Study design This is a prospective case-controlled studyBackground: To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). Methods: 90 patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores.Results: A total of 90 patients were enrolled and the patients were divided into spread group (n=48) and none-spread group(n=42). Cage subsidence of (spread group vs none-spread group) was (0.82±0.68 vs 0.58±0.81) mm, (0.64±0.77 vs 0.34±0.46) mm, (0.48±0.43 vs 0.25±0.28) mm, and (0.45±0.47 vs 0.17±0.32) mm at 3months, 6months, 12months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. Conclusion: The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the "natural height" of cervical vertebra, reduce the occurrence of axial pain in patients with CSM involving single-level, and prevent rapid Cage subsidence and the loss of cervical curvature.
Study design This is a prospective case-controlled studyPurpose: To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). Methods: 90 patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores.Results: A total of 90 patients were enrolled and the patients were divided into spread group (n=48) and none-spread group(n=42). Cage subsidence of (spread group vs none-spread group) was (0.82±0.68 vs 0.58±0.81) mm, (0.64±0.77 vs 0.34±0.46) mm, (0.48±0.43 vs 0.25±0.28) mm, and (0.45±0.47 vs 0.17±0.32) mm at 3months, 6months, 12months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. Conclusion: The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the "natural height" of cervical vertebra, reduce the occurrence of axial pain in patients with CSM involving single-level, and prevent rapid Cage subsidence and the loss of cervical curvatur
Background: Spinal injuries is with high frequency in the modern wars and some patients with severe spinal injures have to accept the emergency spinal surgery. Nutrient foramen is easy to identify intraoperatively. The purpose of this study was to investigate the feasibility and reliability of using the nutrient foramen to guide the pedicle screw placement.Methods: Nine dried human vertebral bone were involved in this study. The anatomical association to the pedicles and bony landmarks were measured in the vertebrae for C6-T6. We also determined the frequency with which the nutrient foramina were present in 86 cadaveric vertebrae. We identified the pedicle location, base of the superior articular process, base of inferior articular process, base of transverse process, and the posterior median line with respect to the nutrient foramenResults: The overall presence of the nutrient foramina was 63% in the specimens. The nutrient foramina located cranially and laterally on the lamina, and the nutrient foramen was located near to the pedicle. Conclusion: The location of nutrient foramen can be used for identifying the entry point for pedicle screws in the cervicothoracic junction. The nutrient foramen is easy to identify during operation and with a high frequency of occurrence. Therefore, the nutrient foramen could be used as a reliable landmark to guide the entry point localization in emergency spinal surgeries in the battlefield.
Background Traumatic spinal cord injury (SCI) causes severe motor dysfunction and persistent central neuropathic pain (Nep) that remains uncured yet. Programmed cell death ligand-1 (PD-L1) is typically produced by cancer cells and contributes to the immune-suppressive in tumor microenvironment, and the role of PD-L1 in regulating inflammatory response and Nep after SCI remains unclear. A growing amount of research has begun to investigate the effect of PD-L1 on macrophages and microglia. Considering the pivotal role of macrophages/microglia in the inflammatory response after SCI, we tested the hypothesis that PD-L1 improved the recovery of locomotor and sensory functions after SCI through macrophages and microglia. Methods The mice SCI model was employed to determine the changes in expression patterns of PD-L1. Meanwhile, we constructed PD-L1 knockout mice to observe differences in functional recovery and phenotypes of macrophages/microglia post-SCI. Results In present study, PD-L1 was significantly upregulated after SCI and highly expressed on macrophages/microglia. PD-L1 knockout (KO) mice showed poor locomotor recovery and serious pathological pain compared with wild-type (WT) mice. Furthermore, deletion of PD-L1 significantly increased the polarization of M1-like macrophages/microglia. Mechanistic analysis revealed that PD-L1 may improve functional outcomes following SCI by inhibiting phosphorylation of p38 and ERK1/2. Conclusions Our observations implicate the involvement of PD-L1 in recovery of SCI and provide a new treatment strategy for prevention and treatment of this traumatic condition.
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