OBJECTIVETo evaluate the value of rectangle titanium cage (SynCage-C) in the anterior cervical spine fusion.

METHODSNineteen patients underwent anterior cervical discectomy and interbody fusion using SynCage-C with average follow-up of 9 months.

RESULTSAll cases had cervical spondylosis with 13 cases of myelopathy and 6 cases of radiculopathy. One level fusion were 16 cases and two levels were 3 cases. The mean operation time was 40 minutes per level with average bleeding 60 ml. Patients were asked to wear a hard collar for average 8.5 weeks after the operation. The fusion was solid on lateral view X-ray films three months post-operation. Only 1 case had neck stiffness due to prolonged collar protection and another case had short term pain on bone dorner site. There were no other complications such as cage subsidence, displacement, milaligment and kyphosis of cervical spine.

CONCLUSIONThe SynCage-C can resort and maintain the intervertebral space effectively with the advantage of immediate stability, satisfactory fusion and easy to use.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Equipment and Supplies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; instrumentation ; methods ; Spinal Diseases ; surgery ; Spinal Fusion ; methods ; Titanium ; therapeutic use ; Treatment Outcome

BACKGROUNDCervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration. Whether accelerated adjacent segment degeneration is prevented in the long term is unclear. This trial compared adjacent segment degeneration in Bryan disc arthroplasty with that in anterior cervical decompression and fusion five years after the surgery.

METHODSWe studied patients with single level degenerative cervical disc disease. The extent of adjacent segment degeneration was estimated from lateral X-rays.

RESULTSTwenty-six patients underwent single level Bryan disc arthroplasty and twenty-four patients underwent single level anterior cervical decompression and fusion. All patients were followed up for an average of sixty months. In the Bryan arthroplasty group, nine (17.6%) segments developed adjacent segment degeneration, which was significantly lower than that (60.4%) in the anterior cervical decompression and fusion group. Eleven segments in the Bryan arthroplasty group developed heterotopic ossification according to McAfee's classification and two segments had range of motion less than 2°. In the heterotopic ossification group, four (19.5%) segments developed adjacent segment degeneration, similar to the number in the non-heterotopic ossification group (16.7%). Adjacent segment degeneration rate was 50% in grade IV group but 11.8% in grade II to III.

CONCLUSIONSAdjacent segment degeneration was accelerated after anterior cervical decompression and fusion. However, Bryan disc arthroplasty avoided accelerated adjacent segment degeneration by preserving motion. Patients with grade IV heterotopic ossification lost motion, and the rate of adjacent segment degeneration was higher than that in patients without heterotopic ossification.

Adult ; Arthroplasty ; adverse effects ; Case-Control Studies ; Cervical Vertebrae ; surgery ; Female ; Humans ; Intervertebral Disc ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; adverse effects ; Young Adult

OBJECTIVETo discuss surgical approaches of ossification of the posterior longitudinal ligament (OPLL) of cervical spine.

METHODSBetween June 2005 to July 2010, 36 patients with OPLL of cervical spine were reoperated. There were 23 male, 13 female, age from 39 to 72 years (mean 57 years). The time of the first operation to the reoperation were 4 months to 24 years, an average of 3.9 years. Among 20 patients underwent anterior corpectomy and fusion (ACD) at first operation, 14 cases combined stenosis of cervical spinal canal, 10 cases were insufficient decompression of OPLL, 5 cases injured of cervical spinal cord during the first operation, 1 case was adjacent disc herniation. Among 14 cases underwent expensive open-door laminoplasty (ELAP) at first operation, 6 cases were insufficient decompression of OPLL, 4 cases were inadequate decompressed segment, 2 cases were cervical segmental kyphosis, 2 cases were progression of OPLL combined with disc herniation. Among 2 cases underwent combined approach at first operation, 1 case was insufficient decompression of OPLL, the other was adjacent disc herniation. Their pre- and post-operative X-ray, CT and MRI were analyzed. The complications of reoperation were recorded.

RESULTThere were 30 patients followed-up, with a period of 1.5 - 4.0 years, average 1.8 years. With 36 patients, none had deterioration, 2 patients had no recovery post-reoperation, 34 patients had 31.2% Japanese Orthopedic Association score improve rate. Among 22 cases underwent ELAP at second operation, 3 cases had postoperative segmental palsy. Among 14 cases underwent ACD at second operation, 3 cases had intraoperative dural defects.

CONCLUSIONSurgical strategy for OPLL of cervical spine should consider the type of OPLL and stenosis of cervical spinal canal.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; surgery ; Reoperation ; Retrospective Studies

Objective:To assess the midterm clinical and radiological outcomes of internal fixation and fusion for the treatment of Hirayama disease and to evaluate the clinical significance and value of this procedure.Methods:In the study,36 patients were treated with anterior cervical internal fixation and fusion.The clinical outcomes including muscle strength and atrophy were recorded.The radiological outcomes including range of motion of cervical spine and the cross-sectional area of spinal cord at each level on MRI scan were measured before and at 3 month,1 year and 2 years follow-up time points after surgery.Results:(1) Clinical outcomes:all the patients showed no further progression of symptoms except one patient with mild progression of muscular weakness and atrophy.As the time passed by,the ratio of the patients with muscle strength and atrophy improvement increased.There were 26.5 ％ of patients in 3 months,36.0％ in 1 year and 85.7％ in 2 years who experienced muscle strength improvement.8.8％ of patients in 3 months,24.0％ in 1 year and 35.8％ in 2 years felt muscle atrophy improvement.And 12 of the 14 patients showed improved muscle strength and atrophy at the end of 2 years period follow-up.(2) Radiological outcomes:the range of motion (ROM) of C2-C7 was significantly decreased after the operation.The ROM of preoperation was 62.25° ±2.10° and that of 2 years postoperation was 13.67° ± 7.51°(P ＜ 0.01).The spinal cord was of no compression on flexion MRI.The cross-section area of spinal cord on MRI was significantly increased only at C6 level (P ＜0.05) at the end of three months follow-up.The level of increased cross-section area rose to C4-C5-C6 levels (P ＜0.01) in 1 year and to C4-C5-C6-C7 levels at the end of 2 years follow-up P ＜ 0.05).The cross-section area increased 15.60％ at C4,19.08％ at C5,21.60％ at C6 and 23.91％ at C7 with significant difference (P ＜0.05) 2 years after the operation.Conclusion:Anterior cervical internal fixation and fusion is an effective surgical treatment for Hirayama disease and may provide preferable midterm clinical and radiological outcomes.This procedure has clinical significance and value in terms of control of the progression and outcome of this disease.

BACKGROUNDS: Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range. METHODS: We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4-C7 (n = 11), C3-C6 (n = 61), C3-C7 (n = 32), and C2-C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral-cord distance (VCD) was used to evaluate the decompression limit. The C2-C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied. RESULTS: There was no significant kyphosis in cervical curvature (> -5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level. CONCLUSIONS Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.

Coronavirus disease 2019 (COVID-19) has yet to be proven to alter male reproductive function, particularly in the majority of mild/asymptomatic patients. The purpose of this study was to explore whether mild/asymptomatic COVID-19 affects semen quality and sex-related hormone levels. To find suitable comparative studies, a systematic review and meta-analysis was done up to January 22, 2022, by using multiple databases (Web of Science, PubMed, and Embase). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify and choose the studies. Meta-analysis was used to examine the semen parameters and sex-related hormones of mild/asymptomatic COVID-19 patients before and after infection. The effects of semen collection time, fever, and intensity of verification on semen following infection were also investigated. A total of 13 studies (n = 770) were included in the analysis, including three case-control studies, six pre-post studies, and four single-arm studies. A meta-analysis of five pre-post studies showed that after infection with COVID-19, sperm concentration (I² = 0; P = 0.003), total sperm count (I² = 46.3%; P = 0.043), progressive motility (I² = 50.0%; P < 0.001), total sperm motility (I² = 76.1%; P = 0.047), and normal sperm morphology (I² = 0; P = 0.001) decreased. Simultaneously, a systematic review of 13 studies found a significant relationship between semen collection time after infection, inflammation severity, and semen parameter values, with fever having only bearing on semen concentration. Furthermore, there was no significant difference in sex-related hormone levels before and after infection in mild/asymptomatic patients. Mild/asymptomatic COVID-19 infection had a significant effect on semen quality in the short term. It is recommended to avoid initiating a pregnancy during this period of time.
Pregnancy ; Female ; Humans ; Male ; Semen Analysis ; Semen ; Infertility, Male ; Sperm Motility ; COVID-19 ; Sperm Count ; Spermatozoa ; Testosterone ; Gonadal Steroid Hormones

Objective: To study the incidence of bloodstream infections, pathogen distribution, and antibiotic resistance profile in patients with hematological malignancies. Methods: From January 2018 to December 2021, we retrospectively analyzed the clinical characteristics, pathogen distribution, and antibiotic resistance profiles of patients with malignant hematological diseases and bloodstream infections in the Department of Hematology, Nanfang Hospital, Southern Medical University. Results: A total of 582 incidences of bloodstream infections occurred in 22,717 inpatients. From 2018 to 2021, the incidence rates of bloodstream infections were 2.79%, 2.99%, 2.79%, and 2.02%, respectively. Five hundred ninety-nine types of bacteria were recovered from blood cultures, with 487 (81.3%) gram-negative bacteria, such as Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa. Eighty-one (13.5%) were gram-positive bacteria, primarily Staphylococcus aureus, Staphylococcus epidermidis, and Enterococcus faecium, whereas the remaining 31 (5.2%) were fungi. Enterobacteriaceae resistance to carbapenems, piperacillin/tazobactam, cefoperazone sodium/sulbactam, and tigecycline were 11.0%, 15.3%, 15.4%, and 3.3%, with a descending trend year on year. Non-fermenters tolerated piperacillin/tazobactam, cefoperazone sodium/sulbactam, and quinolones at 29.6%, 13.3%, and 21.7%, respectively. However, only two gram-positive bacteria isolates were shown to be resistant to glycopeptide antibiotics. Conclusions: Bloodstream pathogens in hematological malignancies were broadly dispersed, most of which were gram-negative bacteria. Antibiotic resistance rates vary greatly between species. Our research serves as a valuable resource for the selection of empirical antibiotics.
Humans ; Bacteremia/epidemiology* ; Cefoperazone ; Sulbactam ; Retrospective Studies ; Drug Resistance, Bacterial ; Microbial Sensitivity Tests ; Hematologic Neoplasms ; Sepsis ; Anti-Bacterial Agents/pharmacology* ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Piperacillin, Tazobactam Drug Combination ; Escherichia coli