OBJECTIVES:To construct a three-dimensional visualized model of the sacral nerve canal, and understand its structure and angles. METHODS:This was a retrospective study including 20 patients undergoing computerized tomography (CT) scanning of the sacrum. Consecutive CT images in Dicom format were directly imported into Mimics software. The images were edited selectively and repaired by hole procession. The sacral nerve canal was removed and a three-dimensional visualized model was acquired. The cylinder model was established to simulate axial images of the sacral nerve foramen. The angles of this cylinder in different conditions were measured and recorded. RESULTS:A three-dimensional visualized model of the sacral nerve canal was successfully constructed, by which the space occupied and course of the sacral nerve canal were directly displayed. The angle between the anterior and posterior sacral nerve canals in the left sacrum 1 was 94.10°±3.72°, while on the right side it was 93.21°±4.19°. The angles between the vertical line and the cross-sectional plane in axial position of the left and right sacral nerve foramens were 26.27°±3.75° and 26.66°±2.65°, respectively. The angles between the vertical line and the sagittal plane in axial position of the left and right sacral nerve foramens were 46.24°±4.24° and 47.74°±5.32°, respectively. No significant differences were found (all P>0.05). CONCLUSIONS:A three-dimensional visualized model of the sacral nerve canal was established based on CT images using the Mimics software. This can reflect the morphologic features and course of the sacral nerve canal accurately, directly, and comprehensively.

OBJECTIVE:To explore the effect of open-door laminoplasty and simultaneous C2 semi-laminectomy with lateral mass screw fixation (LSLF) in treating ossification of the posterior longitudinal ligament (OPLL) in cervical discs at C2 segment.METHODS:In this retrospective study, 76 patients diagnosed with OPLL in cervical discs at C2 segment from November 2016 to May 2019 were included. These patients were assigned into a LSLF group (n=41, LSLF surgery) and LF group (n=35, laminectomy and lateral mass screw fixation) according to the treatment they received. The surgery time and intraoperative blood loss were recorded. Improvements in neurological function (JOA score), cervical curvature index (CCI), spinal cord drift distance, cross-sectional area (CSA) of the posterior muscles from cervical spine, occurrence of C5 palsy, and severity of axial symptoms were evaluated between LSLF group and LF group.RESULTS:Compared with LF group, the operative time was longer and blood loss volume was higher in LSLF group (P<0.05). No statistical difference was found in decompression width between LSLF group and LF group, while the drift distance of spinal cord in LSLF group was larger than that in LF group (P<0.05). No obvious differences were observed in anteroposterior dural sac diameter after the surgery between LSLF group and LF group. CSA in LF group decreased more than that in LSLF group (P<0.05). No remarkable difference was obtained in CCI at the final follow-up between LSLF group and LF group. The NDI score after surgery in the LSLF group was significantly decreased compared to LF group (P<0.05), while no differences were observed in JOA scores or the neurological recovery rate between LSLF group and LF group. The occurrence of C5 palsy in the LSLF group was 4.9%, which was less than that of LF group (20.0%). In contrast to LF group, postoperative axial symptoms in LSLF group were decreased (P<0.05).CONCLUSION:Compared to LF, LSLF could better improve neck functions, and reduce the severity of axial symptoms and the occurrence of C5 palsy for patients with OPLL at C2 segment.

Background At present, surgery is the primary clinical treatment for SCIWORA patients, but conservative treatment still plays an important role in patients with incomplete spinal cord injury. As an important index of cervical spine degeneration, cervical curvature has an impact on the prognosis of spinal cord injury patients. This paper studied the prognosis of conservatively treated patients with SCIWORA and the correlation between cervical curvature and neurological prognosis. Methods A retrospective study was conducted in all the patients with SCI admitted to the Third Affiliated Hospital of Hebei Medical University between January 2017 and June 2020. Data were recorded in 106 eligible patients, including sex, age, injury factors, Cobb angle, CCI, CSA, and ASIA motor and sensory scores. The Wilcoxon sign rank sum test was used to analyze the data postinjury and at the 1-year follow-up. Pearson correlation analysis was performed for the Cobb angle, CCI and CSA. Simple linear regression analysis and multiple linear regression analysis were performed for each group of variables. Results The Wilcoxon signed rank sum test confirmed that the Cobb angle, the CCI and the CSA of the patients were not significantly different at the 1-year follow-up when compared with the postinjury values, and the ASIA motor and sensory scores were significantly improved. The Pearson correlation analysis showed correlations among the Cobb angle, the CCI and the CSA. Simple linear regression analysis and multiple linear regression analysis showed that the nerve recovery rate was negatively correlated with age and was positively correlated with the Cobb angle. Conclusion Conservative treatment of incomplete SCIWORA can achieve a good prognosis. There is a clear correlation between the Cobb angle, CCI and CSA, and the Cobb angle, as an important influencing factor, needs to be considered. For SCIWORA patients undergoing nonsurgical treatment, improving cervical curvature is beneficial to the prognosis of patients. Age negatively affects the neurological prognosis.

Objective . The study aimed to investigate the correlation between the severity of disease and postoperative neurological recovery in patients with cervical spondylotic myelopathy (CSM) combined with developmental spinal stenosis. Methods . A retrospective analysis of the clinical data of 114 CSM patients combined with developmental spinal stenosis admitted to our hospital from June 2019 to June 2020 was performed. All of the patients who underwent posterior cervical unidoor vertebroplasty were divided into the mild, moderate, and severe groups according to the Torg–Pavlov ratio. The clinical data including patients’ age, course of spinal cord high signal change, and first onset age were collected. The recovery time, preoperative, and postoperative Japanese Orthopaedic Association (JOA) scores of patients in each group were compared with the calculation of the improvement rate. The correlation between the severity of disease and postoperative neurological recovery in CSM patients combined with developmental spinal stenosis was analyzed by Pearson correlation. The factors influencing postoperative neurological recovery were analyzed using multivariate logistic regression analysis. The receiver operating characteristic curve (AUC) was used to evaluate the value of each influencing factor in predicting postoperative recovery. Results . Significant differences were observed in the proportion of linear hyperintensity changes in the spinal cord, the age of first onset, the course of the disease, and the Torg–Pavlov ratio among the mild, moderate, and severe groups ( P   <  0.05). The postoperative recovery time of the moderate and severe groups was significantly higher than that of the mild group, while the preoperative JOA score was significantly lower than that of the mild group. On the other hand, the postoperative recovery time of the severe group was prominently higher than that of the moderate group, whereas the preoperative JOA score was observably lower than that of the moderate group ( P   <  0.05). Pearson correlation analysis showed that the postoperative recovery time was significantly negatively correlated with the Torg–Pavlov ratio, age at first onset, and disease course ( r  = −0.359, −0.502, −0.368, P   <  0.05), while it was positively correlated with spinal cord linear high-signal changes ( r  = 0.641, P   <  0.05). Multifactorial logistic regression analysis revealed that the Torg–Pavlov ratio, age at first onset, and disease course were protective factors, while spinal cord linear high-signal alterations were risk factors affecting the recovery time of postoperative neurological function ( P   <  0.05). The area under the curve (AUC) of the Torg–Pavlov ratio, linear hyperintensity changes in the spinal cord, age at first onset, and disease duration in predicting the postoperative neurological recovery time were 0.794, 0.767, 0.772, and 0.802, respectively. The AUC predicted by the combined detection of each factor was 0.876, which was better than the area under the curve of single prediction. Conclusion . Patients with CSM combined with developmental spinal stenosis were characterized by younger age of onset, a short course of the disease, and linear changes in the spinal cord high signal. The degree of developmental spinal stenosis may affect the postoperative recovery time of neurological function in CSM patients but had little effect on postoperative neurological recovery. The Torg–Pavlov ratio, age of first onset, course of the disease, and changes in the spinal cord linear hyperintensity were the factors that affected postoperative neurological recovery, which may provide a basis for reasonably predicting a postoperative neurological recovery in patients with CSM combined with developmental spinal stenosis.

BACKGROUND:Tandem spinal stenosis (TSS) has a complex clinical presentation, and there is no consensus on the optimal surgical strategy. This study retrospectively compared the efficacy of different staged operations and simultaneous decompression for patients with TSS.METHODS:We reviewed data from 132 patients with TSS who received surgical procedures from January 2011 to June 2018. Patients were classified into three groups according to the most symptomatic area of compression (group C: first-stage surgery for cervical compression; group L: first-stage surgery for lumbar compression; group CL: simultaneous surgery for both). Medical records were reviewed for age, gender, comorbidities, operation time, combined estimated blood loss, and time of hospitalization. The JOA-C, JOA-L, NDI, and ODI scores, and complications were also examined.RESULTS:Postoperative outcomes were followed for 32.1 ± 5.4 months. There were significant differences in the re-operation rate and the interval time between the two types of staged operations (p = 0.005 and p = 0.001, respectively). There were no significant differences in gender (p = 0.639), operation time (p = 0.138), combined estimated blood loss (p = 0.116), or complications (p = 0.652) among the three groups, while the simultaneous group was significantly younger (p = 0.027), with fewer comorbidities (p < 0.001) and a shorter hospitalization time (p < 0.001). At the final follow-up, the JOA-C and JOA-L scores were increased, while the NDI and ODI scores were decreased, compared with the preoperative scores.CONCLUSIONS:TSS can be effectively managed by either simultaneous or staged decompressions. First-stage surgery for cervical stenosis significantly lowers the requirement for second-stage lumbar surgery. One-stage simultaneous decompression is safe and effective with the advantage of reduce hospitalization time, without an increase in operative time or bleeding. However, the surgical indications should be strictly controlled and is recommended for younger patients with fewer comorbidities.

Silk fibroin (SF) is a kind of natural protein, which is widely used in biomedical materials because of its biodegradability, easy modification, biocompatibility and good mechanical properties. In this exploration, it was used as bone cement materials and compared with conventional bone cement materials to obtain the efficacy of different bone cement materials in the treatment of osteoporotic vertebral compression fractures. First, the effect of degumming time of silk in boiling on SF was analyzed. Then, hydroxyapatite silk fibroin (HA-SF) was added to calcium phosphate cement (Cap) by coprecipitation method. The properties of the composite bone cement were analyzed by morphology analysis and mechanical properties testing. Finally, 40 patients who underwent percutaneous kyphoplasty (PKP) from May 2019 to June 2020 were selected and divided into two groups. Among them, one group used the composite bone cement material proposed in this exploration, and the other group used the conventional bone cement material. Patients in different groups were evaluated for postoperative treatment. In the experiment, the sericin could be removed by boiling, and the SF short fiber could be peeled by boiling for a long time; the compressive strength of Cap material could be improved by adding HA-SF. At the same time, the introduction of SF could shorten the coagulation time under the premise of injectability, so as to improve the anti-collapse ability of Cap; the patients using different bone cement materials were compared, and the cobb angle, anterior height of vertebral body and VAS score of different groups were analyzed 3 days and 3 months after operation. The results show that the bone cement material proposed in this exploration can effectively treat osteoporotic vertebral compression fractures.

Background There are many surgical procedures that can be used to relieve compression caused by thoracic ossification of the ligamentum flavum (TOLF). The present study aims to retrospectively observe the differences in subsection laminectomy with pedicle screw fixation (SLPF) and lamina osteotomy and replantation with miniplate fixation (LORF) in the treatment of continuous TOLF. Patients and Methods From March 2014 to October 2017, 61 patients with continuous TOLF underwent SLPF (group A) or LORF (group B). The surgical duration, intraoperative blood loss, change in thoracic kyphosis, and perioperative complications were analyzed. Neurological function was evaluated in accordance with the Japanese Orthopedic Association (JOA) score and the American Spinal Injury Association (ASIA) neurological grading. Results The surgical duration, intraoperative blood loss, and postoperative bed-rest duration in group A were significantly lower than those observed in group B (P < 0.05). Both groups demonstrated a significant improvement in JOA score and ASIA grade (P < 0.05). The neurological recovery rate was 69.8% ± 13.5% in group A and 68.5% ± 12.7% in group B (P > 0.05). There was also a significant improvement in ASIA grade at the final follow-up (P < 0.05). During follow-up, the Cobb angle was significantly increased in group B (P < 0.05), whereas no significant difference was observed in group A (P > 0.05). The occurrence rate of perioperative complications was 15.6% (5/32 patients) in group A and 37.9% (11/29 patients) in group B (P < 0.05). Conclusion Both SLPF and LORF significantly promote recovery of neurological function. SLPF has a shorter surgical duration, less intraoperative blood loss, and a lower complication rate. SLPF is more conducive to the correction of sagittal sequence and maintenance of thoracic stability.

Background Two-level symptomatic adjacent segment disease (ASD) is rarely reported, but remains a challenge after anterior cervical arthrodesis. The purpose of this study was to compare the clinical and radiological outcomes of repeat anterior and posterior decompression and fusion procedures for two-level symptomatic ASD. Methods Thirty-two patients with two-level symptomatic ASD were retrospectively reviewed and underwent repeat anterior cervical discectomy and fusion (ACDF) or posterior decompression and fusion (PDF). Clinical outcomes (JOA, NDI, and VAS scores), perioperative parameters (blood loss, operation time, and length of hospital stay), radiological parameters (cervical lordosis and ROM), and complications were compared. Results Eighteen patients underwent ACDF, and 14 patients underwent PDF. Patients who underwent PDF were older, more frequently presented with myelopathic deficits, and were fused at more levels. Patients who underwent ACDF experienced significantly shorter surgery time (p < 0.001), lower blood loss (p < 0.001), and reduced hospital stay (p = 0.002). Both groups exhibited significant increases in JOA scores and decreases in NDI and both neck pain and arm pain VAS scores (p < 0.05), but patients who underwent PDF had significantly higher NDI scores (p = 0.012), neck pain VAS scores (p = 0.019), loss of cervical lordosis (p < 0.001), and loss of ROM (p = 0.001). Three patients developed dysphagia in the ACDF group, and two patients had C5 root palsy and one had hematoma in the PDF group. Recurrent ASD after the second operation occurred in two patients in the ACDF group but no patients in the PDF group. Conclusions For patients with two-level symptomatic ASD, both anterior and posterior decompression and fusion were effective for improving the neurological function. For patients with radicular symptoms, ACDF had less surgical trauma, better restoration of lordosis, and less postoperative neck pain, but higher chance of recurrent ASD. PDF was an effective surgical option for older patients with myelopathy developing in adjacent segments.

目的:对比分析同期手术或分期手术治疗的颈腰综合征患者的临床特点和手术疗效,为治疗选择提供依据.方法:2011年1月～2016年12月,在我院脊柱外科手术治疗并完成随访的颈腰综合征患者共127例,男79例,女48例,年龄46～74岁,平均61.7±8.6岁.依手术顺序不同进行分组研究,86例患者一期行颈椎手术(A组),28例一期行腰椎手术(B组),13例同期行颈腰椎手术(C组),分别记录各组手术时间、出血量、住院天数、术后并发症等,并应用日本骨科协会(Japanese Orthopaedic Association,JOA)评分、颈椎功能障碍指数(neck disability index,NDI)、腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)等评测指标对患者预后行随访研究.结果:所有患者平均随访31.1±5.7个月.A组患者一期行颈椎手术后,33例未行二期手术(A1组),53例行二期腰椎手术(A2组),再手术率61.63％,平均间隔5.32±2.10个月;B组患者一期行腰椎手术后,3例未行二期手术(B1组),25例行二期颈椎手术(B2组),再手术率89.29％,平均间隔3.84±1.75个月;二次手术率及间隔时间两组间差异均有统计学意义(P＜0.05).三组患者末次随访时颈椎JOA、腰椎JOA评分均较术前明显改善,颈椎NDI及腰椎ODI均较术前明显降低,差异均有统计学意义(P＜0.05).将C组同期手术患者同A2、B2组患者进行比较,三组在手术时间、出血量差异均无统计学意义(P=0.106,P=0.255),但同期手术患者的住院时间降低(P＜0.001),并发症稍高但差异无统计学意义(P=0.855).结论:同期或分期手术治疗颈腰综合征均能获得满意临床疗效;依据主要临床症状选择分期手术时,应优先重视颈椎病情治疗,一期解除颈脊髓压迫可以降低二次腰椎手术率;颈腰椎同期手术不增加手术时间、出血量,可减少住院时间,但须严格掌握适应证.

Low- and middle-income countries contribute to only a small percentage of publications in multiple medical fields. Editorial bias was reported to be an important reason for this. However, whether this trend exists in leading spine journals remains unclear. This study determined the composition of the editorial boards of leading spine journals and analyzed the international representation of editorial boards.The editorial board members of four leading subspecialty spine journals, including The Spine Journal, Journal of Neurosurgery: Spine, European Spine Journal, and Spine were identified from the journals' websites. The countries of editorial board members were identified and analyzed according to the continent and country income categories classified by the World Bank.A total of 608 editorial board members were identified from the four leading spine journals. The majority (91.4%) of editorial board members were from high-income countries, followed by upper-middle income countries (7.2%), and lower-middle income countries (1.3%). No editorial board members were from low-income countries. Regarding the continent of residence, 46.5% of the editorial board members were from North America, followed by Europe (38.5%), Asia (9.9%), South America (2.8%), Oceania (1.6%), and Africa (0.7%). The editorial board members came from 40 different countries, which were concentrated in North America, Western Europe, and East Asia. The largest number of editorial board members came from the United States (42.3%), followed by Germany (6.9%), the United Kingdom (6.7%), Switzerland (5.8%), and Italy (5.1%).A lack of international representation on editorial boards exists in leading spine journals. Editorial board members from high-income countries are substantially overrepresented, while editorial board members from low- and middle-income countries are severely underrepresented. The United States is the most represented country on the editorial boards of leading spine journals.

BACKGROUND This study aimed to evaluate the effectiveness of subsection laminectomy with pedicle screw fixation (SLPF) for the treatment of ossification of the ligamentum flavum of the thoracic spine. MATERIAL AND METHODS Thirty patients (age, 40-71 years) with ossification of the ligamentum flavum of the thoracic spine underwent SLPF (13 men, 17 women). Operative time, intraoperative blood loss, preoperative and postoperative change in thoracic kyphosis, and perioperative complications were recorded. The Japanese Orthopedic Association (JOA) score for severity of myelopathy and the American Spinal Injury Association (ASIA) motor and sensory impairment scale were used before and after surgery. RESULTS Mean operative time for SLPF was 208.4±38.3 min and mean intraoperative blood loss was 689.3±171.7 ml. The mean JOA score significantly increased from 5.7±1.9 before surgery to 8.8±2.2 at one month after surgery and 9.3±2.7 at the last follow-up (P<0.01). Postoperative improvement in neurological function increased by 68.3±14.4%. The postoperative ASIA grades significantly improved compared with the preoperative grades (P<0.01). The mean local Cobb angle significantly decreased from 17.8±4.3° before surgery to 15.4±3.6° at one month after surgery and 15.8±3.8° at the last follow-up (P<0.01). Three patients (10%) had operative cerebrospinal fluid (CSF) leak. Postoperatively, one patient had neurological deterioration, two patients had deep venous thrombosis (DVT), and one patient developed a wound infection. CONCLUSIONS SLPF was an effective procedure for the treatment of ossification of the ligamentum flavum of the thoracic spine.

目的 观察椎板分区切除法脊髓减压内固定术治疗胸椎黄韧带骨化症(T-OLF)的临床疗效.方法 33例T-OLF患者接受椎板分区切除法脊髓减压内固定术治疗,有25例获得完整随访,黄韧带骨化2个节段者4例、3个节段13例、4个节段6例、5个节段2例.记录手术时间、出血量及并发症发生情况,观察术后神经功能恢复情况,比较术前、术后3个月、末次随访时JOA评分、局部后凸角.结果 手术时间(207.4±39.6)min,出血量(685.8±176.4)mL,随访时间15～40个月,未出现内固定物松动、脱出及局部后凸畸形.术前ASIA脊髓损害分级:A级1例、B级11例、C级9例、D级4例;术后分级:B级2例、C级7例、D级7例、E级9例,手术前后比较,Z=-4.056,P<0.01.术前、术后3个月、末次随访JOA评分分别为(5.6±1.7)、(7.8±2.2)、(9.5±2.8)分,Cobb角分别为17.6° ±3.9°、15.0° ±3.4°、15.6° ±3.6°,不同时间点JOA评分、Cobb角比较,P均<0.05.末次随访时神经功能改善率为72.2％ ±14.8％.术中共4例(16.0％)患者发生脑脊液漏,取人工硬膜覆盖并严密缝合筋膜层后伤口均愈合良好.结论 椎板分区切除脊髓减压内固定术可减少胸椎黄韧带骨化症椎管内侵袭性操作,硬膜撕裂的发生率低,安全性相对高,且术后胸椎稳定性维持好.

Objective: To analyze the clinical effect of target-anchored vertebroplasty and traditional percutaneous vertebroplasty on the treatment of osteoporotic vertebral compression fractures. Methods: 50 female New Zealand rabbits were selected for establishing the osteoporotic vertebral compression fracture model and divided into two groups, traditional group and target group followed by analysis of the anterior, posterior, and posterior vertebral body anterior height of the fracture and the injection volume of the bone cement at full filling, and to compare the ultimate compressive strength and stiffness differences between the two groups of specimens by biomechanical testing. Results: In traditional group, the operative time was significantly shorter than that of target group, and the intraoperative bleeding was significantly lower than that of target group (P < 0.05). The fracture area of target group was filled with sufficient bone cement, in the traditional group, 3 cases (12%) showed that bone cement was not filled in the fracture area (P < 0.05), but the total bone cement filling volume was not significantly different between the two groups, but the traditional group had more complete bone cement filling than the bone cement filling, the difference was statistically significant (P < 0.05). In addition, the anterior vertebral body height of each group was significantly higher than other observation points in the group (P < 0.05). However, the distribution of permeability and osmotic type of bone cement between the two groups was not significantly different (P > 0.05). Conclusion: Target-anchored vertebroplasty can improve the quality of clinical treatment of osteoporotic vertebral compression fractures, indicating that it might be a new surgical method.

Objective: To investigate the effect of intramedullary magnetic resonance (MR) changes on T2-weighted MR images (T2WI) on the postoperative prognosis in patients with thoracic spinal stenosis. Methods: Between January 2014 and December 2016, a total of 40 patients undergoing surgeries for thoracic spinal stenosis who had been diagnosed as having thoracic spinal stenosis in the Department of Orthopedics in our hospital were enrolled as subjects in this study. The enrolled patients were assigned to the high-intense signal group or the non-highintense signal group in terms of the results of intramedullary signal intensity on T2WI of the thoracic canal. The preoperative JOA score, the rate of postoperative recovery and the severity of thoracic spinal stenosis were compared between the two groups. The patients in the high-intense signal group were stratified into some with increased signal intensity for single segment and the others with increased signal intensity for multiple segments according to the range of lesions, and the differences in the preoperative JOA score and the rate of postoperative recovery were compared between the two subgroups. Results: Compared to the non-high-intense signal group, the preoperative JOA score was markedly lower (4.5±1.5 vs 6.5±1.7; P<0.0001) but the proportion of patients with severe thoracic spinal stenosis was larger in the high-intense signal group (P<0.001). The rate of postoperative recovery was strikingly different between the two groups (38.5±14.6% vs. 48.9±17.8%; P<0.001). The preoperative JOA score and the rate of postoperative recovery were remarkably lower among the patients with increased signal intensity for multiple segments than those with increased signal intensity for single segment (Both P<0.001). Conclusion: The high signal intensity on T2WI of the patients with thoracic spinal stenosis demonstrates that more severe spinal cord injury indicates worse prognosis. The high signal intensity on T2WI can be used as one of the predictors for assessment of surgical prognosis of the patients with thoracic spinal stenosis.

Objective: To investigate the efficacy of posterior decompression and vertebral fusion in the treatment of unstable cervical spine fracture with diffuse idiopathic skeletal hyperostosis (DISH), and evaluate the factors affecting neurological prognosis. Methods: From October 2006 to April 2016, 38 patients underwent posterior decompression and vertebral fusion surgery for unstable cervical spine fracture with diffuse idiopathic skeletal hyperostosis (DISH). Demographics, injury characteristics, surgery profiles, efficacy (neurological function changes evaluated as changes of American Spinal Injury Association (ASIA) grades after surgery) and complications of patients were collected. For patients with complete motor paralysis (ASIA-A/B), we also investigated the relationship between neurological improvements (from ASIA-A/B to ASIA-C or-D) and the elapsed time from injury to surgery by Pearson's correlation analysis. Results: All patients underwent posterior fusion with an average of 4.5 +/- 2.5 instrumented vertebrae (range, 2-7) with 6 patients required secondary halo-vest fixation. 13 improved more than one ASIA grade after treatment, 24 did not improve, and one deteriorated. 8 patients developed severe postsurgical pulmonary complications and 4 of these died. In the 18 ASIA-A/B cases (complete motor paralysis), the time of 8 hours or less from injury to surgery was correlated with neurological function improvement from ASIA A/B to C/D (r=0.669, P=0.003). Conclusion: About one third of the patients with unstable cervical spine fracture with diffuse idiopathic skeletal hyperostosis (DISH) benefited from posterior decompression and vertebral fusion. Patients with complete motor paralysis after a cervical fracture with DISH may recover to partial paralysis if surgically treated within 8 hours of injury.

Objective: To investigate risk factors for C5 palsy following anterior cervical decompression (ACD). Methods: A retrospective analysis was made on clinical data from 100 patients with cervical spondylotic myelopathy (CSM) admitted to the Department of Spine Surgery of The Third Hospital of Hebei Medical University from January 2015 to June 2017. All the patients underwent ACD. In terms of the criteria for diagnosing postoperative C5 palsy, the patients were divided into the palsy group and the non-palsy group. The patients in the two groups were compared in the basic data, the Japanese Orthpaedic Association (JOA) scores, changes in the values of cervical lordosis, the sagittal diameters of C4/C5 intervertebral foramina, and the incidence of preoperative hyper-intense signal changes within the spinal cord at C4-C5. Multivariate logistic regression analysis was employed for exploring the risk factors for C5 palsy. Results: The patients in the two groups differed insignificantly in basic data (age, sex, operative time, intraoperative blood loss, and course of disease). The postoperative JOA scores in the palsy group were significantly lower than those in the non-palsy group (P < 0.001). The changes in the values of cervical lordosis before and after surgery in the paralyzed group were greater than those in the non-palsy group, but sagittal diameters of C4/C5 intervertebral foramina were remarkably larger in the non-palsy group than in the palsy group (all P < 0.001). The incidence of preoperative hyper-intense signal changes within the spinal cord at C4-C5 varied insignificantly between the two groups. Multivariate logistic regression analysis demonstrated that changes in the values (greater than 6.5°) of cervical lordosis before and after surgery, and sagittal diameter (less than 2.2 mm) of C4/C5 intervertebral foramina were risk factors for the presence of postoperative C5 palsy. Conclusion: For patients with CSM who had undergone ACD, changes in the values of cervical lordosis before and after surgery, changes in the values of cervical lordosis, and the sagittal diameter of C4/C5 intervertebral foramina are risk factors for presence of postoperative C5 palsy.

Objective: To investigate the efficacy of the posterolateral decompression combined with interbody fusion and internal fixation for thoracic spinal stenosis in patients. Methods: Between January 2014 and May 2016, a total of 50 patients with thoracic spinal stenosis admitted to the author's institution were selected as participants. All the enrolled participants received the posterolateral decompression combined with interbody fusion and internal fixation. The patients' postoperative complications were documented. The spinal cord functions and surgical outcomes were evaluated according to the spinal cord injury Frankel classification and the Otani grading criteria. Results: The posterolateral decompression combined with interbody fusion and internal fixation was completed successfully among all the eligible patients in this study. The mean operative time was 3.3 +/- 0.7 h, and the mean intraoperative blood loss was 970 +/- 110 ml. Cerebrospinal fluid leak was present in 2 patients, and transient spinal cord dysfunction was also present in 2. Among all the eligible patients, the results of preoperative Frankel classification were markedly different from those at 1 year postoperatively (P<0.05). The evaluation of the Otani grading at 1 year postoperatively revealed that the rate of good and excellent results was 86%. Conclusion: After the posterior decompression combined with interbody fusion and internal fixation, the patients with thoracic spinal stenosis had decreased complications, but favorable clinical outcomes. Thus, it is worthy of clinically wide use.

Objective: This study aims to discuss the clinical effects of Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) technology in patients with anterior ring instability fracture. Methods: The participants were 76 patients with anterior ring instability fracture who were admitted in our hospital from April 2015 to June 2017. The patients were divided into control (n=38) and treatment groups (n=38) by using random number table. The control group was treated with improved Stoppa reconstructive plate fixation, whereas the treatment group was administered with MIPPO technology. The operation conditions, Majeed functional improvement effect, comprehensive therapeutic effect, and postoperative complications of the two groups were compared. Results: The treatment group is significantly superior over the control group in terms of time of operation, intraoperative blood loss, length of stay, and time of fracture healing (P<0.05). The Majeed functional scores of both groups at 1 and 3 months after the operation are significantly higher than those before the operation. In addition, the Majeed functional scores of the treatment group are higher than those of the control group (P<0.05). The control group achieves significantly lower clinical efficiency than the treatment group (P<0.05). By contrast, the treatment group suffers fewer complications than the control group (P<0.05). Conclusions: MIPPO technology significantly affects anterior ring instability fracture. This method is characteristic of small trauma, high safety, feasibility, and quick recovery and is worthy of further clinical popularization.

Background: Prevalence estimates of heterotopic ossification (HO) following cervical artificial disc replacement (ADR) varied widely in previous studies. We conducted a systematic review and meta-analysis to summarize its point prevalence. Methods: Electronic searches of PubMed, Web of Science, Embase, and Cochrane Library databases were conducted to identify studies that reported prevalence of HO. Definitions of HO and severe HO were based on McAfee grading system. Random-effects model was used to estimate the pooled prevalence. We conducted subgroup analyses according to the different length of follow-up time, and performed univariate metaregression analyses to explore the effects of potential variables on the overall prevalence. Results: A total of 38 studies were included in this study. The pooled data showed that the prevalence of HO after cervical ADR within the 1 to 2 years, 2 to 5 years, and 5 to10 years of follow-up was 38.0% (95% confidence interval [CI], 30.2%–46.5%), 52.6% (95% CI, 43.1%–61.9%), and 53.6% (95% CI, 40.0%–66.7%), respectively, while the prevalence of severe HO was 10.9% (95% CI, 9.0%–13.2%), 22.2% (95% CI, 15.5%–30.7%), and 47.5% (95% CI, 30.0%–65.8%), respectively. Follow-up time was positively associated with the prevalence of severe HO (P < .01), and the 1-month growth of mean follow-up went with 0.63% increase of severe HO. Conclusion: This meta-analysis reported data on the prevalence of HO and severe HO after cervical ADR, and provided information on its process of development. These should be useful to enable surgeons and patients to gain a better understanding of HO after cervical ADR.

Currently, multiple microRNAs (miRNAs) have been found to play vital roles in the pathogenesis of osteosarcoma. This study aimed to investigate the role of miR-21 in osteosarcoma. The level of miR-21 in 20 pairs of osteosarcoma and corresponding adjacent tissues was monitored by qPCR. Human osteosarcoma cell line SAOS-2 was transfected with either miR-21 mimic or miR-21 inhibitor, and then cell viability, survival, and apoptosis were measured by MTT, colony formation assay, and flow cytometry. A target of miR-21 was predicted by the microRNA.org database and verified in vitro by using luciferase reporter, qPCR, and Western blot analyses. Finally, cells were cotransfected with siRNA against caspase 8 and miR-21 inhibitor, and the apoptotic cell rate was determined again. Results showed that the mRNA level of miR-21 was highly expressed in osteosarcoma tissues compared with adjacent tissues. Overexpression of miR-21 improved cell viability and survival but suppressed apoptosis. Caspase 8 was a direct target of miR-21, and it was negatively regulated by miR-21. Moreover, miR-21 suppression attenuated caspase 8 silencing and induced the decrease in apoptosis. In conclusion, overexpression of miR-21 suppressed SAOS-2 cell apoptosis via directly targeting caspase 8.