This study aimed to compare the properties and safety of self-designed plates in type II traumatic spondylolisthesis of the axis with those of traditional devices via finite element (FE) analysis. We constructed a hangman's fracture FE model from the occipital bone (C0) level to the C3 level. Then, FE models were constructed for the following four fixation systems: an anterior cervical L-shaped plate with four vertebral screws (4-ACLP), or six screws (6-ACLP), an anterior cervical orion plate (ACOP), and a posterior fixation system. A preloaded compressive force of 50 N and a moment of 1.5 N·m were applied to each model under six working conditions. The mobility of the C2/3 segment decreased significantly in four fixation models. In the Mises stress cloud diagram, 4-ACLP showed a better stress distribution in both the bone graft and fixation system than 6-ACLP and ACOP. The resultant force of 4-ACLP was lower but higher than ACOP in axial force. Additionally, the cage in the 4-ACLP configuration experienced the highest stress in the six working conditions. Hence, this novel self-designed plate has the potential to mitigate the operational difficulties, provide sufficient stability, reduce the risk of plate or screw fractures, and improve bone fusion.

Objective: To compare the clinical efficacy of anterior column reconstruction using single or double titanium mesh cage (TMC) after total en bloc spondylectomy (TES) of thoracic and lumbar spinal tumors.Methods: A retrospective cohort study was performed involving 39 patients with thoracic or lumbar spinal tumors. All patients underwent TES, followed by anterior reconstruction and screw-rod instrumentation via a posterior-only procedure. Twenty-two patients in group A were treated with a single TMC to reconstruct the anterior column, whereas 17 patients in group B were reconstructed with double TMCs.Results: The overall follow-up is 20.5 ± 4.6 months. There is no significant difference between the 2 groups regarding age, sex, body mass index, tumor location, operative time, and intraoperative blood loss. The time for TMC placement was significantly shortened in the double TMCs group (5.2 ± 1.3 minutes vs. 15.6 ± 3.3 minutes, p = 0.004). Additionally, postoperative neural complications were significantly reduced with double TMCs (5/22 vs. 0/17, p = 0.046). The kyphotic Cobb angle and mean intervertebral height were significantly corrected in both groups (p ≤ 0.001), without obvious loss of correction at the last follow-up in either group. The bone fusion rates for single TMC and double TMCs were 77.3% and 76.5%, respectively.Conclusion: Using 2 smaller TMCs instead of a single large one eases the placement of TMC by shortening the time and avoiding nerve impingement. Anterior column reconstruction with double TMC is a clinically feasible, and safe alternative following TES for thoracic and lumbar tumors.

BACKGROUND:The aim of this study was to identify important miRNAs and their target genes involved in cell apoptosis in intervertebral disc degeneration (IDD) patients.METHODS:The dataset, GSE63492, was obtained from the gene expression omnibus platform. After preprocessing, the differentially expressed miRNAs (DEMs) and their target genes were identified using the Limma package and miRWalk2.0 database, respectively. The clusterProfiler package in R was used to perform functional enrichment analysis of these target genes. Subsequently, protein-protein interaction (PPI) network and subnet clusters of the coregulated genes were conducted using the STRING database and MCODE, respectively. Further, the co-regulatory network of the key miRNAs and PPI networks were visualized using Cytoscape. Finally, cell apoptosis-related pathways and the genes enriched in these pathways were identified.RESULTS:The genes targeted by the upregulated (hsa-miR-302c-5p, hsa-miR-631, hsa-let-7f-1-3p, hsa-miR-3675-3p, and hsa-miR-585-3p) and downregulated miRNAs (hsa-miR-185-5p, hsa-miR-486-5p, hsa-miR-4306, and hsa-miR-4674) were interrelated with cell apoptosis-related pathways. MAPK1 and MAPK3 were targeted by hsa-miR-185-5p, while GSK3B was targeted hsa-miR-4306, hsa-miR-486-5p, hsa-miR-185-5p, hsa-let-7f-1-3p, and hsa-miR-631. Besides, MAPK3 and VEGFA were regulated by hsa-miR-3675-3p and hsa-miR-631, respectively.CONCLUSIONS:The expression of GSK3B may be coregulated by miR-4306, miR-185-5p, miR-486-5p, hsa-let-7f-1-3p, and miR-631 and may affect IDD development. Besides, miR-185-5p and miR-3675-3p may control nucleus pulposus (NP) cell apoptosis through the MAPK signaling pathway in IDD patients. VEGFA expression may be regulated by miR-631, and help maintain NP cell survival in IDD patients. Our findings may help guide further research into the role of miRNAs in IDD progression.

Purpose: A three-dimensional finite element model of the lower cervical spine was established to evaluate the biomechanical stabil-ity and stress distribution of the new lower cervical interzygapophyseal fusion device (IZFD) developed by ourselves under different construct. The aim of this study was to provide theoretical basis for further clinical application. Methods: A normal fresh cadaveric specimen (male, 35 years old) was used to establish an intact three-dimensional finite element model of C3-C6. On this basis, the com-parative finite element models of the lateral mass screw rod (LMSR) system and LMSR+IZFD were established. Only C4-C5 is fixed in the lateral mass. The range of motion (ROM) and stress distribution in the flexion,extension, lateral bending and rotation of the C4-C5 segment under the three constructs were analyzed. Results: The ROM and stress distribution of the three-dimensional finite element model under load construct were within a reasonable range, which proved the validity and reliability of the model. The ROM and stress distribution of C4-C5 segment was significantly decreased in both LMSR and LMSR+IZFD constructs than those in the intact construct. The ROM and stresss distribution were even smaller in LMSR+IZFD construct than in LMSR construct. Conclusions: The IZFD com-bined with LMSR system can provide satisfactory stability for the lower cervical spine, and the IZFD can further improve the fixation effect of the LMSR system.

Objectives This study was to explore the effects of teramethylpyrazine (TMP) administered in conjunction with neural stem cell transplantation on motor function, pathological lesions and the Janus kinase (JAK)2/signal transducer and activator of transcription 3 signal transduction pathway in rats following acute spinal cord injury (SCI). Methods Female Sprague-Dawley rats were randomly divided into sham, model, neural stem cells (NSCs) and NSCs+TMP groups. Motor function was evaluated using the Basso, Beattie, Bresnahan scale. Spinal cord neuropathies and neuron apoptosis were observed by HE and TUNEL staining. The brain-derived neurotrophic factor (BDNF), Nogo-A, JAK2 and p-JAK2 protein levels were measured by western blot analysis. Results NSCs+TMP significantly improved rat motor function, attenuated impaired spinal cords, and decreased cellular apoptosis, compared with NSCs therapy alone (P < 0.05). In addition, expression of BDNF protein was significantly higher in NSCs+TMP rats compared with other groups regardless of time postinjury (P < 0.05). The highest expression levels of Nogo-A protein were observed in the model group. The expression of p-JAK2 in the NSCs+TMP group was relatively lower than the model and NSCs groups (P < 0.05). Conclusions In rats with SCI, NSCs+TMP effectively improved motor function and offered spinal cord protection by increasing BDNF and decreasing Nogo-A levels, as well as inhibiting the JAK2/STAT3 signal transduction pathway, suggesting that TMP could be a useful agent in NSCs transplantation in the treatment of SCI.

The recovery of spinal cord injury (SCI) involves multiple factors, of which miRNAs take an important part. In this study, we evaluated the function of microRNA-211-5p (miR-211-5p) on SCI in a rat model. SCI model was established using modified Allen's weight-drop method and Basso-Bcattie-Bresnahan score was applied to assess the locomotor function. MiR-211-5p agomir was utilized to increase miR-211-5p expression and endoplasmic reticulum (ER) stress inhibitor, 4-PBA (4-phenylbutyric acid), was utilized to suppress ER stress. Neuron apoptosis and the expressions of miR-211-5p, activating transcription factor 6 (ATF6), apoptosis-related proteins, pro-inflammatory cytokines and endoplasmic reticulum stress-related proteins were detected. Dual luciferase reporter gene assay was performed to verify the binding between miR-211-5p and ATF6. The results showed that miR-211-5p directly targeted ATF6. MiR-211-5p was down-regulated and ATF6 was up-regulated in SCI rats. Both interferences with miR-211-5p agomir and 4-PBA effectively attenuated neuron apoptosis and reversed the expressions of apoptosis, inflammation and endoplasmic reticulum stress-related molecules post SCI in rats. These findings demonstrated that miR-211-5p could effectively alleviate SCI-induced neuron apoptosis and inflammation via directly targeting ATF-6 and regulating ER stress.

OBJECTIVE:Combining K-line (the connecting line of the midpoint of C₂ and C₇ spinal canal on the cervical lateral X-ray film) to analyze the relationship between cervical range of motion of patients with ossification of posterior longitudinal ligament (OPLL) and surgical prognosis. METHODS:A total 42 patients with ossification of cervical posterior longitudinal ligament underwent cervical posterior single open-door laminoplasty between April 2014 and March 2017 were retrospectively ananyzed. The patients were dividing into K-line (+) group and K-line (-) group according to the position realationship of OPLL and K-line. The lesion of ossification of the posterior longitudinal ligament was not over than the K-line known as K-line (+). Conversely, the lesion of ossification of the posterior longitudinal ligament crossing the K-line was called K-line (-). Preoperative and postoperative 3 months JOA scores were observed, and postoperative 3 months JOA improvement rate were computed to assess patient's neurological function recovery. Preoperation and postoperative 3 months, OPLL occupation ratio (OOR), cervical lordotic angles (CLA) and cervical lordotic value (CLV) were measured respectively. The realationship between postoperative neurologic functional recovery in patients of CLV>0 group and CLV<=0 group was evaluated in different K-line subgroups. RESULTS:For the patients in K (+) group and K (-) group, preoperative CLA were (14.7±9.6)° and (-6.4±9.5)°(P<0.05) respectively, postoperative at 3 months CLA were (14.0±8.0)° and (-1.4±10.4)°(P<0.05) respectively; preoperative JOA scores were 10.9±3.2 and 11.2±2.5 (P>0.05) respectively, postoperative at 3 months JOA scores were 14.2±1.8 and 12.6±2.2 (P<0.05) respectively, and postoperative at 3 months JOA score improvement rate were (54.7±17.6)% and (25.5±15.7)%(P<0.05) respectively. In the K-line (+) group, there were 29 patients in CLV>0 group at 3 months after operation, with improvement rate of (52.3±17.2)%, and 4 patients in CLV<=0 group, with improvement rate of (72.2±7.8)%. The improvement rate of the patients in CLV<=0 group was significantly better than that of the patients in CLV>0 group (P<0.05). CONCLUSIONS:No matter whether the ossification of cervical posterior longitudinal ligament was classified as K-line (+) or K-line (-), the cervical posterior single open-door laminoplasty can improve the neurological symptoms of patients, especially the patients in the K-line(+) group with better prognosis. The patinets in K-line(+) group, when postoperative at 3 months CLV>0, their improvement rate was lower than that of the patients with postoperative at 3 months CLV<=0.