Yan Liang

Background Severe spinal deformity correction is associated with substantial perioperative blood loss. Evidence on pre-closure intraoperative fibrinogen administration in this setting remains limited. This study evaluated whether pre-closure intraoperative fibrinogen administration was associated with more favorable early postoperative hemostasis-related parameters. Methods This single-center retrospective study included 50 patients with severe spinal deformity who underwent head-pelvic ring traction followed by corrective surgery. Patients were classified into a fibrinogen group and a non-fibrinogen group according to whether they received pre-closure intraoperative fibrinogen administration. Postoperative coagulation parameters, hemoglobin (Hb) levels, drainage volume, and radiographic correction outcomes were compared between groups. Results Twenty-five patients were included in each group. Baseline characteristics, operative time, intraoperative blood loss, and radiographic correction outcomes were comparable between groups. Compared with the non-fibrinogen group, the fibrinogen group had lower postoperative prothrombin time and international normalized ratio, and higher prothrombin activity and fibrinogen levels (all P < 0.01). Hb levels on postoperative days 1 and 3 were higher in the fibrinogen group, whereas postoperative drainage volume and postoperative red blood cell transfusion volume were lower (P = 0.002, 0.036, 0.005, and < 0.001, respectively). No significant between-group difference was observed in Hb level on postoperative day 7. Conclusions Pre-closure intraoperative fibrinogen administration was associated with more favorable early postoperative hemostasis-related parameters in patients undergoing corrective surgery for severe spinal deformity. Given the retrospective design and potential residual confounding, these findings should be interpreted as hypothesis-generating and require validation in prospective studies.

Objective: To investigate whether MRI-based paraspinal muscle morphology, assessed using the lumbar cross-sectional indentation value (LCIV), is associated with spinopelvic sagittal balance in patients with degenerative kyphosis (DK). Methods: This retrospective case-control study included 81 patients with DK, defined as degenerative thoracolumbar kyphosis and/or loss of lumbar lordosis, and 60 surgical controls with symptomatic lumbar spinal stenosis but without degenerative spinal deformity. LCIV was measured from T12-L1 to L4-L5 on axial T2-weighted MRI, and the mean LCIV (mLCIV) was calculated. Spinopelvic sagittal balance in the DK group was evaluated using pelvic incidence minus lumbar lordosis (PI-LL) mismatch and pelvic tilt (PT). Associations among mLCIV, body mass index (BMI), thoracolumbar kyphosis, lumbar lordosis, and PT were also analysed. Results: Patients with DK had a lower mLCIV than controls (7.2 ± 5.4 mm vs. 10.8 ± 3.5 mm, P < 0.001). In the DK group, mLCIV was positively correlated with lumbar lordosis and BMI, and lumbar lordosis showed the stronger association in multivariate analysis. Patients with preserved PI-LL matching had a greater mLCIV than those with PI-LL mismatch (9.4 ± 5.2 mm vs. 5.8 ± 5.0 mm, P = 0.005). Similarly, patients with lower PT had a greater mLCIV than those with increased PT (8.5 ± 5.0 mm vs. 5.7 ± 5.4 mm, P = 0.028). Conclusion: Lower mLCIV was observed in patients with PI-LL mismatch and increased PT, suggesting that lower LCIV may accompany spinopelvic sagittal imbalance and compensatory pelvic retroversion in DK. LCIV may provide a simple MRI-based measure of posterior paraspinal muscle contour in sagittal balance evaluation.

Purpose: To characterize the asymmetrical loss of bone mass and identify the association between scoliosis and osteopenia in patients with adolescent idiopathic scoliosis (AIS). Methods: Demographic information, Cobb angle, and Hounsfield unit (HU) of the neutral vertebra (NV) and apical vertebra (apex) of the major curve were collected retrospectively in 54 AIS patients. For 84 control subjects, HU values were measured at T12 and L5. Propensity score matching was performed to balance the interference of age and BMI. Results: In the AIS group, the concave and convex lateral HU of the NV and the convex lateral HU of the apex were negatively correlated with the Cobb angle. The AIS patients had lower bilateral HU. The mean HU and the apex-convex HU were also lower in the AIS group, while the apex-concave HU was slightly higher. After matching, the apex-convex HU of the AIS group remained lower, while the apex-concave HU was higher. Conclusion: Patients with AIS exhibit osteopenia, particularly on the convex side. The severity of scoliosis was found to be directly proportional to the severity of bone loss and the degree of bilateral osteopenia asymmetry. Appropriate intervention for bone loss may be able to curb the progression of scoliosis.

Objective: The aim of this study was to analyze the relationships between values and physical activity in France (a Western European individualistic country) and in China (an East Asian collectivist country).Method: Six hundred and twenty-seven sport science students in France (N = 308, M_age = 18.99, SD = 1.64) and China (N = 319, M_age = 20.44, SD = 1.09) completed the International Physical Activity Questionnaire long version and the Portrait Values Questionnaire.Results: In both France and China, moderated regression analysis revealed that hedonism positively/negatively predicted physical activity, while security-societal, security-personal, and conformity-rules values negatively predicted physical activity. In contrast, stimulation and universalism-nature values positively predicted physical activity only in France. In China, benevolence and benevolence-care positively predicted physical activity, while power dominance negatively predicted physical activity. Additionally, we found evidence of measurement invariance of the value questionnaire.Discussion and conclusion: Our findings add to the literature by showing that the value–behavior link is partly the same across countries and partly different. Further, our findings show that for certain populations, the previously established hierarchy of human values does not replicate.

Severe sharp angular kyphosis resulting from Pott’s disease typically necessitates surgical intervention. The deployment of three-column osteotomy within the lesion and apical regions has been validated as an effective modality for the amelioration of angular kyphosis. Nonetheless, a propensity for residual kyphosis persists, accompanied by a significant perioperative risk profile. In pursuit of optimizing correctional outcomes and diminishing complication rates, we proposed an innovative surgical approach, utilizing osteotomy in the non-lesioned zones for the rectification of severe angular kyphosis associated with Pott’s disease. This retrospective investigation encompasses 16 subjects who underwent this novel surgical tactic, involving osteotomies in non-lesioned vertebral segments, at our institution from 2016 to 2018. Radiographic measures, encompassing kyphotic angle and sagittal vertical axis (SVA), were documented at baseline and during terminal follow-up. Neurological status was evaluated via the American Spinal Injury Association (ASIA) grading system. Operative duration, volume of hemorrhage, and perioperative complications were systematically recorded. The cohort included 6 males and 10 females with an average age of 30.7 ± 11.41 years. Follow-up intervals spanned 24 to 42 months. Mean operative time and blood loss were 492 ± 127.3 min and 1791 ± 788.8 ml, respectively. The kyphotic angle improved from 97.6 ± 14.6° to 28.8 ± 18.70°. In cases with lumbar afflictions, vertebral restoration was achieved (L1–L5 and L2–S1). Initial mean SVA of 6.7 ± 3.58 cm was reduced to 3.3 ± 1.57 cm at follow-up. Neurological function enhancement was observed in six patients, while ten maintained baseline status. Complication rates, including wound infection and rod fracture at 12 months, were observed in approximately 11.8% of cases. Our findings suggest that the surgical strategy is both effective and safe for addressing severe angular kyphosis due to Pott’s disease, contingent upon the expertise of the surgical unit.

Purpose To characterize the change of adjacent segment degeneration (ASD) after cervical total disc replacement (CTDR) with more than 12-year follow-up, and identify the risk factors for ASD. Method This process included 75 patients underwent CTDR from February 2004 to December 2012, with the follow-up of 151.9 ± 36.0 (m). The artificial disc included ProDisc-C, Prestige-LP and Mobi-C. ASD was followed up at 1 week, 6 months, 1 year, 2 years, 5 years, 10 years after CTDR and at the endpoint of June 2022. The radiographic measurements were cervical mobility, intervertebral disc height (IDH), cervical lordosis and balance status. The complications were implant migration, subsidence and heterotopic ossification (HO). Results Cervical mobility in adjacent segments, IDH and lordosis showed no statistical differences between ASD and NASD group. Balance status, subsidence and migration showed no relationship with ASD. Postoperative ASD increased at 6 m and especially between 6 m to 2y. There was no difference between the incidence of upper ASD and lower ASD all the time and few ASD-related reoperation. The majority of adjacent segments were C4/5 (33.6%) and C6/7 (34.2%), and ASD of C5/6 had the highest incidence (61.5%). Cox regression showed ASD was not related to the types of prosthesis or operated numbers. Generalized estimating equations (GEE) analysis showed severe HO had a higher (2.68 times) probability to suffer from ASD. Conclusions After over 12-year follow-up of CTDR, the occurrence of ASD and HO had temporal synchronization. ASD was not merely a natural progression but with the pathological process such as HO.

The relationship between spinal alignment, particularly degenerative thoracolumbar kyphosis (DTLK) combined with lumbar spine stenosis (LSS), and paraspinal muscle content remains underexplored. This study aimed to elucidate the characteristics of paraspinal muscle distribution in DTLK patients and its association with lumbar lordosis (LL) and body mass index (BMI). Methods: A case–control study was conducted comparing 126 patients with DTLK and LSS against 87 control patients. The lumbar crossing indentation value (LCIV) was introduced as a novel measurement for paraspinal muscle content, and its relationship with thoracolumbar kyphosis (TLK), BMI, and LL was assessed. Results: LCIV in DTLK patients was found to be lower than in the control group, with a progressive increase from the upper to lower lumbar spine. In the control group, paraspinal muscle content was observed to increase with age and BMI, and LCIV was higher in males. However, the DTLK group showed no gender difference. LCIV in the DTLK group was more pronounced in patients with increased LL. The degree of TLK was not influenced by BMI but was associated with the content of the paravertebral muscle. Conclusions: Paraspinal muscle content, as measured by LCIV, is significantly associated with DTLK and LSS. The study emphasizes the importance of considering paraspinal muscle health in DTLK patients and offers valuable insights for diagnosis and therapeutic interventions.

The short-segment instrument for precision treatment of lumbar stenosis syndrome (LSS) combined with degenerative thoracolumbar kyphosis (DTLK) receives more attention and the reasonable range of sagittal parameters is debatable in these elderly patients. This study aimed to include LSS patients combined with DTLK performed short-segmental fixation on LSS, to evaluate the efficacy of this procedure, and to determine the reasonable threshold of sagittal parameters. Overall 138 patients (female, 62.3%) were eligible (mean age of 68.8 ± 7.7 years) with a follow-up time of 24.6 ± 11.1 months. Spinopelvic sagittal parameters containing TLK, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis were obtained at baseline and final visit, where |PI-LL|, PT, and sagittal vertical axis were seen as the main parameters. Quality of life was evaluated by the Oswestry Disability Index (ODI), which were divided into 4 quarters orderly. The reasonable threshold of parameters corresponding to ODI was determined by both linear regression and logistic regression. For all participants, TLK decreased by a mean of 8.3° and cases got TLK correction occupied 40.4%. ODI got improvement by the change of 29.9 ± 9.9. At baseline, ODI was correlated to |PI-LL|, while at final, ODI was correlated to |PI-LL| and PT. The independent factor affecting preoperative ODI was |PI-LL|, with ODI = 0.19 × |PI-LL| + 36.9 and the mean threshold of preoperative |PI-LL| was 10.7°. At final, PT was the influencing factor with ODI = 0.21 × PT + 3.16 and PT = 0.60 × |PI-LL| + 12.22. The mean threshold of postoperative |PI-LL| was 16.0° and PT was 23.1° by both linear regression and logistic regression. With short-segment fixation on LSS, >40% of patients with DTLK acquired TLK correction. |PI-LL| = 16.0° and PT = 23.1° was the “reasonable threshold” of sagittal parameters with the procedure for this population.