Vertebral Fusion Research Articles

The Impact of Proton Pump Inhibitor Use on Fusion Rates Following Single-level Anterior Cervical Discectomy and Fusion.

Cohort study. This study explores how proton pump inhibitors (PPIs) affect fusion rates following anterior cervical discectomy and fusion (ACDF), using a large-scale data analysis. ACDF is essential for treating cervical disc herniation leading to myelopathy and radiculopathy, involving disc removal and vertebral fusion, crucial for long-term stability and symptom relief. Notably, PPIs, which are commonly prescribed for acid-related disorders, have been linked to altered bone health and healing processes. Utilizing the TriNetX network database spanning from 2008 to 2023, we identified patients undergoing single-level ACDF, classified into cohorts based on PPI usage following ACDF. A 1:1 propensity score matching was performed to balance demographics and comorbidities between the two groups. The study focused on the incidence of non-fusion, indicated by the International Classification of Disease-10 code M96.0, within 6 months to 2 years postoperatively. The initial cohort comprised 1269 PPI users and 23,932 non-users, adjusted to 1266 per group after matching. Postmatching analysis indicated minimal differences in demographics and comorbidities between the cohorts. Our results showed that postoperative PPI users have a significantly higher risk of non-fusion following single-level ACDF surgery at 1 year (odds ratio: 1.35, 95% CI: 1.05-1.73) and 2 years (odds ratio: 1.42, 95% CI: 1.11-1.81) follow-up. Our study showed a significant link between postoperative PPI use and increased long-term pseudarthrosis risk after ACDF surgery. These findings suggest careful consideration of PPI use in these patients.

Opioid Use after Transforaminal Lumbar Interbody Fusion: A Comparison between Open and Minimally Invasive Surgery.

Opioids are medications frequently used in patients with moderate and severe chronic pain. Their pharmacologic profile allows their use in acute severe postoperative pain. However, due to their highly addictive profile, opioid misuse is considered a public health issue. Vertebral spine fusion, decompression, and instrumentation are often associated with acute, severe postoperative pain. The present study aims to compare postoperative opioid consumption in a group of patients who underwent open transforaminal lumbar interbody fusion (OTLIF) against a similar group of patients who underwent minimally invasive transforaminal lumbar interbody fusion (MTLIF). We present a quantitative, observational, analytical, and historical cohort study. After convenience sampling, we identified 45 patients, 34 of whom underwent OTLIF and 11 underwent MTLIF. The analysis was made after measuring the following variables: demographics, type of surgery, length of stay, pain control, opioid type, and opioid dose. Statistical methods were implemented according to the origin and behavior of the variable. We found a difference between significant and nonsignificant pain among the groups with less opioid consumption in the MTILF group. This difference was seen in the frequency and dosage during all observation periods. However, in the postoperative observation, the frequencies and dosages were equal between groups. According to linear regression, the type of surgery, radiculopathy, and radiculitis explain the significant postoperative pain in up to 50% of cases. Our study reveals a significant difference in opioid consumption between patients undergoing different surgical techniques. While these findings are valid for the studied population, the limitation in sample size highlights the need for further research. The implications of our findings on postoperative pain management and opioid use in spinal surgeries are significant and warrant continued investigation.

Cardiovascular Findings in Klippel-Feil Syndrome: A Systematic Review.

Klippel-Feil syndrome (KFS) is a congenital disease defined by an abnormal fusion between cervical vertebrae. Due to the rarity of the disorder, its prevalence, along with its pathogenesis and associated conditions, remains to be clearly defined. The aim of this review is to summarize the findings of all case reports of KFS in PubMed over the last 10 years that describe cardiovascular disease, defects, or abnormalities. A total of 43 articles containing 46 reports were included from the 157 case reports considered. Cases were reviewed for commonality in biological sex and vertebral fusion and level using the Samartzis classification system to determine what association, if any, exists with the cardiovascular findings analyzed. A total of 72% of cases reported one or more findings consistent with congenital heart disease. Using the Samartzis classification system, type III KFS was the most common fusion profile overall in this subset of patients. The heterogeneity of disease manifestations makes the treatment and management of KFS case-dependent, though current guidelines highlight the importance of a multidisciplinary care team for pediatric patients. Our findings support this notion and provide evidence for the inclusion of a care provider who specializes in cardiovascular medicine in patients of all ages, as well as the consideration of additional diagnostic screening exams for cardiovascular abnormalities.Future studies into the embryological origin of KFS and a more robust search for a genetic marker are needed to better understand the development of the disease and its various associated conditions.

Klippel-Feil Syndrome Associated with Sprengel's Syndrome: A Rare Case Report

Klippel-Feil Syndrome (KFS) is a rare congenital disorder characterized by the fusion of cervical vertebrae, often associated with other anomalies such as Sprengel's deformity. We report the case of a 61-year-old female patient presenting with chronic neck pain and paresthesia in the lower limbs, worsened after a minor domestic accident. Cervical CT imaging revealed multisegmental vertebral fusion (C2-C3, C7-T1) and Sprengel’s deformity with an omovertebral bone. This case highlights the importance of early diagnosis and comprehensive imaging, including X-rays, CT scans, and MRIs, for the optimal management of KFS and its associated complications. Awaiting the correction before proceeding with the payment.

HLA-B27 Frequency and its Association with Ankylosing Spondylitis in Indian Population: A Multi-City Analysis from a Single-Center Study

The human leukocyte antigen HLA-B*27 is a Class 1 antigen of the major histocompatibility complex (MHC) with B locus and has been established in association with pathogenesis of Ankylosing Spondylitis (AS) since 1973. AS is a multifactorial disease which occurs due to interaction between genes, environment, mechanical stress, microbiota and infection. The ankylosing spondylitis is characterized by inflammation of spine, backpain, stiffness of lower back and hips, extrarticular organs such as eyes, and cardiovascular system. In severe cases this may cause the fusion of vertebrae. The current study highlights the mechanism involved in the pathogenesis of AS with a focus to investigate the frequency of HLA B*27 in suspected cases of AS. The patients were recruited from rheumatology clinics of India from age group of 13-69 years. Patients with suspected cases of AS who met the clinical criteria for AS were tested for HLA-B*27. One thousands and four patients were tested for HLA B*27 using RTPCR method. Out of 1004 subjects, 124 (12.35%) were positive for HLA-B*27. Among these, Male/Female ratio was 2.7. Majority of subjects were from North India. The current study highlights the HLA B27 positivity in association with pathogenesis of AS and indicates that HLA B27 serves as a rapid prognostic and diagnostic genetic marker for detection of AS.

Free Vascularized Scapula tip Flap to L5—S1 Vertebral Defect After Chronic Infection Related to Interbody Fusion Cage: A Case Report

ABSTRACTSeptic nonunion after vertebral fusion can lead to significant patient disability. The management of septic nonunions usually involves surgical debridement, bone fixation, and antibiotic therapy. Particularly challenging is lumbosacral vertebral nonunions, which necessitate a difficult surgical approach. We present a novel approach using a scapula tip free flap through an intra‐abdominal approach to reconstruct a L5–S1 vertebral defect after a septic nonunion. Our patient, 31‐year‐old man, with no medical conditions, had a fusion of L5–S1 due to severe lower back pain secondary to isthmic spondylolysis and spondylolisthesis. Despite multiple attempts of surgical fusion, postoperatively the patient developed a septic nonunion. Following a modified DAIR, the nonunion was reconstructed with a scapula tip bone flap 4 × 3 × 2 cm. The subscapular vessels were anastomosed to the deep inferior epigastric vessels after an intra‐abdominal inset. The patient was discharged at 15 days postoperatively without any complications. At 1‐year follow‐up the patient is pain‐free, off opiate analgesia with radiological evidence of fusion between the scapula tip, L5 and the S1 vertebral body. This case report describes the use, for the first time, of a free scapula tip, to a lumbosacral spinal defect. The use of the free scapula tip flap may be considered for reconstruction of osseous spinal defects due to its long pedicle and the unique bone shape.

Risk Factors for Sacroiliac Joint Fusion after Instrumented Spinal Fusion.

Retrospective Cohort Study. To identify risk factors for sacroiliac (SI) joint fusion after instrumented spinal fusion. Patients were identified from the PearlDiver BiscayneBay database. Patients who underwent 1 level (CPT: 22840), 3-6 vertebral segment (22842), and 7+ vertebral segment spinal fusions (22843 and 22844) were identified. Patients were separated based on whether they received an SI joint fusion (27280 and 27279) after their spinal fusion. A univariate analysis and multivariate logistic regression was performed to evaluate the associations between patient factors and incidence of SI joint fusion. 549,625 patients who underwent posterior spinal fusions were identified, 6068 of whom underwent subsequent SI joint fusion (1.1%). Factors associated with future SI joint fusion included female gender, patients with obesity, fibromyalgia, diabetes, tobacco use, increased construct length, and prior SI joint injection. Prior SI joint injection had the highest odds ratio (OR: 8.70; 95% CI: 8.25-9.16; P < 0.001), followed by 7+ vertebral segment (OR: 2.17; 95% CI: 2.03-2.33; P < 0.001) and 3-6 vertebral segment fusion (OR: 1.49; 95% CI: 1.42-1.57; P < 0.001). The highest predictor of requiring subsequent SI joint fusion is a prior SI joint injection. We also found that longer fusion constructs are associated with increased risk for future SI joint fusion.

Endochondral Ossification for Spinal Fusion: A Novel Perspective from Biological Mechanisms to Clinical Applications.

Degenerative scoliosis (DS), encompassing conditions like spondylolisthesis and spinal stenosis, is a common type of spinal deformity. Lumbar interbody fusion (LIF) stands as a conventional surgical intervention for this ailment, aiming at decompression, restoration of intervertebral height, and stabilization of motion segments. Despite its widespread use, the precise mechanism underlying spinal fusion remains elusive. In this review, our focus lies on endochondral ossification for spinal fusion, a process involving vertebral development and bone healing. Endochondral ossification is the key step for the successful vertebral fusion. Endochondral ossification can persist in hypoxic conditions and promote the parallel development of angiogenesis and osteogenesis, which corresponds to the fusion process of new bone formation in the hypoxic region between the vertebrae. The ideal material for interbody fusion cages should have the following characteristics: (1) Good biocompatibility; (2) Stable chemical properties; (3) Biomechanical properties similar to bone tissue; (4) Promotion of bone fusion; (5) Favorable for imaging observation; (6) Biodegradability. Utilizing cartilage-derived bone-like constructs holds promise in promoting bony fusion post-operation, thus warranting exploration in the context of spinal fusion procedures.

Unilateral biportal endoscopic versus microscopic transforaminal lumbar interbody fusion for degenerative lumbar spinal stenosis in China: study protocol for a prospective, randomised, controlled, non-inferiority trial

IntroductionDegenerative lumbar spinal stenosis is a common cause of low back or leg pain and disability in the elderly population. Patients with spinal stenosis who fail to respond to conservative...

Targeting Osteoblast-Osteoclast Cross-Talk Bone Homeostasis Repair Microcarriers Promotes Intervertebral Fusion in Osteoporotic Rats.

Balancing osteoblast-osteoclast (OB-OC) cross-talk is crucial for restoring bone tissue structure and function. Current clinical drugs targeting either osteogenesis or osteoclastogenesis fail to effectively regulate cross-talk, impeding efficient bone repair in osteoporosis patients. Ubiquitin-specific protease 26 (USP26) is shown to coordinate OB-OC cross-talk by independently regulating β-catenin and Iκb-α. However, effective drugs for activating USP26 are still lacking. Here, they constructed bone homeostasis repair microcarriers (BHRC) that encapsulate Usp26 mRNA-loaded lipid nanoparticles (mRNA@LNP) within MMPs-responsive GelMA hydrogel microspheres. These microcarriers target the osteoporotic microenvironment and regulate OB-OC cross-talk, thereby facilitating intervertebral fusion in osteoporotic rats. Results demonstrate that mRNA@LNP exhibits uniform particle size and high transfection efficiency, while GelMA hydrogel microspheres possess excellent biocompatibility and MMP responsiveness, providing favorable cell survival space and controllable release of mRNA@LNP. The released LNP upregulates USP26 protein expression, effectively promoting osteogenesis while suppressing osteoclast formation. In vivo experiments show that injecting BHRC into the defect site of intervertebral discs in osteoporotic rats significantly promotes tail vertebrae fusion by responding to the microenvironment and regulating cell-to-cell cross-talk. Thus, the BHRC holds great potential in regulating osteoporotic homeostasis, particularly in challenging bone defects such as intervertebral fusion in osteoporotic environments.

THE RELATIONSHIPS OF AN ENSEMBLE OF GUATEMALAN AND MEXICAN FROGS (ELEUTHERODACTYLUS: LEPTODACTYLIDAE: AMPHIBIA)

Eleutherodactylus daryi and E. greggi are shown to be species of the Eleutherodactylus gollmeri group which is defined on the basis of having a synapomorphy (fusion of sacrum and presacral vertebrae). Eleutherodactylus omiltemanus is a species of the rhodopis Series rather than thefitzingeri Series. The Eleutherodactylus omiltemanus group disappears because ali of its contained members are placed in other species groups. Eleutherodactylus saltator is a synonym of E. mexicanus. Eleutherodactylus rhodopis sensu lato contains two species, a larger upland E. rhodopis and the more widely distibuted lowland E. loki. The rhodopis Series, containing the rhodopis group, is not definable because no synapomorphies are apparent. Eleutherodactylus occidentalis and E. omiltemanus are assigned to this "group. " Within this "group " there is a cluster of species having black mesorchia (E. hobartsmithi, E. mexicanus, E. pygmaeus, and E. sarton), one having a shortened inner toe (E. jota and E. podiciferus), and one having conical subarticular tubercles (E. bransfordii, E. lauraster, E. loki, E. occidentalis, E. omiltemanus, E. rhodopis, and E. stejnegerianus). Sixty of the 84 essentially Mesoamerican species of the subgenus Craugastor are placed in a monophyletic subunit based on the common presence of marked sexual dimorphism in tympanum size. The subunit includes the nine species ofthe gollmeri group, the thirteen species of the rhodopis group, and 38 additional species (the three species of the biporcatus group, the eleven species of the milesi group, eight species of thefitzingeri group, 15 species of the rugulosus group, and E. uno). The 24 species of Craugastor not included in that clade are the 13 species of the alfredi group (including E. bocourti), the two species of the augusti group, the two species of the bufoniformis group, three species removed from thefitzingeri group (E. andi, E. cuaquero, and E. emcelae), and four species removed from the rugulosus group (E. anatipes, E. anomalus, E. cheiroplethus, and E. zygodactylus).

Experimental Study on the Application of Bioactive Xenogeneic Porcine Cancellous Bone for Cervical Intervertebral Fusion in Goats.

An experimental study in a cervical intervertebral fusion goat model. To investigate the effect of bioactive xenogeneic porcine cancellous bone applied to the intervertebral fusion of goat cervical vertebrae. Although autogenous bone achieves satisfied outcome in cervical intervertebral fusion, it is limited and cause several complications. The application of xenogeneic bone has potential to solve these problems. Thirty local goats were randomly divided into 3 groups: group A (12 goats): autogenous tricortical iliac bone group; group B (6 goats): polyetheretherketone (PEEK) cage with autologous bone; and group C (12 goats): PEEK cage with bioactive xenogeneic porcine cancellous bone. C3-C4 discectomy was performed in each group and the above bone graft and bone graft substitutes were implanted. Lateral cervical spine x-rays were taken at preoperative; immediately postoperative; and 4, 8, 12, and 24 weeks postoperatively every goat. Disc space heights (DSHs) were measured on lateral x-rays. CT examination was performed at 12 and 24 weeks after surgery for the fusion score. After 4 and 8 weeks after surgery, 3 goats were euthanized in both groups A and C to evaluate the immune rejection response through histology. At 12 and 24 weeks after surgery, 3 goats were euthanized in each group. The cervical implants fusion outcome was evaluated through specimen histology observation. As time extended, the immune rejection of bioactive xenogeneic porcine cancellous bone gradually subsided. Radiology, specimen observation, and histology manifested that the C3-4 vertebral bodies of goats in each group gradually fused. All the goats in each group achieved bony fusion at 24 weeks after surgery. In terms of preventing intervertebral space collapse, the PEEK cage could achieve better results. There was no significant difference in the remaining experimental data (P>0.05). Bioactive xenogeneic porcine cancellous bone can obtain satisfied fusion outcomes in cervical intervertebral fusion and is an ideal intervertebral fusion material in goats.

On the suitability of additively manufactured gyroid structures and their potential use as intervertebral disk replacement - a feasibility study.

Intervertebral disk degeneration is a growing problem in our society. The degeneration of the intervertebral disk leads to back pain and in some cases to a herniated disk. Advanced disk degeneration can be treated surgically with either a vertebral body fusion or a disk prosthesis. Vertebral body fusion is currently considered the gold standard of surgical therapy and is clearly superior to disk prosthesis based on the number of cases. The aim of this work was the 3D printing of Gyroid structures and the determination of their mechanical properties in a biomechanical feasibility study for possible use as an intervertebral disc prosthesis. Creo Parametric 6.0.6.0 was used to create models with various Gyroid properties. These were printed with the Original Prusa i3 MK3s+. Different flexible filaments (TPU FlexHard and TPU FlexMed, extrudr, Lauterach, Austria) were used to investigate the effects of the filament on the printing results and mechanical properties of the models. Characterization was carried out by means of microscopy and tension/compression testing on the universal testing machine. The 3D prints with the FlexHard and FlexMid filament went without any problems. No printing errors were detected in the microscopy. The mechanical confined compression test resulted in force-deformation curves of the individual printed models. This showed that changing the Gyroid properties (increasing the wall thickness or density of the Gyroid) leads to changes in the force-deformation curves and thus to the mechanical properties. The flexible filaments used in this work showed good print quality after the printing parameters were adjusted. The mechanical properties of the discs were also promising. The parameters Gyroid volume, wall thickness of the Gyroid and the outer wall played a decisive role for both FlexMed and FlexHard. All in all, the Gyroid structured discs (Ø 50mm) made of TPU represent a promising approach with regard to intervertebral disc replacement. We would like to continue to pursue this approach in the future.

Atlanto-occipital assimilation: A pictorial review of a commonly missed pathology.

Atlanto-occipital assimilation is a congenital craniovertebral junction malformation where the partial or complete fusion of the atlas and occiput occurs. Atlanto-occipital assimilation can be associated with numerous complications, including basilar invagination, atlantoaxial subluxation, Chiari malformation, congenital vertebral bodies fusion, and cord compression. As a result, vigilant identification and accurate reporting of atlanto-occipital assimilation are essential. The purpose of this review article is to discuss the numerous complications and associations of atlanto-occipital assimilation, such that an accurate diagnosis could be made for this commonly missed pathology.

Radiological Evaluation of Lumbar Endplate Dimensions in the Indian Population and Their Correlation With Cage Placement/Length in Diverse Lumbar Fusion Techniques.

Background Lumbar fusion techniques are vital for treating various spinal conditions by promoting vertebral fusion to alleviate pain and restore stability. Given the anatomical uniqueness of the Indian skeletal structure, this study evaluates the radiological dimensions of lumbar endplates in the Indian population and their correlation with the placement and length of interbody cages used in various lumbar fusion techniques such as oblique lateral lumbar interbody fusion (OLIF), transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF). This study aimed to conduct radiological measurements of lumbar endplates in the Indian population and correlate them with cage placement and length in lumbar fusion techniques. Methods This prospective study was conducted at the orthopaedic ward of a tertiary care center in Western Maharashtra, India. Healthy individuals (aged >18 years, either gender) selected with a 95% confidence level using Philip Core Integrity software (Amsterdam, Netherlands) were included in the study. We excluded thosewith a history of low back pain, previous lumbar spine surgeries, fractures, tuberculosis, tumors, deformities, degenerative diseases, or lesions affecting the lumbar spine.Quantitative measurements such as oblique and sagittal diameters, apophyseal ring widths, and interbody cage lengths were calculated using multiplanar reformatting with specific imaging parameters. Results A total of 150 individuals with an average age of 39.83 ± 14.17 years, ranging from 20 to 65 years. Among the study population, 68 were males and 82 were females. Among the male study population, oblique parameters such as Angle AOB and Mid-OD (oblique diameter) show considerable variability, with Angle AOB ranging from 51.43 ± 2.40 mm (L2 inferior) to 31.59 ± 4.25 mm (L5 inferior) and Mid-OD ranging from 41.59 ± 2.59 mm (L3 superior) to 34.38 ± 2.26 mm (S1 superior). Side-sagittal dimensions vary from 32.11 ± 2.50 mm (S1 superior) to 36.48 ±3.26 mm (L3 superior), emphasizing the need for tailored surgical planning. In contrast, females in the study population exhibit distinct anatomical profiles, with Angle AOB ranging from 52.15 ± 2.43 mm (L2 inferior) to 20.45 ± 5.45 mm (S1 superior) and Mid-OD from 33.48 ± 2.15 mm (L3 inferior) to 42.45 ± 2.59 mm (L3 superior). These findings underscore gender-specific anatomical differences crucial for individualized clinical evaluation and treatment strategies. Conclusion This study comprehensively analyzes oblique, side-sagittal, transverse, and midsagittal anatomic parameters across various vertebral levels in men and women, highlighting significant anatomical variations crucial for clinical assessments and surgical interventions.

The postoperative clinical effects of utilizing 3D printed (Ti6Al4V) interbody fusion cages in posterior lumbar fusion: A retrospective cohort study.

The research focused on the postoperative effect of using interbody fusion cage in lumbar posterior lamina decompression and interbody fusion with pedicle screw by comparing the postoperative effect of using 3D printing (Ti6Al4V) and PEEK material interbody fusion cage. Ninety-one patients with lumbar degenerative diseases from the Department of Spine Surgery of Tianjin Hospital were included in the study cohort. They were divided into 3D group (n = 39) and PEEK group (n = 52) according to the use of interbody fusion cage. The imaging data of the patients were collected and the postoperative data of the 2 groups were compared to evaluate patients' health status and the recovery of lumbar structure and function after operation. Combined with the degree of fusion, the clinical effect of 3D printing titanium alloy interbody fusion cage was comprehensively judged. At the last follow-up, the JOA score, ODI index, VAS, prolo function score, and SF-36 scale of the 2 groups showed that the clinical symptoms were better than those before operation (P < .05). The height of intervertebral disc, the area of intervertebral foramen and the physiological curvature of lumbar vertebrae increased in varying degrees after operation (P < .05). At the last follow-up, the vertebral cage fusion rates were as high as 89.13% and 90.91% in the 3D and PEEK groups, with collapse rates of 6.5% and 4.5%, respectively. There were 10 cases of cage displacement in 3D group and 7 cases of cage displacement in PEEK group. There was no significant difference between the 2 groups (P > .05). In conclusion, 3D printed (Ti6Al4V) interbody fusion cage can obtain good clinical effect in the surgical treatment of lumbar degenerative diseases. Posterior lumbar lamina decompression, bilateral pedicle screw fixation combined with 3D printed cage interbody fusion is excellent in rebuilding the stability of lumbar vertebrae. 3D printed interbody fusion cage can be an ideal substitute material for intervertebral bone grafting. The stable fusion time of interbody fusion cage after lumbar fusion is mostly from 3 months to half a year after operation.

Klippel-Feil syndrome: Should additional examination be conducted?

Klippel-Feil syndrome (KF) is a rare disease defined as single or multi-level cervical vertebra fusion. KF could be accompanied by other spinal anomalies or isolated, and in which case necessity of whole spine screening is not clearly known. KF is investigated in terms of prevalence, gender distribution, fusion types, and frequency of accompanying anomalies according to types of KF. Approval from our hospital's ethics committee was received for this single-center, retrospective study. Considering the exclusion criteria among the 40,901 cervical spine MRIs, 40,450 patients were included in the study. It was re-evaluated for KF, fusion level, classification, cervical scoliosis, and other musculoskeletal and spinal anomalies. 125 (0.309%) of 40,450 patients is diagnosed with KF, which is more common in women (P < 0.001). Single fused segment 106 (84.8%), multilevel fused segments 8 (6.4%), contiguous fused segments 11 (8.8%) are observed. Upper level KF is detected in 13 (10.4%) patients. The frequency of additional anomaly is significantly higher in upper level KF compared to other level fusions (P < 0.001, Chi-square t). The cervical scoliosis is diagnosed 34 (27%). In KF patients with scoliosis, the frequency of additional anomalies was significantly higher (P < 0.001, Chi-square t). Klippel-Feil prevalence is 0.309%, it is frequently observed in women, and at C2-C3 level. Additional anomalies are especially associated with 'contiguous fused segments' and 'upper level' types. Klippel-Feil with scoliosis is an indicator of increased risk for associated anomalies, and examination of the whole spine is recommended.

Predicting delayed extubation and transfer to the intensive care unit in children undergoing posterior fusion surgery for scoliosis : Aretrospective observational study.

Delayed extubation and transfer to the intensive care unit (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay, and increase medical expenses; however, whether achild will require delayed extubation or transfer to the ICU after scoliosis orthopedic surgery is not fully understood. In this study, we reviewed the risk factors for delayed extubation and transfer to the ICU after scoliosis orthopedic surgery in children. The electronic medical records of pediatric patients (≤ 18years) who underwent posterior spinal fusion surgery between January 2018 and November 2021 were reviewed and analyzed. Patient characteristics (age, sex, body mass index, American Society of Anesthesiologists, ASA, grade, preoperative lung function, and congenital heart disease), preoperative Cobb angle, scoliosis type, correction rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allogeneic transfusion, intraoperative hemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg predicted body weight), surgical time, postoperative extubation, and transfer to the ICU were collected. The primary outcomes were delayed extubation and transfer to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and ICU transfer. Atotal of 246 children who satisfied the inclusion criteria were enrolled in this study, of whom 23(9.3%) had delayed extubation and 81(32.9%) were transferred to the ICU after surgery. High ASA grade (odds ratio [OR] 5.42; 95% confidence interval [CI] 1.49-19.78; p = 0.010), high Cobb angle (OR 1.04; 95% CI 1.02-1.07; p < 0.001), moderate to severe pulmonary dysfunction (OR 10.9; 95% CI 2.00-59.08; p = 0.006) and prolonged surgical time (OR 1.01; 95% CI 1.00-1.03; p = 0.040) were risk factors for delayed extubation. A high Cobb angle (OR 1.02; 95% CI 1.01-1.04; p = 0.004), high intraoperative bleeding volume (OR 1.06; 95% CI 1.03-1.10; p = 0.001), allogeneic transfusion (OR 3.30; 95% CI 1.24-8.83; p = 0.017) and neuromuscular scoliosis (OR 5.38; 95% CI 1.59-18.25; p = 0.007) were risk factors for transfer to the ICU. A high Cobb angle was arisk factor for both delayed extubation and ICU transfer. Age, sex, body mass index, number of vertebral fusion segments, correction rate, and intraoperative tidal volume were not associated with delayed postoperative extubation and ICU transfer. The most common risk factor for delayed extubation and ICU transfer in pediatric patients who underwent posterior spinal fusion was ahigh Cobb angle. Determining risk factors for apoor prognosis may help optimize perioperative respiratory management strategies and planning of postoperative care for children undergoing complicated spinal surgery.

Genetic insights into the ‘sandwich fusion’ subtype of Klippel–Feil syndrome: novel FGFR2 mutations identified by 21 cases of whole-exome sequencing

BackgroundKlippel–Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of two or more cervical vertebrae during early prenatal development. This fusion results from a failure of segmentation during the first trimester. Although six genes have previously been associated with KFS, they account for only a small proportion of cases. Among the distinct subtypes of KFS, “sandwich fusion” involving concurrent fusion of C0-1 and C2-3 vertebrae is particularly noteworthy due to its heightened risk for atlantoaxial dislocation. In this study, we aimed to investigate novel candidate mutations in patients with “sandwich fusion.”MethodsWe collected and analyzed clinical data from 21 patients diagnosed with “sandwich fusion.” Whole-exome sequencing (WES) was performed, followed by rigorous bioinformatics analyses. Our focus was on the six known KFS-related genes (GDF3, GDF6, MEOX1, PAX1, RIPPLY2, and MYO18). Suspicious mutations were subsequently validated through in vitro experiments.ResultsOur investigation revealed two novel exonic mutations in the FGFR2 gene, which had not previously been associated with KFS. Notably, the c.1750A > G variant in Exon 13 of FGFR2 was situated within the tyrosine kinase domain of the protein, in close proximity to several established post-translational modification sites. In vitro experiments demonstrated that this certain mutation significantly impacted the function of FGFR2. Furthermore, we identified four heterozygous candidate variants in two genes (PAX1 and MYO18B) in two patients, with three of these variants predicted to have potential clinical significance directly linked to KFS.ConclusionsThis study encompassed the largest cohort of patients with the unique “sandwich fusion” subtype of KFS and employed WES to explore candidate mutations associated with this condition. Our findings unveiled novel variants in PAX1, MYO18B, and FGFR2 as potential risk mutations specific to this subtype of KFS.

Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study.

This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance. A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated. The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group (P < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period (P < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups (P < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores (P > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up. Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.