Background: Adjacent segment disease (ASD) is an acknowledged problem of posterior lumbar interbody fusion (PLIF). Many studies have been reported concerning the role of lordosis distribution index (LDI) in spinal biomechanics. However, few reports have been published about the impact of LDI on ASD following L4-S1 PLIF. Methods: The study enrolled 200 subjects who underwent L4-S1 PLIF for degenerative spine disease from 2009 to 2014. The average follow-up term was 84 months. Several lower lumbar parameters were measured, including lower lumbar lordosis (LLL), lumbar lordosis (LL), pelvic incidence (PI), and LDI on the pre and postoperative radiograph. Perioperative information, comorbidities, and operative data were documented. Kaplan-Meier curves were plotted for the comparisons of ASD-free survival of 3 different types of postoperative LDI subgroups. Results: The incidence of ASD was found to be 8.5%. LL and LLL increased by 3.96°(38.71°vs 42.67°; P < 0.001) and 3.60°(26.22°vs 28.82°; P < 0.001) after lower lumbar fusion surgery, respectively. Lordosis distribution index (LDI) increased by 0.03 (0.66 vs 0.69, P = 0.004) postoperatively. A significant difference (P = 0.001) was observed when comparing the incidence of ASD among postoperative LDI subgroups. The Kaplan-Meier curves showed a marked difference in ASD-free survival between low and moderate LDI subgroup (log-rank test, P = 0.0012) and high and moderate LDI subgroup (log-rank test, P = 0.0005). Conclusion: Patients with abnormal postoperative LDI were statistically more likely to develop ASD than those who had normal postoperative LDI. Moreover, patients with low postoperative LDI were at greater risk for developing ASD than those with high postoperative LDI over time.

Background. ASD is an acknowledged problem of PLIF. Many studies have been reported concerning the role of LDI in spinal biomechanics. However, few reports have been published about the impact of LDI on ASD following L4-S1 PLIF. Methods. The study enrolled 200 subjects who underwent L4-S1 PLIF for degenerative spine disease from 2009 to 2014. The average follow-up term was 84 months. Several lower lumbar parameters were measured, including lower lumbar lordosis (LLL), lumbar lordosis (LL) and LDI on the pre- and postoperative radiograph. Perioperative information, comorbidities and operative data were documented. Kaplan-Meier curves were plotted for the comparisons of ASD-free survival of 3 different kinds of postoperative LDI subgroups. Results. The incidence of ASD was found to be 8.5%. LL and LLL increased by 3.96 ° (38.71 ° vs 42.67 ° , P ＜ 0.001) and 3.60 ° (26.22 ° vs 28.82 ° , P ＜ 0.001) after lower lumbar fusion surgery, respectively. Lordosis distribution index (LDI) increased by 0.03 (0.66 vs 0.69, P=0.004) postoperatively. A significant difference(P=0.001) was observed when comparing the incidence of ASD among postoperative LDI subgroups. The Kaplan-Meier curves showed a marked difference in ASD-free survival between low and moderate LDI subgroup (Log Rank test, P=0.0012) , high and moderate LDI subgroup (Log Rank test, P=0.0005) Conclusion. Patients with abnormal postoperative LDI were statistically more likely to develop ASD than those who had normal postoperative LDI. Moreover, patients with low postoperative LDI were at greater risk for developing ASD than those with high postoperative LDI over time.

Rectus sternalis muscle is a rare morphological variation of the musculature of the anterior abdominal wall. A unilateral right sided Rectus sternalis muscle was found during routine dissection of a 55 years old female cadaver with hefty built at

Objective: Preoperative tracheal retraction exercise (TRE) to minimize the occurrence of postoperative oropharyngeal dysphagia after anterior cervical spine surgery. Methods: A total of 220 patients admitted for elective anterior cervical spine surgery from January 2013 to December 2014 were retrospectively reviewed. The patients were allocated into two groups: TRE group and control group (without TRE). Modified dysphagia scoring system (MDSS) was used for evaluating the presence and severity of dysphagia symptoms at 1 week and 1, 3, and 6 months after surgery. Demographics such as age, gender, smoking, type of procedure, number of levels operated, duration of surgery, intraoperative blood loss, and instrumentation were analyzed. The clinical outcomes in both groups were compared with Neck Disability Index (NDI), Visual Analogue Scale (VAS) for arm and neck pain, and Odom's criteria for global outcome. Results: In the first week postoperatively, 86 patients (39.1%) developed dysphagia, which decreased to 72 (32.7%), 5 (2.3%), and 4 (1.8%) after 1, 3, and 6 months, respectively. The patients who received the TRE prior to surgery had significantly better MDSS scores (p ¼ 0.032 for second-level, 0.022 for third-level, and 0.009 for fourth-level fusions) than control group patients who did not receive TRE at the first week of surgery. At the 1-month follow-up, the followed-up patients for second-to fourthlevel fusions in the TRE group had improved MDSS scores than those in the control group (p ¼ 0.041 for second-level, 0.025 for third-level, and 0.0011 for fourth-level fusions). MDSS scores showed no significant difference between both the groups at 1 and 3 months postoperatively for single level anterior cervical fusion. NDI and VAS scores didn't yield any significant difference. Global outcome by Odom's criteria was 88.6%. Conclusion: Preoperative TRE can significantly reduce the occurrence of postoperative dysphagia after ACDF surgery. During follow-up, the incidence of postoperative dysphagia was significantly lower and had resolved at 3 months in all patients.

Background Intervertebral disc degeneration (IDD) is a leading cause of disability with limited treatment strategies. A better understanding of the mechanism of IDD might enable less invasive and more targeted treatments. This study aimed to identify the circular RNA (circRNA)–microRNA (miRNA)–messenger RNA (mRNA) competing endogenous RNA (ceRNA) regulatory mechanisms in IDD. Methods  The GSE67567 microarray dataset was downloaded from the Gene Expression Omnibus database. After data preprocessing, differentially expressed circRNAs, miRNAs and mRNAs between IDD and controls were identified. A ceRNA network was constructed on the basis of the interaction between circRNAs and miRNAs, and miRNAs and mRNAs. Pathway enrichment analysis was performed on the mRNAs in the ceRNA network. Then, with ‘intervertebral disc degeneration’ as keywords, IDD-related Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were searched for in the Comparative Toxicogenomics Database. Results A total of 105 differentially expressed circRNAs, 84 miRNAs and 967 mRNAs were identified. After analysis, 86 circRNA–miRNA, and 126 miRNA–mRNA regulatory relationship pairs were obtained to construct a ceRNA network. The mRNAs were enriched in six KEGG signalling pathways, and four were associated with IDD: the hsa04350: TGF-beta signalling pathway, hsa04068: FoxO signalling pathway, hsa05142: Chagas disease (American trypanosomiasis) and hsa04380: Osteoclast differentiation. An IDD-related ceRNA network was constructed involving four circRNAs, three miRNAs and 11 mRNAs. Auxiliary validation showed that the expression levels of miR-185-5p, miR-486-5p, ACVR1B, FOXO1, SMAD2 and TGFB1 were consistent in different databases. Conclusions Our study identified some circRNA–miRNA–mRNA interaction axes potentially associated with the progression of IDD, viz.: circRNA_100086–miR-509-3p–MAPK1, circRNA_000200–miR-185-5p–TGFB1, circRNA_104308–miR-185-5p–TGFB1, circRNA_400090–miR-486-5p–FOXO1 and circRNA_400090–miR-486-5p–SMAD2.