Surface-enhanced Raman scattering and theoretical studies of the C-terminal peptide of the β-subunit human chorionic gonadotropin without linked carbohydrates

Raman and surface-enhanced Raman scattering (SERS) spectra of the synthetic carboxy terminal peptide of human chorionic gonadatropin β-subunit free of carbohydrate moieties(P37) are reported. The spectral analysis is performed on the basis of our reported Raman spectrum and SERS data of oligopeptides displaying selected amino acids sequences MRKDV, ADEDRDA, and LGRGISL. SERS samples of P37 were prepared by coating the solid peptide with metal colloids on a quartz slide. This treatment makes possible to obtain high spectral batch to batch reproducibility. Amino acids components of P37 display net charges and hydrophobic characteristics, which are related to particular structural aspects of the adsorbate-substrate interaction. The spectroscopic results are supported by quantum chemical calculations performed by using extended Hückel theory method for a model of P37 interacting with an Ag surface. The P37-metal interaction is drove by positively charged fragments of selected amino acids,mainly threonine 109, lysine 122, and arginine in positions 114 and 133. Data here reported intend to contribute to the knowledge about the antigen-antibody interaction and to the drugs delivery research area

Electromyographic thresholds after thoracic screw stimulation depend on the distance of the screw from the spinal cord and not on pedicle cortex integrity

BACKGROUND CONTEXT

Present studies concerning the safety and reliability of neurophysiological monitoring during thoracic pedicle screw placement remain inconclusive, and therefore, universally validated threshold levels that confirm osseous breakage of the instrumented pedicles have not been properly established.

PURPOSE

The objective of this work was to analyze whether electromyographic (EMG) thresholds, after stimulation of the thoracic pedicle screw, depend on the distance between the neural structures and the screws. The modifier effect of different interposed tissues between a breached pedicle and neural structures was also investigated.

STUDY DESIGN

This experimental study uses a domestic pig model.

METHODS

Electromyographic thresholds were recorded after the stimulation of 18 thoracic pedicle screws that had been inserted into five experimental animals using varying distances between each screw and the spinal cord (8 and 2 mm). Electromyographic thresholds were also registered after the medial pedicle cortex was broken and after different biological tissues were interposed (blood, muscle, fat, and bone) between the screw and the spinal cord.

RESULTS

Mean EMG thresholds increased to 14.1±5.5 mA for screws with pedicle cortex integrity that were placed 8 mm away from the dural sac. After the medial pedicle cortex was broken and without varying the distance of the screw to the dural sac, the mean EMG thresholds were not appreciably changed (13.6±6.3 mA). After repositioning the screw at a distance of 2 mm from the spinal cord and after medial cortical breach of the pedicle, the mean threshold significantly slowed to 7.4±3.4 mA (p<.001). When the screw was placed in contact with the spinal dural sac, even lower EMG thresholds were registered (4.9±1.9, p<.001). Medial pedicle cortex rupture and the interposition of different biological tissues in experimental animals did not alter the stimulation thresholds of the thoracic pedicle screws.

CONCLUSIONS

In the experimental animals, the observed electrical impedance depended on the distance of screws from the neural structures and not on the integrity of the pedicle cortex. The screw-triggered EMG technique did not reliably discriminate the presence or absence of bone integrity after pedicle screw placement. The response intensity was not related to the type of interposed tissue.

Impact of a soy drink on climacteric symptoms: an open-label, crossover, randomized clinical trial

OBJECTIVES

The objective of this study is to evaluate the effects of a soy drink with a high concentration of isoflavones (ViveSoy®) on climacteric symptoms.

METHODS

An open-label, controlled, crossover clinical trial was conducted in 147 peri- and postmenopausal women. Eligible women were recruited from 13 Spanish health centers and randomly assigned to one of the two sequence groups (control or ViveSoy®, 500 mL per day, 15 g of protein and 50 mg of isoflavones). Each intervention phase lasted for 12 weeks with a 6-week washout period. Changes on the Menopause Rating Scale and quality of life questionnaires, as well as lipid profile, cardiovascular risk and carbohydrate and bone metabolism were assessed. Statistical analysis was performed using a mixed-effects model.

RESULTS

A sample of 147 female volunteers was recruited of which 90 were evaluable. In both sequence groups, adherence to the intervention was high. Regular consumption of ViveSoy® reduced climacteric symptoms by 20.4% (p = 0.001) and symptoms in the urogenital domain by 21.3% (p < 0.05). It also improved health-related quality life by 18.1%, as per the MRS questionnaire (p <0.05).

CONCLUSION

Regular consumption of ViveSoy® improves both the somatic and urogenital domain symptoms of menopause, as well as health-related quality of life in peri- and postmenopausal women.

Polyurethane on titanium unconstrained disc arthroplasty versus anterior discectomy and fusion for the treatment of cervical disc disease: a review of level I-II randomized clinical trials including clinical outcomes

PURPOSE

To contrast the clinical and radiologic outcomes and adverse events of anterior cervical discectomy and fusion (ACDF) with a single cervical disc arthroplasty design, the polyurethane on titanium unconstrained cervical disc (PTUCD).

METHODS

This is a systematic review of randomized clinical trials (RCT) with evidence level I-II reporting clinical outcomes. After a search on different databases including PubMed, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE, a total of 10 RCTs out of 51 studies found were entered in the study. RTCs were searched from the earliest available records in 2005 to November 2014.

RESULTS

Out of a total of 1101 patients, 562 were randomly assigned into the PTUCD arthroplasty group and 539 into the ACDF group. The mean follow-up was 30.9 months. Patients undergoing arthroplasty had lower Neck Disability Index, and better SF-36 Physical component scores than ACDF patients. Patients with PTUCD arthroplasty had also less radiological degenerative changes at the upper adjacent level. Overall adverse events were twice more frequent in patients with ACDF. The rate of revision surgery including both adjacent and index level was slightly higher in patients with ACDF, showing no statistically significant difference.

CONCLUSIONS

According to this review, PTUCD arthroplasty showed a global superiority to ACDF in clinical outcomes. The impact of both surgical techniques on the cervical spine (radiological spine deterioration and/or complications) was more severe in patients undergoing ACDF. However, the rate of revision surgeries at any cervical level was equivalent for ACDF and PTUCD arthroplasty.

Study of the interactions between avian myeloblastosis virus reverse transcriptase and primer tRNA. Affinity labeling and inactivation of the enzyme by periodate-treated tRNATrp

Reverse transcriptase from avian myeloblastosis virus can react with periodate-treated primer tRNATrp (beef) to form a Schiff's base between an epsilon-NH2 lysine group within the active center of the enzyme and the dialdehyde derivative of the 3' terminal ribose of tRNA. In the presence of cyanoborohydride the reversible imminium moiety of the Schiff's base is reduced to a more stable adduct. Non-primer tRNAs were not able to reduce the extent of primer fixation to the enzyme. Complete inactivation of the enzyme was attained when the ratio enzyme:tRNA in the complex was 1:1. When the 1:1 adduct was analyzed by polyacrylamide gel electrophoresis, radioactivity from the terminal adenosine of tRNA was found exclusively associated with the alpha subunit. At longer times of labeling the beta subunit was also found linked to the oxidized primer tRNA.

Intraoperative Neurophysiological Changes Induced by Thoracic Pedicle Screws Intentionally Placed Within the Spinal Canal: An Experimental Study in Pigs

STUDY DESIGN

Experimental study, OBJECTIVES: To document and analyze the neurophysiological changes during spinal cord monitoring when thoracic pedicle screws are intentionally placed within the spinal canal.

SUMMARY OF BACKGROUND DATA

Although the rate of misplaced screws is relatively high, few patients have neurological impairment. This suggests that a significant degree of medullary displacement and/or compression is necessary to produce neurophysiological changes.

METHODS

The spinal cord of 3 experimental pigs was surgically exposed at 3 different levels (T11, T9, and T6). Two pedicle screws were placed within the spinal canal at each vertebral level under direct vision. One was placed on the lateral edge of the dural sac, causing only a slight cord displacement; a second screw was placed in the middle of the spinal canal, producing marked displacement of the neural structures. During the procedure, neurophysiological monitoring of the spinal cord was performed.

RESULTS

No neurophysiological changes were observed in any screws placed at the lateral edge of the dural sac for 20 minutes after screw placement. When the screws were placed in the center of the spinal canal, neurophysiological changes occurred with a mean latency of 10.1 ± 2.1 minutes, and at 11.6 ± 1.9 minutes there was complete loss of the spinal cord evoked potentials in all cases. After these centered screws were removed, evoked potentials began to recover, with a latency of 9.7 ± 3.0 minutes in 7 of 9 cases.

CONCLUSIONS

Neurophysiological monitoring of the spinal cord does not detect moderate compression even 20 minutes after neural compression. Only thoracic pedicle screws provoking marked displacement of the spinal cord were able to cause delayed neurophysiological changes leading to loss of spinal cord evoked potentials, which in 22% of cases did not recover after the pedicle screw was removed.

Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached

The aim of this study was to report the restoration of normal vertebral morphology and the absence of curve progression after the removal of instrumentation in AIS patients that underwent posterior correction of the deformity by a common all-screws construct without fusion. A series of 36 AIS immature patients (Risser 3 or less) were included in the study. Instrumentation was removed once the maturity stage was complete (Risser 5). The curve correction was assessed pre- and postoperatively, before instrumentation removal, directly post-removal, and more than two years after instrumentation was removed. Epiphyseal vertebral growth modulation was assessed by the coronal wedging ratio (WR) at the apical level of the main curve (MC). The mean preoperative coronal Cobb was corrected from 53.7° ± 7.5 to 5.5° ± 7.5° (89.7%) at the immediate postop. After implant removal (31.0 ± 5.8 months), the MC was 13.1°. T5-T12 kyphosis showed significant improvement from 19.0° before curve correction to 27.1° after implant removal (p < 0.05). Before surgery, the WR was 0.71 ± 0.06, and after removal, 0.98 ± 0.08 (p < 0.001). At the end of the follow-up, the mean sagittal range of motion (ROM) of the T12-S1 segment was 51.2 ± 21.0°. The SRS-22 scores improved from 3.31 ± 0.25 preoperatively to 3.68 ± 0.25 at the final assessment (p < 0.001). In conclusion, a fusionless posterior approach using common all-pedicle screws correctly constructed satisfactory scoliotic main curves and permitted the removal of instrumentation once bone maturity was reached. The final correction was highly satisfactory, and an acceptable ROM of the previously lower instrumented segments was observed.

Site-directed cleavage of immunoglobulin gene segments by lymphoid cell extracts

To study the enzyme(s) involved in the site-specific recombination of immunoglobulin (Ig) gene segments, we designed an assay to detect V-J joining in vitro. The DNA from a hybrid phage (lambda VJCK) containing the VK41 gene segment separated by a 6-kilobase spacer region from the entire J-CK sequence was incubated with lymphoid cell extracts and packaged in vitro. Phages carrying genomic deletions were selected by screening for ethylenediaminetetraacetic acid resistance. Although no site-specific V-J fusion events were detected, the packaging efficiency of lambda VJCK DNA was 10(2)- to 10(3)-fold lower than that of lambda DNA. This suggested the presence in the cell extracts of an endonucleolytic activity with a specificity for the mouse DNA sequences. To detect the endonuclease cleavage products, plasmids containing VK or JK gene segments were used as a DNA substrate and the products of the in vitro reaction were visualized by autoradiography in Southern blots. Double-stranded cleavages were observed to occur near the 5' end of each one of the five JK gene segments and near the 3' end of a VK gene segment. A plasmid containing the mouse I-A beta gene was found to be resistant to cleavage, thus confirming the specificity of the endonucleolytic activity for sequences associated with the mouse Ig gene segments.

Resultados postoperatorios inmediatos y a largo plazo de un abordaje mini-invasivo para la corrección de escoliosis idiopática del adolescente

OBJETIVO: Analizar los resultados de una nueva técnica quirúrgica mínimamente invasiva (MIS, por el inglés "minimally invasive surgery") por vía posterior aislada para la corrección quirúrgica de la escoliosis idiopática del adolescente (EIA). MÉTODOS: Se comparan dos grupos de pacientes con EIA tipo 1A de Lenke, similares en cuanto a edad, género, ángulo de Cobb, ápex de la curva, rotación vertebral, cifosis torácica, niveles de fusión, tipo de instrumentación y seguimiento. El Grupo 1 fue tratado con la técnica mínimamente invasiva que describiremos y el Grupo 2, de forma convencional. Se analizaron el tiempo quirúrgico, la pérdida sanguínea intraoperatoria, los requerimientos analgésicos en el postoperatorio inmediato, la estancia hospitalaria, la tasa de mal posición de los tornillos, la pérdida de corrección, la tasa de pseudoartrosis y la movilización de implantes. RESULTADOS: En el Grupo 1 (MIS) la cirugía disminuyó significativamente el sangrado y presentó menor número de casos de tornillos mal posicionados en la concavidad que el grupo tratado de forma convencional; sin embargo la cirugía tuvo mayor duración. Ambos grupos tuvieron requerimientos analgésicos similares y la estancia hospitalaria no presentó diferencias. A largo plazo en ninguno de los dos grupos se encontraron casos de no-unión, pérdidas de corrección, ni movilización de los implantes. CONCLUSIONES: La técnica MIS demostró prolongación del tiempo quirúrgico y menores pérdidas hemáticas, sin disminuir los requerimientos analgésicos ni la estancia hospitalaria. La corrección inicial de la escoliosis por la convexidad disminuyó la incidencia de tornillos mal posicionados en la concavidad, no dio lugar a pérdidas de corrección, movilización de implantes y no-unión.

Resultado a largo plazo de las fusiones largas espinopelvicas en escoliosis: importancia de la edad, la capacidad de marcha y el tipo de fijación ilíaca

OBJETIVO: Conocer los factores que influyen en los fracasos instrumentales lumbosacros después de fusiones espinopélvicas largas. MÉTODO: Estudio retrospectivo de pacientes diagnosticados con escoliosis, tratados quirúrgicamente por vía posterior, realizándo se fusión espinopélvica de T2 o T3 a ilíaco, utilizando tornillos pediculares e ilíacos. Se analizaron los fracasos instrumentales y su asociación con diferentes parámetros clínicos y radiológicos. RESULTADOS: Se presentan 44 pacientes con edad promedio de 24 años, con diferentes etiologías. El valor promedio preoperatorio de la curva mayor era de 74,2º, y en la revisión final la corrección promedio fue 67%. El desequilibrio anteroposterior y la inclinación pélvica, la cifosis torácica, la lordosis lumbar y el desequilibrio lateral mejoraron significativamente en la revisión final. Hubo 41% de fracasos de instrumentación, todos a nivel lumbosacro. Se encontró asociación significativa con más fracasos instrumentales en mayores de 17 años y en los que tenían deambulación autónoma. En 24 pacientes, se utilizó un solo tornillo ilíaco bilateralmente y en 20 pacientes, dos o más. Los dos grupos tuvieron una incidencia similar de fracasos. En el grupo de dos o más tornillos solo existieron roturas de barras sin desanclajes, ni lisis. El uso de implantes intersomáticos de L3 a S1 o cerclajes sublaminares con una tercera barra disminuyó la incidencia de fracasos. CONCLUSIONES: En esta serie se presentaron un 41% de fracasos instrumentales, todos localizados a nivel lumbosacro. Los pacientes con capacidad de deambulación autónoma y mayores de 17 años presentaron significativamente más fallas instrumentales. En los que se realizó fusión intersomática L3-S1 o una tercera barra con cerclajes sublaminares, disminuyó la incidencia.

Influence of hypotension and nerve root section on the ability to mobilize the spinal cord during spine surgery. An experimental study in a pig model

BACKGROUND CONTEXT

The correction of severe spinal deformities by an isolated posterior approach often involves cord manipulation together with hypotensive anesthesia. To date, the efficiency of methods to increase the tolerance of the cord to displacement and the influence of hypotension on this tolerance is yet to be assessed.

PURPOSE

The objective of this study was to determine the limits of cord displacement before the disappearance of neurophysiologic signals. The influence of the type of force applied, the section of the roots, and the induced hypotension on the cord's tolerance to displacement was also assessed.

STUDY DESIGN

Experimental study using a domestic pig model.

OUTCOME MEASURES

Successive records of cord-to-cord motor evoked potentials were obtained during displacement maneuvers. Displacing forces were released immediately after the absence of neurophysiologic signals.

METHODS

Surgical procedures were performed under conventional general anesthesia. The spinal cord and nerve roots from T6 to T10 levels were exposed by excision of the posterior elements, allowing for free cord movement. Three groups were established according to the method of spinal cord displacement: the separation (Group 1, n=5), the root stump pull (Group 2, n=5), and the torsion groups (Group 3, n=5). An electromechanical external device was used to apply the displacing forces. The three displacement tests were repeated after sectioning the adjacent nerve roots. The experiments were first carried out under normotension and afterward under induced hypotension.

RESULTS

In Group 1, evoked potential disappeared with a displacement of 10.1±1.6 mm with unharmed roots and 15.3±4.7 mm after the sectioning of four adjacent roots (p<.01). After induced hypotension, potentials were lost at 4.0±1.2 mm (p<.01). In Group 2, the absence of potentials occurred at 20.0±4.3 mm and increased to 23.5±2.1 mm (p<.05) after cutting the two contralateral roots. Under hypotensive conditions, the loss of neurophysiologic signals was detected at 5.3±1.2 mm (p<.01). In Group 3, the cord allowed torsion of 95.3±.2° that increased to 112.4±7.1° if the contralateral roots were cut. Under hypotension, the loss of potentials was found at 20±6.2° (p<.01).

CONCLUSIONS

In this experimental model, it was possible to displace the thoracic spinal cord by a distance superior to the spinal cord width without suffering neurophysiologic changes. The limits of cord displacement increase when the adjacent nerve roots are sacrificed. Induced hypotension had a dramatic effect on the tolerance of the spinal cord for displacement. This work has an important clinical significance because induced hypotension during specific spine surgery procedures requiring spinal cord manipulation in humans may increase the risk of neurologic spinal cord injury.

Accuracy of t-EMG stimulation of the middle pedicle track to prevent radiculopathies as a result of misplaced lumbar screws

OBJECTIVE

To describe the accuracy of middle pedicle track stimulation for the detection of pedicle breaches causing misplaced lumbar screws and subsequent neurological symptoms.

PATIENTS AND METHODS

In a comparative observational study with two cohorts, 1440 lumbar pedicle screws were implanted using the freehand technique in 242 patients undergoing surgery for spinal deformities. In the first two-year period (2011-2012), the accuracy of screw placement (802 screws) was assessed by conventional intraoperative palpation of the pedicle track, t-EMG screw stimulation, and fluoroscopic monitoring. In the second period (2012-2013), the middle aspect of the lumbar pedicle tracks was systematically stimulated with a probe (638 screws). When thresholds in the middle track showed <9 mA, potential neurological risk was considered, and therefore, new pedicle tracks were performed.

RESULTS

Six patients (4.4 %) in the first period presented postoperative radicular pain and a normal intraoperative screw t-EMG threshold. CT scans showed seven screws (0.9 %) with >2-mm medial-caudal invasion of the foramen. Before screw removal, t-EMG thresholds of these screws were again normal (≥10 mA). After removal of the screws. t-EMG of the middle part of the pedicle track showed thresholds below 9 mA (mean 5.2 mA). In the second period, the pedicle tracks were systematically stimulated. Low t-EMG thresholds (<9 mA) were found in 11 tracks (1.7 %) and were therefore reworked before screw placement. CT scans in these 10 patients showed that all of the 11 screws were correctly repositioned.

CONCLUSIONS

This study shows that caudal or medial pedicle cortical breaches can be detected effectively by stimulating the middle part of the pedicle track. This technique is strongly recommended to prevent postoperative lumbar radiculopathies due to screw malposition.

Pulmonary function does not improve after 10 years of posterior spinal fusion in adolescent idiopathic scoliosis: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to comprehensively assess the medium- and long-term effects of PSF on respiratory function in patients with adolescent idiopathic scoliosis (AIS) through a systematic review and meta-analysis.

METHODS

Four major databases were searched. Mean differences and differences with 95% confidence intervals (CIs) were calculated. The meta-analysis was performed using Review Manager version 5.4. The risk of bias was assessed using MINORS criteria. Random-effects meta-analyses were conducted across the follow-up periods. Subgroup and sensitivity analyses considered the magnitude of the curve correction.

RESULTS

Nineteen studies comprising 1413 patients treated with PSF were included. Meta-analyses found no significant differences in %FVC between pre- and post-PSF follow-up to 2 years (MD 0.40, 95%CI -1.65 to 2.45), around 5 years (MD 1.02, 95%CI -1.59 to 3.62), and 10 or more years (MD -2.90, 95%CI -5.98 to 0.18). No significant differences were found in %FEV1. Similarly, %TLC showed no significant difference at 2 years (MD -2.75, 95%CI -7.20 to 1.71). Short-term follow-up up to 1 year demonstrated some degree of pulmonary function loss for both %FVC (MD 12.37, 95%CI 6.72 to 18.03) and %FEV1 (MD 12.42, 95%CI 2.48 to 22.35).

CONCLUSIONS

This rigorous meta-analysis demonstrates that PSF does not enhance respiratory function in AIS patients in either the short- or long-term, as assessed using current static pulmonary metrics. Future studies should explore non-fusion alternatives and their effects on lung health.

Neurophysiological monitoring during acute and progressive experimentally induced compression injury of the spinal cord in pigs

PURPOSE

To evaluate the degree of acute or progressive lateral compression needed to cause neurologic injury to the spinal cord assessed by electrophysiological monitoring.

METHODS

In five domestic pigs, the spinal cord was exposed and compressed between T8-T9 roots using a precise compression device. Two sticks placed on both sides of the spinal cord were sequentially brought together (0.5 mm every 2 min), causing progressive spinal cord compression. Acute compression was reproduced by a 2.5-mm displacement of the sticks. Cord-to-cord evoked potentials were obtained with two epidural catheters.

RESULTS

Increasing latency and decreasing amplitude of the evoked potentials were observed after a mean progressive displacement of the sticks of 3.2 ± 0.9 mm, disappearing after a mean displacement of 4.6 ± 1.2 mm. The potential returned after compression removal (16.8 ± 3.2 min). The potentials disappeared immediately after an acute compression of 2.5 ± 0.3 mm, without any sign of recovering after 30 min.

CONCLUSIONS

The experimental model replicates the mechanism of a spinal cord injury caused by medially displaced screws into the spinal canal. The spinal cord had more ability for adaptation to progressive and slow compression than to acute mechanisms.

Elevated blood metal ion levels in patients undergoing instrumented spinal surgery: a systematic review and meta-analysis

BACKGROUND CONTEXT

Elevated blood metal levels have been reported in patients after spinal surgery using metallic implants. Although some studies have suggested an association between heightened blood metal concentrations and potential adverse effects, estimates of the incidence of abnormal metal levels after spinal surgery have been inconsistent.

PURPOSE

The aims of this systematic review and meta-analysis were to assess: (1) mean differences in blood metal ion levels between patients undergoing spinal fusion surgery and healthy controls, (2) odds of elevated blood metal ion levels after surgery compared to presurgery levels, and (3) pooled incidence of elevated blood metal ions overall and by metal type.

STUDY DESIGN

Systematic review and meta-analysis.

PATIENTS SAMPLE

The patient sample included 613 patients from 11 studies who underwent spinal surgery instrumentation.

OUTCOME MEASURES

Blood metal ion concentrations and the incidence of patients with elevated metal levels compared with in those the control group.

METHODS

A comprehensive search was conducted in PubMed, EMBASE, Scopus, and Cochrane Library to identify studies reporting blood metal ion levels after spinal fusion surgery. Mean differences (MD), odds ratios (OR), and incidence rates were pooled using random effects models. Heterogeneity was assessed using I2 statistics, and fixed-effects models were used if no heterogeneity was detected. Detailed statistical analysis was performed using the Review Manager version 5.4 software.

RESULTS

The analysis included 11 studies, with a total of 613 patients. Mean blood metal ion levels were significantly higher after spinal fusion surgery (MD 0.56, 95% CI 0.17-0.96; I2=86%). Specifically, titanium levels were significantly elevated (MD 0.81, 95% CI 0.32-1.30; I2=47%). The odds of elevated blood metal ions were higher after surgery (OR 8.17, 95% CI 3.38-19.72; I2=41%), primarily driven by chromium (OR 23.50, 95% CI 5.56-99.31; I2=30%). The incidence of elevated chromium levels was found to be 66.98% (95% CI 42.31-91.65).

CONCLUSION

In conclusion, blood metal ion levels, particularly titanium and chromium, were significantly increased after spinal fusion surgery compared to presurgery levels and healthy controls. Approximately 70% of the patients exhibited elevated blood levels of chromium and titanium.

Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis

PURPOSE

The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors.

METHODS

PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager.

RESULTS

A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59-32.98%) 10 years after surgery, which significantly increased to 32.32% (95% CI 21.16-43.47% at an average of 13.8 years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD - 0.25, 95% CI - 0.44 to - 0.05; MD - 0.50, 95% CI - 0.75 to - 0.25; and MD - 0.34, 95% CI - 0.66 to - 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10-0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82-12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI - 3.81 to 4.65) were associated with adjacent disc degeneration.

CONCLUSIONS

This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28 years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.

Abolition of sagittal T7-T10 dynamics during forced ventilation in AIS patients with Lenke 1A curves

In healthy subjects, respiratory maximal volumes are highly dependent on the sagittal range of motion of the T7-T10 segment. In AIS, the abolition of T7-T10 dynamics related to the stiffness induced by the apex region in Lenke IA curves could harm ventilation during maximal breathing. The aim of this study was to analyze the dynamics of the thoracic spine during deep breathing in AIS patients and in healthy matched controls. This is a cross-sectional, case-control study. 20 AIS patients (18 girls, Cobb angle, 54.7 ± 7.9°; Risser 1.35 ± 1.2) and 15 healthy volunteers (11 girls) matched in age (12.5 versus 15.8 years mean age) were included. In AIS curves, the apex was located at T8 (14) and T9 (6). Conventional sagittal radiographs of the whole spine were performed at maximal inspiration and exhalation. The ROM of each spinal thoracic functional segment (T1-T7, T7-T10, T10-T12) and the global T1-T12 ROM were measured. In healthy subjects, the mean T1-T12 ROM during forced breathing was 16.7 ± 3.8. AIS patients showed a T1-T12 ROM of 1.1 ± 1.5 (p < 0.05), indicating a sagittal stiffness of the thoracic spine. A wide T7-T10 ROM (15.3 ± 3.0) was found in healthy controls (91.6% of the T1-T12 ROM). AIS patients showed only 0.4 ± 1.4 ROM at T7-T10 (36.4% of the T1-T12 ROM) (p < 0.001). There was a linear relationship between the magnitude of T7-T10 kyphosis in maximal exhalation and both FVC (% of predicted FVC) and FEV1. In conclusion, Lenke 1A AIS patients show a restriction of the thoracic spine motion with an almost complete abolition of T7-T10 ROM, a crucial segment for deep breathing. T7-T10 stiffness could explain the ventilatory limitations found in AIS patients.

Reply to Lemans et al. Comment on "Burgos et al. Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached. J. Clin. Med. 2023, 12, 2408"

We thank Dr. Lemans and coworkers for their interest and knowledgeable comments [...].

Impact of surgical treatment for adolescent idiopathic scoliosis on maternal and obstetric outcomes: a meta-analysis

PURPOSE

To compare the maternal and obstetric health outcomes between pregnant AIS patients treated surgically (AIS surgery), pregnant AIS patients treated conservatively (AIS conservative), and pregnant healthy controls.

METHODS

A systematic review and meta-analysis were conducted according to the PRISMA guidelines (PROSPERO: CRD42023439219). PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched for relevant studies. The risk ratios (RR) and mean differences (MD) were calculated for dichotomous and continuous variables. Heterogeneity was assessed using the chi2 and I2 tests. A fixed-effects or random-effects model was used based on heterogeneity results.

RESULTS

Nine studies involving 4718 women were included. The frequency of caesarean section was higher in the AIS surgery group than in the healthy controls (RR 1.54, 95% CI 1.19 to 1.99), but not compared to the AIS conservative group (RR 1.28, 95% CI 0.96 to 1.69). Patients in the AIS surgery group were more likely to receive general anesthesia during caesarean section than were healthy controls (RR 11.69, 95% CI 3.03 45.13). Patients in the AIS surgery group reported more back pain during pregnancy than healthy controls (RR 4.02, 95% CI 1.20 to 13.49), but not compared to the AIS conservative group (RR 0.81, 95% CI 0.58 1.15). The AIS surgery group had worse scores on the SRS-22 pain and function domains than the healthy controls. There were no differences in marital status or the number of children between the groups.

CONCLUSION

Pregnant AIS patients treated surgically may have a higher risk of caesarean section and more back pain during pregnancy compared to healthy controls. The AIS surgery group also had worse scores on the SRS-22 pain and function domains than the healthy controls. However, there were no differences in marital status or number of children between the groups.

Displaced radial neck fractures in children treated by closed intramedullary pinning (Metaizeau technique)

We report the retrospective results of 17 displaced radial neck fractures (O'Brien type II-III) in children aged between 6 and 16 years treated with closed intramedullary pinning according to the Metaizeau technique, from 1988 to 1992 in our Pediatric Orthopaedic Service at the Ramón y Cajal Hospital. The average follow-up was 4.1 years. Excellent results were observed in all cases except one (94%). Overgrowth of the radial head was present in three cases without functional impairment. We recommend this closed method of treatment because it is simple, easy to perform, and obtains exciting results with few complications.