Objective: Objective: Osteoporosis is a systemic bone disease that seriously threatens the health and quality of life in middle-aged and older adults. In this review, we describe the relationship between bone marrow adipose tissue and aging osteoporosis and mainly focus on bone marrow mesenchymal stem cell osteogenic-adipo differentiation fate with aging along with the relevant mechanisms responsible for these changes. Methods: We summarized recent advance in regulating the bone marrow mesenchymal stem cell differentiation due to aging in this review. Results: Aging-related bone mass loss is accompanied by expanding bone marrow adipose because of an imbalance of bone marrow mesenchymal stem cell differentiation, resulting in adipogenesis. Ectopic adipocytes in the bone marrow increase with age and are a key factor responsible for the aging-related bone mass decrease. Transcription factors and classical regulating pathways are involved in this process during aging. Conclusion: As the global aging population increases, not only older women but also older men face a great fracture risk. Therefore, finding molecular mechanisms controlling the stimulating adipogenesis in BMSC during aging is important for providing the new cue for prevention and therapeutics for aging-related bone loss. Furthermore, upon physical examination of older people, except for the bone mineral density and bone turnover biochemical marker, the bone marrow adipose measurement should be taken into account when assessing the fracture risk and treatment plan that will be beneficial in clinical practice.
Objectives: To investigate the effect of the difference in C2-7 angle on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System.Methods: A retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up from January 2011 to November 2018 was performed. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2-7 angle (dC2-7A) on postoperative dysphagia. At the same time, other possible related factors including the difference between postoperative and preoperative O-C2 angle (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgery segments were analyzed.Results: In total, the non-dysphagia group comprised 139 patients and the dysphagia group comprised 42 patients. The single-factor analysis showed that smoking, PSTS and dC2-7A were significantly different between the two groups (P<0.05). Spearman’s correlation coefficient showed no significant correlation between the degree of dysphagia and dC2-7A (P>0.05). The results of the multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and dC2-7A were significantly associated with the incidence of dysphagia (P<0.05).Conclusions: The postoperative C2-7 angle has an important effect on the occurrence of dysphagia in patients undergoing Zero-P implant system interbody fusion surgery.
Background: To evaluate epidemiological, clinical and radiographic features in the development and prognosis of rapid progressive cervical spondylotic myelopathy (rp-CSM).Methods: A retrospective study of 175 patient records was performed between March 2011 and January 2017. Patients were divided into rp-CSM group and chronic CSM (c-CSM) group according to the deterioration time and severity of preoperative neurological dysfunction. After selection, 25 rp-CSM patients were matched to a control group of 75 patients with c-CSM. The clinical outcomes were assessed by the Modified Japanese Orthopaedic Association (mJOA) score at six different follow-up time points. The imaging parameters including Torg-Pavlov Ratio (TPR) on conventional lateral x-ray and magnetic resonance images (MRI), intervertebral disc level compression ratio and increased signal intensity (ISI) on T2W1 were analyzed between the two groups, and predictors for rapid neurological dysfunction in CSM patients were evaluated using multivariate analysis.Results: Twenty-five patients experienced rp-CSM (18 males; median age 59.04 ± 12.81 years) and were matched with Seventy-five control subjects that with CSM without rapid progression (54 males; median age 56.88 ± 12.31 years). The average time to develop severe neurological deterioration was 0.8 month in rp-CSM group and 24 month in c-CSM group (p=0.001), preoperative mJOA were 6 in rp-CSM patients and 12 in c-CSM patients (p=0.014) and rp-CSM patients demonstrated worse outcomes than the controls in one year after surgery (mJOA improvement rate 54.5% and 80%, p=0.021). There were no differences between the two groups except the history of diabetes and the long-term smoking in basic condition, radiographic measurements signified that TPR MRI, intervertebral disc level compression ratio and increased signal intensity (ISI) on T2W1 were inferior in patients with rp-CSM than patients with c-CSM. Regression analysis verified that the history of diabetes, TPR MRI < 0.4, compression ratio ≥50%, the sagittal diameter of ISI ≥50% of spinal canal diameter on T2W1 have significant correlations with the rapid progressive neurological dysfunction in patients with CSM. Conclusion: The prognosis of rapid progressive CSM is worse than that of common chronic CSM. The rapid neurological deterioration can be identified by TPR MRI (< 0.4), compression ratio (≥50%), sagittal diameter of ISI (≥50% of spinal canal diameter). Besides, a history of diabetes was also a negative factor for these patients.
Background: To investigate the effect of the difference in the C2-7 angle (C2-7A) on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System.Methods: A retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up was performed from January 2011 to November 2018. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2-7As (dC2-7A) on postoperative dysphagia. Furthermore, other possible related factors including the difference between postoperative and preoperative O-C2 angles (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgical segments were analyzed.Results: One hundred thirty-nine patients were included in the non-dysphagia group, and 42 patients were included in the dysphagia group. Single-factor analysis showed that smoking, PSTS and the dC2-7A were significantly different between the two groups (P<0.05). Spearman’s correlation coefficient showed no significant correlation between the degree of dysphagia and he dC2-7A (P>0.05). The results of multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and the dC2-7A were significantly associated with the incidence of dysphagia (P<0.05).Conclusions: The postoperative C2-7A has an important effect on the occurrence of dysphagia in patients undergoing interbody fusion surgery with the Zero-P Implant System.
BackgroundA series of methods, which use angle to quantitatively evaluate cervical sagittal morphology cannot objectively reflect the advantages and disadvantages in some cases. In this study, we try to use the area methods to supplement it in above cases.MethodsThe Cobb angle, range of motion (ROM) of C2-7, and antero-posterior diameter of atlas (C1-APD) were measured at neutral, flexion, and extension X-ray radiographs of the cervical spine in all 191 patients. Patients were divided into Group A and Group B according to whether their cervical sagittal morphology can be objectively quantified with Cobb angle. Pearson correlation analysis was used to compare the consistency of the results, paired t-test was used to compare the dispersion coefficient, receiver operator characteristic (ROC) curve was used to evaluate the diagnostic value.ResultsThe C5 vertebra was used as the vertex to construct the cervical sagittal triangle, and according to the different selection of the other two points, the triangle was further divided into four types. The Area Coefficient (AC) was defined as "\(\text{A}\text{C}=\frac{\left(\text{A}\text{r}\text{e}\text{a} \text{o}\text{f} \text{s}\text{a}\text{g}\text{i}\text{t}\text{t}\text{a}\text{l} \text{t}\text{r}\text{i}\text{a}\text{n}\text{g}\text{l}\text{e}\right)}{{\text{C}1-\text{A}\text{P}\text{D}}^{2}}\)". In Group A, whose cervical sagittal morphology could be objectively quantified with Cobb angle, the AC showed greatly consistency, while in Group B, it was less consistent. AC results have stronger predictive value for clinical symptoms in Group B. The dispersion coefficients of the results measured by the four area methods are significantly smaller than the Cobb angle. The results of quantifying cervical ROM by area methods were also in good agreement with Cobb angle.ConclusionCompared with Cobb angle, AC has better objectivity, stability, and clinical significance.
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