Objective To investigate the risk factors and treatment strategy in treating adjacent segment diseases (ASD) after anterior cervical decompression and fusion.Methods Fourteen patients with ASD after anterior cervical decompression and fusion from December 2005 to August 2012 were analyzed.The overall curvature of the cervical spine,local curvature of surgical segments,and the distances between the plate and the upper and lower intervertebral space were measured and analyzed.10 males and 4 females,age at initial surgery was 36 to 68 years old,the mean was 52.0±11.0 years old.The secondary surgery was taken,according to the number of involved segments and other factors.Anterior decompression and fusion and internal fixation was taken to patients who segment number ≤2 without severe ossification of posterior longitudinal ligament or ossification of the ligamentum flava; posterior decompression and laminoplasty was conducted in patients whose segment number ≥3,but not accompanied with significant kyphosis,instability and serious ossification of the ligamentum flava; and posterior laminectomy and fusion was performed in patients with significant kyphosis,instability and not suitable for anterior decompression due to technical reasons,as well as patients with serious ossification of the ligamentum flava.Results The average time of occurrence of ASD after the initial surgery was 9.3±4.4 years,and the average age of reoperation was 61.3±12.4 years old.The overall curvature of the cervical spine,surgical segment local curvature after the initial surgical procedure were 12.4°± 10.8 o,1.5o±6.8o,respectively; and the distances between the plate and the upper and lower interyertebral space were:0.9± 1.8 mm,3.8±3.2 mm.The secondary surgeries were taken as follows:9 cases anterior decompression and fusion and internal fixation,3 cases posterior decompression and laminoplasty,and 2 cases posterior laminectomy and fusion.All 14 patients were followed up 30.4± 17.8 months,and the average improvement rate of Japanese Orthopaedic Association scores at the last follow up was 73.9％±9.7％.Conclusion The smaller distance between the plate and neighboring intervertebral space,and poorer local curvature of surgical segments might be the risk factors for ASD after anterior cervicad decompression and fusion.The appropriate secondary surgery was taken after comprehensive analysis of the number of adjacent segments,compression factors,cervical curvature and other factors.

In this study, the formulation and preparation process of curcumin nanocrystalline injection were optimized to improve curcumin dissolution rate and bioavailability in vivo.Media grinding method was used to prepare curcumin nanocrystals, and the particle size was used as the evaluation index.The Box-Behnken experimental design was used to optimize its formulation and preparation process, and to characterize its physical and chemical properties.In addition, the dissolution of nanocrystal with different particle sizes was investigated by the paddle method, and the pharmacokinetics in rats were studied.The experimental results showed that the optimal formula and process were obtained through Box-Behnken experimental design, and that uniform curcumin nanocrystals with an average particle size of 223.1 nm were obtained.The results of X-ray diffraction and differential scanning calorimetry analysis showed that the crystal form was stable during the preparation of nanocrystals. In vitro dissolution experiments with different particle sizes showed that the dissolution rate and the degree of dissolution would increase if the particle size was smaller.Pharmacokinetic studies in rats showed that cmax and AUC0-∞ of curcumin nanocrystal injection were 4.9 and 4.1 times that of curcumin raw materials, respectively.In summary, the curcumin nanocrystal injection developed in this research have a stable preparation process and can significantly improve the dissolution rate and bioavailability of the drug, which provides some ideas for the research on curcumin preparation.