Objective To evaluate the feasibility,safety and efficacy of surgical treatment of the thoracic and thoracolumbar disc herniations through the posterior far lateral approach,Methods From April 2005 to June 2010,24 consecutive patients with thoracic or thoracolumbar disc herniations were treated surgically,using the posterior far lateral approach.There were 15 males and 9 females with the mean age of 53.6 years old(range,25-69 years).The levels of herniated discs were located in T4-s,T5-6,T6-7 for 1 case,in T9-10 for 1 case,in T10-11 for 2 cases,in T10-11,T11-12,T12L1 for 1 case,in T11-12 for 3 eases,in T11-12,T12L1 for 3 cases,in T12L1 for 4 cases,in T12L1,L1-2 for 3 cases,and in L1-2 for 6 eases.There were one level disc herniation in 16 cases,two levels disc herniation in 6 cases and three levels disc herniation in 2 cases.16 out of 24 cases had "bony protrusions",including bony separation of the endplate,bony spur,disc calcification or OPLL.The average preoperative Cobb angle of localized kyphosis was 10.5°.According to the Frankel grading system,5 cases were classified as C,16 as D,and 3 as E,preoperatively.Results Average operation time was 3.5 h(2.0-4.5 h),and mean blood loss was 800 ml(300-4000 ml).Postoperative localized kyphosis was an average of 4.6°,with average correction rate of 56.2%.24 cases were followed up for 1 to 62 months,with an average of 18 months.According to Japanese Orthopaedic Association(JOA)criteria system,there were 12 cases(50.0%)with excellent outcome,9 cases(37.5%)with good outcome,and 3 cases(12.5%)with fair outcome.The postoperative Frankel grading were C for 1 case,D for 2 cases,and E for 21 cases.There were no complications intraoperatively and postoperatively.The symptoms were improved in all patients.Conclusion By using "safe triangular zone" and dekyphosis stabilization,the posterior far lateral approach was a relatively safe,reliable,effective and better view surgical procedure for the treatment of the thoracic and thoracolumbar disc herniations.

Objective To investigate the safety and efficiency of thoracic laminectomy with dekyphosis for thoracic myelopathy due to multi-segmental ossification of the posterior ligaments.Methods The clinical data of five cases of thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments who were surgically treated in our hospital between August 2012 and March 2013 were retrospectively analyzed,among which two were male and the other three were female,with an average age of 52 (range,45-56) years old.The pre-operative duration ranged from 2 months to 6 years.All five cases were suffering from progressive bilateral partial paraplegia with an average preoperative JOA score 3.8 (range,3-6),an average segment-number of ossification of the posterior ligaments 7.6 (range,5-10),and also an average segment-number of 5.0 (range,2-10) ossification of the ligamentum flavum.All the five cases showed different kyphosis at the stenotic area of thoracic spine,with an average kyphotic angle (Cobb) of 35.8° (range,22°-56°).Their pre-operative Japanese Orthopaedic Association score (JOA) was 3.8 averagely (range,3-6).Clinical features,operation time,blood loss,perioperative complications and postoperative outcome were recorded.Results The segment number of laminectomy of these five cases was 8.2 averagely.The segment number of dekyphosis was 2 for 2 cases and 1 for the other 3 cases,with a average dekyphotic degree of 7.8° (range,2°-15°).The average operation time was 6.3 hours (range,5.5-7.0 hours) and the average blood loss was 3900 ml.The perioperative complications included cerebrospinal fluid leakage in 4 cases who were treated conservatively,and epidural hematoma in 1 case who underwent reoperation for removing the hematoma.All cases were followed up for 21 to 27 months,and their average final JOA score was 10,with an average recovery rate of 85.6％,and a rate of excellent or good was 100％ by the modified Epstein standard.Conclusion The result of thoracic laminectomy combined with dekyphosis for thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments is quite satisfying,however this procedure is demanding with a long operation time,a huge blood loss and a high complication rate.

This research used inter simple sequence repeat(ISSR)markers to analyze the genetic diversity of Hedyotis diffusa Willd. from different origins. A total of 23 samples of Hedyotis diffusa Willd. in the Guangxi Zhuang Autonomous Region, Guangdong, Hunan, Zhejiang, Fujian, Jiangxi and Anhui, respectively were collected. 150 ISSR primers were used to amplify PCR and then POPGENE1. 32, NTSYS2. 10 software were used to analyze genetic diversity. 11 primers were screened, 115 polymorphic bands were amplified, the polymorphism ratio was 85. 22%, the number of alleles(Na)was 1. 852 2, the effective allele(Ne)was 1. 543 4, Neis gene diversity index(H)was 0. 316 5 and Shannon′s information index(I)was 0. 470 0. The results of cluster analysis show that the Hedyotis diffusa can be divided into three clades. The conclusion is that ISSR molecular markers can provide a insight for the identification of Hedyotis diffusa Willd. .

STUDY DESIGN: A retrospective clinical review. PURPOSE: To investigate the difference in clinical manifestations and severity between polymicrobial and monomicrobial infections after spinal surgery. OVERVIEW OF LITERATURE: Surgical site infections (SSIs) after spinal surgery are a major diagnostic and therapeutic challenge for spinal surgeons. Polymicrobial infections after spinal surgery seem to result in poorer outcomes than monomicrobial infections because of complementary resistance to antibiotics. However, comparison of the clinical manifestations and severity between polymicrobial and monomicrobial infections are limited. METHODS: Sixty-seven patients with SSIs after spinal surgery were studied: 20 patients with polymicrobial infections and 47 with monomicrobial infections. Pathogenic bacteria identified were counted and classified. Age, sex, and body mass index were compared between the two groups to identify homogeneity. The groups were compared for clinical manifestations by surgical site, postoperative time to infection, infection site, incisional drainage, incisional swelling, incisional pain, neurological signs, temperature, white blood cell count, and the percentage of neutrophils. Finally, the groups were compared for severity by hospital stay, number of rehospitalizations, number of debridements, duration of antibiotics administration, number of antibiotics administered, and implant removal. RESULTS: Polymicrobial infections comprised 29.9% of SSIs after spinal surgery, and most polymicrobial infections (70.0%) were caused by two species of bacteria only. There was no difference between the groups in terms of clinical manifestations and severity. In total, 96 bacterial strains were isolated from the spinal wounds: 60 strains were gram-positive and 36 were gram-negative pathogenic bacteria. Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Enterobacter cloacae were cultured in order of the frequency of appearance. CONCLUSIONS: Most polymicrobial infections were caused by two bacterial species after spinal surgery. There was no difference in clinical manifestations or severity between polymicrobial and monomicrobial infections.
Anti-Bacterial Agents ; Bacteria ; Body Mass Index ; Coinfection ; Debridement ; Drainage ; Enterobacter cloacae ; Escherichia coli ; Humans ; Length of Stay ; Leukocyte Count ; Neutrophils ; Postoperative Complications ; Retrospective Studies* ; Spine ; Staphylococcus aureus ; Staphylococcus epidermidis ; Surgeons ; Surgical Wound Infection ; Wounds and Injuries

Objective To investigate the safety and effectiveness of posterior approach laminectomy combined with localized resection of ossified posterior longitudinal ligament and dekyphosis for multilevel ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine.Methods Thirty-one cases of thoracic multilevel OPLL was treated with this new technique between August of 2012 and August of 2016.Twenty-nine among the 31 cases were successfully followed up more than two years.Among these 29 cases,9 were male and the other 20 were female,with an average age of 48.5±7.1 years.The average segment number of OPLLwas 6.5±2.2 (range,3-11).The average segment number of laminectomy was 7.9±2.5 (range,4-13).There were 26 cases combined with ossification of the ligamentum flavum (OLF).Posterior approach laminectomy combined with localized resection of OPLL and dekyphosis for multilevel OPLL in the thoracic spine was applied to all cases.Firstly,en-bloc laminectomy was performed to all the segments of OPLL.Then the nearest segment of ossification to the kyphotic apex and the most stenotie level was selected and limitedly resected.Finally,wedge-shaped osteotomy was conducted to decrease the kyphosis.The outcomes including recovery rate of myelopathy and the radiological changes were recorded during the post-operative follow-up.Single group pre and post analysis was conducted by using paired t-test.Results Twenty-seven cases underwent one-level circumferential decompression,and the other two case underwent two-level localized resection of the ossified posterior longitudinal ligament.The average operation time was 245.2±75.1 min (range,131-423 min).The average blood loss was 1 307.9±1 457.7 ml(range,300-6 000 ml).The average follow-up time was 40.2± 14.9 months (range,25-69 months).The kyphotic angle of the stenotic segments decreased 11.4°±3.5° averagely after the surgery,from pre-operative 28.7°±9.6° to post-operative 17.3°±8.6°.The decreased kyphotic angle was 7.4°±3.1 ° at the final follow-up with an average kyphotic angel of 22.3°± 10.3°.The average length of the resected ossified posterior longitudinal ligament was 11.3±3.9 mm,and the average shortening length of the spinal column was 5.0±3.0 mm (range,0.4-13.8 mm).The pre-operative Japanese Orthopedic Association (JOA) score was 4.3±2.2 averagely (range,1-9),and the final JOA score increased to 9.3±2.3 (rang,3-11).The average recover rate was 85.7％ (range,-100％ to 100％),and the rate of excellent or good was 89.7％.Among the 29 cases,6 cases occurred post-operative transient deterioration and regained a satisfactory recovery eventually;one case occurred post-operative paraplegia and never recovered;19 cases occurred post-operative cerebrospinal fluid leakage and healed under conservative treatment.Conclusion For the thoracic multilevel OPLL,one-stage posterior approach laminectomy combined with localized resection of the ossified posterior longitudinal ligament and dekyphosis can significantly improve the outcomes of the myelopathy with low rate of post-operative paraplegia.Therefore,this new surgery technique is a safe and effective treatment for multilevel OPLL in thoracic spine.

OBJECTIVETo study the risk factors for deep surgical site infection after posterior thoracic and lumbar surgery.

METHODSThe medical data of the patients with deep surgical site infection after posterior thoracic and lumbar surgery from January 2008 to December 2013 were reviewed.For each case patient, 3 non-infected controls were randomly selected from the same database of all patients who underwent posterior thoracic and lumbar surgery.Patients who had diagnosis of spinal fractures, infection, tuberculosis, and tumor were excluded. The microbiology and related factors were collected and analyzed. T-test, χ2 test and Logistic analysis were used to analyze the data, respectively.

RESULTSNinety-nine cases were identified (infection group), 57 men and 42 women, average 54.5 years old, average body mass index 26.4 kg/m2. Fifty-five (55.6%) patients were identified with organisms, and the most common identified organism was Staphylococcus Aureus. Compared with the cases in the control group (44.4 g/L), the cases in the infection group (43.1 g/L) had a significant low albumin preoperatively (P=0.001). Multivariate Logistic analysis showed that obesity (OR=2.102, 95% CI=1.259-3.508), diabetes (OR=1.926, 95% CI=1.041-3.563), number of surgical levels≥3 (OR=1.985, 95% CI=1.130-3.486) were risk factors for this complication (P<0.05).

CONCLUSIONFor deep surgical site infection after posterior thoracic and lumbar surgery, obesity, diabetes, preoperative low albumin and number of surgical levels≥3 are risk factors.

Female ; Humans ; Lumbosacral Region ; surgery ; Male ; Middle Aged ; Orthopedics ; Risk Factors ; Staphylococcus aureus ; Surgical Wound Infection ; Thoracic Vertebrae ; surgery

OBJECTIVETo summarize the clinical characteristics of severe lumbar dysplastic spondylolisthesis, and to investigate the effectiveness of the posterior surgery including decompression, partial reduction with instrumentations and interbody fusion.

METHODSTwelve patients of severe lumbar dysplastic spondylolisthesis treated between March 2007 and February 2012 were studied retrospectively. Twelve patients include 10 female and 2 male patients with an average age of 10.7 years (9-17 years). All of their spondylolisthetic level was L5 vertebrae. None of them were effective after regular conservative treatment. Eleven of 12 patients were treated surgically through a posterior decompression and instrumented reduction. One case was treated by L5 vertebrectomy and reduction of L4 onto sacrum. Their levels of instrumentations were L4-S1 in 8 patients and L5-S1 in 4 patients. All of 12 patients were fused via interbody fusion. The visual analog scale(VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association(JOA) score, slip angle, percentage slip, lumbar lordosis, sagittal balance were used as outcome measures.

RESULTSAll of these patients were followed up regularly with an average follow-up of 32 months (6-64 months). Five of these 12 patients suffered postoperative nerve root impairment, including impairment of unilateral and bilateral L5 nerve roots. At the latest follow-up, only 1 case was still suffering from the weakness of unilateral peroneal long and short muscles, the other 4 patients recovered totally. The degree of their spondylolisthesis was reduced II degrees or more, and their slip angles decreased from 35.6 degree preoperatively to 9.8 degree postoperatively. The VAS, ODI , JOA, lumbar lordosis and sagittal balance were improved postoperatively. No instrumentation loosening or rupture was found.

CONCLUSIONSIn patients with severe lumbar dysplastic spondylolisthesis, isolated posterior decompression, reduction with internal fixation may lead to a satisfactory clinical outcomes. Surgical reduction is helpful to improve the interbody contact area, thus possibly improve the fusion rate. At the same time, reduction may reduce or correct the lumbar-sacral kyphosis, recover the normal lumbar lordosis and normal sagittal alignment with an excellent cosmetic result. The incidence of the postoperative nerve impairment is high because of the stretching of L5 nerve roots secondary to the reduction, but most of the patients with postoperative nerve impairment may recover gradually.

Adolescent ; Child ; Decompression, Surgical ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Lumbosacral Region ; Male ; Orthopedic Procedures ; methods ; Retrospective Studies ; Sacrum ; surgery ; Severity of Illness Index ; Spinal Fusion ; Spondylolisthesis ; surgery ; Treatment Outcome

BACKGROUNDFor young patients, the surgical method for lumbar disc herniation remains controversial. The aim of this study was to prospectively determine the short-term clinical outcome after surgery for young patients with lumbar disc herniation.

METHODSIn this prospective comparative study between April 2010 and August 2011, a total of 80 patients underwent primary surgery at a single level for lumbar disc herniation. The patients were divided into two groups: decompression alone and decompression with instrumented fusion. An independent examiner clinically evaluated the patients at preoperation and at 1, 3, 6, and 12 months after surgery. The patients filled out the instruments for back and leg pain using a Visual Analog Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI), and Japanese Orthopaedic Association (JOA) scores. The differences between the two groups were analyzed.

RESULTSThe mean age of all the patients at the time of surgery was 33.7 years. Of the 80 patients, 38 patients underwent decompression alone and 42 patients underwent posterior lumbar interbody fusion. Increasing complexity of surgery was associated with a longer surgery time, greater blood loss, and a longer hospital stay after surgery. Both methods of surgery independently improved outcomes compared with baseline status based on VAS, ODI, and JOA scores (P < 0.05), and no significant differences were found between the two groups at most of the measuring points in time, although patients with decompression alone had a higher JOA score (P = 0.016) and higher JOA recovery rate (P = 0.010) at the 3-month follow-up.

CONCLUSIONSThe short-term results of our study showed that both methods of surgery obtained effective clinical outcomes, but decompression alone had some advantages (shorter surgery time, less blood loss, shorter hospital stay, and lower cost) compared with decompression with instrumented fusion. Young patients with decompression alone could achieve great physical function earlier.

Adult ; Decompression, Surgical ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Prospective Studies ; Spinal Fusion ; Treatment Outcome

BACKGROUNDScheuermann's disease (SD) is a spinal disorder and includes both a classic form and an atypical form. Interestingly, its existence among the general population as well as the disc disease patients is common. One of our previous studies showed that about 18% of the hospital staff members meet the SD criteria. On the other hand, another study has demonstrated that 95.2% of the symptomatic thoracolumbar disc herniation (STLDH) patients meet the SD criteria, which suggests that STLDH is very likely a special form of SD. The purpose of this study was to discriminate the factors contributing to the development of STLDH by comparing STLDH patients with the healthy SD-like hospital staff members.

METHODSThis is a retrospective study including 33 STLDH patients who met the SD criteria and 30 SD-like hospital staff members. The STLDH group was chosen from a group of patients who underwent surgery after a diagnosis of STLDH (T10/11-L1/2) at our hospital between June 2007 and June 2010. SD-like hospital staff members were chosen from a database created in 2007, which contained a lumbar MR and low back pain (LBP) questionnaire of 188 hospital staff members. The demographic and radiologic characteristics were compared between groups.

RESULTSThere was no statistical difference in sex, age, and height between the two groups. The STLDH patients had higher body weight, boby mass index, and thoracolumbar kyphotic angle than SD-like hospital staff members. In addition, STLDH patients had more levels of Schmorl's nodes (3.5±1.7 vs. 2.0±1.9, t = 3.364, P = 0.001) and irregular endplateson (4.0±1.9 vs. 2.7±1.9, t = 2.667, P = 0.010) compared to the SD-like hospital staff members.

CONCLUSIONSHigher body weight, higher body mass index, larger thoracolumbar kyphosis, and more Schmorl's nodes and irregular endplates on MR may be associated with the development of STLDH in "SD-like people."

Adult ; Female ; Healthy Volunteers ; Humans ; Intervertebral Disc Displacement ; diagnostic imaging ; Middle Aged ; Radiography ; Retrospective Studies ; Scheuermann Disease ; diagnostic imaging ; Thoracic Vertebrae ; diagnostic imaging ; pathology

The immune system is involved in the initiation and progression of cancer. Research on cancer and immunity has contributed to the development of several clinically successful immunotherapies. These immunotherapies often act on a single step of the cancer-immunity cycle. In recent years, the discovery of new nanomaterials has dramatically expanded the functions and potential applications of nanomaterials. In addition to acting as drug-delivery platforms, some nanomaterials can induce the immunogenic cell death (ICD) of cancer cells or regulate the profile and strength of the immune response as immunomodulators. Based on their versatility, nanomaterials may serve as an integrated platform for multiple drugs or therapeutic strategies, simultaneously targeting several steps of the cancer-immunity cycle to enhance the outcome of anticancer immune response. To illustrate the critical roles of nanomaterials in cancer immunotherapies based on cancer-immunity cycle, this review will comprehensively describe the crosstalk between the immune system and cancer, and the current applications of nanomaterials, including drug carriers, ICD inducers, and immunomodulators. Moreover, this review will provide a detailed discussion of the knowledge regarding developing combinational cancer immunotherapies based on the cancer-immunity cycle, hoping to maximize the efficacy of these treatments assisted by nanomaterials.