Jingchuan Sun

Anterior controllable antidisplacement and fusion surgery for the treatment of multilevel severe ossification of the posterior longitudinal ligament with myelopathy: preliminary clinical results of a novel technique

PurposeAlthough anterior and posterior decompression surgery are both reported to treat patients with myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). The surgical strategy of the disease is still controversial when the OPLL is multilevel and severe. This present study reports the preliminary clinical results of a novel technique named anterior controllable antidisplacement and fusion (ACAF) for the treatment of multilevel-severe OPLL with myelopathy.MethodsA series of 15 patients with cervical myelopathy caused by compression of multilevel severe OPLL were enrolled. All the patients underwent ACAF after thorough surgical designing based on preoperative imaging. The patients were followed for a mean follow-up duration of 9xa0months in this study. The main surgical procedures include discectomy of the involved levels, thinning of the anterior part of the involved vertebrae, intervertebral cages, anterior plate and screws installation, bilateral osteotomies of the vertebrae, and antedisplacement of the vertebrae-OPLL complex (VOC). The Japanese Orthopaedic Association (JOA) scales, Visual Analog Scale (VAS) were studied. And the pre- and postoperative radiological parameters, and surgical complications were also investigated.ResultsPostoperative CT and MRI showed complete decompression of the cord by antidisplacement of the VOC. Restoration of neurological defects was confirmed at the last follow-up assessment. Bone fusion was confirmed by CT at 6xa0months follow-up. No specific complications were identified that were associated with this technique.ConclusionsThe present study demonstrates that excellent postoperative outcome can be achieved with the use of the ACAF. Though further study is required to confirm the conclusion, this novel technique has the potential to serve as an alternative surgical technique for the treatment of cervical OPLL.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

miR-32-5p-mediated Dusp5 downregulation contributes to neuropathic pain

Previous studies have demonstrated that microRNAs (miRNAs) play important roles in the pathogenesis of neuropathic pain. In the present study, we found that miR-32-5p was significantly upregulated in rats after spinal nerve ligation (SNL), specifically in the spinal microglia of rats with SNL. Functional assays showed that knockdown of miR-32-5p greatly suppressed mechanical allodynia and heat hyperalgesia, and decreased inflammatory cytokine (IL-1β, TNF-α and IL-6) protein expression in rats after SNL. Similarly, miR-32-5p knockdown alleviated cytokine production in lipopolysaccharide (LPS)-treated spinal microglial cells, whereas its overexpression had the opposite effect. Mechanistic investigations revealed Dual-specificity phosphatase 5 (Dusp5) as a direct target of miR-32-5p, which is involved in the miR-32-5p-mediated effects on neuropathic pain and neuroinflammation. We demonstrated for the first time that miR-32-5p promotes neuroinflammation and neuropathic pain development through regulation of Dusp5. Our findings highlight a novel contribution of miR-32-5p to the process of neuropathic pain, and suggest possibilities for the development of novel therapeutic options for neuropathic pain.

In Situ Decompression to Spinal Cord During Anterior Controllable Antedisplacement Fusion Treating Degenerative Kyphosis with Stenosis: Surgical Outcomes and Analysis of C5 Nerve Palsy Based on 49 Patients

OBJECTIVEnTo observe outcomes of anterior controllable antedisplacement fusion (ACAF) in treatment of degenerative kyphosis with stenosis (DKS) and analyze probability of C5 nerve palsy.nnnMETHODSnFrom 2016 to 2017, a consecutive cohort of adults with DKS underwent ACAF. All patients underwent cervical radiography, computed tomography, and magnetic resonance imaging. Operative duration, blood loss, and hospital stay were estimated. Radiologic assessment included kyphotic correction, decompression width, and spinal canal area. Postoperative curvature of spinal cord was observed on sagittal magnetic resonance imaging. Japanese Orthopaedic Association score was used to evaluate neurologic status. C5 nerve palsy and other complications were recorded.nnnRESULTSnThe study included 49 patients. There was significant kyphosis correction postoperatively (-19.4° vs. 3.5°, P < 0.01). On cross-sectional computed tomography, mean decompression width was 19.0 mm, and spinal canal area was 218.5 mm2. On sagittal magnetic resonance imaging, spinal cord curvature was classified into 5 types: type I, lordosis; type II, straight with no shifting; type III, straight with shifting; type IV, sigmoid; and type V, kyphosis. After ACAF, the spinal cord was maintained in good curvature with no shifting in all patients. No patient presented with C5 nerve palsy. Mean postoperative Japanese Orthopaedic Association score was significantly better than preoperatively (14.9 points vs. 9.0 points, P < 0.01), with mean improvement rate of 79.8%.nnnCONCLUSIONSnACAF provides in situ decompression and good curvature to the spinal cord. Good neurologic recovery is obtained with lower incidence of C5 nerve palsy when ACAF is used to treat DKS.

Anterior Controllable Antedisplacement Fusion (ACAF) for Severe Cervical Ossification of the Posterior Longitudinal Ligament: Comparison with Anterior Cervical Corpectomy with Fusion (ACCF)

OBJECTIVEnAnterior cervical corpectomy and fusion (ACCF), in which a ventral constriction is resected, can decompress myelopathy and is considered the optimal treatment for ossification of the posterior longitudinal ligament (OPLL) up to now. However, its disadvantages are incomplete decompression, high surgery- and implant-related complication rates, and extremely surgical technique demanding. Our object was to introduce anterior controllable antedisplacement fusion (ACAF), a new surgical technique to treat OPLL, and compare it with ACCF.nnnMETHODSnACAF was performed on 34 patients with spinal stenosis with myelopathy due to severe (occupying rate ≥50%) OPLL. Pre- and postoperatively, we measured decompression width and spinal canal area on cross-sectional computed tomography and morphology and anteroposterior diameter of the spinal cord at the most severely affected segment on cross-sectional magnetic resonance imaging and cross-sectional computed tomography. Japanese Orthopedic Association scoring was used to evaluate neurologic status. The ACAF group and a control group of 36 patients with ACCF were compared.nnnRESULTSnPostoperatively, decompression width (17.9 ± 1.0 vs. 15.1 ± 0.8 mm; P < 0.01), spinal canal area (150.4 ± 31.6 vs. 127.0 ± 27.0 mm2; P < 0.01), and anteroposterior spinal cord diameter (5.4 ± 0.6 vs. 5.0 ± 1.1 mm; P < 0.05) were significantly greater in the ACAF group. At 6 months,xa0mean Japanese Orthopedic Association score was significantly better in the ACAF group (15.4 ± 0.9 vs. 14.5 ± 2.5 points; Pxa0= 0.04).nnnCONCLUSIONSnACAF, providing adequate decompression of the spinal cord and good outcomes, is a well choice in the treatment of spinal stenosis due to severe OPLL.

Metabolomic Changes in Rat Model of Cauda Equina Injury

BACKGROUNDnTo show the differences of metabolomic changes in a rat model of cauda equina injury (CEI) and find potent metabolic biomarkers of CEI.nnnMETHODSnA total of 28 Sprague-Dawley rats were used in this study. After the rats were given anesthesia and fixed in a prone position, a piece of silicone block was placed into the epidural space below the lamina. Behavior tests including the Basso, Beattie, and Bresnahan open field locomotor scale and an inclined plane test were conducted 1 day and 2 days after surgery. The cauda equina tissue was collected 12 hours, 1 day, and 2 days after surgery. Ultraperformance liquid chromatography coupled with quadruple time-of-flight mass spectrometry was used for a quantitative analysis of cauda equine metabolic changes in rats from different groups. The differences between the metabolic profiles of the rats in 4 groups were analyzed using partial least squares discriminant analysis.nnnRESULTSnIn behavior tests and histologic analyses given 2 days after surgery, the animals showed remarkable organ dysfunction and pathologic damage. Metabolic profiles showed remarkable differences between the control and model groups. Thirty-four potential CEI metabolite biomarkers were identified between the control group and different time-point model groups. These potential biomarkers appeared in 15 metabolic pathways.nnnCONCLUSIONSnOur results may improve the cause of CEI and provide a basis for clinical diagnosis and locating biomarkers in the early stages of the pathologic process ofxa0CEI.

Neuroprotective Effects of Valproic Acid in a Rat Model of Cauda Equina Injury

BACKGROUNDnHistone deacetylase inhibitors, including valproic acid (VPA), are promising therapeutic interventions in neurological disorders and play an important role in synaptic activity and neuronal function.nnnMETHODSnA total of 30 rats were randomly allocated to 3 groups: sham, control, and VPA. The rats in the VPA and control groups received laminectomy at the L4 level of the vertebrae and silicone gel implantation into the epidural spaces L5 and L6. Rats in the sham group only received laminectomy at the L4 level of vertebrae without any implantation. VPA (300 mg/kg in saline) was administered 2 hours before the surgery. After the surgery, the VPA group received further VPA injections at 300 mg/kg twice a day for 1 week. The same volume of saline was injected in the control group. Neurobehavioral tests using the Basso, Beattie, Bresnahan scale and the oblique board test were performed for 1 week starting at 2 hours before surgery up to day 7 after surgery. At day 7 after surgery, tissues from the compressed cauda equina (L5-L6) were subjected to hematoxylin and eosin, luxol fast blue, or immunofluorescence staining, whereas the terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick-end label assay staining was performed on the tissue from the dorsal root ganglions and the lumbar segment of the spinal cord proximal to the compressed cauda equina (L5-L6).nnnRESULTSnThe behavioral results suggested a significant improvement in the lower limb motor function in the VPA group compared with controls (P < 0.05). Furthermore, histologic assessment revealed a significant reduction in nerve fibers showing Wallerian degeneration and demyelinating lesions in the VPA group, in addition to an increased myelination compared with the control group (Pxa0< 0.05). The terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick-end label assay staining revealed a significant decrease in the number of apoptotic neurons in the spinal cord anterior horn and dorsal root ganglions in the VPA group compared with controls (Pxa0<xa00.05).nnnCONCLUSIONSnOur data demonstrated that VPA could alleviate cauda equina injury, reduce apoptotic cells, and improve motor recovery, suggesting a neuroprotective effect in acute cauda equina syndrome.

Evaluating the Rotation Correction of the Main Thoracic Curve in Severe Adolescent Idiopathic Scoliosis: Bending and Traction vs. Fulcrum – A Preliminary Report

Background Flexibility evaluation methods were only used to assess the changes of coronal Cobb angle in patients with adolescent idiopathic scoliosis (AIS). Little attention was attached to the vertebral rotation in these methods. Material/Method 21 patients with severe adolescent idiopathic scoliosis were enrolled in this study. Coronal flexibility and rotation correction were compared on the supine bending, traction and fulcrum bending radiographs. The apical vertebral body rib ratio (AVB-R), and Perdriolle rotation angles were used to measure the rotation of the main thoracic curve. Statistical analysis was performed with one-way Analysis of Variance(ANOVA). Correlations between postoperative AVB-R and AVB-R in supine bending, traction and fulcrum bending radiographs were assessed utilizing the Linear Regression. Results There were trends towards increased coronal flexibility in fulcrum bending versus traction versus supine bending, but there were no significant differences due to the limited sample size. And all were significantly lower than postoperative correction. The correction of AVB-R at traction and supine bending radiographs were significantly better than fulcrum bending, however, all were significantly lower than postoperative correction. Correction of Perdriolle rotation angle at traction radiograph was best among these methods. A univariant linear regression analysis showed a strong linear correlation between the postoperative AVB-R and the AVB-R in the traction radiograph. Conclusions As to patients with severe AIS, the coronal plane flexibility evaluated at the fulcrum bending radiograph is superior to that at the traction radiograph. This may be explained by the measurement errors induced by the better derotation capacity at the traction radiograph. Rotation correction evaluated at the traction radiograph proves better than the fulcrum bending radiographs, showing a linear correlation with the postoperative correction.

A Comparative Study Between Anterior Controllable Antedisplacement and Fusion Versus Laminoplasty in the Surgical Management of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament

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Quantitative Anterior Enlargement of the Spinal Canal by Anterior Controllable Antedisplacement and Fusion for the Treatment of Cervical Ossification of the Posterior Longitudinal Ligament with Myelopathy

PURPOSEnThis retrospective study aimed to investigate the effect of quantitative enlargement of spinal canal by anterior controllable antedisplacement and fusion (ACAF) for cervical ossification of the posterior longitudinal ligament (OPLL).nnnMETHODSnForty-three patients with OPLL who underwent ACAF were enrolled. According to the use of a curvature ruler (CR), patients were divided into group A (CR used, nxa0= 21) and group B (CR not used, nxa0= 22). The average follow-up was 9.5 months. The occupation rate (OR) of the spinal canal and the curvature of the cervical plate were recorded. The Japanese Orthopedic Association (JOA) scores were analyzed, and the recovery rate (RR) was calculated. Surgical complications were also investigated.nnnRESULTSnThe OR of the spinal canal in group A decreased from 66.7% ± 12.8% to 19.1% ± 10.9% after surgery (P < 0.05). In group B, the preoperative and postoperative OR was 63.9% ± 11.7% and 21.2% ± 8.7%, respectively (P < 0.05). Patients in group A had higher agreement of the curvature of the cervical plate between preoperative planning and postoperative measurement. The RR of JOA scores in group A was 73.7% ± 19.7%, higher than in group B (70.9% ± 7.3%, Pxa0>xa00.05). Further comparison between the 2 groups, excluding those patients with OR <50%, showed that both JOA score and RR in group A were higher than in group B at the final follow-up (P < 0.05).nnnCONCLUSIONSnThe quantitative enlargement of the spinal canal by ACAF may provide a positive and favorable effect on enlarging the spinal canal and achieving better neurologic recovery for the treatment of cervical OPLL with myelopathy. CR can facilitate the achievement of better and more quantitative spinal canal enlargement.

New Technology for Surgical Treatment of Osteoporotic Vertebral Compression Fractures: The Transvertebral Bone Graft and Fixation

OBJECTIVEnTo introduce an innovative surgical technique, transvertebral bone graft and augmentation (TBGA), to and evaluate its clinical efficacy in treating osteoporotic vertebral body compression fractures (VCFs), with balloon kyphoplasty (BKP) as a control.nnnMETHODSnA total of 81 patients with a single-level osteoporotic VCF underwent TBGA (nxa0= 38) or BKP (nxa0= 43) at our hospital between October 2012 and January 2015. The average duration of follow-up period was 27.9 months. The patients were evaluated with plain radiography, computed tomography, and magnetic resonance imaging preoperatively, immediately postoperatively, at 3- and 6-month follow-ups, and every 6 months thereafter. Clinical status was assessed using the Oswestry Disability Index (ODI) and a visual analog scale (VAS). In addition, parameters of anterior vertebral body height (AVBH), kyphosis angle (KA), adjacent segment degeneration (ASD), and complications were also compared between the 2 groups.nnnRESULTSnSignificant clinical improvements in ODI, VAS scores, AVBH, and KA were seen in both the TBGA and BKP groups after surgery (P < 0.05). However, the differences in improvements in ODI and VAS between the TBGA and BKP groups were not statistically significant (P > 0.05). The improvements in AVBH and KA were significantly better in the TBGA group (P < 0.05). Furthermore, the rates of ASD and complications were significantly lower in the TBGA group during the follow-up period (P < 0.05).nnnCONCLUSIONSnTBGA is an effective and safe surgical technique that appears to be a promising alternative to BKP for the surgical treatment of osteoporotic VCFs.