Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. Howev...Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.展开更多
BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk...BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons.Aerosolized particles containing infectious coronavirus are typically 0.5-8.0μm.AIM To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer(OPS).METHODS We quantified airborne particle counts during five posterior spinal instrumentation and fusions(9/22/2020-10/15/2020)using an OPS near the surgical field.Data were analyzed by 3 particle size groups:0.3-0.5μm/m^(3),1.0-5.0μm/m^(3),and 10.0μm/m^(3).We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress.A spike was defined as a>3 standard deviation increase from average baseline levels.RESULTS Upon univariate analysis,bovie(P<0.0001),high speed pneumatic burring(P=0.009),and ultrasonic bone scalpel(P=0.002)were associated with increased 0.3-0.5μm/m^(3)particle counts relative to baseline.Bovie(P<0.0001)and burring(P<0.0001)were also associated with increased 1-5μm/m^(3)and 10μm/m^(3)particle counts.Pedicle drilling was not associated with increased particle counts in any of the size ranges measured.Our logistic regression model demonstrated that bovie(OR=10.2,P<0.001),burring(OR=10.9,P<0.001),and bone scalpel(OR=5.9,P<0.001)had higher odds of a spike in 0.3-0.5μm/m^(3)particle counts.Bovie(OR=2.6,P<0.001),burring(OR=5.8,P<0.001),and bone scalpel(OR=4.3,P=0.005)had higher odds of a spike in 1-5μm/m^(3)particle counts.Bovie(OR=0.3,P<0.001)and drilling(OR=0.2,P=0.011)had significantly lower odds of a spike in 10μm/m^(3)particle counts relative to baseline.CONCLUSION Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range.Further research is warranted to determine if such particles have the potential to contain infectious viruses.Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.展开更多
BACKGROUND Administering anti-osteoporotic agents to patients perioperatively is a widely accepted approach for improving bone fusion rates and reducing the risk of complications.The best anti-osteoporotic agents for ...BACKGROUND Administering anti-osteoporotic agents to patients perioperatively is a widely accepted approach for improving bone fusion rates and reducing the risk of complications.The best anti-osteoporotic agents for spinal fusion surgery remain unclear.AIM To investigate the efficacy and safety of different anti-osteoporotic agents in spinal fusion surgery via network meta-analysis.METHODS Searches were conducted in four electronic databases(PubMed,EMBASE),Web of Science,the Cochrane Library and China National Knowledge Infrastructure(CNKI)from inception to November 2022.Any studies that compared antiosteoporotic agents vs placebo for spinal fusion surgery were included in this network meta-analysis.Outcomes included fusion rate,Oswestry disability index(ODI),and adverse events.Network meta-analysis was performed by R software with the gemtc package.RESULTS In total,13 randomized controlled trials were included in this network metaanalysis.Only teriparatide(OR 3.2,95%CI:1.4 to 7.8)was more effective than placebo in increasing the fusion rate.The surface under the cumulative ranking curve(SUCRA)of teriparatide combined with denosumab was the highest(SUCRA,90.9%),followed by teriparatide(SUCRA,74.0%),zoledronic acid(SUCRA,43.7%),alendronate(SUCRA,41.1%)and risedronate(SUCRA,35.0%).Teriparatide(MD-15,95%CI:-28 to-2.7)and teriparatide combined with denosumab(MD-20,95%CI:-40 to-0.43)were more effective than placebo in decreasing the ODI.The SUCRA of teriparatide combined with denosumab was highest(SUCRA,90.8%),followed by teriparatide(SUCRA,74.5%),alendronate(SURCA,52.7),risedronate(SURCA,52.1%),zoledronic acid(SURCA,24.2%)and placebo(SURCA,5.6%)for ODI.The adverse events were not different between groups.CONCLUSION This network meta-analysis suggests that teriparatide combined with denosumab and teriparatide alone significantly increase the fusion rate and decrease the ODI without increasing adverse events.Based on current evidence,teriparatide combined with denosumab or teriparatide alone is recommended to increase the fusion rate and to reduce ODI in spinal fusion patients.展开更多
Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however...Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix(DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word "demineralized bone matrix", "DBM", "spinal fusion", and "scoliosis". Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer.Limited number of prospective randomized controlled trials(4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis.展开更多
The interpretation of spinal images fixed with metallic hardware forms an increasing bulk of daily practice in a busy imaging department. Radiologists are required to be familiar with the instrumentation and operative...The interpretation of spinal images fixed with metallic hardware forms an increasing bulk of daily practice in a busy imaging department. Radiologists are required to be familiar with the instrumentation and operative options used in spinal fixation and fusion procedures, especially in his or her institute. This is critical in evaluating the position of implants and potential complications associated with the operative approaches and spinal fixation devices used. Thus, the radiologist can play an important role in patient care and outcome. This review outlines the advantages and disadvantages of commonly used imaging methods and reports on the best yield for each modality and how to overcome the problematic issues associated with the presence of metallic hardware during imaging. Baseline radiographs are essential as they are the baseline point for evaluation of future studies should patients develop symptoms suggesting possible complications. They may justify further imaging workup with computed tomography, magnetic resonance and/or nuclear medicine studies as the evaluation of a patient with a spinal implant involves a multi-modality approach. This review describes imaging features of potential complications associated with spinal fusion surgery as well as the instrumentation used. This basic knowledge aims to help radiologists approach everyday practice in clinical imaging.展开更多
Objective.To introduce a new spinal internal fixation system,Texas Scottih Rite Hospital (TSRH),and to investigate its early clinical outcomes.Methods.The preliminary clinical outcomes of 15 patients with thoracolumba...Objective.To introduce a new spinal internal fixation system,Texas Scottih Rite Hospital (TSRH),and to investigate its early clinical outcomes.Methods.The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively.Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results.Preoperatively,the Cobb's angle on the coronal plane was 55.8°(range 35°-78°),and 14° postoperatively,with an average correction of 74.8%.The average unfused thoracial curve was 35.9° preoperatively(range 26°-51°)and 21.8°(10°-42°)postoperatively,with 40% correction.The sagittal curve of lumbar was kept physiologically ,preoperative 27.9° and postoperative 25.7° respectively.The trunk shift was 13.4mm(5-28mm) preoperatively and 3.5mm(0-7mm) postoperatively.The averaged apic vertebra derivation was 47.8mm(21-69mm) before operation and 10.8mm(3-20mm) after operation.The distance of C7 to center sacrum vertical line(CSVL) was 19.5mm(16-42)preoperatively and 11.3mm(0-32mm)postoperatively.The apical vertebra rotation was 3 degree in 15 patients preoperatively,and were improved to normal in 10 patients,1 degree in 4 patients,and 2 degree in 1 patients postoperatively.None had neurological injury and infection.Only 1 patient complained a cool feeling in the low extremity of concave side,and the symtom vanished at 3-month followed up.Couclusion.If used appropriately,TSRH anterior spinal system is a good treatment for low thoracic or thoracic lumbar scoliosis.展开更多
AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an onli...AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis.RESULTS: The response rate was 73.8%. Most surgeons(84%) were orthopaedic surgeons. Range of surgeon experience(1-15 years), number of operations performed in the previous 12 mo(4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfactionit is important that further research evaluates optimal management.展开更多
BACKGROUND Over 400000 Americans annually undergo spinal fusion surgeries, yet up to 40%of these procedures result in pseudoarthrosis even with iliac crest autograft, the current "gold standard" treatment. T...BACKGROUND Over 400000 Americans annually undergo spinal fusion surgeries, yet up to 40%of these procedures result in pseudoarthrosis even with iliac crest autograft, the current "gold standard" treatment. Tissue engineering has the potential to solve this problem via the creation of bone grafts involving bone-promoting growth factors(e.g., bone morphogenetic protein 2). A broad assessment of experimental growth factors is important to inform future work and clinical potential in this area. To date, however, no study has systematically reviewed the investigational growth factors utilized in preclinical animal models of spinal fusion.AIM To review all published studies assessing investigational growth factors for spinal fusion in animal models and identify promising agents for translation.METHODS We conducted a systematic review of the literature using PubMed, Embase,Cochrane Library, and Web of Science databases with searches run on May 29 th,2018. The search query was designed to include all non-human, preclinical animal models of spinal fusion reported in the literature without a timespan limit. Extracted data for each model included surgical approach, level of fusion,animal species and breed, animal age and sex, and any other relevant characteristics. The dosages/sizes of all implant materials, spinal fusion rates,and follow-up time points were recorded. The data were analyzed and the results reported in tables and text. PRISMA guidelines were followed for this systematic review.RESULTS Twenty-six articles were included in this study, comprising 14 experimental growth factors: AB204(n = 1); angiopoietin 1(n = 1); calcitonin(n = 3);erythropoietin(n = 1); basic fibroblast growth factor(n = 1); growth differentiation factor 5(n = 4), combined insulin-like growth factor 1 +transforming growth factor beta(n = 4); insulin(n = 1); NELL-1(n = 5); noggin(n= 1); P-15(n = 1); peptide B2 A(n = 2); and secreted phosphoprotein 24(n = 1).The fusion rates of the current gold standard treatment(autologous iliac crest bone graft, ICBG) and the leading clinically used growth factor(BMP-2) ranged widely in the included studies, from 0-100% for ICBG and from 13%-100% for BMP-2. Among the identified growth factors, calcitonin, GDF-5, NELL-1, and P-15 resulted in fusion rates of 100% in some cases. In addition, six growth factors-AB204, angiopoietin 1, GDF-5, insulin, NELL-1, and peptide B2 A-resulted in significantly enhanced fusion rates compared to ICBG, BMP-2, or other internal control in some studies. Large heterogeneity in animal species, fusion method,and experimental groups and time points was observed across the included studies, limiting the direct comparison of the growth factors identified herein.CONCLUSION Several promising investigational growth factors for spinal fusion have been identified herein; directly comparing the fusion efficacy and safety of these agents may inform clinical translation.展开更多
Backgrou nd Dense titanium(Ti)fusion cages have been commonly used in transforaminal lumbar interbody fusion.However,the stiffness mismatch between cages and adjacent bone endplates increases the risk of stress shield...Backgrou nd Dense titanium(Ti)fusion cages have been commonly used in transforaminal lumbar interbody fusion.However,the stiffness mismatch between cages and adjacent bone endplates increases the risk of stress shielding and cage subsidence.Methods The current study presents a multiscale optimization approach for porous Ti fusion cage development,including microscale topology optimization based on homogenization theory that obtains a unit cell with prescribed mechanical properties,and macroscale topology optimization that determines the layout of framework structure over the porous cage while maintaining the desired stiffness.The biomechanical performance of the designed porous cage is assessed using numerical simulations of fusion surgery.Selective laser melting is employed to assists with fabricating the designed porous structure and porous cage.Results The simulations demonstrate that the designed porous cage increases the strain energy density of bone grafts and decreases the peak stress on bone endplates.The mechanical and morphological discrepancies between the as-designed and fabricated porous structures are also described.Conclusion From the perspective of biomechanics,it is demonstrated that the designed porous cage contributes to reducing the risk of stress shielding and cage subsidence.The optimization of processing parameters and post-treatments are required to fabricate the designed porous cage.The present multiscale optimization approach can be extended to the development of cages with other shapes or materials and further types of orthopedic implants.展开更多
We present an interesting case report of a 49-year-old female who presented with symptoms of post-dural puncture headache following implantation of an intrathecal pain pump. Her history was complicated by previous mul...We present an interesting case report of a 49-year-old female who presented with symptoms of post-dural puncture headache following implantation of an intrathecal pain pump. Her history was complicated by previous multi-level spinal fusion with hardware. The patient was evaluated and felt to be a candidate for epidural blood patch, which she elected to proceed with. Under fluoroscopic guidance epidural blood patch was successfully performed. Immediately following the procedure the patient noted significant improvement in the headache and six hours following the procedure was headache free and remained so at follow up three weeks later.展开更多
Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal jun...Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal junctional failure (DJF) after ASD surgery with a lower instrumented vertebra (LIV) at L5. Overview of Literature: Spinopelvic fixation from the lower thoracic vertebra to the pelvis is the current gold standard treatment for ASD. However, the LIV at L5 is acceptable in some cases. Methods: Fifty-six patients who underwent corrective surgery for ASD with LIV at L5 were included. The upper instrumented vertebra (UIV) was T7 in one patient, T9 in 14, T10 in three, T11 in four, T12 in eight, L1 in 10, and L2 in 16. Regarding clinical parameters, age, sex, curve types of Scoliosis Research Society-Schwab classification, number of levels fused, follow-up period, hip bone mallow density, revision surgery rate, and radiographic measurements were compared between the T (UIV: T7 - 10) and TL (UIV: T11 - L2) groups. Results: The revision surgery rate was 19.6% overall. In the T and TL groups, it was 27.8%, and 15.8%, respectively (p = 0.305). The rate of DJF in the T group (33.3%) was significantly higher than in the TL group (5.3%). The rate of proximal junctional kyphosis in the T group (55.6%) was higher than in the TL group (28.9%), with no significant difference. The mean global alignment, sagittal vertical axis, and C7 plumb line-central sacral vertical line were not different between both groups. Conclusions: ASD surgery with LIV set at L5 and UIV set at the thoracic vertebrae (T7 - T10) has a risk of adjacent segment disease.展开更多
Objective: To quantify the strength of the grafts from different body sites and determine the optimalselection of corticocancellous allografts for anterior interbody fusion. Methods: Complete sets of paired freshfroze...Objective: To quantify the strength of the grafts from different body sites and determine the optimalselection of corticocancellous allografts for anterior interbody fusion. Methods: Complete sets of paired freshfrozen femurs, humeri, tibias and iliac crests were obtained from 6 individual donors. One centimeter thick slicesstarting from the proximal and distal bone ends were cut from the non--diaphysial portions of the long bones usinga razor saw with a customized miter box. 2. 5 cm× 3. 0 cm × 1. 0 cm unicortical bone blocks were shaped similarlyfor clinical use as a lumbar interbody graft. Multiple 1 cm thick grafts with 1. 5 cm depth were obtained from theiliac crests, to simulate a cervical interbody graft. The left and right sides of each pair were randomized intoperpendicular and parallel cut groups in the long bones or tricortical and bicortical preparations of the iliac graft.The samples were tested on an MTS by applying a compressive load to failure. Results: The failure loads of distaltibia and femoral head grafts were significantly higher than distal femur, proximal tibia and burneral head grafts(PR0. 05). The strength of the grafts prepared by parallel cutting decreased significantly as compared with theperpendicular cutting (P <0. 05). No significant changes were seen in femoral and burneral head grafts for the 2sectioning orientations. The grafts closer to the anterior superior iliac spine had significant higher failure loads andfailure strengths than those closer to the posterior superior iliac spine. After trimming off the lateral cortex, themean strength of the bicortical grafts decreased significantly as compared with the tricortical grafts (P <0. 05).Conclusion: The grafts from femoral head and distal tibia by perpendicular cutting have higher failure load than theload bearing in lumbar spine. The grafts cut close to the anterior superior iliac spine are recommended for cervicalinterbody fusion.展开更多
Objectives:Spinal fusion is a widely employed treatment of patients with degenerative disc disease,in which a cage is used to replace the disc for spinal fusion.But it often fails for insufficient mechanical strength ...Objectives:Spinal fusion is a widely employed treatment of patients with degenerative disc disease,in which a cage is used to replace the disc for spinal fusion.But it often fails for insufficient mechanical strength and poor osseointegration.Here,we designed a polyether-ether-ketone(PEEK)/tantalum(Ta)composite cage with a biomimetic gradient porous micro-structure,simultaneously enhancing mechanical properties and accelerating osseointegration in spinal fusion.Materials and methods:In the study,based on the mechanical performances of PEEK and osteogenic potential of Ta,and the three-dimensional(3D)structures of cuttlebone and vertebra,the cages were respectively 3D printed by pure PEEK,PEEK with 5 wt%Ta(PEEK/Ta-5),PEEK with 10 wt%Ta(PEEK/Ta-10)and PEEK with 15 wt%Ta(PEEK/Ta-15),then verified<i>in vitro</i>and in sheep cervical fusion model systematically.Results:Vertebral Gyroid structure PEEK/Ta-15 cage exhibited superior mechanical properties than Cuttlebone-like structure PEEK/Ta-15 cage,closer to the cervical vertebra.Furthermore,PEEK/Ta-15 cage with higher Ta microparticles in PEEK provided a biomimetic gradient porous micro-structure with higher surface energy,guiding cell biological behavior,promoting new bone penetration,and accelerating osseointegration<i>in vivo</i>.Conclusion:In conclusion,the study designed a biomimetic gradient porous cage with a micro-structure for enhancing mechanical properties,accelerating osseointegration and forming an anatomical lock in the fusion segment through composites,mechanical efficiency,surface extension,and pores.展开更多
BACKGROUND Acute spinal subdural haematoma(ASSH)is a rare and potentially devastating condition with a variable prognosis.Previously described subdural haematomas were thought to have occurred spontaneously or be rela...BACKGROUND Acute spinal subdural haematoma(ASSH)is a rare and potentially devastating condition with a variable prognosis.Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery,spinal puncture or epidural anaesthesia.Other contributing pathologies have been described,such as intradural tumours or spinal arteriovenous malformations.ASSH has also been associated with anticoagulation therapy,haemostatic abnormalities and risk factors such as pregnancy.To the best of our knowledge,this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient.The patient was not known to have any coagulopathies,and no obvious vascular lesions were documented.The surgical procedure did not directly involve the dura mater,and no evident intraoperative dural tears were found.CASE SUMMARY We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis.This condition has not been previously described.We made recommendations for facing such an occurrence,explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol.We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders.We reviewed recommendations regarding neuromonitoring and treatment management in such cases.CONCLUSION ASSH is a rare complication of posterior spinal instrumented fusion.Published cases are more often associated with anticoagulation therapy or coagulopathy.Neuromonitoring is strongly recommended to detect and assess neurological status,thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.展开更多
针对自动驾驶路面上目标漏检和错检的问题,提出一种基于改进Centerfusion的自动驾驶3D目标检测模型。该模型通过将相机信息和雷达特征融合,构成多通道特征数据输入,从而增强目标检测网络的鲁棒性,减少漏检问题;为了能够得到更加准确丰富...针对自动驾驶路面上目标漏检和错检的问题,提出一种基于改进Centerfusion的自动驾驶3D目标检测模型。该模型通过将相机信息和雷达特征融合,构成多通道特征数据输入,从而增强目标检测网络的鲁棒性,减少漏检问题;为了能够得到更加准确丰富的3D目标检测信息,引入了改进的注意力机制,用于增强视锥网格中的雷达点云和视觉信息融合;使用改进的损失函数优化边框预测的准确度。在Nuscenes数据集上进行模型验证和对比,实验结果表明,相较于传统的Centerfusion模型,提出的模型平均检测精度均值(mean Average Precision,mAP)提高了1.3%,Nuscenes检测分数(Nuscenes Detection Scores,NDS)提高了1.2%。展开更多
Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after...Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.展开更多
Post-traumatic spinal cord remodeling includes both degenerating and regenerating processes,which affect the potency of the functional recovery after spinal cord injury(SCI).Gene therapy for spinal cord injury is prop...Post-traumatic spinal cord remodeling includes both degenerating and regenerating processes,which affect the potency of the functional recovery after spinal cord injury(SCI).Gene therapy for spinal cord injury is proposed as a promising therapeutic strategy to induce positive changes in remodeling of the affected neural tissue.In our previous studies for delivering the therapeutic genes at the site of spinal cord injury,we developed a new approach using an autologous leucoconcentrate transduced ex vivo with chimeric adenoviruses(Ad5/35)carrying recombinant cDNA.In the present study,the efficacy of the intravenous infusion of an autologous genetically-enriched leucoconcentrate simultaneously producing recombinant vascular endothelial growth factor(VEGF),glial cell line-derived neurotrophic factor(GDNF),and neural cell adhesion molecule(NCAM)was evaluated with regard to the molecular and cellular changes in remodeling of the spinal cord tissue at the site of damage in a model of mini-pigs with moderate spinal cord injury.Experimental animals were randomly divided into two groups of 4 pigs each:the therapeutic(infused with the leucoconcentrate simultaneously transduced with a combination of the three chimeric adenoviral vectors Ad5/35‐VEGF165,Ad5/35‐GDNF,and Ad5/35‐NCAM1)and control groups(infused with intact leucoconcentrate).The morphometric and immunofluorescence analysis of the spinal cord regeneration in the rostral and caudal segments according to the epicenter of the injury in the treated animals compared to the control mini-pigs showed:(1)higher sparing of the grey matter and increased survivability of the spinal cord cells(lower number of Caspase-3-positive cells and decreased expression of Hsp27);(2)recovery of synaptophysin expression;(3)prevention of astrogliosis(lower area of glial fibrillary acidic protein-positive astrocytes and ionized calcium binding adaptor molecule 1-positive microglial cells);(4)higher growth rates of regeneratingβIII-tubulin-positive axons accompanied by a higher number of oligodendrocyte transcription factor 2-positive oligodendroglial cells in the lateral corticospinal tract region.These results revealed the efficacy of intravenous infusion of the autologous genetically-enriched leucoconcentrate producing recombinant VEGF,GDNF,and NCAM in the acute phase of spinal cord injury on the positive changes in the post-traumatic remodeling nervous tissue at the site of direct injury.Our data provide a solid platform for a new ex vivo gene therapy for spinal cord injury and will facilitate further translation of regenerative therapies in clinical neurology.展开更多
Roof plate secretion of bone morphogenetic proteins(BMPs)directs the cellular fate of sensory neurons during spinal cord development,including the formation of the ascending sensory columns,though their biology is not...Roof plate secretion of bone morphogenetic proteins(BMPs)directs the cellular fate of sensory neurons during spinal cord development,including the formation of the ascending sensory columns,though their biology is not well understood.Type-ⅡBMP receptor(BMPRⅡ),the cognate receptor,is expressed by neural precursor cells during embryogenesis;however,an in vitro method of enriching BMPRⅡ^(+)human neural precursor cells(hNPCs)from the fetal spinal cord is absent.Immunofluorescence was undertaken on intact second-trimester human fetal spinal cord using antibodies to BMPRⅡand leukemia inhibitory factor(LIF).Regions of highest BMPRⅡ^(+)immunofluorescence localized to sensory columns.Parenchymal and meningeal-associated BMPRⅡ^(+)vascular cells were identified in both intact fetal spinal cord and cortex by co-positivity with vascular lineage markers,CD34/CD39.LIF immunostaining identified a population of somas concentrated in dorsal and ventral horn interneurons,mirroring the expression of LIF receptor/CD118.A combination of LIF supplementation and high-density culture maintained culture growth beyond 10 passages,while synergistically increasing the proportion of neurospheres with a stratified,cytoarchitecture.These neurospheres were characterized by BMPRⅡ^(+)/MAP2ab^(+/–)/βⅢ-tubulin^(+)/nestin^(–)/vimentin^(–)/GFAP^(–)/NeuN^(–)surface hNPCs surrounding a heterogeneous core ofβⅢ-tubulin^(+)/nestin^(+)/vimentin^(+)/GFAP^(+)/MAP2ab^(–)/NeuN^(–)multipotent precursors.Dissociated cultures from tripotential neurospheres contained neuronal(βⅢ-tubulin^(+)),astrocytic(GFAP+),and oligodendrocytic(O4+)lineage cells.Fluorescence-activated cell sorting-sorted BMPRⅡ^(+)hNPCs were MAP2ab^(+/–)/βⅢ-tubulin^(+)/GFAP^(–)/O4^(–)in culture.This is the first isolation of BMPRⅡ^(+)hNPCs identified and characterized in human fetal spinal cords.Our data show that LIF combines synergistically with high-density reaggregate cultures to support the organotypic reorganization of neurospheres,characterized by surface BMPRⅡ^(+)hNPCs.Our study has provided a new methodology for an in vitro model capable of amplifying human fetal spinal cord cell numbers for>10 passages.Investigations of the role BMPRⅡplays in spinal cord development have primarily relied upon mouse and rat models,with interpolations to human development being derived through inference.Because of significant species differences between murine biology and human,including anatomical dissimilarities in central nervous system(CNS)structure,the findings made in murine models cannot be presumed to apply to human spinal cord development.For these reasons,our human in vitro model offers a novel tool to better understand neurodevelopmental pathways,including BMP signaling,as well as spinal cord injury research and testing drug therapies.展开更多
Based on the Wallerian degeneration in the spinal cord pathways,the changes in synaptic connections,and the spinal cord-related cellular responses that alter the cellular structure of the brain,we presumed that brain ...Based on the Wallerian degeneration in the spinal cord pathways,the changes in synaptic connections,and the spinal cord-related cellular responses that alter the cellular structure of the brain,we presumed that brain diffusion tensor imaging(DTI)parameters may change after spinal cord injury.However,the dynamic changes in DTI parameters remain unclear.We established a Beagle dog model of T10 spinal cord contusion and performed DTI of the injured spinal cord.We found dynamic changes in DTI parameters in the cerebral peduncle,posterior limb of the internal capsule,pre-and postcentral gyri of the brain within 12 weeks after spinal cord injury.We then performed immunohistochemistry to detect the expression of neurofilament heavy polypeptide(axonal marker),glial fibrillary acidic protein(glial cell marker),and NeuN(neuronal marker).We found that these pathological changes were consistent with DTI parameter changes.These findings suggest that DTI can display brain structure changes after spinal cord injury.展开更多
Spinal cord organoids are three-dimensional tissues derived from stem cells that recapitulate the primary morphological and functional characteristics of the spinal cord in vivo.As emerging bioengineering methods have...Spinal cord organoids are three-dimensional tissues derived from stem cells that recapitulate the primary morphological and functional characteristics of the spinal cord in vivo.As emerging bioengineering methods have led to the optimization of cell culture protocols,spinal cord organoids technology has made remarkable advancements in the past decade.Our literature search found that current spinal cord organoids do not only dynamically simulate neural tube formation but also exhibit diverse cytoarchitecture along the dorsal-ventral and rostral-caudal axes.Moreover,fused organoids that integrate motor neurons and other regionally specific organoids exhibit intricate neural circuits that allows for functional assessment.These qualities make spinal cord organoids valuable tools for disease modeling,drug screening,and tissue regeneration.By utilizing this emergent technology,researchers have made significant progress in investigating the pathogenesis and potential therapeutic targets of spinal cord diseases.However,at present,spinal cord organoid technology remains in its infancy and has not been widely applied in translational medicine.Establishment of the next generation of spinal cord organoids will depend on good manufacturing practice standards and needs to focus on diverse cell phenotypes and electrophysiological functionality evaluation.展开更多
文摘Background: In spine surgery postoperative closed suction drainage is used to decrease the potential risks of wound hematoma formation, and reduces the risk of infection, cord compression and neurologic deficit. However, the efficacy of drains used for this purpose in adolescent idiopathic scoliosis is controversial. The purpose of this study is to evaluate outcomes of patients after posterior spinal fusion with instrumentation for adolescent idiopathic scoliosis without wound suction drainage. Methods: A total of 66 Patients who underwent posterior spinal fusion and instrumentation for the correction of Adolescent idiopathic scoliosis without the use of drain from January 2012 to January 2021 were included. Wound dehiscence, wound hematoma, infection, preoperative and postoperative hemoglobin levels and need for transfusion were described as frequency and mean values. Results: The average age was 15.06 years. Hospital stay was 2.2 days. Patients were followed-up over 50.21 months. There was no deep infection, wound hematoma. The difference between just postoperative and three days after operation hemoglobin levels was not significant and no need for transfusion. Only 3 (4.5%) cases with superficial skin infection and 4 (6%) cases with skin and Wound dehiscence were treated with dressing and antibiotics with full recovery. Conclusion: Without using drain for patients with idiopathic scoliosis who underwent posterior spinal fusion and instrumentation, no increase in blood loss, transfusion requirements, wound infection, skin dehiscence, and wound hematoma was observed.
文摘BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons.Aerosolized particles containing infectious coronavirus are typically 0.5-8.0μm.AIM To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer(OPS).METHODS We quantified airborne particle counts during five posterior spinal instrumentation and fusions(9/22/2020-10/15/2020)using an OPS near the surgical field.Data were analyzed by 3 particle size groups:0.3-0.5μm/m^(3),1.0-5.0μm/m^(3),and 10.0μm/m^(3).We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress.A spike was defined as a>3 standard deviation increase from average baseline levels.RESULTS Upon univariate analysis,bovie(P<0.0001),high speed pneumatic burring(P=0.009),and ultrasonic bone scalpel(P=0.002)were associated with increased 0.3-0.5μm/m^(3)particle counts relative to baseline.Bovie(P<0.0001)and burring(P<0.0001)were also associated with increased 1-5μm/m^(3)and 10μm/m^(3)particle counts.Pedicle drilling was not associated with increased particle counts in any of the size ranges measured.Our logistic regression model demonstrated that bovie(OR=10.2,P<0.001),burring(OR=10.9,P<0.001),and bone scalpel(OR=5.9,P<0.001)had higher odds of a spike in 0.3-0.5μm/m^(3)particle counts.Bovie(OR=2.6,P<0.001),burring(OR=5.8,P<0.001),and bone scalpel(OR=4.3,P=0.005)had higher odds of a spike in 1-5μm/m^(3)particle counts.Bovie(OR=0.3,P<0.001)and drilling(OR=0.2,P=0.011)had significantly lower odds of a spike in 10μm/m^(3)particle counts relative to baseline.CONCLUSION Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range.Further research is warranted to determine if such particles have the potential to contain infectious viruses.Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.
文摘BACKGROUND Administering anti-osteoporotic agents to patients perioperatively is a widely accepted approach for improving bone fusion rates and reducing the risk of complications.The best anti-osteoporotic agents for spinal fusion surgery remain unclear.AIM To investigate the efficacy and safety of different anti-osteoporotic agents in spinal fusion surgery via network meta-analysis.METHODS Searches were conducted in four electronic databases(PubMed,EMBASE),Web of Science,the Cochrane Library and China National Knowledge Infrastructure(CNKI)from inception to November 2022.Any studies that compared antiosteoporotic agents vs placebo for spinal fusion surgery were included in this network meta-analysis.Outcomes included fusion rate,Oswestry disability index(ODI),and adverse events.Network meta-analysis was performed by R software with the gemtc package.RESULTS In total,13 randomized controlled trials were included in this network metaanalysis.Only teriparatide(OR 3.2,95%CI:1.4 to 7.8)was more effective than placebo in increasing the fusion rate.The surface under the cumulative ranking curve(SUCRA)of teriparatide combined with denosumab was the highest(SUCRA,90.9%),followed by teriparatide(SUCRA,74.0%),zoledronic acid(SUCRA,43.7%),alendronate(SUCRA,41.1%)and risedronate(SUCRA,35.0%).Teriparatide(MD-15,95%CI:-28 to-2.7)and teriparatide combined with denosumab(MD-20,95%CI:-40 to-0.43)were more effective than placebo in decreasing the ODI.The SUCRA of teriparatide combined with denosumab was highest(SUCRA,90.8%),followed by teriparatide(SUCRA,74.5%),alendronate(SURCA,52.7),risedronate(SURCA,52.1%),zoledronic acid(SURCA,24.2%)and placebo(SURCA,5.6%)for ODI.The adverse events were not different between groups.CONCLUSION This network meta-analysis suggests that teriparatide combined with denosumab and teriparatide alone significantly increase the fusion rate and decrease the ODI without increasing adverse events.Based on current evidence,teriparatide combined with denosumab or teriparatide alone is recommended to increase the fusion rate and to reduce ODI in spinal fusion patients.
文摘Spinal fusion remains the gold-standard treatment for several pathological spine conditions. Although, autologous Iliac Crest Bone Grafting is considered the goldstandard graft choice to promote spinal fusion; however, it is associated with significant donor site morbidity and a limited graft quantity. Therefore, several bone graft alternatives have been developed, to augment arthrodesis. The purpose of this review is to present the results of clinical studies concerning the use of demineralized bone matrix(DBM), alone or as a composite graft, in the spinal fusion. A critical review of the English-language literature was conducted on Pubmed, using key word "demineralized bone matrix", "DBM", "spinal fusion", and "scoliosis". Results had been restricted to clinical studies. The majority of clinical trials demonstrate satisfactory fusion rates when DBM is employed as a graft extender or a graft enhancer.Limited number of prospective randomized controlled trials(4 studies), have been performed comparing DBM to autologous iliac crest bone graft in spine fusion. The majority of the clinical trials demonstrate comparable efficacy of DBM when it used as a graft extender in combination with autograft, but there is no clinical evidence to support its use as a standalone graft material. Additionally, high level of evidence studies are required, in order to optimize and clarify the indications of its use and the appropriate patient population that will benefit from DBM in spine arthrodesis.
文摘The interpretation of spinal images fixed with metallic hardware forms an increasing bulk of daily practice in a busy imaging department. Radiologists are required to be familiar with the instrumentation and operative options used in spinal fixation and fusion procedures, especially in his or her institute. This is critical in evaluating the position of implants and potential complications associated with the operative approaches and spinal fixation devices used. Thus, the radiologist can play an important role in patient care and outcome. This review outlines the advantages and disadvantages of commonly used imaging methods and reports on the best yield for each modality and how to overcome the problematic issues associated with the presence of metallic hardware during imaging. Baseline radiographs are essential as they are the baseline point for evaluation of future studies should patients develop symptoms suggesting possible complications. They may justify further imaging workup with computed tomography, magnetic resonance and/or nuclear medicine studies as the evaluation of a patient with a spinal implant involves a multi-modality approach. This review describes imaging features of potential complications associated with spinal fusion surgery as well as the instrumentation used. This basic knowledge aims to help radiologists approach everyday practice in clinical imaging.
文摘Objective.To introduce a new spinal internal fixation system,Texas Scottih Rite Hospital (TSRH),and to investigate its early clinical outcomes.Methods.The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively.Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results.Preoperatively,the Cobb's angle on the coronal plane was 55.8°(range 35°-78°),and 14° postoperatively,with an average correction of 74.8%.The average unfused thoracial curve was 35.9° preoperatively(range 26°-51°)and 21.8°(10°-42°)postoperatively,with 40% correction.The sagittal curve of lumbar was kept physiologically ,preoperative 27.9° and postoperative 25.7° respectively.The trunk shift was 13.4mm(5-28mm) preoperatively and 3.5mm(0-7mm) postoperatively.The averaged apic vertebra derivation was 47.8mm(21-69mm) before operation and 10.8mm(3-20mm) after operation.The distance of C7 to center sacrum vertical line(CSVL) was 19.5mm(16-42)preoperatively and 11.3mm(0-32mm)postoperatively.The apical vertebra rotation was 3 degree in 15 patients preoperatively,and were improved to normal in 10 patients,1 degree in 4 patients,and 2 degree in 1 patients postoperatively.None had neurological injury and infection.Only 1 patient complained a cool feeling in the low extremity of concave side,and the symtom vanished at 3-month followed up.Couclusion.If used appropriately,TSRH anterior spinal system is a good treatment for low thoracic or thoracic lumbar scoliosis.
文摘AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis.RESULTS: The response rate was 73.8%. Most surgeons(84%) were orthopaedic surgeons. Range of surgeon experience(1-15 years), number of operations performed in the previous 12 mo(4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfactionit is important that further research evaluates optimal management.
文摘BACKGROUND Over 400000 Americans annually undergo spinal fusion surgeries, yet up to 40%of these procedures result in pseudoarthrosis even with iliac crest autograft, the current "gold standard" treatment. Tissue engineering has the potential to solve this problem via the creation of bone grafts involving bone-promoting growth factors(e.g., bone morphogenetic protein 2). A broad assessment of experimental growth factors is important to inform future work and clinical potential in this area. To date, however, no study has systematically reviewed the investigational growth factors utilized in preclinical animal models of spinal fusion.AIM To review all published studies assessing investigational growth factors for spinal fusion in animal models and identify promising agents for translation.METHODS We conducted a systematic review of the literature using PubMed, Embase,Cochrane Library, and Web of Science databases with searches run on May 29 th,2018. The search query was designed to include all non-human, preclinical animal models of spinal fusion reported in the literature without a timespan limit. Extracted data for each model included surgical approach, level of fusion,animal species and breed, animal age and sex, and any other relevant characteristics. The dosages/sizes of all implant materials, spinal fusion rates,and follow-up time points were recorded. The data were analyzed and the results reported in tables and text. PRISMA guidelines were followed for this systematic review.RESULTS Twenty-six articles were included in this study, comprising 14 experimental growth factors: AB204(n = 1); angiopoietin 1(n = 1); calcitonin(n = 3);erythropoietin(n = 1); basic fibroblast growth factor(n = 1); growth differentiation factor 5(n = 4), combined insulin-like growth factor 1 +transforming growth factor beta(n = 4); insulin(n = 1); NELL-1(n = 5); noggin(n= 1); P-15(n = 1); peptide B2 A(n = 2); and secreted phosphoprotein 24(n = 1).The fusion rates of the current gold standard treatment(autologous iliac crest bone graft, ICBG) and the leading clinically used growth factor(BMP-2) ranged widely in the included studies, from 0-100% for ICBG and from 13%-100% for BMP-2. Among the identified growth factors, calcitonin, GDF-5, NELL-1, and P-15 resulted in fusion rates of 100% in some cases. In addition, six growth factors-AB204, angiopoietin 1, GDF-5, insulin, NELL-1, and peptide B2 A-resulted in significantly enhanced fusion rates compared to ICBG, BMP-2, or other internal control in some studies. Large heterogeneity in animal species, fusion method,and experimental groups and time points was observed across the included studies, limiting the direct comparison of the growth factors identified herein.CONCLUSION Several promising investigational growth factors for spinal fusion have been identified herein; directly comparing the fusion efficacy and safety of these agents may inform clinical translation.
基金financially supported by the National Natural Science Foundation of China(No.51975336)the Key Basic Research Project of Natural Science Foundation of Shandong Province,China(No.ZR2018ZB0106)the Key Research and Development Program of Shandong Province,China(No.2019JZZY010112)。
文摘Backgrou nd Dense titanium(Ti)fusion cages have been commonly used in transforaminal lumbar interbody fusion.However,the stiffness mismatch between cages and adjacent bone endplates increases the risk of stress shielding and cage subsidence.Methods The current study presents a multiscale optimization approach for porous Ti fusion cage development,including microscale topology optimization based on homogenization theory that obtains a unit cell with prescribed mechanical properties,and macroscale topology optimization that determines the layout of framework structure over the porous cage while maintaining the desired stiffness.The biomechanical performance of the designed porous cage is assessed using numerical simulations of fusion surgery.Selective laser melting is employed to assists with fabricating the designed porous structure and porous cage.Results The simulations demonstrate that the designed porous cage increases the strain energy density of bone grafts and decreases the peak stress on bone endplates.The mechanical and morphological discrepancies between the as-designed and fabricated porous structures are also described.Conclusion From the perspective of biomechanics,it is demonstrated that the designed porous cage contributes to reducing the risk of stress shielding and cage subsidence.The optimization of processing parameters and post-treatments are required to fabricate the designed porous cage.The present multiscale optimization approach can be extended to the development of cages with other shapes or materials and further types of orthopedic implants.
文摘We present an interesting case report of a 49-year-old female who presented with symptoms of post-dural puncture headache following implantation of an intrathecal pain pump. Her history was complicated by previous multi-level spinal fusion with hardware. The patient was evaluated and felt to be a candidate for epidural blood patch, which she elected to proceed with. Under fluoroscopic guidance epidural blood patch was successfully performed. Immediately following the procedure the patient noted significant improvement in the headache and six hours following the procedure was headache free and remained so at follow up three weeks later.
文摘Study Design: This is a retrospective cohort study using data from the adult spinal deformity (ASD) database of a single institution. Purpose: To investigate the incidence of proximal junctional failure and distal junctional failure (DJF) after ASD surgery with a lower instrumented vertebra (LIV) at L5. Overview of Literature: Spinopelvic fixation from the lower thoracic vertebra to the pelvis is the current gold standard treatment for ASD. However, the LIV at L5 is acceptable in some cases. Methods: Fifty-six patients who underwent corrective surgery for ASD with LIV at L5 were included. The upper instrumented vertebra (UIV) was T7 in one patient, T9 in 14, T10 in three, T11 in four, T12 in eight, L1 in 10, and L2 in 16. Regarding clinical parameters, age, sex, curve types of Scoliosis Research Society-Schwab classification, number of levels fused, follow-up period, hip bone mallow density, revision surgery rate, and radiographic measurements were compared between the T (UIV: T7 - 10) and TL (UIV: T11 - L2) groups. Results: The revision surgery rate was 19.6% overall. In the T and TL groups, it was 27.8%, and 15.8%, respectively (p = 0.305). The rate of DJF in the T group (33.3%) was significantly higher than in the TL group (5.3%). The rate of proximal junctional kyphosis in the T group (55.6%) was higher than in the TL group (28.9%), with no significant difference. The mean global alignment, sagittal vertical axis, and C7 plumb line-central sacral vertical line were not different between both groups. Conclusions: ASD surgery with LIV set at L5 and UIV set at the thoracic vertebrae (T7 - T10) has a risk of adjacent segment disease.
文摘Objective: To quantify the strength of the grafts from different body sites and determine the optimalselection of corticocancellous allografts for anterior interbody fusion. Methods: Complete sets of paired freshfrozen femurs, humeri, tibias and iliac crests were obtained from 6 individual donors. One centimeter thick slicesstarting from the proximal and distal bone ends were cut from the non--diaphysial portions of the long bones usinga razor saw with a customized miter box. 2. 5 cm× 3. 0 cm × 1. 0 cm unicortical bone blocks were shaped similarlyfor clinical use as a lumbar interbody graft. Multiple 1 cm thick grafts with 1. 5 cm depth were obtained from theiliac crests, to simulate a cervical interbody graft. The left and right sides of each pair were randomized intoperpendicular and parallel cut groups in the long bones or tricortical and bicortical preparations of the iliac graft.The samples were tested on an MTS by applying a compressive load to failure. Results: The failure loads of distaltibia and femoral head grafts were significantly higher than distal femur, proximal tibia and burneral head grafts(PR0. 05). The strength of the grafts prepared by parallel cutting decreased significantly as compared with theperpendicular cutting (P <0. 05). No significant changes were seen in femoral and burneral head grafts for the 2sectioning orientations. The grafts closer to the anterior superior iliac spine had significant higher failure loads andfailure strengths than those closer to the posterior superior iliac spine. After trimming off the lateral cortex, themean strength of the bicortical grafts decreased significantly as compared with the tricortical grafts (P <0. 05).Conclusion: The grafts from femoral head and distal tibia by perpendicular cutting have higher failure load than theload bearing in lumbar spine. The grafts cut close to the anterior superior iliac spine are recommended for cervicalinterbody fusion.
文摘Objectives:Spinal fusion is a widely employed treatment of patients with degenerative disc disease,in which a cage is used to replace the disc for spinal fusion.But it often fails for insufficient mechanical strength and poor osseointegration.Here,we designed a polyether-ether-ketone(PEEK)/tantalum(Ta)composite cage with a biomimetic gradient porous micro-structure,simultaneously enhancing mechanical properties and accelerating osseointegration in spinal fusion.Materials and methods:In the study,based on the mechanical performances of PEEK and osteogenic potential of Ta,and the three-dimensional(3D)structures of cuttlebone and vertebra,the cages were respectively 3D printed by pure PEEK,PEEK with 5 wt%Ta(PEEK/Ta-5),PEEK with 10 wt%Ta(PEEK/Ta-10)and PEEK with 15 wt%Ta(PEEK/Ta-15),then verified<i>in vitro</i>and in sheep cervical fusion model systematically.Results:Vertebral Gyroid structure PEEK/Ta-15 cage exhibited superior mechanical properties than Cuttlebone-like structure PEEK/Ta-15 cage,closer to the cervical vertebra.Furthermore,PEEK/Ta-15 cage with higher Ta microparticles in PEEK provided a biomimetic gradient porous micro-structure with higher surface energy,guiding cell biological behavior,promoting new bone penetration,and accelerating osseointegration<i>in vivo</i>.Conclusion:In conclusion,the study designed a biomimetic gradient porous cage with a micro-structure for enhancing mechanical properties,accelerating osseointegration and forming an anatomical lock in the fusion segment through composites,mechanical efficiency,surface extension,and pores.
文摘BACKGROUND Acute spinal subdural haematoma(ASSH)is a rare and potentially devastating condition with a variable prognosis.Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery,spinal puncture or epidural anaesthesia.Other contributing pathologies have been described,such as intradural tumours or spinal arteriovenous malformations.ASSH has also been associated with anticoagulation therapy,haemostatic abnormalities and risk factors such as pregnancy.To the best of our knowledge,this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient.The patient was not known to have any coagulopathies,and no obvious vascular lesions were documented.The surgical procedure did not directly involve the dura mater,and no evident intraoperative dural tears were found.CASE SUMMARY We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis.This condition has not been previously described.We made recommendations for facing such an occurrence,explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol.We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders.We reviewed recommendations regarding neuromonitoring and treatment management in such cases.CONCLUSION ASSH is a rare complication of posterior spinal instrumented fusion.Published cases are more often associated with anticoagulation therapy or coagulopathy.Neuromonitoring is strongly recommended to detect and assess neurological status,thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.
文摘针对自动驾驶路面上目标漏检和错检的问题,提出一种基于改进Centerfusion的自动驾驶3D目标检测模型。该模型通过将相机信息和雷达特征融合,构成多通道特征数据输入,从而增强目标检测网络的鲁棒性,减少漏检问题;为了能够得到更加准确丰富的3D目标检测信息,引入了改进的注意力机制,用于增强视锥网格中的雷达点云和视觉信息融合;使用改进的损失函数优化边框预测的准确度。在Nuscenes数据集上进行模型验证和对比,实验结果表明,相较于传统的Centerfusion模型,提出的模型平均检测精度均值(mean Average Precision,mAP)提高了1.3%,Nuscenes检测分数(Nuscenes Detection Scores,NDS)提高了1.2%。
基金National Natural Science Foundation of China(No.82160435)。
文摘Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.
基金supported by a grant from the Russian Science Foundation,No. 16-15-00010 (to RRI)funded by government assignment for FRC Kazan Scientific Center of RAS
文摘Post-traumatic spinal cord remodeling includes both degenerating and regenerating processes,which affect the potency of the functional recovery after spinal cord injury(SCI).Gene therapy for spinal cord injury is proposed as a promising therapeutic strategy to induce positive changes in remodeling of the affected neural tissue.In our previous studies for delivering the therapeutic genes at the site of spinal cord injury,we developed a new approach using an autologous leucoconcentrate transduced ex vivo with chimeric adenoviruses(Ad5/35)carrying recombinant cDNA.In the present study,the efficacy of the intravenous infusion of an autologous genetically-enriched leucoconcentrate simultaneously producing recombinant vascular endothelial growth factor(VEGF),glial cell line-derived neurotrophic factor(GDNF),and neural cell adhesion molecule(NCAM)was evaluated with regard to the molecular and cellular changes in remodeling of the spinal cord tissue at the site of damage in a model of mini-pigs with moderate spinal cord injury.Experimental animals were randomly divided into two groups of 4 pigs each:the therapeutic(infused with the leucoconcentrate simultaneously transduced with a combination of the three chimeric adenoviral vectors Ad5/35‐VEGF165,Ad5/35‐GDNF,and Ad5/35‐NCAM1)and control groups(infused with intact leucoconcentrate).The morphometric and immunofluorescence analysis of the spinal cord regeneration in the rostral and caudal segments according to the epicenter of the injury in the treated animals compared to the control mini-pigs showed:(1)higher sparing of the grey matter and increased survivability of the spinal cord cells(lower number of Caspase-3-positive cells and decreased expression of Hsp27);(2)recovery of synaptophysin expression;(3)prevention of astrogliosis(lower area of glial fibrillary acidic protein-positive astrocytes and ionized calcium binding adaptor molecule 1-positive microglial cells);(4)higher growth rates of regeneratingβIII-tubulin-positive axons accompanied by a higher number of oligodendrocyte transcription factor 2-positive oligodendroglial cells in the lateral corticospinal tract region.These results revealed the efficacy of intravenous infusion of the autologous genetically-enriched leucoconcentrate producing recombinant VEGF,GDNF,and NCAM in the acute phase of spinal cord injury on the positive changes in the post-traumatic remodeling nervous tissue at the site of direct injury.Our data provide a solid platform for a new ex vivo gene therapy for spinal cord injury and will facilitate further translation of regenerative therapies in clinical neurology.
基金supported by grants from the National Health and Medical Research Council(NHMRC)of Australia(Nos.571100 and 1048082)the Baxter Charitable Foundation(to TCL)+1 种基金Medical Research grants from the Rebecca L.Cooper Medical Research Foundation(to MWW,TCL,and MDL)supported by a Charles D.Kelman,M.D.Postdoctoral Award(2010)from the International Retinal Research Foundation(USA)。
文摘Roof plate secretion of bone morphogenetic proteins(BMPs)directs the cellular fate of sensory neurons during spinal cord development,including the formation of the ascending sensory columns,though their biology is not well understood.Type-ⅡBMP receptor(BMPRⅡ),the cognate receptor,is expressed by neural precursor cells during embryogenesis;however,an in vitro method of enriching BMPRⅡ^(+)human neural precursor cells(hNPCs)from the fetal spinal cord is absent.Immunofluorescence was undertaken on intact second-trimester human fetal spinal cord using antibodies to BMPRⅡand leukemia inhibitory factor(LIF).Regions of highest BMPRⅡ^(+)immunofluorescence localized to sensory columns.Parenchymal and meningeal-associated BMPRⅡ^(+)vascular cells were identified in both intact fetal spinal cord and cortex by co-positivity with vascular lineage markers,CD34/CD39.LIF immunostaining identified a population of somas concentrated in dorsal and ventral horn interneurons,mirroring the expression of LIF receptor/CD118.A combination of LIF supplementation and high-density culture maintained culture growth beyond 10 passages,while synergistically increasing the proportion of neurospheres with a stratified,cytoarchitecture.These neurospheres were characterized by BMPRⅡ^(+)/MAP2ab^(+/–)/βⅢ-tubulin^(+)/nestin^(–)/vimentin^(–)/GFAP^(–)/NeuN^(–)surface hNPCs surrounding a heterogeneous core ofβⅢ-tubulin^(+)/nestin^(+)/vimentin^(+)/GFAP^(+)/MAP2ab^(–)/NeuN^(–)multipotent precursors.Dissociated cultures from tripotential neurospheres contained neuronal(βⅢ-tubulin^(+)),astrocytic(GFAP+),and oligodendrocytic(O4+)lineage cells.Fluorescence-activated cell sorting-sorted BMPRⅡ^(+)hNPCs were MAP2ab^(+/–)/βⅢ-tubulin^(+)/GFAP^(–)/O4^(–)in culture.This is the first isolation of BMPRⅡ^(+)hNPCs identified and characterized in human fetal spinal cords.Our data show that LIF combines synergistically with high-density reaggregate cultures to support the organotypic reorganization of neurospheres,characterized by surface BMPRⅡ^(+)hNPCs.Our study has provided a new methodology for an in vitro model capable of amplifying human fetal spinal cord cell numbers for>10 passages.Investigations of the role BMPRⅡplays in spinal cord development have primarily relied upon mouse and rat models,with interpolations to human development being derived through inference.Because of significant species differences between murine biology and human,including anatomical dissimilarities in central nervous system(CNS)structure,the findings made in murine models cannot be presumed to apply to human spinal cord development.For these reasons,our human in vitro model offers a novel tool to better understand neurodevelopmental pathways,including BMP signaling,as well as spinal cord injury research and testing drug therapies.
基金supported by the National Natural Science Foundation of China, No. 82102676 (to CBL)a grant from Beijing Municipal Science & Technology Commission, No. Z171100001017076 (to JJL)+1 种基金National Key Research and Development Program, No. 2018YFF0301104 (to JJL)Research on Medical Protection Technology and Application of Induced Neural Stem Cells in the Treatment of Military Spinal Cord Injury, No. Z181100004118004 (to JL)
文摘Based on the Wallerian degeneration in the spinal cord pathways,the changes in synaptic connections,and the spinal cord-related cellular responses that alter the cellular structure of the brain,we presumed that brain diffusion tensor imaging(DTI)parameters may change after spinal cord injury.However,the dynamic changes in DTI parameters remain unclear.We established a Beagle dog model of T10 spinal cord contusion and performed DTI of the injured spinal cord.We found dynamic changes in DTI parameters in the cerebral peduncle,posterior limb of the internal capsule,pre-and postcentral gyri of the brain within 12 weeks after spinal cord injury.We then performed immunohistochemistry to detect the expression of neurofilament heavy polypeptide(axonal marker),glial fibrillary acidic protein(glial cell marker),and NeuN(neuronal marker).We found that these pathological changes were consistent with DTI parameter changes.These findings suggest that DTI can display brain structure changes after spinal cord injury.
基金supported by the sup-project of National Key R&D Program of China,No.2018YFA0108602CAMS Innovation Fund for Medical Sciences,No.CIFMS,2021-I2M-C&T-B-016National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-112(all to JG).
文摘Spinal cord organoids are three-dimensional tissues derived from stem cells that recapitulate the primary morphological and functional characteristics of the spinal cord in vivo.As emerging bioengineering methods have led to the optimization of cell culture protocols,spinal cord organoids technology has made remarkable advancements in the past decade.Our literature search found that current spinal cord organoids do not only dynamically simulate neural tube formation but also exhibit diverse cytoarchitecture along the dorsal-ventral and rostral-caudal axes.Moreover,fused organoids that integrate motor neurons and other regionally specific organoids exhibit intricate neural circuits that allows for functional assessment.These qualities make spinal cord organoids valuable tools for disease modeling,drug screening,and tissue regeneration.By utilizing this emergent technology,researchers have made significant progress in investigating the pathogenesis and potential therapeutic targets of spinal cord diseases.However,at present,spinal cord organoid technology remains in its infancy and has not been widely applied in translational medicine.Establishment of the next generation of spinal cord organoids will depend on good manufacturing practice standards and needs to focus on diverse cell phenotypes and electrophysiological functionality evaluation.
