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Pirillo V, Berti PP, Prontera A, Rizzo P, Broger M. Biomechanics considerations in the treatment of double traumatic non-contiguous subaxial cervical lesions. Br J Neurosurg 2023; 37:1781-1785. [PMID: 33792457 DOI: 10.1080/02688697.2021.1907309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Double traumatic non-contiguous lesions of the subaxial cervical region are a rare event mostly caused by multiple, simultaneous or rapidly consecutive high-energy-impact traumas. The modality of treatment chosen for these lesions must be related to local lower cervical spine biomechanics. We present the case of a 59 year-old patient who suffered a subaxial cervical spine double fracture-dislocation following a complex-dynamic trauma. Radiological imaging displayed a C4-C5 and C7-T1 fracture-dislocation with cord signal intensity abnormalities. This patient showed a complete neurological deficit (ASIA A; mJOA 0) with a C4 sensory-motor level. He was urgently operated upon through an anterior approach, reduction of both dislocations and positioning of intervertebral cages and anterior plates at C4-C5 and C7-T1. At a 16-month follow-up he displays neurological improvement, moving his upper extremities at the C7-C8 motor level and a T5 sensory level (mJOA 3; Odom's Criteria 3). The check-CT scan at 24-month shows the correct positioning of the stabilization system and a complete bone fusion.Double traumatic lesions of the subaxial cervical spine, when interposed by healthy functional segments can be treated as two single independent lesions in order to allow a better outcome.
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Affiliation(s)
- Vania Pirillo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Pier Paolo Berti
- Department of Neurosurgery, Civile Maggiore Hospital, University of Verona, Verona, Italy
| | - Andrea Prontera
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
| | - Paolo Rizzo
- Department of Neurosurgery, S. Maurizio Hospital, Bolzano, Italy
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Naguib SM, Hamza HM, Hosny KM, Saleh MK, Kassem MA. Classification of Cervical Spine Fracture and Dislocation Using Refined Pre-Trained Deep Model and Saliency Map. Diagnostics (Basel) 2023; 13:diagnostics13071273. [PMID: 37046491 PMCID: PMC10093757 DOI: 10.3390/diagnostics13071273] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Cervical spine (CS) fractures or dislocations are medical emergencies that may lead to more serious consequences, such as significant functional disability, permanent paralysis, or even death. Therefore, diagnosing CS injuries should be conducted urgently without any delay. This paper proposes an accurate computer-aided-diagnosis system based on deep learning (AlexNet and GoogleNet) for classifying CS injuries as fractures or dislocations. The proposed system aims to support physicians in diagnosing CS injuries, especially in emergency services. We trained the model on a dataset containing 2009 X-ray images (530 CS dislocation, 772 CS fractures, and 707 normal images). The results show 99.56%, 99.33%, 99.67%, and 99.33% for accuracy, sensitivity, specificity, and precision, respectively. Finally, the saliency map has been used to measure the spatial support of a specific class inside an image. This work targets both research and clinical purposes. The designed software could be installed on the imaging devices where the CS images are captured. Then, the captured CS image is used as an input image where the designed code makes a clinical decision in emergencies.
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Yang C, Wang Q, Xu S, Guan C, Li G, Wang G. Early expansive single sided laminoplasty decompression treatment severe traumatic cervical spinal cord injury. Front Surg 2022; 9:984899. [PMID: 36189395 PMCID: PMC9523128 DOI: 10.3389/fsurg.2022.984899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Severe traumatic cervical spinal cord injury (tcSCI) is a disastrous event for patients and families. Maximizing spinal cord function recovery has become the primary therapeutic goal. This study investigated the effect of early extensive posterior decompression on spinal cord function improvement after severe tcSCI. Methods A retrospective review of 83 consecutive patients who underwent extensive open-door laminoplasty decompression within 24 h after severe tcSCI (American Spinal Injury Association (ASIA) impairment scale (AIS) grade A to C) between 2009 and 2017 at our institution was performed. The patient clinical and demographic data were collected. Neurological functional recovery was evaluated according to the Japanese Orthopaedic Association (JOA) score system, ASIA motor score (AMS) and AIS grade. Results Among the 83 patients initially included, the baseline AIS grade was A in 12, B in 28, and C in 43. Twenty-three patients (27.7%) had a high cervical injury. Cervical spinal stenosis (CSS) was identified in 37 patients (44.6%). The mean intramedullary lesion length was 59.6 ± 20.4 mm preoperatively and 34.2 ± 13.3 mm postoperatively (p < 0.0001). At the final follow-up visit, an improvement of at least one and two AIS grades was found in 75 (90.4%) and 41 (49.4%) patients, respectively. 24 (64.9%) patients with an improvement of least two AIS grades had CSS. The mean AMS and JOA score were significantly improved at discharge and the final follow-up visit compared with on admission (p < 0.0001). Conclusions Our results suggest that early expansive laminoplasty decompression may improve neurological outcomes after severe tcSCI, especially in patients with CSS. Larger and prospective controlled studies are needed to validate these findings.
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Affiliation(s)
- Chaohua Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Chaohua Yang Gaoju Wang
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shuang Xu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Can Guan
- Department of Orthopaedics, Xuanhan People's Hospital, DaZhou, China
| | - Guangzhou Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gaoju Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Correspondence: Chaohua Yang Gaoju Wang
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Clinical and radiological outcomes of posterior cervical decompression and fusion for severe cervical compressive-extension injury: A case series. J Orthop Sci 2022:S0949-2658(22)00086-0. [PMID: 35491298 DOI: 10.1016/j.jos.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/03/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although severe cervical compressive-extension (CE) injuries are usually repaired using a combined anterior-posterior approach, the repair is possible using a posterior approach alone with reliable anchors. This study aimed to present the outcomes and imaging analysis results of posterior cervical decompression and fusion (PCDF) for severe CE injuries. METHODS We retrospectively reviewed 16 patients who underwent PCDF surgery for severe CE injuries (>50% subluxation) between January 2012 and December 2018. All patients completed 1-year follow-up, and their mean age at the time of surgery was 63.5 years. American Spinal Injury Association Impairment Scale (AIS) grade, kyphotic angle of lower vertebra (KALV), and anterior defect area of lower vertebra (ADLV) were assessed preoperatively. RESULTS Of 16 patients, nine patients improved at the final follow-up, and eight patients could walk with or without assistance. All patients achieved bone union postoperatively, but four patients showed progression of correction loss of ≥10°. Therefore, patients were divided into two groups: NL group with correction loss of <10°; L group with correction loss of ≥10°. All patients in L group showed KALV of ≥15°, while 10 of 12 patients in NL group showed KALV of <15°. Furthermore, all patients in L group showed ADLV of ≥50%, whereas all patients in NL group showed ADLV of <50%. CONCLUSIONS PCDF is feasible and a favorable procedure for severe CE injuries that require early reduction and cervical spinal stabilization. However, in the cases of advanced destruction of the anterior vertebra, loss of correction after PCDF might occur postoperatively.
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Srivastava SK, Gaddikeri M, Raj A, Bhosale S, Marathe N, Naseem A. Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? - A Long-Term Retrospective Analysis of 78 Patients. Asian J Neurosurg 2021; 16:512-517. [PMID: 34660362 PMCID: PMC8477831 DOI: 10.4103/ajns.ajns_518_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/08/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022] Open
Abstract
Study Design: This was a retrospective study. Purpose: The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine. Overview of Literature: Literature shows varied results regarding the approach to be chosen. Most studies prefer a combined approach since biomechanically forms more stable construct. The isolated posterior approach is preferred by many as it is easy to reduce and fix three-column injuries. There are very few studies which show the isolated anterior approach to be better than the other two. Materials and Methods: Seventy-eight patients of three-column injury operated by anterior approach with follow-up of atleast 2 years were included and retrospectively analyzed. Clinical data included age, sex, time to surgery, methods of reduction, postoperative mobilization, and neurological evaluation using the ASIA scale. Radiological data included pre- and postreduction X-ray, computed tomography, and magnetic resonance imaging (MRI). X-rays taken post-operatively at 1,3, 6 months, 1yr and 2yrs. Variables like fracture type (AO Classification), overall alignment, localized kyphosis, time for fusion and grade of fusion mass were noted. Results: Of 78 patients, 61 had bifacetal dislocation and 17 unifacetal. The most common site was C5-6, followed by C3-4 and C6-7. The mean patient age was 35.98 years with 60 males and 18 females. The mean time to surgery was 4.4 days. Forty dislocations were reduced by closed method and 38 by open anterior approach. Fifty-six percent of patients had traumatic disc injury on MRI. All are managed by single-level anterior cervical discectomy and fusion with iliac crest autograft for fusion. The mean preoperative lordosis: 4.44° (range −13.4° to 25°) and mean postoperative lordosis: 28.57° (P < 0.0001) mean loss of alignment: 2.59° by 2 years, 100% fusion with mean time – 22.82 weeks, neurological recovery in 34.6% with atleast one grade improvement in ASIA scale. No neurological worsening or need for revision surgery was observed. Conclusion: The goal of surgery in cervical injury is bony stabilization and fusion using a least morbid approach and one with good long-term outcome. Above study concludes that only anterior stabilization after reduction of three-column injury would suffice with good long-term outcome, thereby obviating need for global fusion.
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Affiliation(s)
- Sudhir K Srivastava
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Manojkumar Gaddikeri
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Aditya Raj
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sunil Bhosale
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nandan Marathe
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Atif Naseem
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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A novel anatomic titanium mesh cage for reducing the subsidence rate after anterior cervical corpectomy: a finite element study. Sci Rep 2021; 11:15399. [PMID: 34321548 PMCID: PMC8319430 DOI: 10.1038/s41598-021-94787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022] Open
Abstract
Fusion with a titanium mesh cage (TMC) has become popular as a conventional method after cervical anterior corpectomy, but postoperative TMC subsidence has often been reported in the literature. We designed a novel anatomic cervical TMC to reduce the postoperative subsidence rate. According to the test process specified in the American Society of Testing Materials (ASTM) F2267 standard, three-dimensional finite element analysis was used to compare the anti-subsidence characteristics of a traditional TMC (TTMC) and novel TMC (NTMC). Through analysis, the relative propensity values of a device to subside (Kp) of the TTMC and NTMC were 665.5 N/mm and 1007.2 N/mm, respectively. A higher Kp measurement is generally expected to indicate that the device is more resistant to subsidence into a vertebral body. The results showed that the novel anatomic titanium mesh cage (NTMC) significantly improved the anti-subsidence performance after anterior cervical corpectomy and fusion (ACCF), which was approximately 51.3% higher than that of the traditional titanium mesh cage.
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Hogan MK, Barber SM, Rao Z, Kondiles BR, Huang M, Steele WJ, Yu C, Horner PJ. A wireless spinal stimulation system for ventral activation of the rat cervical spinal cord. Sci Rep 2021; 11:14900. [PMID: 34290260 PMCID: PMC8295294 DOI: 10.1038/s41598-021-94047-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/24/2021] [Indexed: 11/09/2022] Open
Abstract
Electrical stimulation of the cervical spinal cord is gaining traction as a therapy following spinal cord injury; however, it is difficult to target the cervical motor region in a rodent using a non-penetrating stimulus compared with direct placement of intraspinal wire electrodes. Penetrating wire electrodes have been explored in rodent and pig models and, while they have proven beneficial in the injured spinal cord, the negative aspects of spinal parenchymal penetration (e.g., gliosis, neural tissue damage, and obdurate inflammation) are of concern when considering therapeutic potential. We therefore designed a novel approach for epidural stimulation of the rat spinal cord using a wireless stimulation system and ventral electrode array. Our approach allowed for preservation of mobility following surgery and was suitable for long term stimulation strategies in awake, freely functioning animals. Further, electrophysiology mapping of the ventral spinal cord revealed the ventral approach was suitable to target muscle groups of the rat forelimb and, at a single electrode lead position, different stimulation protocols could be applied to achieve unique activation patterns of the muscles of the forelimb.
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Affiliation(s)
- Matthew K Hogan
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, USA.
| | - Sean M Barber
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, USA
| | | | - Bethany R Kondiles
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, USA.,International Collaboration on Repair Discovories, University of British Columbia, Vancouver, Canada
| | - Meng Huang
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, USA
| | - William J Steele
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, USA
| | | | - Philip J Horner
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, USA
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Abdelgawaad AS, Metry ABS, Elnady B, El Sheriff E. Anterior Cervical Reduction Decompression Fusion With Plating for Management of Traumatic Subaxial Cervical Spine Dislocations. Global Spine J 2021; 11:312-320. [PMID: 32875864 PMCID: PMC8013942 DOI: 10.1177/2192568220903741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN Prospective case series. OBJECTIVE To evaluate the efficacy of anterior-only approach, for treatment of type C F4 (AO classification) traumatic subaxial cervical spine injuries. METHODS Patients with type C F4 traumatic cervical injuries presenting to a tertiary center between June 2017 and July 2018 were included. Outcome measures included self-reported measures (Neck Disability Index, visual analogue scale, and return to work), radiological measures (local segmental angle, Ishihara curvature index, cervical lordosis angle, and step-off distance), fusion state, and neurological state according to American Spinal Injury Association (ASIA) Impairment Scale (AIS). RESULTS Twenty-one cases were operated by anterior approach with mean age 39.1 ± 13.8 years. The most common injury was at C4-5 (47.6%). Six out of 7 cases (85.7%) with preoperative neurological impairment showed late follow-up improvement by one or more grade in AIS. Complete anatomical reduction and imaging measures did not correlate significantly to the self-reported outcome measures. Median value of local segmental angle improved from -16° (-11° to -20) preoperatively to 0° (-7°) to 8°) at late follow-up. The cervical lordotic angle and Ishihara curvature index improved from 35° (29° to 43°) and 6.92 (-2.7 to 28.9) preoperatively, to 44° (33° to 51°) and 18.7 (-3.5 to 26.9) at the late follow-up, respectively. Step-off distance decreased postoperatively, however; complete reduction could not be achieved. CONCLUSION Surgical treatment of lower cervical traumatic instability by anterior decompression and fusion is efficient regarding fusion state and patients' satisfaction. The anterior approach can be recommended in cases with neurological impairment and in patients with medical comorbidities or when a short operative time-compared with combined approach-is preferred.
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Affiliation(s)
- Ahmed Shawky Abdelgawaad
- Spine Center - Helios Klinikum Erfurt, Erfurt, Germany,Department of Orthopedics and Trauma, Assiut University School of Medicine, Assiut, Egypt,Ahmed Shawky Abdelgawaad, Spine Center, Helios Klinikum Erfurt, Nordhaeuser Street 74, 99089 Erfurt, Germany.
| | - Arsany B. S. Metry
- Department of Orthopedics and Trauma, Assiut University School of Medicine, Assiut, Egypt
| | - Belal Elnady
- Department of Orthopedics and Trauma, Assiut University School of Medicine, Assiut, Egypt
| | - Essam El Sheriff
- Department of Orthopedics and Trauma, Assiut University School of Medicine, Assiut, Egypt
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Lee W, Wong CC. Anterior-Alone Surgical Treatment for Subaxial Cervical Spine Facet Dislocation: A Systematic Review. Global Spine J 2021; 11:256-265. [PMID: 32875872 PMCID: PMC7882821 DOI: 10.1177/2192568220907574] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation. METHODS A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate. RESULTS Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability. CONCLUSIONS This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.
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Affiliation(s)
- Wendy Lee
- Department of Orthopaedic Surgery, Sibu Hospital, Sarawak, Malaysia,Wendy Lee, Department of Orthopaedic Surgery, Clinical Research Center, Sibu Hospital, 5 1/2 Miles, Old Oya Road Sibu 96000 Malaysia.
| | - Chung Chek Wong
- Department of Orthopaedic Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia
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Rao Y, Li J, Liang S, Yang L, Han Z, Zhu B. [Treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of interlocking facet through the Luschka joint and anterior lamina space]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:39-45. [PMID: 33448197 DOI: 10.7507/1002-1892.202006137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space. Methods Twelve patients with lower cervical interlocking fracture and dislocation were analyzed retrospectively between January 2013 and June 2015. There were 7 males and 5 females, aged 25-59 years with an average age of 38.4 years. The disease duration was 9.6 hours to 100 days with an average of 7.3 days. There were 8 cases of unilateral locking and 4 cases of bilateral locking; 4 cases of old injury and 8 cases of fresh injury. The injured segments were 2 cases of C 3, 4, 5 cases of C 4, 5, 3 cases of C 5, 6, and 2 cases of C 6, 7. According to Meyerding classification, there were 9 cases of grade Ⅰ and 3 cases of grade Ⅱ. According to the functional classification of American Spinal Injury Association (ASIA), there were 2 cases of grade C, 6 cases of grade D, and 4 cases of grade E. The interlocking facet was released through the Luschka joint and anterior lamina space, and the anterior cervical fusion and internal fixation were used to treat the fracture and dislocation of the lower cervical spine. The recovery of spinal cord function was judged by the functional classification of ASIA; visual analogue scale (VAS) score, neck disability index (NDI) score, modified Japanese Orthopaedic Association (m-JOA) score were used to evaluate the clinical efficacy; the Cobb angle of fusion segment were observed by X-ray film. The intervertebral bone graft fusion was evaluated at 6 months after operation. Results The average operation time was 78.30 minutes, the average intraoperative blood loss was 167.30 mL, and the average postoperative drainage volume was 58.12 mL. No blood transfusion was given during or after operation. During the operation, there was no accidental injury of large blood vessels, esophagus, and trachea; no laryngo edema, dysphagia, hoarseness, and cerebrospinal fluid leakage occurred after operation; no spinal cord injury or nerve root injury aggravated; the incision healed by first intention, and no infection occurred. All 12 cases were followed up 15-20 months, with an average of 16.5 months. The symptoms and function of the nerve injury were significantly improved when compared with that before operation. Re-examination of the cervical spine X-ray film at 6 months after operation showed that the Cage or bone graft was not displaced or broken, the screw was not loosened or detached, and the intervertebral graft fusion rate was up to 100%. At last follow-up, the ASIA grade, Cobb angle of fusion segment, neck pain VAS score, m-JOA score, and NDI score were significantly improved when compared with preoperative one ( P<0.05). Conclusion The effectiveness of treatment of locked lower cervical fracture and dislocation with anterior cervical fusion and internal fixation combined with the release of the interlocking facet through the Luschka joint and anterior lamina space is clear, which not only can make the injured segment get satisfactory reduction, immediate stability and reconstruction, and full decompression, but also can effectively prevent the secondary injury of spinal cord.
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Affiliation(s)
- Yaojian Rao
- Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Junjie Li
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedic Hospital of Traditional Chinese & Western Medicine, Wuhan Hubei, 430079, P.R.China
| | - Shuhan Liang
- Department of Minimally Invasive Spinal Surgery, Hubei 672 Orthopaedic Hospital of Traditional Chinese & Western Medicine, Wuhan Hubei, 430079, P.R.China
| | - Lei Yang
- Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Zhi Han
- Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Bo Zhu
- Department of Spine Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
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Comparison of anterior and posterior approaches for treatment of traumatic cervical dislocation combined with spinal cord injury: Minimum 10-year follow-up. Sci Rep 2020; 10:10346. [PMID: 32587305 PMCID: PMC7316727 DOI: 10.1038/s41598-020-67265-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Anterior reduction and interbody fusion fixation has not been compared directly with posterior reduction and short-segmental pedicle screw fixation for lower cervical dislocation, and so consensus is lacking as to which is the optimal method. The purpose of this paper is to compare long-term outcomes of the anterior versus posterior approach for traumatic cervical dislocation with spinal cord injury. One hundred and fifty-nine patients could be followed for more than 10 years (follow-up rate 84.1%). Ninety-two patients underwent anterior reduction and interbody fusion and fixation, and 67 patients underwent posterior reduction and short-segmental pedicle screw fixation. Japanese Orthopaedic Association (JOA) scores, the Neck Disability Index (NDI), the American Spinal Injury Association grading (ASIA), Odom's criteria, cervical kyphosis, operative parameters, and surgical or post-operative complications were evaluated. Patients were followed for 10 to 17 years. There was no significant difference in main JOA scores, NDI scores or ASIA scores between the two groups at follow-up. The posterior approach was associated with greater loss of alignment by two years (P = 0.012) and at final follow-up (P < 0.001). The posterior approach group had more blood loss (P < 0.001), longer operation times (P < 0.001), longer hospital stays (P < 0.001) and fewer complications than the anterior approach group. The anterior approach is better than the posterior approach for preserving cervical lordosis, which is associated with a better long-term effect.
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Öğden M, Özdemir A, Yüksel U, Bakar B, Özveren MF. Alt servikal omurga dislokasyonlarında olası prognostik belirteçler. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.512089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tang C, Zhu G. Classic and Novel Signaling Pathways Involved in Cancer: Targeting the NF-κB and Syk Signaling Pathways. Curr Stem Cell Res Ther 2019; 14:219-225. [PMID: 30033874 DOI: 10.2174/1574888x13666180723104340] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 01/03/2023]
Abstract
The nuclear factor kappa B (NF-κB) consists of a family of transcription factors involved in the regulation of a wide variety of biological responses. Growing evidence support that NF-κB plays a major role in oncogenesis as well as its well-known function in the regulation of immune responses and inflammation. Therefore, we made a review of the diverse molecular mechanisms by which the NF-κB pathway is constitutively activated in different types of human cancers and the potential role of various oncogenic genes regulated by this transcription factor in cancer development and progression. We also discussed various pharmacological approaches employed to target the deregulated NF-κB signaling pathway and their possible therapeutic potential in cancer therapy. Moreover, Syk (Spleen tyrosine kinase), non-receptor tyrosine kinase which mediates signal transduction downstream of a variety of transmembrane receptors including classical immune-receptors like the B-cell receptor (BCR), which can also activate the inflammasome and NF-κB-mediated transcription of chemokines and cytokines in the presence of pathogens would be discussed as well. The highlight of this review article is to summarize the classic and novel signaling pathways involved in NF-κB and Syk signaling and then raise some possibilities for cancer therapy.
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Affiliation(s)
- Cong Tang
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Guodong Zhu
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
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Wang B, Hao D, Zhang Z, Gao W, Pan H, Xiao Y, He B, Kong L. Inhibition effects of a natural inhibitor on RANKL downstream cellular signalling cascades cross-talking. J Cell Mol Med 2018; 22:4236-4242. [PMID: 29911332 PMCID: PMC6111857 DOI: 10.1111/jcmm.13703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/26/2018] [Indexed: 01/25/2023] Open
Abstract
Myricitrin is a natural occurring flavonoid glycoside that possesses effects on inhibiting nitric oxide (NO) transmission and preventing inflammatory reaction. Although previous study showed the myricitrin possesses antibone loss effects via reducing the expression of IL-6 and partially suppressing reactive oxygen species (ROS) production. However, the effects of myricitrin on nuclear factor-kappaB ligand (RANKL)-stimulated osteoclastogenesis have not yet been further investigated. The current study was aimed to demonstrating the inhibitory effects of myricitrin on RANKL-stimulated osteoclastogenesis and relevant mechanisms. We found myricitrin significantly suppressed osteoclastogenesis suggesting that it may acts on RANKL/RANK induced downstream signal cross cascading in osteoclast precursors. In that, our Western blotting results showed myricitrin significantly attenuated RNAKL/MAPKs (phosphorylation of p38, ERK, JNK) and AKT signal cascading. Complementing previous study, our results suggesting as a natural inhibitor, myricitrin possesses the potential therapeutic effects on inflammatory osteolysis.
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Affiliation(s)
- Biao Wang
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Dingjun Hao
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Zhen Zhang
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Wenjie Gao
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Hu Pan
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Yuan Xiao
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Baorong He
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Lingbo Kong
- Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
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