Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of single level lumbar spondylolisthesis

Regular Articlejournal articl

Cyclin-dependent kinase-specific activity predicts the prognosis of stage I and stage II non-small cell lung cancer

BACKGROUND: Lung cancer is one of the leading causes of cancer death worldwide. Even with complete resection, the prognosis of early-stage non-small cell lung cancer is poor due to local and distant recurrence, and it remains unclear which biomarkers are clinically useful for predicting recurrence or for determining the efficacy of chemotherapy. Recently, several lines of evidence have indicated that the enzymatic activity of cyclin-dependent kinases could be a clinically relevant prognostic marker for some cancers. We investigated whether the specific activity of cyclin-dependent kinases 1 and 2 could predict recurrence or death in early non-small cell lung cancer patients. METHODS: Patients with newly diagnosed, pathologically confirmed non-small cell lung cancer were entered into this blinded cohort study. The activity of cyclin-dependent kinases was determined in 171 samples by the C2P® assay, and the results were subjected to statistical analysis with recurrence or death as a clinical outcome. RESULTS: The Cox proportional hazards model revealed that the activity of cyclin-dependent kinase 1, but not 2, was a predictor of recurrence, independent of sex, age, and stage. By contrast, cyclin-dependent kinase 2 activity was a predictor of death, independent of sex and stage. CONCLUSION: This study suggested the possible clinical use of cyclin-dependent kinase 1 as a predictor of recurrence and cyclin-dependent kinase 2 as a predictor of overall survival in early-stage non-small cell lung cancer. Thus, a combination of activity of cyclin-dependent kinases 1 and 2 is useful in decision-making regarding treatment strategies for non-small cell lung cancer after surgery. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2407-14-755) contains supplementary material, which is available to authorized users

Long-term outcomes of microendoscopic laminoplasty in patients with lumbar spinal stenosis: impact of the surgical approach and facet tropism

　Microendoscopic laminoplasty (MEL) is the surgical procedure of choice at our institution for decompressing nerve roots in lumbar spinal stenosis (LSS). This minimally invasive procedure allows for bilateral decompression via unilateral endoscopic surgical access and maximum preservation of the lumbar zygapophyseal (facet) joints at the level (s) of interest. For this procedure, the surgical approach is generally made on the ipsilateral side of the stenosis. However, this rule of thumb is not always applicable because of lumbar facet joint degeneration and variations in the long-axis orientation of the spinous processes. 　Few studies to date have proposed criteria about the surgical approach for MEL. Surgeons use their clinical judgment to decide on a case-by-case basis. Facet tropism is frequently encountered in patients with LSS undergoing MEL. Long-term postoperative changes in spinal alignment parameters could guide selection of the side for the surgical approach in MEL.　This retrospective study included 45 patients who underwent MEL for single-level LSS between April 1, 2010 and June 30, 2014. The mean age of the patients was 74.8 ± 8.2 years; 23 (51%) were male. FT was defined as a bilateral facet joint angle difference of ≥10 degrees. Study variables included lumbar lordosis angle, Cobb angle, and vertebral slippage based on standing radiographic images. The study population was divided into two groups based on the degree of facet joint sagittal orientation on the side of the incision. Specifically, patients in whom the surgical approach was made on the side of the more sagittally oriented facet joint were categorized into Group S. The other patients were categorized into Group N.　The percent change in mean Cobb angle between preoperative and postoperative assessments was 124 ± 164% for Group S and 45.6 ± 62.5% for Group N (P < 0.05), indicating postoperative progression of scoliosis in Group S.　Considering the postoperative risk of scoliosis and related complications, approaching from the side of the less sagittally oriented facet joint is preferable in MEL for the treatment of LSS in patients with FT

Effect of Minimally Invasive Spine Stabilization in Metastatic Spinal Tumors

Background and Objectives: There have been numerous advances in spine surgery for metastatic spinal tumors, and minimally invasive spine stabilization (MISt) is becoming increasingly popular in Japan. MISt is a minimally invasive fixation procedure that temporarily stabilizes the spine, thereby reducing pain, preventing pathological fractures, and improving activities of daily living at an early stage. MISt may be useful given the recent shift toward outpatient cancer treatment. Materials and Methods: This study enrolled 51 patients with metastatic spinal tumors who underwent surgery using MISt between December 2013 and October 2020. The Spinal Instability Neoplastic Score, an assessment of spinal instability, was used to determine the indication for surgery, and the Epidural Spinal Cord Compression scale was used for additional decompression. Results: The patients comprised 34 men and 17 women, and the mean age at surgery was 68.9 years. The mean postoperative follow-up period was 20.8 months, and 35 of 51 patients (67%) had died by the last survey. The mean operative time was 159.8 min, mean blood loss was 115.7 mL, and mean time to ambulation was 3.2 days. No perioperative complications were observed, although two patients required refixation surgery. Preoperatively, 37 patients (72.5%) were classified as Frankel grade E. There were no cases of postoperative exacerbation, and six patients showed improvement of one or more Frankel grades after surgery. The median duration of patient survival was about 22.0 months. Patients with breast, prostate, renal, and thyroid cancers had a good prognosis, whereas those with gastrointestinal and head and neck cancers had a poor prognosis. Conclusions: MISt can benefit patients who are ineligible for conventional, highly invasive surgery and is also suitable because cancer treatment is increasingly performed on an outpatient basis. Furthermore, choosing the right surgery for the right patient at the right time can significantly affect life expectancy

Efficiency of Long Lateral Mass Screws

Introduction: Lateral mass screws (LMS) have been widely used for the posterior fusion of the cervical spine. Even though LMS are safe, the screws are short and postoperative fixation is uncertain. Therefore, we measured and reported a technique using long lateral mass screws (LLMS), a new method of screw insertion, using a Zed spine from LEXI (Tokyo, Japan). Materials and Methods: In this study, we evaluated the outcomes of 35 patients who underwent surgery using LLMS at our hospital from 2019 to 2021. Operative time, blood loss, complications, inserted screw length, screw length based on gender differences, and screw deviation rate were evaluated. The Mann–Whitney U test was used to determine the gender differences in screw length. Screw deviation was evaluated by postoperative CT and a Zed spine to determine the screw insertion angle. Results: The mean operative time was 185 ± 51 min (120–327 min), and the mean blood loss was 236 ± 316 g (10–1720 g). The total number of screws was 183. The screw length was 22.2 (16–28) mm for males and 20.8 (16–28) mm for females, with an average length of 21 ± 2.7 mm. No gender differences were observed in terms of screw length (p > 0.01 NS). The number of deviated screws above G3 was one in the third cervical vertebra, three in the fourth cervical vertebra, one in the fifth cervical vertebra, and one in the sixth cervical vertebra. The number of deviated screws was 6 out of 183, and the deviation rate was 3.2%. Conclusions: In this study, the LLMS deviation rate was 3.2%, and strong fixation was possible without any complications. We measured the screw length and screw deviation rate in cases in which LLMS were actually inserted