Objective To study cerebral cortical activation preoperatively and postoperatively in patients with cervical spondylotic myelopathy (CSM), and discuss effect of the surgery on cortical reorganization in functional recovery.Methods 19 cases with CSM intrial group underwent cervical vertebra canal decompression surgery according to clinical routine.Cases in trial group completed clinical assessment using the modified Japanese Orthopaedic Association Scores (mJOA) prior to decompression and 12 months following surgery, and underwent cerebral functional MRI and conventional MRI in the same time.19 controls also carried out cerebral functional MRI and conventional MRI.All subjects performed a finger-tapping paradigm with right hand during processing functional MRI.The imagings and data of trial group were divided into preoperative group and postoperative group in accordance with the time of completed and than analysed.Results The mJOA score of postoperative group was increased significantly (P<0.001).Cortical volume of activation (VOA) of preoperative group was significantly higher than the control group (P<0.05).VOA was lower in the postoperative group, but still significantly higher than the control group (P<0.05).The preoperative group was able to detect and activate the signal only in the left precentral gyrus.The postoperative group was able to detect and activate the signal in the l left postcentral gyrus, the premotor area and the supplementary motor area, and the right cerebral cortex could also detect a small amount of activation signal.Conclusion CSM patients undergo cerebral cortical remodeling, causing sensory and motor function activation areas to expand and shift.The changes of cortical reorganization after cervical vertebra canal decompression surgery are associated with functional recovery.The surgical treatment may promote the compensating cortical reorganization.

Objective To explore the association between C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene and susceptibility to hyperuricemia and gout.Methods The case-control studies from Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang,Weipu,PubMed,Cochrane Library,OvidSP,Wiley Online Library,EBSCO,Elsevier Science Direct,Springer Link and Google scholar databases for the association of C677T polymorphism of MTHFR gene with hyperuricemia and gout.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from randomeffects or fixed-effects models to assess the association strength by RevMan 5.3 and Stata 12.0 software.Results Ten references enrolled 1 899 hyperuricemia patients and 5 403 controls,and 3 references enrolled 209 gout patients and 194 controls in total.The meta analysis showed that carriers of genotype CC [OR=0.42,95％CI (0.29,0.63),P＜0.01] and allele C [OR=0.54,95％CI (0.42,0.71),P＜0.01] had lower risk of hyperuricemia;genotype TT [OR=1.55,95％CI (1.32,1.83),P＜0.01] and allele T [OR=1.84,95％CI (1.38,2.45),P＜0.01] had higher risk of hyperuricemia,carriers of genotype CC [OR=0.32,95％CI (0.15,0.68),P=0.003] and allele C [OR=0.35,95％CI (0.17,0.70),P=0.003] hadlower risk of gout;genotype TT [OR=2.92,95％CI (1.74,4.92),P＜0.01] allele T [OR=2.69,95％CI(1.50,4.84),P=0.0009] had higher risk of gout.Conclusion The meta analysis reveals that C677T polymorphism of MTHFR gene is associated with the susceptibility to hyperuricemia and gout.

Objective To explore the association between the polymorphism in-308 site of tumor necrosis factor (TNF)-α promoter region and ankylosing spondylitis (AS).Methods The case-control studies from PubMed,Cochrane Library,Ovid,Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang and Weipu databases for the association polymorphism in-308 site of TNF-α promoter region with AS.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from random-effects models or fixed-effects models to assess the association strength by RevMan 5.2 and Stata 12.0 software.Results Nineteen references enrolled 2 155 AS patients and 2 367 controls in total.The meta analysis showed that the frequencies of GG vs (AA +GA) genotypes was not statistically different between AS group and the control group in total populations [OR=1.20,95％CI (0.85,1.70),P=0.30],in the populations of Asian origin [OR=1.29,,95％CI (0.66,2.52),P=0.45] and in the populations of non-Asian origin [OR=1.16,95％CI (0.78,1.72),P=0.46].The analysis also showed that the frequencies of AA vs (GG +GA) genotypes was not statisticalLY differenT between AS group and the control group in total populations[OR=0.78,95％CI (0.53,1.15),P=0.21],in the populations of Asian origin [OR=1.15,95％CI (0.33,4.00),P=0.82] and in the populations of non-Asian origin[OR=0.69,95％CI (0.42,1.13),P=0.14].The analysis also showed that the frequencies of allele G vs A was not statistically different between AS group and the control group in total populations [OR=1.09,95％CI (0.79,1.50),P=0.61],in the populations of Asian origin [OR=1.17,95％CI (0.65,2.09),P=0.60] and in the populations of non-Asian origin [OR=1.05,95％CI (0.71,1.54),P=0.81].Conclusion The Meta-analysis reveales that all genotypes and alleles of-308 site of TNF-α promoter region may not be associated with AS.

Objectives: To explore the association between the polymorphism in -857 site of tumor necrosis factor (TNF)-α promoter region and the susceptibility to ankylosing spondylitis (AS). Methods: Case-control studies Pubmed, Cochrane Library, Ovid, Chinese Biomedical Database(CBM), Chinese National Knowledge In-frastructure(CNKI), Wanfang and Weipu data bases from inception to October 2013 for the association between TNF-α-857 C/T polymorphism and the susceptibility to AS were collected. Meta-analysis was performed by Revman 5.2 and Stata 12.0 software. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were de-rived from random-effects or fixed-effects models to assess the strength of the association. Results: Nine case-control studies were included in the final meta-analysis, including a total of 933 AS patients and 1094 controls. Statistically significant differences between AS and control groups were observed in the susceptibility to AS and TNF-α-857 genotype CC [OR=0.46, 95%CI (0.26, 0.81), P=0.007], allele C [OR=0.61, 95%CI (0.41, 0.91), P=0.02] and T [OR=1.64, 95%CI (1.10, 2.43), P=0.02]. But, no statistical difference in the fre-quency of genotype TT [OR=1.49, 95%CI (0.95, 2.34), P=0.08] was observed between AS and control groups. There were obvious heterogeneities among the studies of genotype CC(P<0.00001, I2=87%), allele C(P<0.00001, I2=84%) and allele T(P<0.00001, I2 =84%), except genotype TT(P=0.09, I2=42%). Sensitivity analysis was per-formed by leaving out one study at a time, but the heterogeneity remained obvious. It was symmetric of the funnel plots of genotype CC, allele C and T with AS, but genotype TT. There was no statistical significance in genotype CC[Begg′s test(z=0.52, P=0.602), Egger′s test(t=0.23, P=0.825)], genotype TT[Begg′s test(z=0.94, P=0.348), Egger′s test(t=1.26, P=0.248)], allele C[Begg′s test(z=0.31, P=0.754), Egger′s test(t=0.72, P=0.494)] or allele T[Begg′s test(z=0.31, P=0.754), Egger′s test(t=-0.72, P=0.494)]. Conclusions: Genotype CC, allele C and T of TNF-α-857 are associated with the susceptibility to AS, and T-allele carriers have higher risk of AS.

BACKGROUND:Cervical kyphosis post laminectomy is a common iatrogenic,and progressive abnormality of the curvature of cervical spine,and can influence the function of cervical spine of children and adults.OBJECTIVE:To explore the effect of multiple levels of laminectomies on the curvature of cervical spine,and analyze the role of the elastic modulus of cervical intervertebral disc and ligaments on maintaining curvature of postlaminectomy cervical spine.DESIGN,TIME AND SETTING:Three-dimensional finite element analysis was performed in Changzheng Hospital,Second Military Medical University of Chinese PLA between January 2003 and January 2004.MATERIALS:The highly resolution pictures of the cross-section of cervical spine(interval distance of layer 1 mm) were came from male cross-section of cervical spinal of American visible human project,which was freely downloaded from The Visible Human Project.METHODS:The highly resolution pictures of cervical spinal cross-section were used as data to reconstruct the three-dimensional multiple levels postlaminectomy cervical spine models including all structure of spine from cranial base to the first thoracic vertebrae except the vertebral lamina,spinous process,ligamentum flavum,interspinous and supraspinous ligament from the second to the seventh cervical spine.The finite element and elastic modulus of the structures of cervical spine were defined according to previous reports.With this model and Ansys6.1 finite element analysis software,the effect of laminectomy on the curvature of cervical spine and impact of the elastic modulus of intervertebral disc and ligament to the curvature of postlaminectoy cervical spine were analyzed.MAIN OUTCOME MEASURES:The influence of the elastic modulus of cervical intervertebral disc and ligament(anterior and posterior longitudinal ligaments) on the curvature of the postlaminectomy cervical spine.RESULTS:The physical lordosis of multiple levels postlaminectomy cervical spine was reduced after multi-level loading,and the physical lordosis of the superior cervical spine disappeared with only slightly kyphosis.The kyphosis was aggravated after reducing the elastic modulus of intervertebral disc and ligament(anterior and posterior longitudinal ligaments).Following increased elastic modulus of intervertebral disc and ligament,the kyphosis of cervical spine was reduced even disappeared,and gradually regained the normal lordosis of cervical spine.CONCLUSION:Multiple levels cervical laminectomy can significant reduce the physical lordosis of cervical spine,and convert the physical cervical lordosis to cervical kyphosis.The elastic modulus increase of cervical intervertebral disc and ligament can inhibit kyphosis formation post laminectomy.

Objectives:To evaluate the long-term complications of percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures (OVCF),and to provide evidence for clinical procedure.Methods:Databases including CNK1,CBM,PubMed,The Cochrane Library(lssue 2,2017),Wiley Online Library,ELSEVIER Science Direct(SDOS) were used to collect the randomized controlled trials(RCTs) which compared PKP with conservative treatment in the treatment of OVCF from inception to February 2017.The diagnosis of thoracolumbar vertebral compression fracture was confirmed by X-ray,CT and MRI.The presence of thoracolumbar osteoporotic T which was less than or equal to-2.5,was confirmed by bone mineral density measurement.All the patients were 50 years or older,and disease duration was less than 6 months;postoperative outcomes included at least one of the following indicators:new vertebral fractures,adjacent fractures,serious adverse events,visual analogue score.Cochrane system evaluation manual 5.0.1 was referred to evaluate the quality of the included literatures.Results:Five RCT studies included four English literatures and one Chinese literature.Methodological quality assessment of 4 articles were more than or equal to 4 points,one article scored 3 points.PKP group consisted of 417 cases,conservative treatment group of 458 cases.The results of meta-analysis showed that there was statistical difference in VAS between the two groups after 3 to 6 months' treatment(mean difference=-0.36;95％CI-0.07 to-0.65;P=0.02).However,there was no statistical difference in new vertebral fractures,adjacent fractures or serious adverse events.Conclusions:Application of PKP in OVCF can reduce the patients' long-term (3-6 months) VAS pain score and does not increase the risks of new vertebral fractures,adjacent fractures and serious adverse events.

hyperflexion,and the differentiation was significant(P

Objective To investigate incision pathogenic bacteria after spinal surgery, and observe clinical effects of therapeutic methods. Methods A total of 30 cases of early surgical incision infection (7 cases of superficial infection and 23 cases of deep infection) after spinal surgery were retrospectively analyzed. The basic data including clinical manifes-tations, diagnosis, treatment, etiology and follow-up results were analyzed. Results It was found that the mean infection time after operation was 2-15 days in 30 patients. Thirty-three strains were isolated including 18 gram-positive cocci (54.5%, and Staphylococcus aureus account for 13, 39.4%), 15 gram-negative bacteria (45.5%, and Coli communior account for 6, 18.2%). The drug susceptibility test showed that gram-positive cocci were highly sensitive to vancomycin, rifampin, tei-coplanin and cotrimoxazole. No vancomycin-resistant Staphylococcus aureus were found. Gram negative bacteria were high-ly sensitive to imipenem (100%). Seven cases of superficial infection were cured after dressing. Twenty-three cases of deep incision wound infection were no recurrence of infection after treatment by deep wound debridement, and postoperative cathe-terization. Conclusion The early wound infection after spinal surgery is usually due to Staphylococcus aureus. It is good to perform wound debridement, continuous perfusion drainage, and treatment with vancomycin for deep wound infection.

Objective To assess the efficacy of radiofrequency therapy combined with ozone injection in the treatment of lumbar disc protrusion. Methods A total of 202 patients with lumbar disk protrusion were included and divided into three groups:radiofrequency (RF) group, ozone (Oz) group, and combination (Co) group. The efficacy was evaluated by visual analogue scale (VAS), Macnab curative effect evaluation, and oswestry disability index (ODI) at 1d, 1m and 6m after treat?ment. Results There were no significant differences in gender, age, the course of disease, preoperative VAS scores and ODI scores (P>0.05). All patients were operated successfully. There were no infection of the intervertebral disc, no compli?cations of spinal cord, nerve and no blood vessel injury. There were no significant differences in preoperative VAS and ODI scores between three groups. The VAS and ODI scores were significantly lower at 6 month and 12 month after operation in Co group combined with those of RF group and Oz group. There were no significant differences in these two scores between RF group and Oz group (P>0.05). There were no significant differences in effective rates at 1d, 6 month and 12 month after operation between three groups (P>0.05). But the excellent and good effective rates were higher in Co group than those of RF and Oz groups. There were no significant differences in excellent and good effective rates between RF group and Oz group. Conclusion The therapy of radiofrequency combined with ozone injection is an efficient and mini-invasive tech?nique for the treatment of lumbar disc protrusion and worth promoting.

Objective To study the relationship between degenerative lumbar spondylolisthesis and degeneration of cartilage endplate by magnetic resonance imaging.Methods The median sagittal scanning of LA/L5 and L5/S1 intervertebral discs of all subjects were performed by magnetic resonance imaging with T2.Measureed the inclination angle of the front half of the endplate and the inclination angle of the posterior half of the endplate,then the ratio of the anterior horn and the posterior horn was calculated as the change rate of the endplate.The differences of the rate of cartilage endplate in the corresponding stage of spondylolisthesis group and normal group were compared.Results In L4 lumbar spondylolisthesis group,both upper and lower endplate of L4/L5 intervertebral disc have significant differences between the lumbar spondylolisthesis group and the normal group (t =11.280,-3.765,P =0.000).In L5 lumbar spondylolisthesis group,there are significant differences between the lumbar spondylolisthesis group and the normal group (t =11.280,-3.765,P =0.000),both upper and lower endplate of L5/S1 intervertebral disc;and significant differences were found among the upper and lower endplates of the L5/S1 (t =4.633,P =0.000).Among all the subjects,between the upper and lower endplate of L4/L5,significant differences were found,too(t =17.377,3.137,2.199,P =0.000,0.005,0.035).In addition to the above,the differences were not statistically significant.Therefore,lumbar spondylolisthesis can lead to degenerative in cartilage endplate of Slippage stage.Conclusion The degree of degeneration of the anterior and the posterior half of the same cartilage endplate is asymmetrical,for example,the degeneration of the posterior half of the upper endplate is worse than that of the anterior half of the plate,but the degeneration of the anterior half of the lower endplate is worse than that of the posterior half endplate.The degenerative degree of cartilage endplate was less affected by lumbar spondylolisthesis in the non slip stage.