Interim 1-Year Radiographic and Clinical Outcomes Following Anterior Cervical Discectomy and Fusion Using Hydroxyapatite-Infused Polyetheretherketone Interbody Cages

BACKGROUND

This is a multicenter observational registry analysis of 1-year radiographic and clinical outcomes following anterior cervical discectomy and fusion (ACDF) using hydroxyapatite (HA)-infused polyetheretherketone (PEEK) intervertebral cages.

METHODS

Radiographic and clinical outcome data were collected preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively. To assess fusion, dynamic flexion-extension radiographs were independently evaluated with a validated method. Clinical outcomes were assessed using the following disease-specific measures: Neck Disability Index (NDI) and visual analog scale (VAS) for neck, left arm, and right arm pain. Patient satisfaction was also evaluated.

RESULTS

A total of 789 ACDF patients (men: 51.5%/women: 48.5%; mean body mass index: 29.9 kg/m2) were included at the time of analysis, and 1565 segments have been operated. Successful fusion was confirmed in 91.3% of all operated levels after 6 months and 92.2% after 12 months. Mean NDI scores improved significantly (P < 0.01) preoperatively (46.3, n = 771) to postoperatively (12 months: 25.2, n = 281). Consistently, mean VAS neck (preoperative: 64.2, n = 770; 12 months: 28.6, n = 278), VAS right arm (preoperative: 42.6, n = 766; 12 months: 20.4, n = 277), and VAS left arm (preoperative: 41.1, n = 768; 12 months: 20.8, n = 277) decreased significantly (P < 0.01). Patients reported high satisfaction rates after surgery with no significant changes in postoperative patient satisfaction between 6 weeks and 12 months (95.1%, n = 273).

CONCLUSIONS

ACDF with HA-infused PEEK cages demonstrates promising radiographic and clinical outcomes, supporting the potential benefits of incorporating HA into PEEK cages to enhance fusion rates and improve patient outcomes.

CLINICAL RELEVANCE

This study demonstrates a >90% fusion rate by level with reliable improvements in patient reported outcomes, along with a high rate of patient satisfaction, in a large patient cohort undergoing ACDF with HA-infused PEEK cages.

LEVEL OF EVIDENCE

2 .

Unintentional Epidural Anesthesia Mimicking Cauda Equina Syndrome from Suprafascial Injection of Liposomal Bupivacaine After Lumbar Foraminotomy: A Case Report

CASE

This case report describes a 46-year-old woman undergoing right-sided L5 to S1 decompression who received liposomal bupivacaine (LB) for postoperative analgesia and developed unintentional epidural anesthesia with symptoms mimicking cauda equina syndrome. The patient's symptoms resolved 72 hours postoperatively, approximately the length that LB typically lasts. At the 16-month follow-up, the patient demonstrated complete neurological function with no lower extremity strength or sensation deficits.

CONCLUSIONS

Tracking of LB into the epidural space after lumbar surgery may cause transient epidural anesthesia with symptoms that mimic cauda equina syndrome.

The value of detecting pepsinogen and gastrin-17 levels in serum for pre-cancerous lesion screening in gastric cancer

The aim of the study was to estimate the value of detecting pepsinogen (PG) I, PGII, and gastrin-17 (G-17) levels in serum for chronic atrophic gastritis (CAG) screening and to determine the clinical applicability of combined measurement of serum G-17, pepsinogens (PGI, PGII) and PGI/PGII ratio (PGR) as a screening test for CAG. The PGI, PGII, and G-17 levels were detected by ELISA in 68 patients with CAG and 86 healthy volunteers who underwent gastroscopy for gastroduodenal diseases at Taizhou Municipal Hospital between January 2016 and December 2016. Concentrations of all measured serum markers were lower in patients with CAG in comparison to healthy volunteers and achieved statistical significance (P<0.01) in PGI (93.25 vs 126.98) and PGR (12.67 vs 17.09). Receiver operating characteristic (ROC) curve analysis revealed the optimal cut-off values for PGI, PGII, PGR, and G-17 at 98.10 μg/l, 6.92 ng/l, 15.77 and 1.94 pmol/l, with sensitivities of 72.10%, 58.10%, 61.60%, and 59.30% and specificities of 61.8%, 51.50%, 77.90%, and 55.90%, respectively. The areas under the curve (AUCs) of PGI, PGR, and G-17 were 0.728, 0.726, and 0.556, respectively. The increase of AUC was observed only in PGR and G-17 combination (0.741) with increased sensitivity (69.10% vs 61.60%) of screening for CAG, whereas the specificity was reduced (72.10% vs 77.90%) in comparison to PGR alone. Combination of serum indicators can raise the diagnosis accuracy of CAG in some respects. However, further research including a larger sample size is necessary in order to accurately determine the sensitivity and specificity of combined detection of serum indicators.

[Changes in levels of human nutritious metabolites after exposure to abnormal acceleration of sea state]

OBJECTIVE

To investigate the changes in the levels of human blood nutritious metabolites and its major regulating factors after exposure to abnormal acceleration of sea state, and to provide clues for further investigating the mechanism of fatigue due to maritime operations.

METHODS

Using randomly sampling method, 60 healthy male adults from one troop were selected as the subjects on April 20, 2010. All subjects were exposed to six degrees of freedom motion simulator ship for 15 min. Their blood samples were collected before and after exposure to abnormal acceleration immediately. The metabolomic technology was used to measure the levels of nutritious metabolites in the serum. Enzyme - linked immunosorbent assay or radioimmunoassay was used to measure the levels of glucocorticoids, adrenaline, insulin, glucagon, ghrelin, resistin, leptin, and gastric inhibitory peptide.

RESULTS

After exposure to abnormal acceleration, the subjects showed significant decreases in the levels of serum essential amino acids, such as L-lysine[(23.63±8.24)×10(6) vs(32.83±13.58)×10(6), P<0.05], L-methionine[(4.16±1.12)×10(6) vs(5.80±1.69)×10(6), P<0.05], and L-tryptophan[(29.38±8.56)×10(6) vs (35.93±11.82)×10(6), P<0.05], and the levels of some non-essential amino acids, such as L-histidine[(1.69±0.55)×10(6) vs(2.16±0.92)×10(6), P<0.05] and 4-hydroxy- L-proline[(3.21±1.50)× 10(6) vs (7.92±4.79)×10(6), P<0.05]. After exposure to abnormal acceleration, the subjects had significant increases in the levels of serum carbohydrate metabolites, such as glucose[(2412.40±700.36)×10(6) vs(1939.30±554.33)×10(6), P< 0.05] and pyruvic acid[(9.97±5.96)×10(6) vs(2.43±1.34)×10(6), P<0.05], and the levels of fat metabolites, such as β-hydroxybutyric acid[(37.47±60.21)×10(6) vs(10.29±20.64)×10(6), P<0.05], oleic acid[(31.94±30.39)×10(6) vs (15.94±10.37)×10(6), P<0.05], and linoleic acid[(26.19±19.16)× 10(6) vs (13.58±6.29)× 10(6), P<0.05]. After exposure to abnormal acceleration, the subjects had significant increases in the levels of serum glucocorticoids [(743.63±129.06)nmol/L vs (539.66±155.58)nmol/L, P<0.05], adrenaline[(725.04±367.08)pmol/L vs (482.58±194.97)pmol/L, P<0.05], glucagon[(5.85±1.57)pmol/L vs(5.18±1.64)pmol/L, P<0.05], and ghrelin[(62.55±32.34)pmol/L vs (40.47±22.18)pmol/L, P<0.05], and decreases in the levels of serum insulin[(107.41±21.09)pmol/L vs(150.89±48.65)pmol/L, P<0.05], gastric inhibitory peptide[(41.05±17.91)pmol/L vs(170.34±82.64) pmol/L, P<0.05], leptin[(25.62±21.75)nmol/L vs (46.50±27.40)nmol/L, P<0.05], and resistin[(209.24±107.65)nmol/L vs (535.04±263.13)nmol/L, P<0.05].

CONCLUSION

After exposure to abnormal acceleration of sea state, the levels of serum nutritious metabolites show significant changes and the levels of fatigue-associated products, such as serum pyruvic acid, increase significantly, which may be related to induced stress response and changes in the levels of metabolic regulators.

Clinical study to evaluate the safety and effectiveness of the Aesculap Activ-L artificial disc in the treatment of degenerative disc disease

BACKGROUND

The objective of this clinical study is to evaluate the safety and effectiveness of the Activ-L Artificial Disc for treatment of single-level degenerative disc disease of the lumbar spine in patients who have been unresponsive to at least six months of prior conservative care. The hypothesis of the study is that the Activ-L Disc is non-inferior to the control (the Charité Artificial Disc [DePuy Spine] or ProDisc-L Total Disc Replacement [Synthes Spine]) with respect to the rate of individual subject success at 24 months. Individual subject success is a composite of effectiveness and safety.

METHODS/DESIGN

The study proposed is a prospective, randomized, single-masked, controlled, multi-center clinical trial consisting of an estimated 414 subjects with single-level DDD of the lumbar spine (L4/L5, or L5/S1) who have failed to improve with conservative treatment for at least six months prior to enrollment. After enrollment, subjects will be randomized in a 2:1 ratio to either the Activ-L Disc (investigational device) or the control (Charité or ProDisc-L). Radiographic endpoints will be evaluated by an independent reviewer at an imaging core laboratory. Each subject will be followed for 5 years post-treatment.

DISCUSSION

The safety and effectiveness of the Activ-L Artificial Disc for treatment of single-level degenerative disc disease of the lumbar spine will be equivalent to Charité Artificial Disc [DePuy Spine] or ProDisc-L Total Disc Replacement [Synthes Spine] at 24 months.

TRIAL REGISTRATION

Current Controlled Trials NCT00589797.