BACKGROUND: The high incidence of nonunion in osteoporosis vertebral compression fractures (OVCFs) among the elderly population is a significant concern. But the hypothesis about etiopathogenesis of the intravertebral cleft (IVC) is not convincing. This study aims to investigate the association between spinopelvic parameters and IVC. METHODS: Patients with single segment IVC or healed vertebral compression fracture (HVCF) were retrospectively recruited for the study. Patients with IVC were assigned to the IVC group, the others were assigned to the HVCF group. We estimated whether IVC or HVCF locates the vertebra inflection point on lumbar lateral radiography. Distance between the sagittal line passing through the anterosuperior corner of S1and the center of the vertebra of healed fracture or with IVC (DSVA) and sacral slope (SS) were measured on lumbar lateral plain films. Intergroup spinopelvic parameters were analyzed. analysis to identify independent variables associated with IVC incidence. The receiver operating characteristics (ROC) curve was generated to identify the optimal cut-off point for statistically significant variables. RESULTS: Sixty-five patients were included in the study. Thirty patients (mean age: 74 +/- 7.16 years) had single-level IVC, and 35 patients (mean age: 67.71 +/- 7.30 years) had single-level HVCF. Age, body mass index (BMI), and DSVA were statistically different between the groups (all P < 0.05). The occurrence of IVC was related to the DSVA in the multivariate logistic regression analysis (OR [ 0.73, P < 0.05). CONCLUSIONS: According to the results of this study, large DSVA was a risk factor for IVC formation in patients with OVCFs. Patients with global spinal malalignment should be actively observed during conservative treatment.

A novel interspinous distraction fusion (ISDF) device has been used to treat lumbar degenerative diseases. As a minimally invasive technique, ISDF differs from the traditional interspinous process distraction devices. Currently, biomechanical studies on ISDF are rare. To investigate the biomechanical properties of the ISDF device (BacFuse) which is used to treat lumbar degenerative diseases. Three-dimensional L3-L5 models were created. The models were divided into four groups: intact (M1), local decompression alone (M2), internal fixation alone (M3) and local decompression combined with internal fixation (M4), based on different surgical procedures. Local laminectomy was performed to resect the lower part of the L4 lamina and the upper part of the L5 lamina at the right lamina of L4/5 in the M2 and M4 groups. After meshing the models elements, Abaqus were used to perform the finite element (FE) analysis. The intervertebral range of motion (ROM) was measured during flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation under a follower load of 400 N with a 7.5Nm moment. The distributions of disc and facet joint stresses were observed and recorded. Spinal vertebral stress was compared, and internal fixation device stress was observed. The ROM of L4/5 in M2 increased in flexion, extension, left lateral bending, right lateral bending, left rotation and right rotation compared with that in M1. In all motion directions, the ROM at L4/5 decreased, and the ROM at L3/4 increased after implantation of the ISDF device in M3 and M4 groups. The disc stress and facet joint stresses in the instrumented segment decreased after implantation of the ISDF device. The spinous process loaded a certain amount of stress in M3 and M4 groups. The spikes of the internal fixation device were loaded with the maximum stress. BacFuse exhibited a reduction in intervertebral ROM, as well as decreased stress on the intervertebral disc and facet joint, while also demonstrating a discernible impact on the upper adjacent segment.

目的 探讨骨折风险评估工具(Fracture Risk Assessment Tool,FRAX)对绝经后女性骨折风险的预测价值.方法 回顾性分析 750 名北京地区绝经后女性的FRAX评分,收集每位受试者股骨颈骨密度(bone mineral density,BMD)及FRAX算法中需要的危险因素,并随访收集 10 年内是否新发骨折,计算年龄及体质量指数(body mass index,BMI),用FRAX工具计算10 年内骨质疏松引起主要部位骨折(脊柱、前臂、肩部骨折)概率(the 10-year probability of major osteoporotic fractures,PMOF)和 10 年内髋骨骨折概率(the 10-year probability of hip osteoporotic fractures,PHF).分析FRAX预测值与年龄、BMI、股骨颈BMD的相关性,建立二分类Logistic回归方程研究 10 年内新发骨折的显著危险因素,并建立模型得到预测值,以 10 年内是否新发骨折为标准绘制受试者工作曲线(receiver operating characteristic curve,ROC),计算FRAX预测值、BMD及模型预测值曲线下面积(area under curve,AUC),以AUC评估FRAX工具的预测价值.结果 研究对象平均年龄为(62.49±6.59)岁,平均体质量为(63.03±9.63)kg,平均身高为(156.11±5.10)cm,平均股骨颈BMD(T值)为-1.12±0.95.危险因素与FRAX预测值的相关性分析显示,除吸烟和饮酒外,余危险因素与PMOF的差异均有统计学意义(P＜0.05);除饮酒和风湿性关节炎外,余危险因素与PHF的差异均有统计学意义(P＜0.05).年龄、BMI和股骨颈BMD与FRAX评分的相关性分析显示,年龄与PMOF和PHF呈正相关,差异有统计学意义(P＜0.05),而BMI、股骨颈BMD与PMOF和PHF均 呈负相关,差异有统计学意义(P＜0.05).以 10 年内是否新发骨折为因变量生成Logistic回归方程评估危险因素,得出骨折史、吸烟、股骨颈BMD、体重、身高对女性骨折风险的影响较大并得到预测模型.ROC曲线分析PMOF、PHF、股骨颈BMD和回归模型预测 10 年内骨折的AUC分别为 0.616、0.600、0.573 和 0.670(P＜0.05),但诊断能力较低.结论 FRAX可应用于北京地区绝经后女性骨折风险评估,但预测准确性有待提高.绝经后女性如果有骨折史,应尽早行FRAX及DXA评估,并尽快得到医疗建议.

Kümmell disease (KD) is a complication of osteoporotic vertebral compression fractures. There is a lot of literature on KD, but the reported cases are all single vertebrae. This study reports five double vertebrae KD cases (10 levels) and discusses the possible underlying mechanisms with a literature review. One hundred and thirty vertebrae KD were diagnosed from 2074 osteoporotic vertebral compression fractures patients treated in our hospital between 2015 and 2019. These vertebrae KD were divided into two groups, one-level vertebrae KD (n = 125) and double-level KD (n = 5). The diagnosis of KD is mainly based on the signs of intravertebral vacuum cleft on X-ray or CT scan. Double vertebrae KD cases were classified by using the KD staging system. The analysis was performed on KD to compare age, gender, femoral neck bone mineral density of femoral neck (BMD), vertebrae distribution, Cobb angle, and visual analog scale (VAS) between one-level KD and double-level by t-tests, Welch's t-test, or hypothesis testing. The mean age of the participants in the one-level KD group was 78.69 years, while the mean age in the double-level KD group was 82.4 years. The difference was statistically significant (t = 3.66, p = 0.0004). There were 89 females and 36 males in the one-level KD group, while the double-level KD group had five females and no males. The femoral neck BMD was significantly different between the two groups, with the one-level KD group having a mean BMD of -2.75 and the double-level KD group having a mean BMD of -4.2 (t = 2.99, p= 0.0061). The vertebrae distribution was different between the groups, with the one-level KD group having vertebrae from T7 to L4 and the double-level KD group having vertebrae from T11 to L1. The Cobb angle was also significantly different between the groups, with the one-level KD group having a mean angle of 20.58 and the double-level KD group having a mean angle of 31.54 (t = 6.22, p = 0.0001). Finally, the VAS scores were similar between the two groups, with the one-level KD group having a mean score of 8.63 and the double-level KD group having a mean score of 8.8 (t = 1.35, p = 0.1790). It is concluded that double vertebrae Kümmell disease has special clinical significance due to its potential to cause greater spinal instability and deformity, increased risk of neurological symptoms, more complex surgical management, and greater risk of complications.

Introduction This article introduced the management of a case with severe left lower extremity pain and forced hip flexion after posterior lumbar interbody fusion and a final diagnosis of left psoas hematoma. Materials and methods Here we reported a case of a 65-year-old female received posterior lumbar interbody fusion (PLIF) for L4-L5 spondylolisthesis and L4 instability. On the postoperative day one, the hemoglobin level decreased from 108 g/L to 78 g/L. Meanwhile, the patient presented low back pain and inner thigh radiating pain (VAS pain scale = 8). The pain was so severe that it could be barely relieved by keeping left hip in flexion position. On the postoperative day 6, the pain was still severe even after taking mecobalamin, ankylosaurus, dehydrant agents and central pain relievers(VAS pain scale = 9). Computed Tomography indicated a left intramuscular hematoma image extending down to the left iliac fossa. Active hemorrhage of lumbar segmental arterial was detected by B-ultrasound. The patient then received vascular embolization under angiography on the postoperative day 7. Results The pain in the low back and inner thigh were significantly relieved after the procedure (VAS3-4). On the postoperative day nineteen, the left hip can be fully extended, but the patient was still not able to stand on left leg without a walking stick. On the postoperative day 27, she was able to walk independently. Discussion The main reason for the complication was the second conical dilation channel slipped and entered the lateral side of the vertebral body along the transverse process. After timely embolization, pain was significantly relieved and muscle strength was improved. Conclusions Angiographic embolization is an effective treatment for psoas hematoma after posterior lumbar interbody fusion.

Study Design: A meta-analysis. Objective: This study aimed to analyze the incidence of spontaneous resorption of lumbar disk herniation (LDH) after conservative treatment. Summary of Background Data: The resorption of intervertebral disks has been more frequently reported, but there is a lack of reference to the probability of resorption. Methods: We strictly refer to the standard established in the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-analysis) statement, comprehensively searched electronic databases using the terms related to the spontaneous resorption of LDH. Two reviewers independently evaluated the potential studies, extracted, and analyzed the enrolled data. Results: Thirty-one studies with 2233 patients who received conservative treatment were included for this analysis. We found that the pooled overall incidence of disk resorption was 70.39%, 87.77% for disk sequestration, 66.91% for disk extrusion, 37.53% for disk protrusion, and 13.33% for disk bugle, respectively. The resorption incidence in of 25%≤ reduction of disk herniation (RDH) 50%, RDH≥50%, and RDH=100% were 40.19%, 43.62, and 36.89%. The resorption incidence was 66.98% in Japan, 61.66% in the United States, 83.52% in Korea, 60.68% in China, 78.30% in the UK, 56.70% in Italy, and 83.68% in Turkey, respectively. Subgroup analysis showed that there was no significant difference in resorption incidence among prospective, retrospective studies and randomized controlled trials ( P =0.77), and there was no significant difference in evaluation method among qualitative and quantitative studies ( P =0.05). Conclusions: The existing evidence shows that the overall resorption incidence of LDH was 70.39%, the resorption incidence of ruptured LDH is higher than that of contained LDH. There are significant differences in the resorption incidence among countries. The resorption process mainly occurred within 6 months of conservative treatment.

Background The purpose of this study is to evaluate the change patterns of leg numbness (LN) after lumbar decompression surgery (LDS), and to find the predictive factors that affect the recovery of numbness. Methods Patients who underwent LDS in our institution between August 2020 and July 2021 were prospectively enrolled in this study, and were followed by a 12-month follow-up. The degree of LN, leg pain (LP) and the disability were assessed using the visual analog scale (VAS) and oswestry disability index (ODI). Results A total of 314 patients finished the 12-month follow-up. The preoperative mean VAS-LN score was 3.49 ± 2.44, which decreased to 1.91 ± 1.30 at 3 months, to 1.29 ± 0.97 at 6 months and to 1.26 ± 0.96 at 12 months after surgery. The preoperative mean VAS-LP score was 6.05 ± 1.30, which decreased to 2.00 ± 0.86 at 3 months, to 1.02 ± 0.80 at 6 months, and to 0.49 ± 0.71 at 12 months after surgery. The preoperative mean ODI score was 27.90 ± 7.08, which decreased to 9.73 ± 3.09 at 3 months, to 6.72 ± 2.98 at 6 months, and to 4.57 ± 2.76 at 12 months after surgery. Via multivariate logistic regression analysis, only preoperative VAS-LN score (p < 0.001*) was identified as a significantly independent predictive factor for residual LN after operation. Conclusion Clinically significant improvement in LN was observed in the majority of patients within 6 months after LDS, and the improvement of VAS-LN was slower than the VAS-LP. High pre-operative VAS-LN score can independently predict the presence of residual LN after surgery at 12-month follow up.

With the recent development of minimally invasive techniques, minimally invasive posterior cervical foraminotomy (MIS-PCF) has become increasingly popular as a minimally invasive method to treat cervical radiculopathy. However, there are still controversies about whether MIS-PCF is superior to anterior cervical discectomy and fusion (ACDF). The purpose of this study is to evaluate the therapeutic effects of MIS-PCF and ACDF on unilateral cervical radiculopathy without myelopathy. We searched PubMed, Embase, the Cochrane Library, and Scopus comprehensively using the terms related to MIS-PCF. Two reviewers independently evaluated the potential studies, and extracted and analyzed the data of operation time, hospital stay, neck disability index (NDI) score, visual analog scale for neck pain (VAS-neck) and arm pain (VAS-arm) scores, reoperation rate, and complications. Seven studies with 1175 patients were included. The study population was 53.5% male, with a mean age of 48.9. MIS-PCF presented a significantly shorter postoperative hospitalization time compared to ACDF, while the operation time, complication/reoperation rate, and VAS-arm, VAS-neck, and NDI scores were comparable between the two cohorts. In North America, the average cost of MIS-PCF is lower than ACDF. Thus, we suggest that MIS-PCF is an alternative to ACDF for selected patients.

ABSTRACT The researchers aimed in highlighting the correlations of serum MMP-9, TIMP-1, TGF-β1 and bFGF levels with atrial fibrillation (AF) within diseased persons showing no structural heart ailment. A total of 236 eligible diseased persons had been categorized within AF category (n=168) and non-AF category (n=68). Left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) had been measured through cardiac ultrasonography. Comparing concerning non-AF category, AF class had larger LAD and smaller LVEF (P<0.01). MMP-9 and TGF-β1 levels had been higher while TIMP-1 level remained less within AF class as compared to non-AF class (P<0.01). Age, LVEF and left atrial MMP-9/TIMP-1 remained free correlative factors of AF (P<0.01). MMP-9/TIMP-1 remained definitely correlated concerning LAD within AF class (r=0.509, P<0.01). Left atrial MMP-9/TIMP-1 remained higher within diseased persons regarding persistent AF (P<0.01). Left atrial MMP-9/TIMP-1 is correlated with AF within diseased persons having no structural heart ailment, particularly in the case of persistent AF.

To explore a suitable indication of interspinous process distraction device for lumbar spinal stenosis with BacFuse. Patients of lumbar spinal stenosis (LSS) who experienced interspinous process distraction device surgery with BacFuse from June 2014 to January 2015 in our institute were included. We classified LSS into central and lateral types, and then divided these into severe and moderate according to the degree of stenosis. Each type was divided into 2 groups. Patients in group A underwent distraction without bone decompression (stand-alone), while patients in group B underwent bone decompression combined with distraction. Follow-up was performed at 1 month, 3 months, 6 months, 2 years, and 5 years after surgery. Zurich Claudication Questionnaire (ZCQ) was recorded to assess the patient's postoperative condition at each follow-up. A total of 142 patients were available for follow up at each time interval. There was a significant difference between the preoperative and final follow-up ZCQ scores for every LSS type. In addition, there was no difference between group A and group B in the postoperative ZCQ scores with the exception of the lateral severe type. In the study, 22 of the 23 patients (95.65%) in the lateral moderate type were considered to have a satisfactory result in group B, with a similar result of 93.33% (14/15) in group A (P = .75). In the lateral severe type, the patient satisfaction rate was 65.22% (15/23) and 90.63% (29/32) in group A and group B (P = .02), respectively. In the central moderate type, the patient satisfaction rate was 81.82% (15/23) and 76.92% (10/13) in group A and group B (P = .77), respectively. Satisfaction rate for the follow-up results in the central severe type reached 57.14% (4/7) in group A, and 54.55% (6/11) in group B (P = .91). Moreover, no relationship was found between satisfaction and neurogenic intermittent claudication. The most suitable indication for BacFuse treatment was the lateral moderate type. For lateral severe patients, distraction combined with decompression is suggested for a higher satisfaction rate. Severe central spinal stenosis was shown to be a relative contraindication for BacFuse.

Abstract Background: This study used the meta-analytic approach to assess the safety and treatment efficacy of bone marrow stem cells (BMSCs) with core decompression (CD) for osteonecrosis of the femoral head (ONFH) based on randomized controlled trials (RCTs). Methods: Electronic database of PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), and Wanfang database was searched up to December 26, 2019 for relevant RCTs about combined utilization of BMSCs and CD versus CD alone for ONFH. Gray literature sources were also searched. We conducted a meta-analysis following the guidelines of the Cochrane Reviewer's Handbook. Two independent reviewers performed the data extraction and assessed study quality. Our outcomes included the Harris hip scores (HHS) at 12 months, HHS at 24 months, necrotic area of femoral head, conversion to total hip arthroplasty (THA), visual analog pain scale at final follow-up, and adverse effects. The meta-analysis was performed with Stata 12.0. Results: A total of 15 published studies with 688 patients fulfilled the requirements of inclusion criteria. Across all populations, participants in combined utilization of BMSCs group showed a statistical significance with higher HHS at 12 months (standard mean difference [SMD] 0.53, 95% confidence interval [CI] 0.29–0.77) and 24 months (SMD 0.57, 95% CI 0.36–0.77). Similarly, participants in combined utilization of BMSCs group had more advantages in reducing necrotic area of femoral head (SMD −1.05, 95% CI −1.73 to −0.38) and the rate of conversion to THA (risk ratio [RR] = 0.53, 95% CI 0.38–0.74, P = .000). No significant differences were identified regarding postoperative adverse effects postoperatively (RR = 1.03, 95% CI 0.64–1.67, P = .893). Conclusion: Compared with CD treated alone in the treatment of ONFH, combined utilization of CD and autologous BMSCs implantation has a better pain relief and clinical outcomes and can delay the collapse of the femoral head more effectively.

INTRODUCTION:The pregnancy and lactation-associated osteoporosis (PLO) is a rare disease whose precise pathophysiological mechanisms remain mostly unknown.CASE REPORT:We reported here a case of PLO that occurred in the early postpartum period and led to multiple compression fractures. Combination therapy with alendronate, calcium carbonate, and vitamin D was used to treat the patient and a marked but gradual increase in the density of bone mineral was observed. Moreover, no further fractures have occurred.CONCLUSION:PLO is a very rare type of osteoporosis associated with severe chronic back pain. Increased bone resorption significantly increases the risk of bone fractures in women with PLO. Early diagnosis, stopping breastfeeding, treatment of calcium and vitamin D, bisphosphonates, or other antiosteoporosis medicine and regular follow-ups of these cases are particularly important in the prevention of fractures and to increase the quality of life of patients.

Percutaneous vertebroplasty (PVP) is a minimally invasive treatment that has been widely used for the treatment of osteoporotic vertebral compression fractures and vertebral tumors. However, the maximum number of vertebral segments treated in a single PVP remains controversial. Furthermore, PVP may cause complications, including cement leakage, pulmonary embolism, bone cement toxicity, and spinal nerve-puncture injury. We report the rare case of a patient who underwent multilevel PVP for vertebral metastases, with no bone cement leakage or spinal cord injury, but who developed temporary paraparesis.

Objective To assess the preoperative and postoperative changes in MRI image and the short-term efficacy of the ISDF with BacFuse covering 3 years. Methods 32 patients who underwent ISDF were involved in this retrospective study. The symptoms assessment including VAS, ODI, and SF-12 were evaluated preoperative and postoperative at 1 year and 3 years. The X-ray was used to measure posterior disk height (PDH), foramina height (FH), foramina width (FW), and MRI was taken to assess the cross-sectional area of dura sac (CSADS), cross-sectional area of canal (CSAC), herniated disc area, ligamentum flavum area. The preoperative ratio of herniated disc area and ligamentum flavum area to CSAC were compared with post-operative ratio. The modified Pfirrmann grade system was used to assess the surgical lumbar disc. Results The symptom indexes were significantly improved after surgery. PDH and FH increased significantly (P < 0.05) after surgery compared with that before surgery, but there was no statistical difference in FW (P > 0.05). CSADS and CSAC increased obviously (P < 0.05), while the area of herniated disc and ligamentum flavum decreased significantly (P < 0.05). The ratio changes showed a significant difference between last follow-up and pre-operation (P < 0.05), but there was no statistical significance in grade changes of surgical disc. Conclusion ISDF with BacFuse could relieve clinical symptoms and expanse the spinal canal area in MRI. During 3-year observation, it could provide continuous traction and maintain the area of spinal canal, so as to partially retract the herniated disc and make it possible to repair the disc.

Purpose: The spine is the most common skeletal site for metastatic tumors. In the treatment of vertebral metastases, the absolutely safe number of levels that can be treated via percutaneous kyphoplasty (PKP) during one procedure remains controversial. Thus, the present study aimed to evaluate the safety and efficacy of multilevel (>3) PKP for painful osteolytic vertebral metastases. Patients and methods: We retrospectively analyzed the data from 176 patients who received PKP for painful osteolytic spinal metastases. Group A (n=104) received PKP at a maximum of three vertebral levels per procedure, while group B (n=72) received PKP at more than three levels during one operation. Surgical efficacy was assessed via a comparison of the VAS, Oswestry Disability Index (ODI), and general health (GH) and mental health (MH) scores of the Short Form-36 Health Survey before and after PKP. The complications were observed to evaluate the safety. Results: Both groups had significantly improved VAS, ODI, GH and MH scores after PKP (P<0.05). One week after surgery, group A had significantly less pain (VAS 3.41±0.1) than group B (VAS 3.74±0.13) (P<0.05). At 3 and 6 months postoperatively, the GH score was more significantly improved in group A than group B (P<0.05). There were no significant differences between the two groups in the ODI, MH score, and complications (P>0.05). Conclusion: Multilevel PKP is safe and results in effective pain relief, and improvement of spinal mobility and GH in patients with osteolytic vertebral metastases. However, patients who undergo PKP at more than three levels have slightly worse short-term pain relief (less than 1 week postoperatively) and improvement of GH in the long-term (more than 3 months postoperatively) compared with patients who undergo PKP at less than three levels.

Objective To summarize the experience of anterolateral percutaneous vertebroplasty (PVP) in the treatment of cervical metastases in advanced lung cancer,and to evaluate its therapeutic effect on patients with cervical metastases in advanced lung cancer.Methods A total of 27 patients with advanced cervical spine metastases were enrolled from July 2009 to September 2018 in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University.A retrospective analysis was performed on 20 patients who underwent PVP and had complete follow-up data.There were 12 males and 8 females,aged (59.15±7.55) years.A total of 32 cervical metastases were performed.Bone cement leakage was observed by X-ray and CT after operation,and complications were recorded during and after operation.Follow-up visits were made by outpatient or telephone until the 3rd month after the operation.By comparing visual analogue scale (VAS),analgesic use score,cervical dysfunction index (NDI) and KPS before and after operation,the improvement of the quality of life of patients after operation was comprehensively evaluated.The measurement data were expressed as (Mean ± SD).The paired t test was used to test the normal distribution of the paired difference before and after the operation,and the paired rank sum test was used to test the difference before and after the operation which did not conform to the normal distribution.Results The preoperative Tokuhashi correction score was (7.15 ± 2.87) score in 20 patients and the Tomita score was (7.55 ± 2.21) score.The single-segment cervical vertebrae cement injection volume was (1.17 ± 0.25) ml.The postoperative cement leakage rate was 53.13％ (17/32),but no serious complications.VAS before surgery and 3 months after surgery [preoperative (8.30 ± 1.08) score,postoperative (3.60 ± 1.67) score,P =0.000)],analgesic use score [preoperative (3.35 ± 0.59) score,postoperative (1.70 ± 0.80) score,P =0.000],cervical dysfunction index [preoperative (63.10 ± 7.94) score,postoperative (42.55 ± 15.69) score,P =0.000)] and KPS [Preoperative (54.50 ± 6.86) score,postoperative (61.67 ± 12.95) score,P =0.011] were significantly improved,and the difference was statistically significant.Conclusion PVP via anterolateral approach is effective in the treatment of advanced cervical metastases of lung cancer,and can effectively improve the quality of life of patients with advanced cervical metastases,but the surgical leakage rate is high and needs attention.