Chaofeng Guo

Association of Estrogen Receptor Gene Polymorphisms With Susceptibility to Adolescent Idiopathic Scoliosis

Study Design. A case-control study is presented. Objective. To investigate the association of estrogen receptor gene polymorphisms with adolescent idiopathic scoliosis (AIS) risk. Summary of Background Data. Previous studies have shown that genetic factors are important in the pathogenesis of idiopathic scoliosis. Only 1 publication suggested that XbaI site polymorphism was associated with curve severity of idiopathic scoliosis. However, to our knowledge, the relationship of estrogen receptor gene polymorphisms and the individual susceptibility to idiopathic scoliosis has not been studied. Methods. This study included 202 patients with AIS and 174 healthy controls. Height, menarche status, curve pattern, Cobb angle, and Risser sign in female patients were recorded. There were 2 polymorphic loci, PvuII and XbaI locus, of estrogen receptor analyzed by restriction fragment length polymorphisms. Results. The frequency of XX genotype was significantly higher in patients than that in controls (P = 0.005).The X allele appeared to be overrepresented in patients compared with controls (P = 0.001). Furthermore, the frequencies of XX genotype in female patients whose height was ≥160 cm and Cobb angle ≥40° were higher than those whose height was <160 cm and Cobb angle <40° (P = 0.001 and P < 0.001, respectively). Conclusions. The XbaI site polymorphism of estrogen receptor gene may be associated with a risk of AIS.

One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion.

Study Design A retrospective clinical study of 1-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region (MTSUTR). Objective MTSUTR has rarely been documented in the literature. We present a retrospective clinical study of 23 patients with MTSUTR treated by anterior decompression, strut autografting, posterior instrumentation, and fusion. The purpose was to determine the clinical efficacy of such surgical treatment for MTSUTR. Summary of Background Data It is considered safe and effective to treat surgically tuberculous spondylitis with local spinal cord compression. Many reports have documented a good clinical efficacy of surgical management for spinal tuberculosis. However, how to deal with MTSUTR is rarely reported in the literature. Methods There were 14 men and 9 women, with average age of 35 years. All patients underwent 1 stage anterior debridement, strut autografting, and posterior instrumentation and received combined medication antituberculosis chemotherapy for 12 to 24 months (average 18 mo). The following data were followed up for an average period of 42 months (24 to 60 mo) in these patients: deformity angle, neurologic function, and spinal bony fusion. Results The average preoperative deformity angle was 44 degrees, correcting to 20-degree postoperatively and 24 degrees at final follow up. In the series, 19 patients with preoperative neurologic deficit restored by 1.3 grades according to Frankel. All patients got bony spinal fusion within 6 months postoperatively. There was no recurrent tuberculous infection. Conclusions Single-stage anterior debridement, strut autografting, posterior instrumentation, and fusion proved safe and effective for MTSUTR, which can achieve goals of complete spinal cord decompression and good deformity correction.

Association between FokI polymorphism in vitamin D receptor gene and susceptibility to spinal tuberculosis in Chinese Han population.

BACKGROUND AND AIMS Studies have shown that the vitamin D receptor (VDR) gene polymorphisms may be associated with pulmonary tuberculosis (TB) and play important roles in the regulation of calcium in a variety of tissues including bone. To our knowledge, however, whether FokI polymorphism in VDR gene is associated with susceptibility to spinal TB is still unknown. We undertook this study to investigate the association between FokI polymorphism in VDR gene and susceptibility to spinal TB in Chinese Han population. METHODS This study included 110 patients with spinal TB and 102 volunteers as controls. FokI polymorphism in VDR gene was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in the spinal TB group and the control group. The frequencies of VDR-FokI genotypes in the two groups were compared using chi(2) test. RESULTS There was a significant difference between groups in regard to the frequencies of the VDR-FokI genotypes (p <0.05). In the spinal TB group, the frequency of the ff genotype was 46.36%, which was significantly higher than the corresponding value for the control group (28.43%). Furthermore, the odds ratio (OR) was 2.176 (p <0.05), and the 95% confidence interval (CI) ranged from 1.236-3.832. CONCLUSIONS FokI polymorphism in VDR gene may be associated with the susceptibility to spinal TB in Chinese Han population. Furthermore, the ff genotype may be the susceptible genotype of spinal TB.

Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level

OBJECT The object of this study was to evaluate the efficacy and safety of posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. METHODS Between January 2003 and December 2005, 11 patients (8 men and 3 women) with thoracic myelopathy due to OLF and OPLL at the same level underwent posterior decompressive laminectomy and excision of OLF. Posterior instrumentation was also performed for stabilization of the spine and reducing the thoracic kyphosis angle by approximately 5-15 degrees (kyphosis correction), and spinal fusion was performed in all cases. The follow-up period ranged from 2 to 4 years (mean 2.8 years). The outcomes were evaluated using a recovery scale based on the Japanese Orthopaedic Association classification. The score of each patient was calculated before surgery, 1 year after surgery, and at the final follow-up visit. RESULTS After surgery, the thoracic kyphosis in the stabilization area was reduced from 30.0 +/- 4.02 degrees to 20.8 +/- 2.14 degrees on average. The mean score on the Japanese Orthopaedic Association scale improved from 3.5 +/- 1.69 preoperatively to 8.5 +/- 1.63 at the final follow-up, with a recovery rate of 68.0%. The results were good in 9 patients and fair in 2 patients. Postoperative MR imaging showed that the spinal cord was shifted posteriorly and decompressed completely in all cases. Myelopathy was not aggravated in any case after surgery. CONCLUSIONS A considerable degree of neurological recovery was observed after posterior decompression and kyphosis correction. The procedure is easy to perform with a low risk of postoperative paralysis. The authors therefore suggest that the procedure is useful for patients whose spinal cords are severely impinged by OLF and OPLL at the same level.

Monocyte chemoattractant protein-1 in spinal tuberculosis: -362G/C genetic variant and protein levels in Chinese patients.

The objective of the study is to explore the possible association of the monocyte chemoattractant protein (MCP)-1-362G/C genetic polymorphism and plasma levels of MCP-1 in patients with spinal tuberculosis (TB). The MCP-1-362G/C (rs2857656) polymorphism and blood levels of MCP-1 in patients with spinal TB and healthy subjects were evaluated and compared. Three hundred thirty-two patients and 336 healthy subjects were genotyped using polymerase chain reaction and Sanger DNA sequencing technology. MCP-1 plasma levels were measured by a solid-phase enzyme-linked immunosorbent assay. When comparisons were made between patients and controls, the frequency of the MCP-1-362*C minor allele (55.4% versus 47.5%, P = 0.004, odds ratio [OR] = 1.376, 95% confidence interval [CI]: 1.109-1.706) and the carriers of the MCP-1-362*C allele (80.7% versus 71.4%, P = 0.005, OR = 1. 657, 95% CI: 1.167-2.403) were over-represented in patients. The mean MCP-1 plasma level in spinal TB patients was significantly higher than in controls (154.44 ± 68.81 pg/mL versus 36.69 ± 21.71 pg/mL, t = -5.85, P < 0.001). The patients with the CC genotype had the highest MCP-1 level (150.63 ± 73.89 pg/mL), followed by those with the GC genotype (108.63 ± 52.09 pg/mL, t = 2.351, P = 0.022) and GG (91.29 ± 54.31 pg/mL, t = 3.091, P = 0.003) homozygotes. We report the association of the -362G/C genetic polymorphism and increased plasma levels of MCP-1 in patients with spinal TB and nominate the -362*C minor allele as a risk factor for spinal TB in the Chinese population.

Prevalence of scoliosis among primary and middle school students in Mainland China: a systematic review and meta-analysis.

Study Design. Systematic review and meta-analysis of published prevalence of scoliosis among primary and middle school students in Mainland China. Objective. To evaluate the prevalence of scoliosis among primary and middle school students in Mainland China. Summary of Background Data. There is substantial uncertainty regarding the prevalence of scoliosis in Mainland China among the primary and middle school students. We conducted a systematic review aiming to describe the prevalence of scoliosis in Mainland China. Methods. We systematically reviewed the published epidemiological studies or reports on the prevalence of scoliosis in Chinese cities. Scopus, PubMed, WanFang Database, CNKI, China National Science and Technology Digital Library, and WeiPu Database were searched for studies reporting a prevalence estimate for scoliosis in primary and middle school students. Meta-analyses were performed to estimate the pooled prevalence of scoliosis by STATA 12.0. Subgroup analyses were conducted according to the sex, age, and geographical area. Results. A total of 38 articles, including 697,043 patients, were eligible for inclusion in this review. Meta-analyses revealed the prevalence of scoliosis to be 1.02% (95% [confidence interval] CI, 0.85–1.18) among the primary and middle school students in Mainland China. The female to male ratio was 1.54 (95% CI, 1.35–1.74; P < 0.001). According to the subgroup analysis by different ages, the prevalence of scoliosis increased from 0.73% (95% CI, 0.55–0.90) to 1.14% (95% CI, 0.86–1.42). Conclusion. Meta-analyses showed that the prevalence of scoliosis in Mainland China was 1.02% among the primary and middle school students. The prevalence of scoliosis in females was higher than in males and the ratio was 1.54. As they grew older, the prevalence of scoliosis increased in the students. Level of Evidence: 2

Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only

Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three‐column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68‐year‐old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting, and internal fixation can be completed with only one incision and surgical position, and the deformity correction efficiency is higher than anterior surgery.

Opposite Function of ERα and ERβ in Controlling 17β-Estradiol-mediated Osteogenesis in Osteoblasts.

Estrogen receptor plays critical roles in osteogenesis but the underlying mechanism remains unclear. In order to determine the effect of ERα and ERβ on several critical factors in regulating osteogenesis in human osteoblasts. Cell based assy, RT-PCR and immunoblot analyses were used in the research. Both RT-PCR and immunoblot showed that gene expression of OPG, MBP2, TGF-β, RUNX2, IGF-1 was significantly reduced while expression of RANKL was drastically increased after shRNA-based depletion of ERα in MG-63 osteoblasts. Surprisingly, 17β-estradiol (E2) treatment led to remarkably reduced RANKL compared with that in E2 untreated cells. In contrast, ERβ plays an opposite role in regulating gene expression of OPG, MBP2, TGF-β, RUNX2, IGF-1 and RANKL. However, double depletion of ERα and ERβ could not rescue the gene expression of these factors in vitro. Our results provide a novel mechanism of estrogen receptor in controlling osteogenesis in human cells as well as a potential clinic therapeutic target in human osteoporosis.

Use of finite element analysis of a Lenke type 5 adolescent idiopathic scoliosis case to assess possible surgical outcomes

Objective: To use the finite element model of a Lenke 5 adolescent idiopathic scoliosis (AIS) patient to simulate four corrections (including anterior and posterior correction); to investigate the corrective effect of different surgical protocols; and to analyze the biomechanical stress and strain of the scoliotic spines. Methods: Four surgical strategies were designed and simulated with the model of scoliosis. All the main steps of each strategy, including derotation and compression, were simulated. The stress variation of the spine and the corrective effect were compared among the protocols for different surgical approaches and fusion levels. Results: With the four different surgical protocols, the coronary lumbar deformity was corrected to 22°, 23°, 26° and 26°, respectively, and a physiological sagittal configuration was maintained; however, higher stress was observed with solutions A1 (screw model implanted in the convex side of T12-L3) and A2 (screw model implanted in the convex side of T11-L4), while solution B2 (the posterior approach: T10-L5, fusion to SV) lost too many lumbar movement segments. A similar apical rotational correction was recorded (41.68° and 37.79°) for solutions A2 and B1 (the posterior approach: T10-L4, fusion to LEV), which both instrumented the lower end vertebrae. Conclusions: The presented model could be used successfully to simulate correction procedures, including 90° derotation and compression, for the first time. The Lenke 5 AIS in this particular case was more rigid, and solution B1 was considered the ideal choice for treatment of this patient.

Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only

PURPOSE To analyse the efficacy and feasibility of surgical management for elderly patients with multilevel non-contiguous spinal tuberculosis(MNSTB)by using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. METHODS From September 2009 to October 2013, 15 elderly patients with MNSTB were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. There were 10 males and 5 females with a mean age of 63.2 years (range: 60-68 years) at the time of surgery. The mean follow-up time was 40 months(range 26-68 months). Patients were evaluated before and after surgery in terms of erythrocyte sedimentation rate(ESR), neurological status, pain and kyphotic angle. RESULTS The spinal tuberculosis was completely cured, and the grafted bones were fused in all 15 patients. There were no recurrent tuberculous infections. The ESR reached a normal level within 3 months in all patients. The ASIA neurological classification improved in all cases, and pain relief was reported by all patients. The average preoperative kyphosis was 20.1° (range 8-38°) and decreased to 7.6° (range 1-18°) postoperatively. There was no significant loss of the correction at the latest follow-up. CONCLUSIONS Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion was an effective treatment for elderly patients with MNSTB. It is characterized by minimum surgical trauma, good neurological recovery, and good correction of kyphosis.