Min Dai

The correlation between radiographic and pathologic grading of lumbar facet joint degeneration

BackgroundBefore performing spine non-fusion surgery that retains the facet joints, choosing an accurate radiographic method to evaluate the degree of facet joint degeneration is extremely important. Therefore, the objective of this study was to determine the accuracy and reliability of different radiographic classifications by analyzing the correlation between radiographic and pathologic grading of lumbar facet joint degeneration. Taking the pathologic examination as standard, the consistency of computed tomography (CT) and magnetic resonance imaging (MRI) assessment of lumbar facet joint degeneration was compared.MethodsA total of 74 facet joints obtained from 42 patients who underwent posterior lumbar surgery were evaluated. All patients underwent CT and MRI before surgery. The pathologic grade was evaluated with a method based on hematoxylin-eosin and toluidine blue staining. The radiographic grade was evaluated using the methods proposed by different authors.ResultsThere was a moderate consistency between pathologic and radiographic grading for facet joint degeneration. The weighted kappa coefficients comparing pathologic with radiographic grading were 0.506 for CT, 0.561 for MRI, and 0.592 for CT combined with MRI, respectively. Taking the pathologic examination as standard, the consistency of CT and MRI examination was also moderate, and the weighted kappa coefficient was 0.459.ConclusionThe radiographic examination has moderate accuracy and reliability for evaluating degeneration of facet joints. Therefore, a more accurate method for evaluating the degeneration of facet joints is necessary before performing spine non-fusion surgery that retains the facet joints.

Correlation between facet tropism and lumbar degenerative disease: a retrospective analysis

BackgroundThe aim of this study was to investigate the correlation between facet tropism and spinal degenerative diseases, such as degenerative lumbar spondylolisthesis, degenerative lumbar scoliosis, and lumbar disc herniation.MethodsThis study retrospectively analysed clinical data from the Department of Orthopaedics at The First Affiliated Hospital of Nanchang University. Ninety-two patients were diagnosed with lumbar spondylolisthesis, 64 patients with degenerative scoliosis, and 86 patients with lumbar disc herniation between 1 October 2014 and 1 October 2016. All patients were diagnosed using 3.0xa0T magnetic resonance imaging and underwent conservative or operative treatment. Facet tropism was defined as greater than a ten degree between the facet joint angles on both sides.ResultsFor L3-L4 degenerative lumbar spondylolisthesis, one out of six cases had tropism compared to seven out of the 86 controls (pu2009=u20090.474). At the L4-L5 level, 17/50 cases had tropism compared to 4/42 cases in the control group (pu2009=u20090.013). At the L5-S1 level, 18/36 cases had tropism compared to 7/56 controls (pu2009=u20090.000). For degenerative lumbar scoliosis at the L1-L5 level, 83/256 cases had tropism as compared to 36/256 controls (pu2009=u20090.000). For L3-L4 lumbar disc herniation two out of eight cases had tropism compared to 14/78 controls (pu2009=u20090.625). At the L4-L5 level, 19/44 cases had tropism compared to four out of 42 controls (pu2009=u20090.001). At the L5-S1 level, 24/34 cases had tropism compared to 10/52 controls (pu2009=u20090.000).ConclusionAt the L4–5 and L5-S1 levels, facet tropism is associated with degenerative spondylolisthesis. In the degenerative lumbar scoliosis group, the number of case with facet tropism was significantly higher than that of the control group. Facet tropism was associated with lumbar disc herniation at the L4–5 and L5-S1 levels. Overall, in these three lumbar degenerative diseases, facet tropism is a common phenomenon.

Unilateral Versus Bilateral Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Study Design A retrospective study of patients who underwent kyphoplasty at a single institute. Objective To examine and compare the safety and long-term radiographic and clinical effects of unilateral or bilateral kyphoplasty to treat symptomatic vertebral compression fractures (VCF). Summary of Background Data Kyphoplasty (KP) involves placement of inflatable bone tamp via unilateral and bilateral approaches. Few randomized study comparing the radiographic and clinical outcomes using unilateral and bilateral approaches was reported. Methods 50 patients with osteoporotic vertebral compression fractures (VCF) were allocated into two groups adopting unilateral or bilateral kyphoplasty. Preoperative and postoperative pain scores, Vertebral body height were compared and analyzed. Results Both unilateral and bilateral kyphoplasty resulted in significant pain reduction. Significant increases of midline vertebral body height were recorded for both groups after surgery and maintained for the period of follow-up. Asymptomatic cement extravasation occurred in 8 of 50 patients, and 2 patients developed additional fractures at untreated levels during the period of follow-up. Conclusions Both unilateral and bilateral KP can improve clinical effects of osteoporotic VCF and result in significant vertebral height restoration for at least 18 months after treatment.

ABT-737 potentiates cisplatin-induced apoptosis in human osteosarcoma cells via the mitochondrial apoptotic pathway

ABT-737 is a BH-3 mimetic that inhibits Bcl-2 and induces apoptosis of cancer cells, which has potential for anticancer therapies. Studies have shown that Bcl-2 expression in human osteosarcoma (OS) cells plays a significant role in tumor progression; however, its effects on OS cell apoptosis are still unknown. Therefore, we examined whether ABT-737 was effective in eliminating human U-2OS cells, either alone or in combination with the chemotherapy drug cisplatin [cis-diamminedichloroplatinumxa0(II); DDP]. Furthermore, we studied the molecular mechanisms of ABT-737 in combination with DDP to induce apoptosis. To analyze the role of ABT-737 and/or DDP on osteosarcoma progression, CCK-8 viability assay, flow cytometry, Hoechstxa033258 staining, and western blots were performed. Combined use of ABT-737 and DDP synergistically suppressed cell viability and induced apoptosis in human U-2OS cells when compared with either compound treated alone at low doses. We found that the combination of ABT-737 and DDP upregulated the expression of the pro-apoptotic protein Bax and downregulated the expression of the pro-survival protein Bcl-2, resulting in a change in the Bax/Bcl-2 ratio, release of cytochromexa0c, and activation of the mitochondrial apoptotic pathway, which resulted in caspase-9 and caspase-3 activation and PARP cleavage. Our results demonstrated that ABT-737 alone has a nominal influence on human U-2OS cells when treated within the clinically administered range, but when combined with DDP, it can inhibit the proliferation of human U-2OS cells by inducing apoptosis via the mitochondrial apoptotic pathway.

Comparing the efficacy of short-segment pedicle screw instrumentation with and without intermediate screws for treating unstable thoracolumbar fractures

Abstract It is generally acknowledged that short-segment pedicle screw instrumentation is the preferred surgical method for thoracolumbar fractures. However, the use of short-segment instrumentation with or without intermediate screws at the fracture level remains controversial. We retrospectively evaluated 44 patients (28 men, 16 women) with unstable thoracolumbar fractures. The patients were divided into 2 groups according to the surgical method used. In group 1, 24 patients underwent surgery with a posterior approach via short-segment pedicle screw instrumentation (1 level above and 1 level below the fractured level). In group 2, 20 patients received an additional 2 screws at the fractured vertebrae. Clinical and radiologic parameters were evaluated before surgery and at 1 week, 6 months, and 1 year after surgery. We found no significant difference in the demographic characteristics between the 2 groups. No significant difference was observed in the operative time and intraoperative blood loss between the 2 groups. Clinical outcomes also showed no significant differences between the groups preoperatively or at all follow-up periods. The correction of the Cobb angle (CA) 1 week after surgery was better in group 2, whereas the anterior vertebral body height of the fractured level (AVHF) and compression ratio of the AVHF (AVHFCR) were not significantly different between the 2 groups 1 week after surgery. Moreover, group 2 had better maintenance of restored CA, AVHF, and AVHFCR at the fractured level than did group 1 at 6 months and 1 year postoperatively. In addition, the reduction of mid-sagittal diameter (MSD) of spinal canal 1 week and 1 year after surgery was better in group 2. Besides, bone fragments in the spinal canal have a tendency to be less in group 2 1 week and 1 year after surgery. Reinforcement with intermediate screws for a single thoracolumbar fracture not only enhanced the stability of the internal fixation system, but it was also conducive to the correction of kyphosis and the maintenance of the reduction effects. Furthermore, this method is helpful to restore the spinal canal and reduce the bone fragments in the spinal canal. However, more long-term follow-up studies are needed.

Risk factors for acute surgical site infections after lumbar surgery: a retrospective study

BackgroundCurrently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery.MethodsWe retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital’s spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses.ResultsTwenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients’ mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (pu2009<u20090.05). Additionally, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, preoperative antibiotics, type of disease, and operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (pu2009<u20090.05). Using binary logistic regression analyses, body mass index, smoking, diabetes mellitus, osteoporosis, preoperative antibiotics, fracture, operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery.ConclusionsIn order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

Key Triggers of Osteoclast-Related Diseases and Available Strategies for Targeted Therapies: A Review

Osteoclasts, the only cells with bone resorption functions in vivo, maintain the balance of bone metabolism by cooperating with osteoblasts, which are responsible for bone formation. Excessive activity of osteoclasts causes many diseases such as osteoporosis, periprosthetic osteolysis, bone tumors, and Paget’s disease. In contrast, osteopetrosis results from osteoclast deficiency. Available strategies for combating over-activated osteoclasts and the subsequently induced diseases can be categorized into three approaches: facilitating osteoclast apoptosis, inhibiting osteoclastogenesis, and impairing bone resorption. Bisphosphonates are representative molecules that function by triggering osteoclast apoptosis. New drugs, such as tumor necrosis factor and receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors (e.g., denosumab) have been developed for targeting the receptor activator of nuclear factor kappa-B /RANKL/osteoprotegerin system or CSF-1/CSF-1R axis, which play critical roles in osteoclast formation. Furthermore, vacuolar (H+)-ATPase inhibitors, cathepsin K inhibitors, and glucagon-like peptide 2 impair different stages of the bone resorption process. Recently, significant achievements have been made in this field. The aim of this review is to provide an updated summary of the current progress in research involving osteoclast-related diseases and of the development of targeted inhibitors of osteoclast formation.

Inhibitory Effects of Lanthanum Chloride on Wear Particle-Induced Osteolysis in a Mouse Calvarial Model

Osteolysis is a bone disorder associated with progressive destruction of bone tissues. However, the effects of lanthanum chloride (LaCl3) on osteolysis remain unknown. Therefore, the aim of this study was to determine the effects of LaCl3 on osteolysis in vivo. In a mouse calvarial model, C57BL/6J mice were injected with wear particles with or without LaCl3. Microcomputed tomography, hematoxylin and eosin staining, and tartrate-resistant acid phosphatase staining were performed for the pathological characterization of calvariae, and eight calvariae per group were prepared for the assay of TNF-α, IL-1β, and RANKL secretion using quantitative enzyme-linked immunosorbent assay (ELISA). In mice treated with high-dose LaCl3, particle-induced osteolysis and inflammatory reaction were reduced compared with that in the vehicle-treated control. Moreover, treatment with high-dose LaCl3 suppressed the wear particle-induced decrease in bone mineral content, bone mineral density, and bone volume fraction. Bone destruction and resorption were higher in the LaCl3-treated group than in the saline-treated group but lower than those in the wear particle group. Finally, our results showed that treatment with a high dose of LaCl3 suppressed osteoclastogenesis. Thus, LaCl3 may represent a novel therapeutic agent for the treatment or prevention of wear particle-induced osteolysis and aseptic loosening.

Correlations between the feature of sagittal spinopelvic alignment and facet joint degeneration: a retrospective study

BackgroundSagittal spinopelvic alignment changes associated with degenerative facet joint arthritis have been assessed in a few studies. It has been documented that patients with facet joint degeneration have higher pelvic incidence, but the relationship between facet joint degeneration and other sagittal spinopelvic alignment parameters is still disputed. Our purpose was to evaluate the correlation between the features of sagittal spinopelvic alignment and facet joint degeneration.MethodsImaging data of 140 individuals were retrospectively analysed. Lumbar lordosis, pelvic tilt (PT), pelvic incidence (PI), sacral slope, and height of the lumbar intervertebral disc were measured on lumbar X-ray plates. Grades of facet joint degeneration were evaluated from the L2 to S1 on CT scans. Spearman’s rank correlation coefficient and Student’s t-test were used for statistical analyses, and a P-value <0.05 was considered statistically significant.ResultsPI was positively associated with degeneration of the facet joint at lower lumbar levels (pu2009<u20090.001 ru2009=u20090.50 at L5/S1 and Pu2009=u20090.002 ru2009=u20090.25 at L4/5). A significant increase of PT was found in the severe degeneration group compared with the mild degeneration group: 22.0° vs 15.7°, Pu2009=u20090.034 at L2/3;21.4°vs 15.1°, Pu2009=u20090.006 at L3/4; 21.0° vs 13.5°, Pu2009=u20090.000 at L4/5; 20.8° vs 12.1°, Pu2009=u20090.000 at L5/S1.ConclusionOur results indicate that a high PI is a predisposing factor for facet joint degeneration at the lower lumbar spine, and that severe facet joint degeneration may accompany with greater PT at lumbar spine.

Anatomic study of individualized and improved pedicle screw implantation in the lower cervical spine.

The objective of this study was to explore a safe, reliable, and effective method for pedicle screw implantation in the lower cervical spine. Recently, a number of studies have shown that cervical pedicle screw fixation is better than roadside steel plate after cervical screw internal fixation within the scope of its indications. However, the difficulty of the former surgery technology is relatively higher and it is much easier to cause many complications. Therefore, domestic and foreign scholars have been positively exploring safer, easier operations and cheaper methods of pedicle screw implantation in the lower cervical spine. The lower cervical spine areas (C3-C7) of 7 adult cadavers were carried out with computed tomography (CT) scans of 1-mm slices. The entry point, angle, and length of the screws were determined by the measurement of CT images in a picture archiving and communication system. The pedicle screws were implanted with the technique of improved Abumi pedicle screw placement in the lab. The accuracy of the screws was evaluated by the Andrew CT classification criteria of pedicle screw position and gross observation after the experiment. A total of 66 screws were implanted in the lower cervical spine, and 90.9% of the screws inserted were found to be in an optimal position. The method of individualized and improved pedicle screw implantation in the lower cervical spine is relatively safe and reliable, which can be considered to be used in the clinic.