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PURPOSE The epidemiology and clinicopathology of aneurysmal bone cysts (ABCs) secondary to giant cell tumors of bone (GCTBs) have been well documented in the previous literature. However, reports on whether secondary ABCs could affect the postoperative recurrence of GCTBs are rare. This study analyzed the effects of secondary ABCs and other relevant clinical factors on the postoperative recurrence of GCTBs of the extremities. METHODS We retrospectively analyzed 256 cases of GCTBs of the extremities that were treated surgically at our institution. Among them, there were 60 patients diagnosed with GCTBs combined with secondary ABCs and 196 patients diagnosed with simple GCTBs. Intralesional curettage and tumor resection were performed in 136 and 120 cases, respectively. Univariate analysis, Kaplan-Meier survival analysis, and multivariate regression analysis were used to assess the factors for postoperative recurrence. The follow-up period was at least 24 months. RESULTS The total postoperative recurrence rate was 32%. The recurrence rate in the secondary ABCs group was significantly higher than that in the simple GCTBs group (53.3% vs 25.5%, P

Background To retrospectively analyze the tumor resection method used in 20 patients with clavicular tumors and evaluate its clinical efficacy. Methods A total of 9 patients with clavicular benign tumors underwent intracapsular resection, and 11 patients with clavicular malignant tumors underwent tumor resection from May 2012 to May 2017. Of the 11 patients, 5 underwent clavicular reconstruction using the plate-cement complex. Surgical efficacy was assessed using the Musculoskeletal Tumor Society, Constant-Murley, and American Shoulder and Elbow Surgeons shoulder outcome scores preoperatively until 12 months postoperatively. Results The average duration of follow-up care was 33.7 (12–71) months. Of the 20 patients, 3 patients died, 3 survived with tumor recurrence or metastasis, and 14 survived with no tumor recurrence. Among the 5 patients who underwent resection of malignant clavicular tumors and reconstruction, 2 underwent a re-operation because of a loose screw and plate displacement. In the functional assessment of the shoulder joint, patients with benign and malignant clavicular tumors showed significantly higher scores postoperatively compared with preoperative scores. For malignant clavicular tumors, no significant improvement was observed when comparing the non-reconstruction and reconstruction groups. Conclusions Surgery is an optimal treatment for clavicular tumors. In patients with benign clavicular tumors, simple intracapsular resection can achieve a satisfactory prognosis. Reconstruction of a clavicular defect after resection of a clavicular malignant tumor is not recommended.

The purpose of this study was to investigate the association of Vitamin D Receptor (VDR) gene polymorphisms and VDR levels with lumbar disc degeneration (LDD). TaqMan SNP Genotyping Assay was utilized to probe VDR gene polymorphisms including the FokI (rs2228570), ApaI (rs7975232) and TaqI (rs731236) in 454 patients with LDD and 485 controls. Enzyme-Linked Immunosorbent Assay (ELISA) was used to detect plasma VDR levels. The patients with LDD were divided into three subgroups (subgroup 1: lumbar disc herniation; subgroup 2: lumbar spinal stenosis; subgroup 3: lumbar spondylolisthesis) to further probe the association of plasma VDR levels and VDR gene polymorphisms and LDD. Moreover, immunohistochemistry (IHC) was implemented to evaluate VDR expression in lumbar degenerated disc and normal disc. Allele and genotype frequency of TaqI (rs731236) were significantly different in patients with LDD and controls (all P TaqI polymorphism, the frequencies of T allele were significantly higher in the LDD patients compared with controls (OR = 1.319; 95%CI 1.091 to 1.595; P = 0.004, adjusted (OR = 1.319; 95%CI 1.091 to 1.595; P = 0.004, adjusted OR = 1.383; 95%CI 1.135 to 1.684; P = 0.016). Furthermore, the allele distribution showed a higher frequency of the T allele in the patients with lumbar disc herniation in subgroup 1 (OR = 1.384; 95% CI 1.105 to 1.732; P = 0.004, adjusted OR = 1.319; 95%CI 1.091 to 1.595; P = 0.016). Plasma VDR levels and VDR expression were significantly lower in patients with LDD compared with controls (all P TaqI polymorphism was significantly associated with lower plasma VDR levels in patients with LDD (P = 0.002). TaqI (rs731236) polymorphism was associated with a predisposition to LDD. Plasma VDR and VDR expression levels may be the marker for the occurrence and development of LDD.

Introduction: The increase in the incidence of tuberculosis in developing countries has resulted in increased reporting on more related complications. We report the successful management of an intraoperative spontaneous rupture of a tuberculous pseudo aneurysm associated with spinal tuberculosis. Methodology: We report the case of a 66 years old woman diagnosed with spinal tuberculosis of the T3/T4 vertebrae. During an anterior approach surgical reconstruction for the degenerative vertebrae, massive hemorrhage was observed after the removal of a portion of the prevertebral fascia of the affected vertebrae. This led to the exploration of the hilar fascia for the possibility of hilar hemorrhage, and when no hemorrhage was observed, aneurysm rupture was suspected. A portion of the hilar fascia was then sutured to the prevertebral fascia and the hemorrhage was partially controlled. Results: On the 32nd month post-operative follow-up, the symptoms of chest and back pain had disappeared and the tuberculous lesion eradicated. Conclusion: Presently, there are few reports on the successful treatment of intraoperative spontaneous rupture of tuberculous pseudoaneurysms. We therefore report on the successful management of such a case.

At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility. Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI). The mean follow-up duration was 22.1 months (range: 12–54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ± 14.9 min (range: 82–135 min), and mean blood loss was 386.2 ± 147.9 mL (range: 210–850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively. Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.

Background Currently, there are no known reports on the aetiology of local giant cell tumour (GCT) recurrence in the proximal fibula following en bloc resection. We analysed 21 cases of proximal fibular GCT, focusing on the presence of residual bone in the tibiofibular joint, its causes and its impact on postoperative recurrence. Methods We retrospectively analysed 21 cases with proximal fibular GCT occurring between 2000 and 2017. Results There were 14 males and 7 females. The average patient age was 25.0 years. Seventeen patients were diagnosed and treated at our facility, while 4 were referred after local recurrence. Six patients presented with residual bone fragments in the tibiofibular joint during their first month of follow-up. Patients with residual bone fragments had a higher local recurrence rate (83.3%) than those without (0%, p = 0.0003). Upon further analysis, patients with a preoperative Campanacci grade III tumour (p = 0.0055) and pathological fractures (p = 0.0109) were at a higher risk of exhibiting postoperative residual bone fragments. Conclusions The presence of residual bone fragments in the tibiofibular joint was the main cause of postoperative local recurrence. The presence of residual bone fragments may be related to the preoperative Campanacci grade and pathological fractures. Therefore, close attention should be paid to postoperative follow-up examinations, and if recurrence is suspected, surgical resection should be planned.

Objectives The purpose of this study was to examine the biomechanical effects of fixation on range of motion (ROM) in the upper and lower adjacent segments of different lumbar spine segments in a goat spine model. Methods Fifteen goat spine specimens (vertebrae T12–S1) were randomly divided into three groups: A (single-segment fixation), B (double-segment fixation), and C (triple-segment fixation). Motion in different directions was tested using a spinal motion simulation test system with five external loading forces. Transverse, forward–backward, and vertical displacement of the upper and lower adjacent segments were measured. Results As the external load increased, the upper and lower adjacent segment ROM increased. A significantly greater ROM in group C compared with group A was found when the applied external force was greater than 75 N. The upper adjacent segment showed a significantly greater ROM than the lower adjacent segment ROM within each group. Conclusions Adjacent segment ROM increased with an increasing number of fixed lumbar segments. The upper adjacent segment ROM was greater than that of the lower adjacent segments. Adjacent segment stability after lumbar internal fixation worsened with an increasing number of fixed segments.

Background An increasing number of studies have investigated associations between collagen IX alpha 2 chain (COL9A2) and collagen IX alpha 3 chain (COL9A3) gene polymorphisms and the risk of lumbar disc degeneration (LDD). However, these studies have yielded contradictory results. The purpose of this meta-analysis is to investigate the association between the collagen IX gene polymorphisms (rs12077871, rs12722877, rs7533552 in COL9A2; rs61734651 in COL9A3) and LDD. Methods All relevant articles were collected from PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI). The last electronic search was performed on September 1, 2017. The allele/genotype frequencies were extracted from each study. The odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of associations under the five comparison genetic models. Statistical analysis was performed by Review Manager (RevMan) 5.31 software. Results The meta-analysis of 10 case-control studies, including 2102 LDD cases and 2507 controls, indicated that COL9A2 gene (rs12077871, rs12722877, rs7533552) and COL9A3 gene (rs61734651) polymorphisms were not associated with LDD (rs12077871: T vs. C, OR = 1.85, 95% CI = 0.87–3.91, P = 0.11; rs12722877: G vs. C, OR = 0.83, 95% CI = 0.69–1.01, P = 0.06; rs7533552: G vs. A, OR = 1.11, 95% CI = 0.98–1.25, P = 0.09; rs61734651: T vs. C, OR = 1.57, 95% CI = 0.51–4.84, P = 0.43). The Egger text and the Begg funnel plot did not show any evidence of publication bias. Conclusion rs12077871, rs12722877, and rs7533552 variants in COL9A2 and rs61734651 variant in COL9A3 were not significantly associated with a predisposition to LDD. Large-scale and well-designed studies are needed to confirm this conclusion.

Background/Aims: Phytoestrogens are known to prevent tumor progression by inhibiting proliferation and inducing apoptosis in cancer cells. Formononetin is one of the main components of red clover plants, and is considered as a typical phytoestrogen. This study investigates formononetin induction of apoptosis of human osteosarcoma cell line U2OS by regulating Bcl-2 and Bax expression in vitro and in vivo. Methods: U2OS cells were treated with different concentrations of formononetin and the proliferation of the cells was measured using an MTT assay. Cell apoptosis was examined by flow cytometry. The levels of miR-375, Bax and Bcl-2 protein expression in treated cells were determined by Western blot and RT-PCR. The antitumor activity of formononetin was also evaluated in vivo in nude mice bearing orthotopic tumor implants. Results: High concentrations of formononetin significantly suppress the proliferation of U2OS cells and induce cell apoptosis. Moreover, compared to control group the expression of Bcl-2 and miR-375 decreases with formononetin in the U2OS cells, while Bax increases. Conclusion: Formononetin has inhibitory effects on the proliferation of U2SO cells, both in vitro and in vivo. This antitumor effect is directly correlated with formononetin concentration.

Adriamycin (ADM) is a first‑line agent administered during the therapeutic regimes against osteosarcoma. Clinical administration of ADM produces systemic toxicity and resistance in patients, which restricts its applicability. In the present study the effects of phenethyl isothiocyanate (PEITC) on ADM‑induced apoptosis in osteosarcoma cells was evaluated. Using U2‑OS osteosarcoma cell line cells, treatment with PEITC or ADM for 24 h was observed to dose‑dependently inhibit proliferation of U2‑OS cells with half maximal inhibitory concentration (IC50) values of 5.33 µM and 10.32 µg/ml, respectively. When U2‑OS cells were treated with a combination of the two agents, the inhibition was apparently enhanced, as the IC50 values decreased to 2 µM for PEITC and 1 µg/ml for ADM. Flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labeling revealed that treatment with PEITC or ADM alone reduced the viability of the U2‑OS cells. Furthermore, the viability of the U2‑OS cells was additionally reduced when treatment was with PEITC and ADM together. Supporting this finding, the activity and expression of caspase‑3 were observed to be enhanced in the U2‑OS cells following treatment with either PEITC or ADM, or a combination of the two. These results clearly indicate that PEITC enhances ADM‑induced apoptosis in osteosarcoma cells.

Objectives A previous study identified a significant association between several single nucleotide polymorphisms (SNPs) and lumbar disc degeneration (LDD) in Indians. To validate the association between these SNPs and specific lumbar spine pathologies, we performed a case–control study in Chinese Han population. Design An observational study. Setting University Hospital in Nanning, China. Participants This study included 428 patients with LDD and 400 normal controls. Outcome measures Patients with LDD were classified into four subgroups, including disc herniation only (subgroup 1), discopathies or/and osteochondrosis associated with disc herniation (subgroup 2), spinal stenosis or/and spondylolisthesis (subgroup 3) and degenerative scoliosis (subgroup 4). This study was conducted by examining two aspects: environmental factors and SNP genotyping. The environmental factors were evaluated with a questionnaire survey including questions about body mass index, smoking habits, the physical demands of their job and exposure to vibrations. Rs1337185, rs5275, rs5277, rs7575934, rs3213718 and rs162509 were genotyped using a PCR-based invader assay. Results The physical workload was significantly higher in patients with lumbar spine pathologies than in the normal controls (p=0.035). The genotype and allele frequencies of rs1337185 and rs162509 were significantly different between the patients with LDD and the normal controls. In rs1337185, a significant association was found between the C allele (risk allele) and the presence of disc herniation (OR=1.80; 95% CI 1.21 to 2.68; p=0.003, adjusted p=0.012) and the presence of spinal stenosis and spondylolisthesis (OR=1.92; 95% CI 1.29 to 2.89; p=0.001, adjusted p = 0.004). In rs162509, the G allele represented 1.58-fold increased risk to suffer from disc herniation (OR=1.58; 95% CI 1.20 to 2.09; p=0.001, adjusted p = 0.004). Conclusion The SNPs rs1337185 in COL11A1 and rs162509 in ADAMTS5 are associated with susceptibility to LDD. The C allele of rs1337185 is risky for patients who are affected by lumbar pathologies such as disc herniation, stenosis and spondylolisthesis. The G allele of rs16250 represents a risk factor for the development of disc herniation.

Background: Previous studies have shown that some phytoestrogens inhibits proliferation and induces apoptosis in estrogen-dependent cancers via estrogen receptor (ER)-mediated signaling pathway. In view of the expression of ER in human osteosarcoma cells, the purpose of this study is to investigate whether formononetin and calycosin, two of the major isoflavones in Radix astragali, could also elicit anti-tumor activity against osteosarcoma, along with the underlying mechanism. Methods: Human osteosarcoma cells U2OS were respectively treated with various concentrations of formononetin or calycosin. Cell proliferation was determined by MTT assay, while apoptosis by flow cytometry. Next, the expression levels of apoptosis-related genes ERK, Akt, Bcl-2, Bax and caspase-3 were quantified by real-time PCR and Western blotting. Results: Formononetin exhibited higher anti-proliferative activities toward human osteosarcoma cells U2OS, when compared with calycosin. Therefore, U2OS cells were then respectively treated with various concentrations of formononetin, in order to elucidate the isoflavones-related signaling pathway. It was found that formononetin dose-dependently triggered apoptosis of U2OS cells in vitro. Furthermore, treatment of formononetin led to significant inactivation of ERK and Akt, followed by downregulation of Bcl-2, upregulation of Bax and finally increased expression of caspase-3. Conclusion: Formononetin is more effective than calycosin at promoting cell death of U2OS cells by induction of apoptosis, which is mediated by inactivation of ERK and Akt signaling pathways. Thus isoflavones, especially formononetin, may be useful as anti-cancer drugs for osteosarcoma through their apoptosis-inducing effects.

Supplemental Digital Content is available in the text, The Ladybird Homeobox 1 (LBX1) gene has been implicated in the etiology of adolescent idiopathic scoliosis (AIS). The association between LBX1 gene polymorphisms and AIS has been investigated in several studies. However, these findings have yield contradictory results rather than conclusive evidence. This study is to provide a meta-analysis of the published case-control studies on the association between LBX1 gene polymorphisms and AIS in Asian and Caucasian populations. This meta-analysis conformed to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We conducted a literature research on PubMed, Embase, Web of Science, and Cochrane Library until February 10, 2018. We included all case-control or cohort studies about association between LBX1 gene polymorphisms and AIS. The Risk Of Bias In Non-randomised Studies-of Interventions and Critical Appraisal Skills Programme were used to evaluate the risk of bias and study quality. We assessed the strength of association by pooled odds ratios (ORs) and 95% confidence intervals (CIs) in all genetic models under a fixed-effect model or random-effect model. We further performed subgroup analysis by ethnicity and sex. Sensitivity analysis and publication bias were also undertaken. A total of 10 studies (11,411 cases and 26,609 controls) were included in this meta-analysis. The pooled results showed a statistically significant association between LBX1 gene polymorphisms and AIS (for rs11190870, T vs C, OR = 1.54, 95% CI = 1.48–1.61, P

Study design: Systematic review and meta-analysis. Objectives: Posterior laminectomy with instrumented fusion and laminoplasty are widely used for the treatment of multilevel cervical spondylotic myelopathy (MCSM). There is great controversy over the preferred surgical method. The purpose of this study is to evaluate the clinical outcomes and safety between laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM. Methods: Related studies that compared the effectiveness of laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to April 2018. Included studies were evaluated according to eligibility criteria. The main endpoints included: preoperative and postoperative Japanese Orthopedic Association (JOA) scores, preoperative and postoperative visual analog scale (VAS), preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), overall complication rate, C5 nerve palsy rate, axial symptoms rate, operation time and blood loss. Results: A total of 15 studies were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale (NOS). Among 1131 patients, 555 underwent laminectomy with instrumented fusion and 576 underwent laminoplasty. The results of this meta-analysis indicated no significant difference in preoperative and postoperative JOA scores, preoperative and postoperative VAS, preoperative and postoperative CCI, preoperative ROM and axial symptoms rate. However, compared with laminoplasty, laminectomy with instrumented fusion exhibited a higher overall complication rate [RR = 1.99, 95% confidence intervals (CI) (1.24, 3.21), P

Study design: Systematic review and meta-analysis. Background: Anchor screw fixation and mini-plate fixation are widely used in unilateral open-door laminoplasty. There is a great controversy over the preferred fixation method. The purpose of this study is to evaluate the clinical outcomes between anchor screw fixation and mini-plate fixation for the treatment of multilevel cervical spondylotic myelopathy (MCSM). Methods: Related studies that compared the clinical effectiveness of anchor screw fixation and mini-plate fixation in cervical laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to March, 2018. Included studies were evaluated according to eligibility criteria. The main end points included: preoperative Japanese Orthopedic Association (JOA) scores, postoperative JOA scores, JOA scores improvement rate, preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), lamina open angle, operation time, blood loss, C5 nerve palsy rate and axial symptoms rate. Results: Papers in English and Chinese were searched for the initial review, but only 12 articles in Chinese were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale (NOS). Among 809 patients, 372 underwent anchor screw fixation and 437 underwent mini-plate fixation. The results of this meta-analysis indicated that no significant difference was found in preoperative JOA score, JOA scores improvement rate, preoperative CCI, preoperative ROM, C5 palsy rate and blood loss. However, compared with mini-plate fixation, anchor screw fixation patients showed higher axial symptoms rate [RR = 1.75, 95% CI (1.31, 2.35), P

Ischemic neurological injury is the most feared complication of spinal deformity surgery.In recent years, more attention has been paid to ischemic neurological injury during spinal deformity surgery including causes, risk factors, and prevention. The direct and indirect causes of ischemic neurological injury contains ligature of the segmental arteries, perioperative bleeding and excessive stretching or shortening of the spinal cord.Those patients at greatest risk for paraplegia following diagnosis of thoracic kyphosis or kyphoscoliosis, unilateral vessel ligation, perioperative hypotension, and extensive anterior and posterior surgery. Keeping reasonable mean arterial pressure and multimodal intraoperative monitoring may effectively prevent ischemic neurologic injury during surgery for spinal deformity.

To examine the association between Vitamin D receptor (VDR) gene polymorphisms and lumbar disc degeneration (LDD) predisposition. A comprehensive literature search was conducted to identify all the relevant studies. The allele/genotype frequencies were extracted from each study. We calculated the pooled odds ratios (ORs) and 95 % confidence intervals (CI) to assess the strength of the association between the VDR gene polymorphisms and LDD risk. Statistical analysis was performed using RevMan 5.31 software. A total of 23 case–control studies (1835 cases and 1923 controls) were included in this systematic review. For the TaqI (rs731236), FokI (rs2228570) and ApaI (rs7975232) polymorphisms of VDR gene, nine studies, seven studies, and five studies, were eventually included in the meta-analysis, respectively. There was no evidence that the VDR gene polymorphisms (TaqI, FokI, ApaI) had significant associations with LDD risk.(for TaqI allelic comparison, OR = 1.07, 95 % CI 0.81–1.40, p = 0.64; for FokI allelic comparison, OR = 1.23, 95 % CI 0.83–1.82, p = 0.31; for ApaI allelic comparison, OR = 0.79, 95 % CI 0.55–1.14, p = 0.20). For stratified analyses by ethnicity and study design, no significant associations were found in Caucasian population and Asian population, as well as the population-based studies and hospital-based studies under all genetic models. TaqI, FokI, and ApaI polymorphisms of VDR gene were not significantly associated with the predisposition of LDD. Large-scale and well-designed international studies are needed to further analyze this field.

Objective To study an anterior transsternal approach for treatment of upper thoracic vertebral (T(l)-T(4)) tuberculosis (TB). Methods Sixteen patients with upper thoracic vertebral TB underwent anterior decompression and fusion through an anterior transsternal approach. There were nine men and seven women with a mean age of 48.6 ± 2.3 years (range, 37 to 72 years). The involved area included T(l) in three patients, T(2) in one, T(2) and T(3) in four, T(3) in two, T(3) and T(4) in four, and T(4) in two. The "inside window of the brachiocephalic artery" was used to access T(1) and T(2) lesions, and the "outside window of the brachiocephalic artery" for T(3) and T(4) lesions, for T2 and T3, both "windows" were used. According to the Frankel grading system, two patients were of Grade A, one Grade B, two Grade C, six Grade D and five Grade E. The kyphosis Cobb's angle ranged from 15°-40° (mean, 22° ± 2.5°) preoperatively. Results All patients tolerated surgery wel1. The operation time was 120-150 minutes and bleeding during operation 300-600 ml. The kyphosis Cobb's angle ranged from 10°-25° (mean, 17° ± 2.5°) postoperatively. Eight patients with preoperative neurologic deficit had improved. During the follow-up period, all cases healed without any recurrence. There was no failure of internal fixation. Spinal bone fusion occurred after 3-6 months (mean, 4.2 months) after bone graft in all patients. Conclusion The anterior transsternal approach provides safe and effective access for surgical treatment of upper thoracic TB.

Objective To observe the clinical effect of anterior decompression and reconstruction using titanium mesh with locking plates in the treatment of cervical spondylotic myelopathy. Methods One hundred and twenty patients with cervical spondylotic myelopathy were treated by anterior decompression and reconstruction using titanium mesh with locking plates. There were 66 men and 54 women ranges in age from 37 to 72 Years (mean age, 58.3 years). The mean Japanese orthopedic surgery association (JOA) scale was 9.6 points before operation. Patients were followed up clinically and radiographically. Results Having stood surgery well, the operation time ranged between 60~100 min and bleeding during operation ranged between 20~200 ml. There were no case of postoperative infection, recurrent laryngeal nerve palsy, or esophageal or tracheal laceration or rupture. The average follow-up period was 14.3 months (range, 12 to 24 months) in 96 who were followed up. At the last follow-up visit the mean JOA scale had improved to 14.4 points, reflecting an improvement of 4.8 points. The results were considered to be excellent in 87 patients, good in 25, fair in 6, and poor in 2. No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods. Stable bone union was observed in all cases and the average time required for fusion was 5.7 months. Conclusion Titanium mesh filled with autologous bone graft can avoid the complications associated with harvesting bone from the iliac crest donor site. When combined with cervical anterior locking plate, it can obtain satisfatory clinical results for the treatment of cervical spondylotic myelopathy.

Background Previous studies found that the facet joint of the C1 vertebra were removed (C1 facetectomy) before extirpation from the extramedullary tumor in craniocervical junction, leading to postoperative upper cervical instability or deformity. Occipito-cervical fusion (OCF) is a demanding and morbid surgical procedure, which can be used in such patients. This study is to analyze the clinical manifestation and surgical outcome of patients with craniocervical extramedullary tumor undergoing an extirpation of spinal tumors and OCF by one-stage posterior approach. Methods The surgical and clinical databases were searched for operative procedures that had been performed for patients with spinal extramedullary tumors in craniocervical junction at a single institution from January 2008 to July 2011. The following inclusion criteria were applied: (1) initial surgery for craniocervical extramedullary tumor, (2) gross total resection and occipito-cervical fusion had been performed, (3) minimum 2-year follow-up, and (4) no previous cervical spine surgery. Medical records included demographic characteristics, clinical assessment, and radiographic studies. Clinical outcomes before and after the surgery were assessed using Frankel grade and the Japanese Orthopaedic Association (JOA) score. Cervical sagittal alignment was evaluated by C0-2 angle and C2-7 angle based on X-ray. Results Nine patients were included in the study. Five patients had schwannoma, three patients had meningioma, and only one patient had neurofibroma. All cases were followed up for 24–42 months (average, 34.2 months). At the last follow-up, three patients improved from Frankel grade C to grade D, two patients from Frankel grade C to grade E, and one patient from Frankel grade D to grade E, while two patients remained stationary at the Frankel grade D. The JOA score of the eight patients were 9.0 (range, 6–17) before surgery and were 14.6 (range, 12–17) at the most recent follow-up (p

To compare the results between unilateral and bilateral pedicle screw (PS) fixation for the patients with degenerative lumbar diseases. A systematic review and meta-analysis of cohort studies were conducted between unilateral PS fixation with cage fusion (unilateral group) and bilateral PS fixation with cage fusion (bilateral group) for the treatment of degenerative lumbar diseases from 1990 to June 2014. An extensive search of studies was performed in PubMed, Mediline, Embase and the Cochrane library. The following outcome measures were extracted: visual analogue scale (VAS), Oswestry disability index (ODI), Short-Form health survey (SF-36), fusion rate, complications, blood loss and operation time. Data analysis was conducted with RevMan 5.0. Eight RCTs involving 545 patients were included in this meta-analysis. The pooled analysis showed that there was no statistically significant difference in terms of the VAS, ODI and SF-36 scores, fusion rate [OR = 0.49 (0.23, 1.04), P = 0.06], complication rate(implant-related complication: P = 0.35, general complication rate: P = 0.71) and blood loss between two groups. However, there was less operation time in the unilateral group compared with bilateral group. Four patients (1.48 %) in unilateral group and one patient (0.36 %) in bilateral group were found cage migration, the difference did not achieve statistical significance (P = 0.213). As compared to bilateral PS fixation with cage fusion, unilateral PS fixation with cage fusion achieves a similar VAS, ODI and SF-36 scores, fusion rate, complications and smaller surgical trauma. However, it is still uncertain whether unilateral pedicle screw fixation with cage fusion is as effective and safe as bilateral pedicle screw fixation with cage fusion.

This is a meta-analysis to compare the results between anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) for the patients with multilevel cervical spondylotic myelopathy (MCSM). Systematic review and meta-analysis of cohort studies between ACDF with plate fixation and ACCF with plate fixation for the treatment of MCSM. An extensive search of literature was performed in PubMed, Mediline, Embase and the Cochrane library. The following outcome measures were extracted: JOA scores, fusion rate, cervical lordosis (C2–7), complications, blood loss and operation time. Data analysis was conducted with RevMan 5.0. Four cohorts (six studies) involving 258 patients were included in this study. The pooled analysis showed that there was no significant difference in the postoperative JOA score [WMD = −0.14 (−1.37, 1.10), P = 0.83], fusion rate [OR = 0.84 (0.15, 4.86), P = 0.85] between two group. However, there was significant difference in the cervical lordosis [WMD = 3.38 (2.52, 4.23), P

OBJECTIVES The purpose of the present study was to simultaneously examine the transcript levels of a large number of interleukins (ILs; IL-9, IL-10, IL-12, IL-13, IL-16, IL-17, IL-18, IL-26, and IL-27) and investigate their correlation with the clinicopathological profiles of patients with tuberculous intervertebral discs. METHODS Clinical data were collected from 150 patients participating in the study from January 2013 to December 2013. mRNA expression levels in 70 tuberculous, 70 herniated, and 10 control intervertebral disc specimens were determined by real-time polymerase chain reaction. RESULTS IL-10, IL-16, IL-17, IL-18, and IL-27 displayed stronger expression in tuberculous spinal disc tissue than in normal intervertebral disc tissue (P

To explore the feasibility and effectiveness of spinal pedicle screw internal fixation through endoscope-assisted posterior approach for the treatment of traumatic atlantoaxial instability.Between September 2008 and September 2010, 44 patients with traumatic atlantoaxial instability received spinal pedicle screw internal fixation through endoscope-assisted posterior operation (micro-invasive surgical therapy group, n=22) or traditional surgical therapy (control group, n=22). There was no significant difference in gender, age, type of injury, disease duration, and preoperative Japanese Orthopedic Association (JOA) score between 2 groups (P0.05). The blood loss, operation time, length of the incision, improvement rate of JOA, and graft fusion rates were compared between 2 groups to assess the clinical outcomes.The blood loss, operation time, and length of the incision in the micro-invasive surgical therapy group were better than those in control group (P0.05). All incisions were primary healing. Of 88 pedicle screws, 7 pedicle screws penetrated into the interior walls of cervical transverse foramen in the micro-invasive surgical therapy group and 8 in the control group, but there was no syndrome of vertebral artery injury. All patients of the 2 groups were followed up 12 to 37 months (mean, 26 months). Bony fusion was achieved in all cases within 3 to 12 months (mean, 5.3 months). No loosening or breakage of screw occurred. At 6 months to 1 year after operation, the internal fixator was removed in 6 cases and the function of head and neck rotary movement were almost renewed. The JOA score was significantly improved at last follow-up when compared with preoperative score (P0.05), and no significant difference in JOA score and improvement rate between the 2 groups at last follow-up (P0.05).The micro-invasive surgical therapy can acquire the same effectiveness to the traditional surgical therapy in immediate recovery of stability, high graft fusion rate, and less complication. Moreover, it can significantly reduce the operation time, blood loss, and soft tissue injury, so this approach may be an ideal way of internal fixation to treat traumatic atlantoaxial instability.

The purpose of the present study was to simultaneously examine the transcript levels of a large number of MMPs (-3, -8, -9, -13 and -14) and ADAMTS-4 and to investigate their correlation with the clinicopathological profile of patients suffering from tuberculous intervertebral discs.Clinical data were collected from 130 patients participating in the study from March 2011 to April 2012. mRNA expression levels were determined by means of the real-time polymerase chain reaction in 60 tuberculous (TB), 60 herniated, and 10 control intervertebral disc (ID) specimens.MMP-8, -9, -13, and -14 that showed a stronger expression in spinal TB disc tissue compared to normal ID tissue (P0.05). Our results showed multiple positive correlations among MMP-8, -9, and -13 mRNA in TB samples. Smoking habits were found to significantly up-regulate the transcript levels of MMP-3 and -13 (P0.05). Pain intensity, duration of symptoms, CRP, and ESR significantly affected the transcript levels of several MMPs (P0.05).The MMPs may drive extracellular matrix destruction in spinal tuberculosis intervertebral discs. The experimental data imply a synergistic effect on the activity of these MMPs in spinal tuberculosis intervertebral discs. Furthermore, the experimental data suggest that smoking plays an unfavourable role in the prognosis of spinal tuberculosis intervertebral discs. Moreover, pain intensity, duration of symptoms, CRP, and ESR may affect the process of extracellular matrix destruction by increasing the expression of MMPs in spinal tuberculosis intervertebral disc samples.

To evaluate the effectiveness of cervical disc replacement for cervical myelopathy.Between October 2006 and October 2008, 20 patients (26 segments) with cervical myelopathy underwent single-level (14 segments) or bi-level (6 segments) cervical disc replacement. There were 8 males and 12 females with an average age of 46 years (range, 26-65 years). The disease duration ranged 2-18 months (mean, 7 months). The effectiveness was evaluated using visual analogue scale (VAS) score, cervical range of motion (ROM), and the Odom et al. criteria. Heterotopic ossification (HO), osteophyte formation, and prosthesis loosening were observed.All incisions healed by first intention, with no severe complication. Twenty patients were followed up 30-48 months (mean, 34 months). At 28 months after operation, according to Odom et al, criteria, the results were excellent in 17 cases and good in 3 cases. The VAS scores of the neck, shoulder, and upper limb were significantly improved when compared with preoperative scores (P0.05). At 30 months after operation, X-ray films showed that 20 replaced segments were mobile and ROM was (10.6 +/- 4.5) degrees, showing no significant difference (P0.05) when compared with that of upper adjacent segment (10.8 +/- 3.7) degrees and lower adjacent segment (7.5 +/- 4.2) degrees. HO occurred in 10 cases (13 segments). No displacement, subsidence, or loosening occurred except 1 case of retrodisplacement of the prosthesis.Cervical disc replacement can obtain good effectiveness. It can maintain normal cervical ROM and physiological curvature. But it needs further long-term follow-up to evaluate the function and the influence on the adjacent segments.

Intraspinal teratomas associated with congenital scoliosis are extremely rare, especially in an elderly adult.We report the seventh case of intraspinal extramedullary teratoma coexisting with congenital scoliosis in a patient older than 50 years, possibly the oldest patient documented in literature. A 56-year-old male suffered from low back pain that increased with calf numbness and foot weakness. Conventional radiography showed a congenital scoliosis due to incomplete segmentation of the L2 and L4 vertebras, and magnetic resonance images revealed a heterogeneous intraspinal extramedullary mass located at L4-S1.The tumor was totally removed, and was confirmed as a mature teratoma on biopsy. The patient remains asymptomatic at 34-month follow-up.Rare intraspinal teratoma should be included in the differential diagnosis of intraspinal mass, especially in patient with congenital scoliosis. Patient with mature teratoma may survive with out any symptoms in the long term. Progressing neurological deficit is a main indication for surgery. Excellent clinical outcomes could be achieved by surgical resection and dural sac decompression.

BackgroundNumerous studies examining the relationship between Cyclooxygenase-2 (COX-2) immunoexpression and clinical outcome in osteosarcoma patients have yielded inconclusive results. MethodsWe accordingly conducted a meta-analysis of 9 studies (442 patients) that evaluated the correlation between COX-2 immunoexpression and clinical prognosis (death). Pooled odds ratios (OR) and risk ratios (RR) with 95% confidence intervals (95% CI) were calculated using the random-effects or fixed-effects model. ResultsMeta–analysis showed no significant association between COX-2 positivity and age, gender, tumor location, histology, stage, metastasis or 90% necrosis. Conversely, COX-2 immunoexpression was associated with overall survival rate (RR=2.12; 95% CI: 1.10–3.74; P=0.009) and disease-free survival rate (RR=1.63; 95% CI: 1.17–2.28; P=0.004) at 2 years. Sensitivity analysis performed by omitting low quality studies showed that the pooled results were stable. ConclusionsCOX-2 positivity was associated with a lower 2-year overall survival rate and disease-free survival rate. COX-2 expression change is an independent prognostic factor in patients with osteosarcoma.