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PURPOSE: This study was to explore the clinical correlation between osteoporosis thoracolumbar vertebral compression fracture (thoracolumbar OVCF) and lumbar spondylolisthesis (LS). METHODS: In total, 208 patients with thoracolumbar OVCF (fracture group) and 250 elderly patients with osteoporosis (non-fracture group) were retrospectively analyzed. The incidence of LS was compared between the two groups. At the same time, 75 cases of elderly patients with osteoporosis were selected, including 25 patients with isthmic spondylolisthesis (IS group), 25 patients with degenerative spondylolisthesis (DS group), and 25 patients without LS (non-LS group). All patients underwent full-length spine anteroposterior and lateral X-ray, and the spinal pelvic imaging parameters were collected for comparison. RESULTS: The incidence of LS in the fracture group (10.1%, 21/208) was significantly higher than that in the non-fracture group (4.8%, 12/250); the difference was statistically significant (χ2 = 4.763, P = 0.029). The incidence of trauma in the fracture group (51.0%, 106/208) was significantly higher than that in the non-fracture group (13.6%, 34/250); the difference was statistically significant (χ2 = 74.673, P = 0.000). The LS (OR = 2.273, 95% CI = 1.030-5.017, P = 0.042) and trauma (OR = 6.622, 95% CI = 4.203-10.432, P = 0.000) were independently associated with thoracolumbar OVCF. There were significant differences in pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), thoracolumbar kyphosis (TLK), and thoracic kyphosis (TK) among the IS, DS, and non-LS groups (P < 0.05). Among them, PI, SS, LL, TLK, and TK of the IS group and the DS group were significantly higher than those of the non-LS group (P < 0.05). CONCLUSIONS: Patients with LS are more likely to suffer from OVCF in the future, and LS is one of the important risk factors for secondary OVCF.
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Fracturas por Compresión , Cifosis , Lordosis , Osteoporosis , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Espondilolistesis , Anciano , Fracturas por Compresión/complicaciones , Fracturas por Compresión/diagnóstico por imagen , Humanos , Cifosis/complicaciones , Cifosis/diagnóstico por imagen , Lordosis/complicaciones , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Osteoporosis/complicaciones , Fracturas Osteoporóticas/complicaciones , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/epidemiología , Estudios Retrospectivos , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/epidemiología , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico por imagenRESUMEN
BACKGROUND: To observe the effects of vitamin D on the apoptotic human nucleus pulposus cells under tumor necrosis factor-α (TNF-α) treatment. METHODS: The gene expression data was downloaded from the NCBI Gene Expression Omnibus (GEO) database ( https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE34095 ). Differentially expressed genes between degenerative disc and non-degenerative disc were performed by R software. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment analyses were performed using The Database for Annotation, Visualization and Integrated Discovery (DAVID). Then, the human nucleus pulposus tissue was harvested from 12 patients according to the modified Pfirrmann classification and human nucleus pulposus cells were obtained from digestion of herniated nucleus pulposus tissue. The collected nucleus pulposus cells were treated with different concentration of TNF-α, and cellular apoptosis was measured by flow cytometry. Then, human nucleus pulposus cells were divided into following groups: normal culture medium, TNF-α treated, TNF-α, and vitamin D-treated groups. Cellular apoptosis rate was quantified by flow cytometry. Protein expression of p-p65, p65, and IkBa was detected with western blot analysis. RESULTS: A total of 536 differentially expressed genes were identified through bioinformatic analysis. KEGG pathway revealed that NF-kB signaling pathway was involved in the process of disc degeneration. In the NP cell cultures, vitamin D significantly increased cell proliferation potency. Furthermore, vitamin D inhibited TNF-α induced apoptosis of human nucleus pulposus cells. Vitamin D reduced the phospho-NF-κB/p65 expression in the TNF-α-treated NP cells. CONCLUSION: Vitamin D can attenuate TNF-α-induced NP cells apoptosis through interfering with the NF-κB pathway.
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Apoptosis/efectos de los fármacos , FN-kappa B/metabolismo , Núcleo Pulposo/citología , Transducción de Señal/efectos de los fármacos , Factor de Necrosis Tumoral alfa/metabolismo , Vitamina D/farmacología , Células Cultivadas , Bases de Datos Genéticas , HumanosRESUMEN
BACKGROUND: At present, much is unknown about the etiology and pathogenesis of ULDH. However, it is interesting to note that many ULDH patients have a radiographic feature of adjacent vertebral wedge deformation. The purpose of this study is to investigate the relationship between symptomatic upper lumbar disc herniation (ULDH) and wedge-shaped vertebrae (WSV). METHODS: This was a retrospective study of 65 patients with single-level ULDH, who had undergone surgery at our medical center between January 2012 and December 2016. Clinical data including clinical and radiological evaluation results were performed. RESULTS: The incidence of WSV in the ULDH group (44.6%, 29/65) was more than in the lower lumbar disc herniation group (21.5%, 14/65). And there were statistically significant differences in WSV (χ2 = 7.819, P = 0.005), wedging angle of the vertebrae (WAV) (t = 9.013, P < 0.001), and thoracolumbar kyphotic angle (TL) (t = 8.618, P < 0.001) between two groups. Based on multivariate logistic regression analysis, WAV (OR = 0.783, 95% CI = 0.687-0.893, P < 0.001) and TL (OR = 0.831, 95% CI = 0.746-0.925, P = 0.001) were independently associated with ULDH. The cutoff values of WAV and TL were 5.35° and 8.35°, which were significantly associated with ULDH (OR = 3.667, 95% CI = 1.588-8.466, P = 0.002). CONCLUSION: The WSV is an independent risk factor for ULDH. WAV > 5.35° and TL > 8.35° were the predictors for ULDH. It should be noted that the patients with vertebral wedge deformation combined with thoracolumbar kyphosis have a higher risk of ULDH.
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Degeneración del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/anomalías , Vértebras Lumbares/diagnóstico por imagen , Adulto , Femenino , Humanos , Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
PURPOSE: The purpose of this study was to compare the clinical efficacy and safety of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of the elderly with very severe osteoporotic vertebral compression fractures (vsOVCFs). METHODS: From September 2012 to September 2015, 57 patients with vsOVCFs who had undergone PVP and PKP surgeries at our medical center were reviewed retrospectively, at least 2 years follow-up. All patients were divided into PVP group (n=31) and PKP group (n=26). Clinical data including clinical and radiological evaluation results were performed pre- and postoperatively. RESULTS: The operation time of PVP group (29.6±3.3 minutes) was less than that of PKP group (37.4±4.2 minutes), with significant differences (P<0.05). Compared with preoperative data, the VAS scores, Oswestry disability index (ODI) scores, and local kyphotic angle were improved with significant differences at 1 day after surgery and the last follow-up in two groups (P<0.05). However, there were no differences in VAS and ODI scores between the two groups (P>0.05). The local kyphotic angle of PVP group was more than that of PKP group after surgery, with significant differences (P<0.05). At 1 day after surgery and the last follow-up, the anterior height of vertebrae fractured was significantly improved compared with preoperative in PKP group (P<0.05), and there was no statistical difference compared with preoperative in PVP group (P>0.05). However, there were no significant differences between the two groups in the leakage rate of bone cement (P>0.05) and incidence of adjacent-level vertebra fracture (P>0.05). CONCLUSION: Both PVP and PKP can significantly relieve the pain of the patients with vsOVCFs. Restoring the vertebral height and local kyphotic angle corrections of PKP are comparatively better than those of PVP. However, the operation time of PKP is significantly longer than that of PVP and PKP is not superior in the leakage rate of bone cement and incidence of adjacent-level vertebra fracture compared to PVP.
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Objective This study aimed to identify the risk factors for vertebral compression fractures in patients with osteoporosis. Methods A total of 864 patients with osteoporosis were enrolled in a retrospective study from February 2010 to June 2016. Patients with diseases, such as pathological fractures, high-energy direct injury to the thoracic or lumbar vertebrae, and severe spinal deformity, were excluded. The patients were divided into two groups: those with vertebral compression fractures (288) and those with no vertebral compression fractures (576). Information on the patients' age, sex, lumbar bone mineral density (BMD), trauma, body mass index, previous history of vertebral compression fractures, and spondylolisthesis was recorded. Logistic regression analysis and the chi-square test were applied for comparisons. Results Univariate logistic regression analysis and chi-square test results showed no significant differences in age, sex, body mass index, type 2 diabetes, previous history of vertebral fracture, and trivial trauma between the groups. Multivariate analysis showed significant associations between spondylolisthesis and BMD. Logistic regression analysis showed that spondylolisthesis and BMD were risk factors for vertebral compression fractures. Conclusions Lumbar spondylolisthesis is an independent risk factor for vertebral compression fractures in patients with osteoporosis. Therefore, patients with osteoporosis and lumbar spondylolisthesis require more attention.
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Fracturas por Compresión/etiología , Vértebras Lumbares , Fracturas Osteoporóticas/etiología , Fracturas de la Columna Vertebral/etiología , Espondilolistesis/complicaciones , Anciano , Anciano de 80 o más Años , Densidad Ósea , Enfermedades Óseas Metabólicas/complicaciones , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Distraction-flexion of the lower cervical spine is a severe traumatic lesion, frequently resulting in paralysis. The optimal surgical treatment is controversial. It has been a challenge for orthopedic surgeons to manage distraction-flexion injury in the lower cervical spine while avoiding the risk of iatrogenic damage. Thus, safer strategies need to be designed and adopted.This study aimed to evaluate the clinical efficacy of immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine. METHODS: Twenty-four subjects of traumatic lower cervical spinal distraction-flexion were retrospectively analyzed from January 2010 to December 2013. Traffic accident was the primary cause of injury, with patients presenting with dislocated segments in C4-5 (n = 8), C5-6 (n = 10), and C6-7 (n = 6). Sixteen patients had unilateral facet dislocation and eight had bilateral facet dislocation. Spinal injuries were classified according to the American Spinal Injury Association (ASIA) impairment scale (2000 edition amended), with four cases of grade A, four cases of grade B, ten cases of grade C, four cases of grade D, and two cases of grade E. On admission, all patients underwent immediate reduction under general anesthesia and combined anterior and posterior fusion. The mean follow-up time was 3.5 years. RESULTS: All operations were completed successfully, with no major complications. Postoperative X-rays showed satisfactory height for the cervical intervertebral space and recovery of the vertebral sequence. Bone fusion was completed within 4 to 6 months after surgery. Surgery also significantly improved neurological function in all patients. CONCLUSION: Immediate reduction under general anesthesia and combined anterior and posterior fusion can be used to successfully treat distraction-flexion injury in the lower cervical spine, obtaining completed decompression, safe spinal re-alignment, and excellent immediate postoperative stability.
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Anestesia General , Vértebras Cervicales/lesiones , Vértebras Cervicales/cirugía , Luxaciones Articulares/cirugía , Traumatismos de la Médula Espinal/cirugía , Fusión Vertebral/métodos , Adulto , Anestesia General/métodos , Vértebras Cervicales/diagnóstico por imagen , Femenino , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Traumatismos de la Médula Espinal/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND Cervical facet dislocation is the anterior displacement of one cervical vertebral body on another. The aim of this study was to evaluate the clinical efficacy of skull traction through an anterior cervical approach in the treatment of severe lower cervical facet dislocation without vertebral body fracture. MATERIAL AND METHODS Forty subjects with severe lower cervical facet dislocation, without vertebral body fracture, were treated between February 2010 and December 2013. Road traffic accident was the primary cause of injury. Patients presented with dislocated segments in C3-C4 (n=4), C4-C5 (n=4), C5-C6 (n=12), and C6-C7 (n=20). Twenty-six patients had unilateral facet dislocation, and 14 patients had bilateral facet dislocation. Spinal injuries were graded according to the American Spinal Injury Association (ASIA) impairment scale and included grade A (eight cases), grade B (six cases), grade C (six cases), grade D (12 cases), and grade E (eight cases). The mean follow-up time was 4.2 years. RESULTS All procedures were completed successfully, with no major complications. Postoperative X-rays showed satisfactory height for the cervical intervertebral space and recovery of the vertebral sequence. Bone fusion was completed within four to six months after surgery. Surgery significantly improved neurological function in all patients. CONCLUSIONS Skull traction and an anterior approach can be used to successfully treat severe lower cervical facet dislocation, obtaining complete decompression, good reduction, and maintenance of intervertebral height with retention of the physiological curvature of the cervical spine.
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Descompresión Quirúrgica/métodos , Luxaciones Articulares/cirugía , Articulación Cigapofisaria/cirugía , Adulto , Anciano , Vértebras Cervicales/cirugía , China , Femenino , Humanos , Articulaciones/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Tracción/métodosRESUMEN
BACKGROUND The aim of this study was to analyze the clinical features and to evaluate the efficacy of anterior partial corpectomy and titanium mesh fusion and internal fixation of old fracture dislocation of the lower cervical spine. MATERIAL AND METHODS We retrospectively analyzed the clinical data of 52 patients with old lower cervical fracture and dislocation treated with anterior partial corpectomy and titanium mesh fusion fixation between January 2008 and December 2013, with a mean follow-up period of 4.1 years. There were 35 males and 17 females. Patient radiological data and clinical parameters were recorded and compared before and after the operations. RESULTS The average follow-up was 4.1 years. Intervertebral height and physiological curvature were well-reconstructed for all cases. No loosening or rupturing of titanium plate or screw occurred. The neurological function of the patients with incomplete spinal cord injury was significantly improved, and the function of the nerve roots at the injury level was also improved in patients with complete spinal cord injury. Bone fusion was completed within 6 months to 1 year after surgery. CONCLUSIONS Completed decompression, sequence and physiological curvature of the cervical vertebra, immediate and long-term anterior cervical column support, and nerve function restoration can be achieved by using anterior partial corpectomy and titanium mesh fusion and internal fixation to treat old fracture dislocation of the lower cervical spine. For cases with locked facet joints or posterior structures invading the vertebral canal, the combined anterior and posterior approaches should be performed, when necessary, to achieve better results.
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Fijación Interna de Fracturas/métodos , Fusión Vertebral/métodos , Adulto , Placas Óseas , Tornillos Óseos , Trasplante Óseo/métodos , Vértebras Cervicales/cirugía , Descompresión Quirúrgica/métodos , Femenino , Fractura-Luxación , Humanos , Luxaciones Articulares/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fracturas de la Columna Vertebral/cirugía , Titanio , Resultado del TratamientoRESUMEN
Studies in the literature have not delineated the surgical approaches of symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation after an initial anterior cervical fusion (ACF). The purpose of this study was to determine the optimal surgical approaches of ASD and the incidence of the dysphagia after reoperation.This was a retrospective study of 49 patients with ASD after an initial ACF surgery, which had undergone a reoperation at our medical center between January 2010 and December 2014. The surgical approaches were used by anterior cervical discectomy and fusion (ACDF), ACDF with the Zero-profile device, laminoplasty, and laminectomy with internal fixation. Patients were classified according to the different surgical approaches of anterior (n = 38) versus posterior (nâ=â11) groups and ACDF (nâ=â25) versus Zero-P (nâ=â13) groups. Clinical evaluations were performed preoperatively and repeated in 24 months after operation.This retrospective study included 26 men and 23 women with a mean age at revision surgery of 54.3 years and ASD onset time of 7.3 years. The patients were followed up with an average of 4.1 years. The reoperation rate was 5.4% in this study. The Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and visual analogue scale (VAS) scores demonstrated significant improvements compared with preoperative in both anterior and posterior groups (Pâ<â.05). However, there were no differences between the 2 groups (Pâ>â.05). The operation time of ACDF group was more than Zero-P group, with significant differences (Pâ<â.05). However, there were no differences in JOA, NDI, and VAS scores between the ACDF and Zero-P groups pre- and postoperative (Pâ>â.05). A total of 12 (24.5%) patients had dysphagia after reoperation. The incidence of dysphagia in Zero-P group (1/13) was less than ACDF group (11/25), with significant differences (Pâ<â.05). There were no cases of major neurological or vascular complications, and wound complications.The clinical situation, initial operation, and secondary preoperative imaging findings were analyzed comprehensively, anterior or posterior approach were chosen, which can effectively relieve spinal cord compression and improve spinal cord function. In ACDF with the Zero-profile device surgery, there was no need to remove the previous internal fixation, shorten the operation time, and reduce the incidence of postoperative dysphagia.