis (DLS). Methods Our study included 134 patients with L4-5 DLS. We used preoperative multi-slice spiral computed tomography to measure a range of pedicle morphological parameters, and the SS and percentage of slip distance (SDP) of the L4 vertebra were measured on preoperative standing neutral lumbar radiography. Patients were divided into three groups based on their degree of SS: the low sacral slope (LSS) group with SS values of 45°. Results As the SS increased across groups, the pedicles of L4 became longer and thinner and the pedicle camber angle was smaller. The SDP, pedicle length parameters were positively correlated with the SS, while pedicle width, height, and camber angle were negatively correlated with the SS in the three groups. Conclusions SS had an impact on the degree of spondylolisthesis and on pedicle morphological parameters in patients with DLS, with greater slope resulting in greater impact. The progression of DLS occurred due to the increasing forward shear force of the vertebra being greater than the reverse resistance. The pedicle at the slip level adaptively remodeled, becoming slenderer and tilting inward due to the long-term traction of the two opposing forces.

OBJECTIVE: To investigate the effects of gender and age on the posterior cranial fossa linear volume and cerebellar tonsil position in normal populations. METHODS: A total of 180 normal adults who underwent cervical MRI examination at the physical examination center were selected, including 90 males and 90 females; the age ranged from 20 to 79 years, with an average of 50.4 years. The posterior cranial fossa linear volume and cerebellar tonsil position were measured by two spine surgeons on the mid-sagittal plane of the cervical MRI T2-weighted image. The posterior cranial fossa linear volume included the length of clivus (AB), anteroposterior diameter of foramen magnum (BC), length of supraocciput (CD), anteroposterior diameter of posterior fossa (DA), posterior fossa height (BE), and clivus angle (∠α). The index of the cerebellar tonsil position was the distance from the lower edge of the cerebellar tonsil to the baseline (MN). The differences of each indicators between males and females were compared, and the correlations between age and each indicators were analyzed. RESULTS: The posterior fossa cranial linear volume AB, BC, CD, BE, and ∠α in males were significantly larger than those in females (P

Negative pressure wound therapy (NPWT) is one of the new modality for the treatment of diabetic foot ulcers. In this article we will investigate the efficacy and safety of it by literature search and meta-analysis.The databases of PubMed, Embase, Ovid, and Cochrane library were selected as search platforms. Randomized controlled trials (RCTs) published after 2010 were searched with the keyword "vacuum-assisted closure therapy" OR "negative pressure wound therapy" OR "diabetic foot". The Cochrane Review Handbook was used to assess the bias of the literatures. The software RevMan 5.4 was used for analysis to obtain a forest plot and funnel plot.In this study, 363 articles were initially screened, and 9 literatures were finally included, involving a total of 943 patients. Combined analysis using the fixed effects model showed that the healing rate of the NPWT group was significantly lower than the standard group [odds ratio (OR) =3.60, 95% confidence interval (CI): 2.38 to 5.45, P0.001]. The granulation tissue formation time of the NPWT group was significantly less than the standard group [mean difference (MD) =-8.95, 95% CI: -10.26 to -7.64, P0.001]. The rate of adverse events of both groups showed no significant difference (OR =0.49, 95% CI: 0.10 to 2.42, P=0.38). The amputation rate of both groups showed no statistically significant (OR =0.33, 95% CI: 0.09 to 1.26, P=0.10) too.Negative pressure wound therapy can effectively accelerate wound healing, it is equally safe with general routine treatment. However, the negative pressure value should be appropriately maintained and adjusted to avoid bleeding tendency of the wound when applying this new modality.

Background Using a cage filled with local bone in anterior cervical discectomy and fusion (ACDF) can eliminate morbidities associated with autograft harvest from the iliac crest while achieving high fusion rates. However, there is still no consensus regarding the methods for using local bone grafts. This retrospective study was performed to compare the clinical and radiological outcomes of using a mixture of bone dust and morselized bone versus morselized bone alone in ACDF. Methods A retrospective study of 228 patients affected by cervical degenerative disease who had undergone single- or double-level ACDF between January 2014 and June 2018 was performed. Nanohydroxyapatite/polyamide-66 (n-HA/PA66) combined with morselized bone was used in 111 patients (group A: single-level ACDF in 51 patients and double-level ACDF in 60 patients), whereas the n-HA/PA66 cage combined with a mixture of bone dust and morselized bone was used in 117 patients (group B: single-level ACDF in 58 patients and double-level ACDF in 59 patients). The fusion rate, extent of cage subsidence, fusion segmental height (FSH), C2-7 lordosis, segmental sagittal alignment (SSA), 10-point visual analog scale (VAS) score, and Neck Disability Index (NDI) were compared between the two groups. Results The VAS score and NDI were significantly reduced after the operation in group A and group B. At the final follow-up, the fusion rate was 90.2 % (46/51) and 94.8 % (55/58) in patients treated with single-level ACDF in group A and group B, respectively (p > 0.05). In patients treated with double-level ACDF, bone fusion was achieved in 52 patients (86.7 %) in group A and 55 patients (93.2 %) in group B (p > 0.05). The fusion rate of single- and double-level ACDF was higher in patients in group B than those in group A at the 3-month, 6-month and 12-month follow-ups (p . The extent of cage subsidence after single- and double-level ACDF was lower in patients in group B (1.5 ± 0.5 mm and 2.3 ± 0.8 mm, respectively) than in those in group A (1.8 ± 0.7 mm and 2.9 ± 1.4 mm, respectively) (p ). There was no significant difference between the two groups in the C2-7 lordosis, FSH, SSA, VAS score, or NDI before or after the operation (p > 0.05). Conclusions Using a mixture of local bone dust and morselized bone as cage-filling materials yielded comparably good clinical outcomes as using morselized bone alone in single- and double-level ACDF. However, the mixture graft of bone dust and morselized bone was more beneficial in promoting early fusion and reducing cage subsidence.

Background Dumbbell-shaped tumor is a type of inner and outer cervical spinal canal tumor, and most of these are neurogenic. Desmoid tumors are rare, and, to the best of our knowledge, no case of desmoid tumors involving intervertebral foramen formed dumbbell-shaped tumors in the cervical spine have been reported before in English literature. Here we report a case of a desmoid tumor occurring in the cervical spine that is presented as a typical dumbbell-shaped tumor. Case Description A 47-year-old woman was admitted to our department with a mass in the left side of her neck. The tumor was initially thought to be a neurogenic cervical dumbbell tumor based on physical and radiologic examination. Postoperative hematoxylin-eosin staining and immunohistochemical staining verified the diagnosis of a cervical dumbbell desmoid tumor, which, to our knowledge, had never been reported before. We report our experience and reviewed literature regarding desmoid tumor to share our experience and explore proper treatment options of such lesions. Conclusions Desmoid tumors in the head and neck may present as cervical dumbbell-shaped tumors. Before the treatment plan was made, thorough examinations, including surgical pathology, were necessary.

To investigate the morphological characteristics and para-positions of the facets of lateral atlantoaxial joints (FLAJs) in patients with congenital atlantoaxial dislocation (CAAD) and to propose a classification system for the FLAJs. A total of 93 cases of CAAD were included in this retrospective study. The obliquity and slippage of the FLAJs in the sagittal and coronal planes were measured and observed in the CT images of all of the cases. The obliquity and slippage of the FLAJs represented the morphological characteristics and the para-positions, respectively, and were used as classification parameters. Accordingly, a classification system for the FLAJs was established. We additionally investigated the correlation between the classifications of the FLAJs and various types of CAAD. The classifications of the FLAJs in 34 patients with irreducible AAD (IAAD) were also investigated. One hundred eighty-six FLAJs in 93 patients were classified into 6 types (namely, A, B1, B2, C, D1, and D2) for obliquity and 3 types (namely, S0, S1, and S2) for slippage. Among the 186 FLAJs, type B1 and type S0 were the most common obliquity and slippage types, respectively. There were 11 combination types for obliquity and 5 combination types for slippage of bilateral FLAJ in 93 patients. Most of the patients (69.7%, 47/70) with anteroposterior AAD had accompanying slippage and anteversion of the FLAJ in the sagittal plane. Rotational AAD was found in 10 patients with asymmetrical slippage in both FLAJs in the sagittal plane. Lateral translational AAD was found in 6 patients with an S1-type FLAJ in the coronal plane. In 5 patients with lateral angular AAD, FLAJs of types D1 and S2 were observed on one side. Among the 34 patients with IAAD, 31 patients had both obliquity and slippage in the FLAJs on one or both sides. The morphological characteristics and para-positions of the FLAJs on both sides largely determine the types of AAD in patients with CAAD. The types of obliquity and slippage of the FLAJ are related to the reducibility of AAD.

Background The proper choice of anesthesia for kyphoplasty remains controversy. There are only a few clinical studies specially focusing on and giving detailed information about this treatment under local anesthesia with or without conscious sedation. To evaluate the effect of preoperative prone position exercises on patient tolerance to percutaneous kyphoplasty under local anesthesia. Methods Eighty-three patients with single level osteoporotic vertebral compression fractures were nonrandomly assigned to undergo percutaneous kyphoplasty under local anesthesia with preoperative prone position exercises or without. The number of procedure with or without a pause, need for intravenous sedation, and patient satisfactory were recorded and analyzed. Clinical outcomes were assessed using the visual analog scale and the Oswestry Disability Index. The follow-up time was 6 months. Results The baseline characteristics of both groups were comparable. The number of procedure without a pause in the exercises group was more than the control group (30/42 patients and 10/41 patients, respectively, P

Objective To evaluate results and feasibility of primary posterior reduction and fixation without fusion using C1-C2 screw-rod system for odontoid fractures. Methods This study comprised a consecutive series of 46 patients with odontoid fractures. Posterior reduction and fixation without fusion using the C1-C2 screw-rod system was performed, and instrumentation was not removed. Radiologic outcomes were assessed on follow-up computed tomography or plain radiographs. Visual analog scale of neck pain, American Spinal Injury Association impairment scale, patient satisfaction, neck disability index, and range of motion of flexion extension and rotation of the cervical spine were recorded and analyzed. Results Mean follow-up time was 4.1 years (range, 12 months to 8 years). Radiographic evaluation indicated solid fusion of odontoid fractures in all cases and no implant failures. No patient reported severe neck pain at follow-up. Neurologicl evaluation showed there was 1- to 2-grade improvement in patients with neurologic deficit. Of patients, 31 reported acceptable outcomes, and 15 reported good outcomes. Range of motion of rotation of the cervical spine and neck disability index score gradually improved significantly during 1 year of follow-up with no obvious change after that. Rate of neck disability index score improvement was 85%. Conclusions Posterior reduction and fixation without fusion can be successfully performed for healing of odontoid fractures with acceptable results and minimal morbidity.

Background: To describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects that can be used to guide the restoration of vertical dislocation of the occipitocervical region in patients with basilar invagination and to perform standardized testing of occipitocervical constructs.Methods: Neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) judged to be normal were analyzed. The mean age was 48.0±8.4 years old (range 20–69 years; 48.4±10.2 years old for males and 47.6±6.4 years old for females). Analysis consisted of measurement of the OC4D. The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor’s line. Two spine surgeons measured the OC4D thrice in the normal population and obtained the average values. Height, weight, and body mass index (BMI) of each subject was recorded and analyze its correlation with OC4D.Results: The values of OC4D on neutral, flexion, and extension lateral cervical spine radiographs were 69.0±6.9 mm, 68.9±6.8 mm and 68.1±6.9 mm, respectively. There was no significantly different from the values measured in neutral、flexion and extension (P> 0.05). But the OC4D of males were higher than females in neutral, flexion, and extension (P < 0.001 for all). There was a positive correlation between OC4D and height and weight in neutral、flexion and extension (P 0.05). The ICC values of inter- and intra-observer agreements for the radiographic parameter in all of the cervical positions were more than 0.93.Conclusions: OC4D, a new measurement method for occipital-cervical distance that is not affected by the change in neutral, flexion, and extension positions, should be a valuable parameter and intra-operative tool to guide the vertical restoration during OCF for patients with altered occiput-cervical anatomy.

In this retrospective comparative study, the efficacy and clinical outcomes of long posterior instrumentation, with or without laminectomy, were evaluated and the necessity of the second stage of anterior debridement in the treatment of spinal tuberculosis (TB) was discussed.This retrospective study included 41 patients who were diagnosed with spinal TB between January 2010 and June 2016. A total of 18 patients had received long posterior instrumentation, with or without laminectomy (group A), whereas the other 23 patients had posterior instrumentation plus anterior debridement and autogenous bone grafting (group B). The surgical information, clinical effectiveness, laboratory tests, and imaging results were compared between the 2 groups.One patient in group B died. Sinus drainage and incomplete bone fusion were discovered 1 year postoperatively. TB symptoms were significantly improved after surgery compared with those before surgery (P0.05), and there was no significant difference in the treatment efficacy between the 2 groups at the final follow-ups (P0.05). Compared with those of group B, the surgical time, bed-rest time, and hospitalization time of group A were all significantly shorter (P0.05), whereas the times before abscesses disappeared, bone graft fusion, and erythrocyte sedimentation rate returning to normal were all significantly longer (P0.05).Single-stage long posterior instrumentation, with or without laminectomy, is a safe, effective, and feasible method for the treatment of spinal TB. The second stage of anterior debridement surgery may not be necessary for every spinal TB treatment.

OBJECTIVE: To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis. METHODS: The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups (P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients’ lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients’ lumbar and back function improvement before operation and at 6 months after operation. RESULTS: The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B (P0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups (Z=–0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference (χ(2)=0.001, P=0.979 ). CONCLUSION: The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.

Symptomatic epidural hematoma (SEH) after anterior cervical spine surgery is very rare, but it has disastrous consequences for the patients. Timely diagnosis and evaluation can effectively reduce the sequelae of neurological deficit in SEH. The purpose of this study was to retrospectively analyze a subset of clinical data of SEH after anterior cervical spine surgery, and to investigate the risk factors and treatment experience of this serious complication. Neurological deterioration after anterior cervical spine surgery was detected in six patients. Epidural hematoma was confirmed by emergency cervical magnetic resonance imaging (MRI). The patients included five males and one female, with an average age of 56.7 ± 13.1 years (range 42–76 years). Three patients had a history of drinking and/or smoking. All of the patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively, but without anticoagulant drugs or pre-spinal surgery. The coagulation function was normal in all patients. Except for one patient, who had lower blood pressure (BP) during the operation and higher BP after the operation, the other patients had a normal level of BP during the pre-, intra-, and post-operation periods. The average time was 9.9 ± 6.7 hours (range, 2−19 hours) from the postoperative period to the initial neurological deficit and 6.3 ± 6.0 hours (range, 1.8−16.7 hours) from the initial deterioration to evacuation. Five patients underwent emergency evacuation, and one patient underwent conservative treatment. Four patients who underwent evacuation and one patient who received conservative treatment achieved neurological function recovery with an American Spinal Injury Association (ASIA) grade 2.4 ± 0.9 (range, 2−4 score) score at the last follow-up. One patient with confirmed arterial epidural hemorrhage during the evaluation showed no neurological function recovery at the last follow-up. Wide exposure of the epidural space and BP level during the perioperative period play an important role in the formation of SEH after anterior cervical spine surgery. Arterial epidural hematoma has serious consequences; therefore, early diagnosis and evaluation play an important role in the recovery from paralysis.

Dumbbell-shaped tumor is a type of the inner and outer cervical spinal canal tumor, and most of them are neurogenic tumors. Desmoid tumor is a rare tumor, and no case of them involving intervertebral foramen formed dumbbell-shaped in cervical spine have been reported before in English literature. Here we report a case of desmoid tumor arising in the cervical spine which is presented as typical dumbbell-shaped tumor.A 47-year-old female was admitted to our department with a mass in her left neck. The tumor was initially thought to be a neurogenic cervical dumbbell tumor based on physical and radiological examination. Postoperative HE and immunohistochemical staining verified the diagnosis of a cervical dumbbell desmoid tumor, which had never been reported before. We report our experience and reviewed literature about desmoid tumor to share our experience and explore proper treatment option of such lesion.Desmoid tumors in the head and neck may present as cervical dumbbell-shaped tumors. Before the treatment plan was undertaken, thorough examinations including surgical pathology were necessary.

OBJECTIVE: To compare the clinical efficacy between one-stage combined posterior and anterior approaches (PA-approach) and simple posterior approach (P-approach) for lower lumbar tuberculosis so as to provide some clinical reference for different surgical procedures of lower lumbar tuberculosis. METHODS: A retrospective analysis was made on the clinical data of 48 patients with lower lumbar tuberculosis treated between January 2010 and November 2014. Of them, 28 patients underwent debridement, bone graft, and instrumentation by PA-approach (PA-approach group), and 20 patients underwent debridement, interbody fusion, and instrumentation by P-approach (P-approach group). There was no significant difference in gender, age, course of the disease, and destructive segment between 2 groups (P>0.05). The operation time, blood loss, bed rest time, visual analogue scale (VAS) and complication were recorded and compared between 2 groups; American Spinal Injury Association (ASIA) grade was used to evaluate the nerve function, Bridwell classification and CT fusion criteria to assess bone fusion, erythrocyte sedimentation rate (ESR) to evaluate the tuberculosis control, and Oswestry disability index (ODI) to estimate lumbar function. RESULTS: The operation time, blood loss, and the bed rest time of the P-approach group were significantly less than those of the PA-approach group (P0.05). During follow-up, no internal fixation broken, loosening, or pulling was found. Bridwell bone fusion rates were 89.29% (25/28) and 80.00% (16/20) respectively, and CT fusion rates were 96.43% (27/28) and 90.00% (18/20) respectively, showing no significant difference between the 2 groups (P>0.05). CONCLUSION: Both one-stage PA-approach and simple P-approach could obtain good clinical efficacy. The PA-approach should be selected for patients with anterior-vertebral destroy, presacral or psoas major muscles abscess, and multiple vertebral body destroy, while P-approach should be selected for patient who could gain a good debridement evaluated by imaging before operation, especially for patients with middle-vertebral body destroy, block the iliac blood vessels and old patients.

Atypical Hangman fractures (AHF) were first formally reported and considered to be more often associated with neurologic deficit in 1993. However, there is a paucity of literature focusing on these fractures. The purpose of the retrospective study was to introduce a new classification scheme for AHF and its application. Sixty-two patients with Hangman fractures were identified. There were 46 (74.2%, 46/62) AHF patients, including 29 type I, 9 type II, 5 type IIa, and 3 type III fractures (Levine–Edwards classification). Based on fracture patterns, incidence, and their impact on neurologic status, a primary classification for AHF was devised. The clinical features of AHF were observed, and a new classification was introduced. The appropriate treatment strategy of AHF was discussed. Of 46 AHF patients, 27 underwent surgical treatment (24 with posterior approach with screw-rod fixation and fusion, 1 with anterior approach by C2/3 discectomy and fusion, and 2 with anterior and posterior approach), and the remaining 19 patients underwent nonoperative treatment. No patient complained severe neck pain at final follow-up. Neurologic status improved 1 to 2 grade in 12 cases with neurologic deficit. All patients achieved bony fusion within the follow-up period. AHF should be recognized as a distinct fracture subtype. The new classification for AHF is based on the feature of fracture patterns, injury mechanism, incidence, and their impact on neurologic deficit. And the new classification is complementary to Levine–Edwards.

Study Design. A retrospective study. Objective. To evaluate the radiological and clinical results of simultaneous surgery with preservation of the posterior vertebral wall for rigid post-traumatic kyphosis in the thoracolumbar spine. Summary of Background Data. Management of rigid post-traumatic kyphosis has been a challenge for surgeons. Current widely used posterior osteotomy procedures have the disadvantages of significant invasiveness, spinal column shortening, and instrumentation-related complications. Methods. From 2004 to 2009, 21 patients with rigid post-traumatic kyphosis in the thoracolumbar spine (T11–L2) were managed in our hospital. Average kyphotic angle was 45.2° ± 11.2° (range, 31°–67°). The surgical technique used was posterior and anterior circumferential release and anterior corpectomy with posterior vertebral wall preservation and short segmental instrumentation. Preoperative and postoperative kyphotic angle was measured to assess the degree of kyphosis correction and maintenance. Changes in low back pain were assessed by Japanese Orthopaedic Association scores. Results. All patients were successfully managed with this procedure without major complications. Most patients (19 of 21) were instrumented with anterior-only fixation, while posterior interspinal wire was added in 2 patients with osteoporosis. The mean blood loss was 470 mL (range, 300–700 mL). Patients were followed for an average of 32 months (range, 6–70 mo) postoperatively. Back pain was relieved to some degree in all patients and the improvement in Japanese Orthopaedic Association scores was 76.9% ± 7.9. Average kyphotic angle was 6.0° ± 5.7° (range, −2 to 17) immediately after surgery and 7.2° ± 5.8° (range, −3 to 17) at final follow-up. Average of 1° of correction loss was documented and all patients obtained solid fusion uneventfully. Conclusion. This technique is indicated for most patients with rigid post-traumatic kyphosis in the thoracolumbar spine and can yield satisfactory clinical results not only in terms of pain relief, kyphosis correction, vertebral height restoration, and spinal canal integrity preservation, but also in reducing the risk of excessive bleeding and spinal cord injury.

To observe the effect of transplantation of neural stem cells (NSCs) induced by all-trans-retinoic acid (ATRA) combined with glial cell line derived neurotrophic factor (GDNF) and chondroitinase ABC (ChABC) on the neurological functional recovery of injured spinal cord in Sprague Dawley (SD) rats.Sixty adult SD female rats, weighing 200-250 g, were randomly divided into 5 groups (n = 12): sham operation group (group A), SCI model group (group B), NSCs+GDNF treatment group (group C), NSCs+ChABC treatment group (group D), and NSCs+GDNF+ChABC treatment group (group E). T10 segmental transversal injury model of the spinal cord was established except group A. NSCs induced by ATRA and marked with BrdU were injected into the site of injury at 8 days after operation in groups C-E. Groups C-E were treated with GDNF, ChABC, and GDNF+ChABC respectively at 8-14 days after operation; and group A and B were treated with the same amount of saline solution. Basso Beattie Bresnahan (BBB) score and somatosensory evoked potentials (SEP) test were used to study the functional improvement at 1 day before remodeling, 7 days after remodeling, and at 1, 2, 5, and 8 weeks after transplantation. Immunofluorescence staining and HE staining were performed to observe the cells survival and differentiation in the spinal cord.Five mouse died but another rats were added. At each time point after modeling, BBB score of groups B, C, D, and E was significantly lower than that of group A, and SEP latent period was significantly longer than that of group A (P0.05), but no difference was found among groups B, C, D, and E at 7 days after remodeling and 1 week after transplantation (P0.05). BBB score of groups C, D, and E was significantly higher than that of group B, and SEP latent period was significantly shorter than that of group B at 2, 5, and 8 weeks after transplantation (P0.05); group E had higher BBB score and shorter SEP latent period than groups C and D at 5 and 8 weeks, showing significant difference (P0.05). HE staining showed that there was a clear boundary between gray and white matter of spinal cord and regular arrangement of cells in group A; there were incomplete vascular morphology, irregular arrangement of cells, scar, and cysts in group B; there were obvious cell hyperplasia and smaller cysts in groups C, D, and E. BrdU positive cells were not observed in groups A and B, but could be found in groups C, D and E. Group E had more positive cells than groups C and D, and difference was significant (P0.05). The number of glial fibrillary acidic protein positive cells of groups C, D, and E was significantly less than that of groups A and B, and it was significantly less in group E than groups C and D (P0.05). The number of microtubule-associated protein 2 positive cells of groups C, D, and E was significantly more than that of groups A and B, and it was significantly more in group E than groups C and D (P0.05).The NSCs transplantation combined with GDNF and ChABC could significantly promote the functional recovery of spinal cord injury, suggesting that GDNF and ChABC have a synergistic effect in the treatment of spinal cord injury.

To investigate the effectiveness of pedicle screw internal fixation for the atlantoaxial instability of children.Between July 2005 and January 2012, 19 cases of atlantoaxial instability were treated, included 10 boys and 9 girls with an average age of 7.5 years (range, 4-15 years). The X-ray films, CT, and MRI examinations of the cervical spine showed craniocervical malformation in 9 cases, congenital os odontoideum in 3 cases, odontoid fracture (type II) in 1 case, disruption of transverse ligament in 2 cases, atlantoaxial fracture and dislocation in 4 cases; and spinal cord injury in 8 cases, according to the American Spinal Cord Injury Association (ASIA) impairment scale, 1 case was rated as grade B, 2 as grade C, and 5 as grade D. Preoperative skull traction was performed routinely on all cases, and complete reduction was achieved in 17 cases, no reduction in 2 cases. In 17 patients who achieved complete reduction, pedicle screw internal fixation was used through posterior approach, including occipitocervical fusion and fixation in 5 cases, and atlantoaxial fusion and fixation in 12 cases; in 2 patients with no reduction, pedicle screw internal fixation was used through posterior approach (atlantoaxial fusion and fixation) after release by transoral approach.The operation was successfully performed in all patients. The mean operation time was 89 minutes; the mean intraoperative blood loss was 95 mL; the mean postoperative drainage volume was 73 mL; and the mean hospitalization days were 14 days. The patients were followed up 6-27 months (mean, 18.3 months). Satisfactory atlantoaxial fusion was obtained, and bone fusion was obtained at 3-7 months after operation (mean, 4.5 months). No breakage of screw or rods and re-dislocation occurred during follow-up. At last follow-up, the cervical range of motion (CROM) of the left and right rotation were (62.0 +/- 5.9) degrees and (63.9 +/- 3.8) degrees respectively in 5 patients receiving occipitocervical fusion and fixation, showing significant difference when compared with the values of normal children [(72.3 +/- 7.0) degrees and (74.1 +/- 7.6) degrees, respectively] at the same age (t = -3.915, P = 0.018; t = -5.954, P = 0.004). The CROM of the left and right rotation were (70.5 +/- 5.8) degrees and (72.7 +/- 4.9) degrees respectively in 14 patients receiving atlantoaxial fusion and fixation, showing no significant difference when compared with normal children at the same age (t = -1.417, P = 0.180; t = -1.021, P = 0.323). The visual analogue scale (VAS) score was significantly decreased from 7.8 +/- 1.1 at pre-operation to 3.5 +/- 0.8 at last follow-up (t = 17.267, P = 0.000). In 8 cases having spinal cord injury, 2 cases were rated as grade C, 1 case as grade D, and 5 cases as grade E according to ASIA impairment scale.Technique of pedicle screw internal fixation has been proven to be an effective treatment for the atlantoaxial instability of children. It plays an important part in relieving pain and limitation of the cervical region.

To investigate the role of hepatocyte apoptosis and mitochondrial permeability transition pore (MPTP) opening in the pathogenesis of nonalcoholic fatty liver disease (NAFLD).Thirty male SD rats were randomized into normal diet group and high-fat diet group. At 4, 8 and 12 week of feeding. The hepatocyte apoptosis index (AI) was measured using flow cytometry, and MPTP opening was evaluated with ultraviolet spectrophotometry. Immunohistochemistry was employed to detect hepatic expressions of Bcl-2 and Bax, and Western blotting was used to detect Bax protein expression changes.High-fat feeding resulted in significantly increased hepatocyte AI at 4-12 weeks and gradually increased MPTP opening. In the high-fat diet group, hepatic Bcl-2 expression was detected but the positive cell number remained stable, whereas Bax-positive cell number increased steadily with time with progressively increased intensity of Bax protein expression, resulting in gradually decreased Bcl-2/Bax ratio.Hepatocyte apoptosis occurs in the rat model of NAFLD in close correlation with mitochondrial damage. Increased MPTP opening as the result of increased Bax expression and aberrant Bcl-2/Bax ratio is an important mechanism of hepatocyte mitochondrial damage in NAFLD.

A prospective, consecutive case series.To evaluate which variable has a strong association with neurological damage in thoracolumbar burst fractures (T12 or L1): severity of injury or narrowing of the spinal canal.Department of Spine Surgery, the Affiliated Hospital, Luzhou Medical College, Sichuan Province, China.This study included 42 patients with thoracolumbar junction burst fractures (T12 or L1), 24 patients with neurological deficit, and 18 patients without deficit. The severity of injury was determined using the Injury Severity Score (ISS) and the New Injury Severity Score (NISS), and the narrowing of the spinal canal was measured by axial computed tomography. The statistical comparison of the neurological deficit and the non-neurological deficit was carried out using nonparametric tests (Mann-Whitney test). The correlation of these scores and narrowing of the spinal canal to the neurological status was determined using a Spearman correlation test.Higher ISS (21 vs. 11), NISS (30 vs. 15), Injury Severity Score with modification (ISSM) (13 vs. 11), New Injury Severity Score with modification (NISSM) (21 vs. 15), and canal compromise (48 vs. 25) were found in patients with neurological deficit, which evidently yielded statistical differences between the patients with neurological deficit and those without (P0.01), and they also had a positive correlation with the American Spine Injury Association (ASIA) score (r0.5, P0.001). Moreover, there was also a positive correlation (r=0.375, P0.05) between ISSM and ASIA scores, although it seemed weak. The correlations between the NISS, NISSM, and neurological deficit (respectively r=0.868, P0.001; r=0.676, P0.001) were stronger than with the narrowing of the spinal canal (r=0.560, P0.001).NISS have a closer correlation with neurological deficit in thoracolumbar burst fractures; thus, we can put forward a hypothesis that perhaps NISS is able to reflect the dynamic fracture process.

To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterior-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall.Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores.No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 +/- 3.9) was significantly improved when compared with the pre-operative score (14.0 +/- 5.7) (t = 4.536, P = 0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilized time. The Cobb angle was corrected from (43.2 +/- 11.5) degrees preoperatively to (9.8 +/- 5.7) degrees at last follow-up, showing significant difference (P0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P0.05). The intervertebral height of fractured vertebra was restored to 87.0% +/- 11.2% of adjacent disc height.Posterior-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satisfactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.

To investigate the diagnostic value of MR imaging in cervical spinal canal stenosis combined with spinal cord injury.From August 1998 to May 2008, 41 patients with cervical spinal canal stenosis and spinal cord injury were treated, including 34 males and 7 females aged 32-71 years (average 53.4 years, 27 patients being older than 60 years). Patients' MRI data were retrospectively analyzed. Injury was caused by falling from height in 8 cases, traffic accident in 19 cases, crush due to heavy objects in 3 cases and other reasons in 11 cases. The time from injury to operation ranged from 2 hours to 3 years. There were 12 cases of anterior spinal cord injury syndrome, 23 of central spinal cord syndrome and 6 of Brown-Sequard syndrome. JOA score of spinal cord function was 3-11 points (average 6.6 points).MR imaging diagnosis before operation showed abnormal signal changes within the spinal cord in 37 cases (41 sites), anterior and posterior longitudinal ligaments and discs (APLLD) injury in 28 cases (30 sites) and signal of edema and hematoma signals in anterior surface of cervical spines (EBC) in 34 cases (36 sites). Diagnosis during operation revealed edemas raises, contusions tears of posterior soft tissue in 18 cases (20 sites), appendix fracture in 6 cases (7 sites), formation of EBC in 20 cases (23 sites), APLLD injury in 34 cases (44 sites), intervertebral instability without the rupture of ligament and intervertebral disc in 7 cases (10 sites). Significant difference was evident between the MRI diagnosis before operation and the intraoperative discoveries (P0.05).The MR imaging diagnosis before operation do not correspond to the intraoperative discoveries, indicating that MRI diagnosis fails to make a relatively comprehensive and accurate diagnosis. So it is advisable to make a diagnosis based on clinical symptoms.

To explore the expression of Wnt-1 during the process of inducing neural stem cells (NSCs) into neurons by using all-trans-retinoic acid (ATRA) in vitro and the effect of Wnt-1 on NSCs differentiation.NSCs isolated from cerebral cortex of SD rat embryo (12-16 days' gestation) were cultured. The concentration of cells at passage 3 were adjusted to 1 x 10(6) cells /mL and treated with ATRA at 0.5, 1.0, 5.0 and 10.0 micromol/L, respectively. Differentiation ratio of NSCs into neurons in each group was detected by double-labelling immunofluorescence technique and flow cytometry, and 1.0 micromol/L was selected as the best concentration for ATRA to promote NSCs differentiation. In experimental group, NSCs at passage 3 were cultured with ATRA at 1.0 micromol/L in vitro, and expression of Wnt-1 was detected by immunocytochemistry staining, real-time fluorescent quantitive PCR and Western blot at 3, 5, 7 and 9 days after culture, respectively. The cells at passage 3 receiving no ATRA served as control group.Immunocytochemistry staining: in the control group, there was little Wnt-1 protein expression; in the experimental group, peak expression of Wnt-1 and numerous positive cells occurred at 3 days after culture, the positive expression of Wnt-1 was still evident at 5 days after culture, and there was significant difference between two groups in integrated absorbance (IA) value at 3 and 5 days after culture(P0.05), obvious decrease of positive expression of Wnt-1 was evident, and no significant difference was evident between two groups in IA value at 7 and 9 days (P0.05). Real-time fluorescence quantitative PCR: the relative expression of Wnt-1 mRNA in the control group was 0.021 7 +/- 0.072 1; the relative expression of Wnt-1 mRNA in the experimental group at 3, 5, 7 and 9 days was 0.512 2 +/- 0.280 0, 0.216 4 +/- 0.887 0, 0.038 5 +/- 0.299 4 and 0.035 5 +/- 0.309 5, respectively, indicating the value decreased over time, and there were significant difference between two groups at 3 and 5 days (P0.05), and no significant difference at 7 and 9 days (P0.05) . Western blot detection: specific and visible staining band was noted; in the control group, Wnt-1 protein expression was 0.005 1 +/- 0.558 3; in the experimental group, Wnt-1 protein expression at 3, 5, 7 and 9 days was 0.451 7 +/- 0.071 3, 0.311 7 +/- 0.080 5, 0.007 3 +/- 0.052 7 and 0.004 7 +/- 0.9314, respectively, suggesting the value decreased over time; there were significant differences between two groups at 3 and 5 days (P0.05), and no significant differences at 7 and 9 days (P0.05).With the induction of ATRA at 1.0 mmicromol/L, Wnt-1 and NSCs differentiation in early stage are positively correlated. Its possible mechanism may rely on the activation of such signals as classic Wnt-1 signal pathway, indicating Wnt-1 relates to the differentiation of NSCs into neurons.

To investigate the effectiveness of all-trans-retinoic acid (ATRA) at different concentrations on proliferation and differentiation of the rat embryonic neural stem cells (NSCs), and to find the optimal concentration of ATRA that promoting the differentiation of NSCs into neurons.NSCs were isolated from cerebral cortex of rat embryos (embryonic day 12-16, average 15 days), and were cultured in serum-free medium (DMEM/F12 medium containing 20 ng/mL bFGF and 20 ng/mL EGF) at the concentration of 1 x 10(6) cells/mL. Subcultures were performed 7 days after the primary culture. The cell clusters of the 3rd passage were centrifuged and divided into 5 groups. In the experimental groups (groups A, B, C, D), the ATRA concentration was 0.5, 1.0, 5.0, 10.0 micromol/L in DMEM/F12 complete medium respectively, while in control group (group E), the ATRA concentration was 0 in DMEM/F12 complete medium. The proliferation rate of each group was analyzed by cell counting day by day till 7th day, and BrdU positive cell counting 1, 3, 5, 7, 9 days after culture. In addition, collecting the 3rd passage NSCs and divided into 5 groups. In the experimental groups (groups A, B, C, D), the ATRA concentration was 0.5, 1.0, 5.0, 10.0 micromol/L in DMEM/F12 medium containing 5% FBS respectively, while in control group (group E), the ATRA concentration was 0 in DMEM/F12 medium containing 5% FBS. The capacity of NSCs differentiation toward neurons was determined by immunofluorescence double-labelling and flow cytometry.Cell counting 1-7 days after culture in each experimental group (groups A, B, C, D) showed no significant differences (P0.05). Cell counting at each time point of all the experimental groups were less than those of control group (P0.05). BrdU positive cells were increased 1, 3, 5, 7, 9 days after culture in each experimental group (groups A, B, C, D), but there was no significant difference between each experimental group (P0.05). BrdU positive cells at each time point of control groups were more than those of all the experimental groups (P0.05). The differentiation ratio of neurons was enhanced in experimental groups and the optimal ATRA treatment concentration was 1.0 micromol/L (experimental group B). The differentiation ratio of neurons induced by ATRA in group B was 29.46% +/- 0.47%, 47.25% +/- 0.46% and 66.81% +/- 0.57% respectively after cultured 3, 5 and 7 days, whereas the differentiation ratio of neurons was 11.11% +/- 0.59%, 14.10% +/- 0.32% and 15.92% +/- 0.70% respectively in control group. The majority of NSCs differentiated into astroglial phenotypes in control group. By flow cytometry detection, the differentiation ratio of neurons after cultured 3 days and 7 days in experimental groups were more than those in control group (P0.05).ATRA treatment remarkably promoted the differentiation of NSCs into neurons and the optimal concentration was 1.0 micromol/L.

This study aims to assess the effectiveness and advantages of Vertex multiaxial screw system in use for stabilizing the atlanto-axial junction. The entry point of the atlas was located 18-20 mm lateral to the midline and 2.0 mm superior to the inferior border of posterior arch, and the direction of screw was chosen to be about 10 degrees medial to the sagittal plane and about 5 degrees cephalad to the transverse plane. In odontoid vertebra (C2), the direction of the drill bit was guided directly by the medial and superior aspect of the individual C2 pedicle. All screws were placed properly without incidence of nerve or blood vessel injury, and no complication appeared in operation and after surgery. All cases were followed up for an average of 9 months, all cases achieved well reposition and fixation of atlantoaxial joint, average JOA grade was 9.6 before preoperation and 15.9 after operation. Fixation of the atlantoaxial complex using Vertex multiaxial screw system seemed to be a reliable technique and should be considered a good alternative in atlantoaxial fusion. The technique could be used in young patiens.

To explore the technique of fusing the reconstructed titanic plate, the C2 pedical screws, and the autogenous granulated cancellous bone graft in the occipitocervical region.From April 2002 to January 2005, 19 patients aged 31-67 years with occipitocervical instability underwent the occipitocervical fusion using the reconstructed plate, C2 pedical screws, and autogenous granulated cancellous bone graft. Of the patients, 8 had complex occipitocervical deformity, 8 had old atlantoaxial fracture and dislocation, 2 had rheumatoid arthritis and anterior dislocation of the atlantoaxial joint, and 1 had cancer of the deltoid process of the axis.No complication occurred during and after operation. The follow-up for an average of 16 months in 19 patients showed that all the patients achieved solid bony fusion in the occipitocervical region. There was no broken plate, broken screw, looseness of the internal fixation or neurovascular injury.The fixation of the C2 pedical screws with the reconstructed titanic plate is reliable, the insertion is easy, and the autogenous granulated cancellous bone graft has a high fusion rate, thus resulting in a satisfactory effect in the occipitocervical fusion.