BackgroundStudies have shown that lumbar disc herniation, degenerative lumbar instability, and other degenerative lumbar spinal diseases are often secondary to disc degeneration. By studying the intervertebral disc, researchers have clarified the pathological changes involved in intervertebral disc degeneration but have ignored the roles of biomechanical factors in the development of disc degeneration. This study aims to investigate the relationships among the location, scope, and extent of lumbar disc degeneration and sagittal spinal-pelvic parameters.MethodsA retrospective analysis was performed on the clinical data of 284 patients with lumbar degenerative disc diseases (lumbar disc herniation and degenerative lumbar instability) from January 2013 to December 2016. Statistics were calculated for the following: (1.) patients’ general information: name, sex, age, height, and weight. (2.) Measurements of sagittal parameters from total spinal radiographs: thoracic kyphosis (TK), Lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), T1 tilt angle (TA), and T1 pelvic angle (TPA). (3.) Location, scope, extent, and overall degree of lumbar disc degeneration. Parameters were analyzed in groups by sex, PI, and SVA, and a correlation analysis was performed for the location, scope, extent, and overall degree of lumbar intervertebral disc degeneration with 8 spinal-pelvic sagittal parameters.ResultsThe mean ages of the male and female patient groups were 59.00 and 53.28 years old, respectively (P < 0.05). The PT, location, scope, and overall degree of degradation were significantly different between the sexes (P < 0.05). Linear correlation analysis results showed that the overall degree and extent of degradation (r = 0.788, P < 0.01), LL and SS (r = 0.737, P < 0.01), PI and PT (r = 0.607, P < 0.01), and TPA and PT (r = 0.899, P < 0.01) were strongly correlated. The location values were 4.08 ± 0.72 in patients with PI≤50° and 3.62 ± 0.94 in patients with PI> 50° (P = 0.018). Different SVASVA groups differed in their overall degree of degeneration (P = 0.002).ConclusionsThe location of lumbar intervertebral disc degeneration is affected by spinal-pelvic sagittal morphology. Populations with small PI values tend to exhibit degeneration at the L4/5 and L5/S1 discs, and populations with large PI values tend to exhibit degeneration at the L3/4 and L4/5 discs. The SVA value and the overall degree of lumbar disc degeneration are positively correlated.
To investigate trends in long-noncoding (lnc) RNA research systematically, we compared the contribution of publications among different regions, institutions, and authors. Publications on lncRNA were retrieved from Web of Science (WoS) from 1975 to 2017. A total of 3879 papers were identified, and together they were cited 62967 times. The literature on lncRNA had been continuously growing since 2006, and the expansion might continue at a rapid pace until around 2021. China contributed the greatest proportion (63.47%) of lncRNA publications, and the USA ranked second in the number of publications (944 articles), while it had the highest citation frequency (43168 times) and H-index (97). The journal Oncotarget has the greatest number of publications on lncRNA research, with 305 papers. The keywords could be stratified into two clusters: cluster 1 (application) and cluster 2 (characteristics). Correspondingly, the “TNM stage,” “epithelial mesenchymal transition (EMT),” “cell apoptosis,” and “overall survival” are research hotspots since 2015. Thus, research on lncRNA showed a swiftly expanding trend, with China making the largest contribution. The focus on lncRNA is gradually shifting from “characteristics” to “application.”
The aim of this stusy was to investigate whether spinal fusion to T2, T3, or T4 affects sagittal alignment of the cervical spine in Lenke 1 adolescent idiopathic scoliosis (AIS) patients.A retrospective study comprised of 64 Lenke 1 AIS patients was performed to assess the radiographic and clinical outcome. According to the upper instrumented vertebrae (UIV) (T2, T3, or T4), the patients were divided into 3 groups. Comparison analyses were performed among these 3 groups of patients as between pre-op, immediate post-op, and final follow-up, as well as between these groups.Between groups, comparison analyses did not detect a statistical difference in cervical lordosis (CL) preoperatively (P = .501), immediately after surgery (P = .795), and at follow-up (P = .510). Immediately after surgery, CL increased significantly in all groups (T2, P = .004, T3, P < .001 and T4, P = .002 respectively). Compared with immediate postoperatively, CL at final follow-up increased in T2 group (P = .037), and T4 group (P = .010). Furthermore, CL at follow-up was significantly correlated with the following parameters: preoperative (coronal plane balance [r = .349, P = .004], pelvic tilt [r = 0.347, P = .004), pelvic incidence [r = 0.261, P = .031], and CL [r = 0.471, P < .001]) immediately postoperative (CL [r = 0.946, P < .001], T1-slope [r = −0.646, P < .001], and thoracic kyphosis [TK] [r = −0.353, P = .003]), and at follow-up (TK [r = −0.342, P = .004], and T1-slope [r = −0.821, P < .001]). However, there was no significant correlation between a selection of UIV and CL at follow-up (r = 0.031, P = .802). Moreover, Scoliosis Research Society (SRS-22) scores between groups were similar preoperatively (P = .242), immediately after surgery (P = .828), and at follow-up (P = .219).In Lenke 1 AIS patients, the selection of UIV mainly affects the coronal plane, especially shoulder balance. Fusion to T2, T3, or T4 did not affect the alignment of the cervical spine, and the SRS-22 score.Level of evidence: Level IV.
Recombinant human bone morphogenetic proteins (rhBMPs) can stimulate bone formation and growth in the treatment of spinal fusions and nonunions. However, it is still unclear whether rhBMPs function in the prevention of intervertebral disc degeneration (IDD). Here, we discovered that BMP levels were decreased in IDD patients, which impaired the BMP/Smad (Mothers against decapentaplegic homologs) signaling. Conducting a microarray assay in Smad4-knockdown cells, we found that expression of PUMA (p53-upregulated modulator of apoptosis) was significantly induced. The molecular analysis revealed that Smad4 recruited HDAC1 (histone deacetylase 1) and the phosphorylated Smad1/5/8 to dock on the promoter of PUMA to repress its expression. The impairment of BMP/Smad signaling in IDD patients caused the significant induction of Puma-dependent apoptosis and resulted in the pathogenesis of IDD. In vitro knockdown of BMP receptors (BMPR1a and BMPR2) in nucleus pulposus (NP) cells could mimic the molecular changes of BMP/Smad signaling and Puma-dependent apoptotic signaling that were observed in IDD patients. Exposing NP cells to RITA (reactivating p53 and inducing tumor apoptosis) small molecule and rhBMP2 (or rhBMP7), we observed that rhBMP2/7 could significantly decrease protein levels of Puma and its downstream proapoptotic molecules, blocking cell apoptosis. Importantly, administration of rhBMPs in aged rats could inhibit the occurrence of IDD. Our results provide a link between BMP/Smad signaling and Puma-dependent apoptotic signaling, revealing a new mechanism of how BMPs contribute to IDD pathogenesis and providing evidence that rhBMPs may decrease apoptosis and improve the outcome of IDD.
This study evaluated the risk factors for dysphagia after anterior cervical spine surgery by multidimensional analysis and investigated the predictive values of these risk factors for dysphagia. The patients underwent anterior cervical spine surgery and were followed for at least 6 months. Sex, age, tracheal mobility, smoking history, implant type, C3 anterior vertebral soft tissue swelling, narrowest esophageal distance before internal fixation, cervical curvature, operative time, occurrence of fusion, number of operative segments, and highest vertebral segment were recorded. Chi-square test and logistic regression were performed to analyze the predictive value of each dimension for dysphagia. A total of 158 patients were included in this study. The mean C3 anterior vertebral soft tissue swelling was 8.8±4.5 mm, the mean narrowest esophageal distance before internal fixation was 6.9±4.4 mm, and the mean operative time was 78.5±39.2 minutes. Chi-square test results showed that age 60 years and older, female sex, internal fixation with titanium plate/titanium mesh, narrowest esophageal distance before internal fixation of less than 5 mm, and 3 operative segments indicated a relatively high incidence of dysphagia. Logistic regression analyses showed that age, sex, implant type, narrowest esophageal distance before internal fixation, and number of operative segments were all risk factors predictive of postoperative dysphagia. The area under the receiver operating characteristic curve was 0.872. Age 60 years and older, female sex, internal fixation with titanium plate/titanium mesh, narrowest esophageal distance before internal fixation of less than 5 mm, and 3 operative segments were risk factors for dysphagia after anterior cervical surgery. The regression equation may be used to predict the occurrence of dysphagia. [Orthopedics. 2018; 41(1):e110-e116.].
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