Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature

BACKGROUND: There is considerable controversy as to which posterior technique is best for the treatment of multi-level cervical spondylotic myelopathy. The aim of this study was to compare the clinical and radiographic results and complications of laminoplasty (LAMP) and laminectomy (LAMT) in the treatment of multi-level cervical spondylotic myelopathy. METHODS: We reviewed and analyzed papers published from January 1966 and June 2013 regarding the comparison of LAMP and LAMT for multi-level cervical spondylotic myelopathy. Statistical comparisons were made when appropriate. RESULTS: Fifteen studies were included in this systematic review. There was no significant difference in the incidence of surgical complications between LAMP and LAMT. Compared to conventional LAMT and skip LAMT, postoperative ROM was more limited in LAMP, but this was still superior to postoperative ROM following LAMT with fusion. Postoperative kyphosis occurred in 8/180 (4.44%) in LAMP and 13/205 (6.34%) in LAMT, whereas no cases of kyphosis were reported for skip LAMT. Skip LAMT appears to have better clinical outcomes than LAMP, while the outcome was similar between LAMP and LAMT with fusion. CONCLUSIONS: Based on these results, a claim of superiority for laminoplasty or laminectomy was not justified. In deciding between the two procedures, the risks of surgical and neurological complications, and radiologic and clinical outcome, must be taken into consideration if both options are available in multi-level cervical spondylotic myelopathy

The role of preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis

Abstract Background The patients with extremely severe spinal deformity are commonly considered high-risk candidates for surgical treatment because of their underlying lung disease. Currently, little has been reported about the postoperative pulmonary complication events in this population. This retrospective study sought to evaluate preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. Methods Preoperative forced vital capacity (FVC), FVC ratio, forced expiratory volume at the end of the first second (FEV1), FEV1 ratio, peak expiratory flow (PEF), and PEF ratio were performed and evaluated on 60 patients with extremely severe scoliosis (coronary main Cobb angle ≥100°). Results Among the 60 patients, 11 (18.3%), 13 (21.7%), and 22 (36.7%) had severe, moderate, and mild pulmonary dysfunction, respectively. Compared with the moderate and mild scoliosis groups, significant differences were observed in Cobb, FVC, FVC ratio, FEV1, FEV1 ratio, and PEF ratio in the extremely severe scoliosis group. Various postoperative pulmonary complications occurred in nine cases (15%). Patients with severe or moderate dysfunction as measured by the FVC ratio had a higher incidence of postoperative pulmonary complications. A transthoracic procedure was not related to postoperative pulmonary complications, but thoracoplasty significantly increased the incidence of postoperative pulmonary complications (P < 0.001, OR = 20, 95% CI = 3.45–115.97). Discussion Pulmonary function was impaired in extremely severe scoliosis. Patients with severe restrictive pulmonary dysfunction had a higher incidence of postoperative pulmonary complications. Thoracoplasty was an important risk factor in the prediction of postoperative pulmonary complications

Bone Morphogenetic Protein-2 Promotes Osteosarcoma Growth by Promoting Epithelial-Mesenchymal Transition (EMT) Through the Wnt/b-Catenin Signaling Pathway

The correlation between BMP-2 and osteosarcoma growth has gained increased interest in the recent years, however, there is still no consensus. In this study, we tested the effects of BMP-2 on osteosarcoma cells through both in vitro and in vivo experiments. The effect of BMP-2 on the proliferation, migration and invasion of osteosarcoma cells was tested in vitro. Subcutaneous and intratibial tumor models were used for the in vivo experiments in nude mice. The effects of BMP-2 on EMT of osteosarcoma cells and the Wnt/β-catenin signaling pathway were also tested using a variety of biochemical methods. In vitro tests did not show a significant effect of BMP-2 on tumor cell proliferation. However, BMP-2 increased the mobility of tumor cells and the invasion assay demonstrated that BMP-2 promoted invasion of osteosarcoma cells in vitro. In vivo animal study showed that BMP-2 dramatically enhanced tumor growth. We also found that BMP-2 induced EMT of osteosarcoma cells. The expression levels of Axin2 and Dkk-1 were both down regulated by BMP-2 treatment, while β-catenin, c-myc and Cyclin-D1 were all upregulated. The expression of Wnt3α and p-GSK-3β were also significantly upregulated indicating that the Wnt/β-catenin signaling pathway was activated during the EMT of osteosarcoma driven by BMP-2. From this study, we can conclude that BMP-2 significantly promotes growth of osteosarcoma cells (143B, MG63), and enhances mobility and invasiveness of tumor cells as demonstrated in vitro. The underlying mechanism might be that BMP-2 promotes EMT of osteosarcoma through the Wnt/β-catenin signaling pathway. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1638–1648, 2019. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc

Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature

Abstract Background There is considerable controversy as to which posterior technique is best for the treatment of multi-level cervical spondylotic myelopathy. The aim of this study was to compare the clinical and radiographic results and complications of laminoplasty (LAMP) and laminectomy (LAMT) in the treatment of multi-level cervical spondylotic myelopathy. Methods We reviewed and analyzed papers published from January 1966 and June 2013 regarding the comparison of LAMP and LAMT for multi-level cervical spondylotic myelopathy. Statistical comparisons were made when appropriate. Results Fifteen studies were included in this systematic review. There was no significant difference in the incidence of surgical complications between LAMP and LAMT. Compared to conventional LAMT and skip LAMT, postoperative ROM was more limited in LAMP, but this was still superior to postoperative ROM following LAMT with fusion. Postoperative kyphosis occurred in 8/180 (4.44%) in LAMP and 13/205 (6.34%) in LAMT, whereas no cases of kyphosis were reported for skip LAMT. Skip LAMT appears to have better clinical outcomes than LAMP, while the outcome was similar between LAMP and LAMT with fusion. Conclusions Based on these results, a claim of superiority for laminoplasty or laminectomy was not justified. In deciding between the two procedures, the risks of surgical and neurological complications, and radiologic and clinical outcome, must be taken into consideration if both options are available in multi-level cervical spondylotic myelopathy

Bone cement distribution is a potential predictor to the reconstructive effects of unilateral percutaneous kyphoplasty in OVCFs: a retrospective study

Abstract Background Osteoporotic vertebral compression fracture (OVCF) is a common type of fracture, and percutaneous kyphoplasty (PKP) is an eligible solution to it. Previous studies have revealed that both the volume and filling pattern of bone cement correlate with the clinical outcomes after PKP procedure. However, the role of bone cement distribution remains to be illustrated. Methods To retrospectively evaluate the relationship between the bone cement distribution and the clinical outcomes of unilateral PKP, we enrolled 73 OVCF patients receiving unilateral PKP treatment. All the intervened vertebrae were classified into three groups based on the bone cement distribution observed on postoperative X-ray films. Preoperative and postoperative radiographic parameters including the vertebral height and kyphotic Cobb angle were recorded, and anterior vertebral height restoration rate (AVHRR) and Cobb angle correction (CR) were then calculated to assess the vertebral height reconstruction. Preoperative and postoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) were adopted by interviewing patients to assess the mobility improvement and pain relief. Demographic data, body mass index (BMI), lumbar bone mineral density (evaluated by BMD T-score) of each patient, bone cement volume (BV), and bone cement extravasation (BE) were also recorded. Between- and within-group comparisons and multivariable correlation analysis were carried out to analyze the data. Results VAS and ODI scores were both significantly improved in all of the enrolled cases with no significant differences between groups. Among the three groups, the average age, AVHRR, and BV were significantly different. Occurrence of BE was significantly different between two of the three groups. AVHRR was demonstrated to correlate negatively with preoperative anterior vertebral height ratio and positively with preoperative Cobb angle, CR, diffusion score, and ODI changes. Conclusions Bone cement distribution is a potential predictor to the reconstructive effects in unilateral PKP for OVCFs. Bone cement distribution is associated with AVHRR and BV, as well as the risk of BE occurrence. Greater bone cement distribution may indicate better vertebral restoration along with a higher BE risk

Activation of TNF‐α/NF‐κB axis enhances CRL4BDCAF11 E3 ligase activity and regulates cell cycle progression in human osteosarcoma cells

Cullin 4B, a member of the Cullins, which serve as scaffolds to facilitate the assembly of E3 ligase complexes, is aberrantly expressed in many cancers, including osteosarcoma. Recently, we observed that CUL4B forms the CRL4BDCAF11 E3 ligase, which specifically ubiquitinates and degrades the cyclin‐dependent kinase (CDK) inhibitor p21Cip1 in human osteosarcoma cells. However, the underlying mechanisms regarding the aberrant expression of CUL4B and the upstream members of this signaling pathway are mostly unknown. In this study, we demonstrate that nuclear factor kappaB (NF‐κB) is a direct modulator of CUL4B expression. The CUL4B promoter is responsive to several NF‐κB subunits, including RelA, RelB, and c‐Rel, but not to p50 or p52. Additional studies reveal that the tumor necrosis factor alpha (TNF‐α)/NF‐κB axis pathway is activated in human osteosarcoma cells. This activation causes both CUL4B and NF‐κB subunits to become abundant in the nucleus of human osteosarcoma cells. The down‐regulation of individual genes, including TNFR1, RelA, RelB, c‐Rel, and CUL4B, or pairs of them, including TNFR1 + RelA, TNFR1 + RelB, TNFR1 + c‐Rel, and RelA+CUL4B, has similar effects on cell growth inhibition, colony formation, cell invasion, and in vivo tumor formation, whereas the overexpression of CUL4B in these knockdown cells significantly reverses their phenotypes. The inhibition of the TNF‐α/NF‐κB pathway greatly attenuates CRL4BDCAF11 E3 ligase activity and causes the accumulation of p21Cip1, thereby leading to cell cycle arrest at the S phase. Taken together, our results support a model in which the activation of the TNF‐α/NF‐κB axis contributes to an increase in CRL4BDCAF11 activity and a decrease in p21Cip1 protein levels, thereby controlling cell cycle progression in human osteosarcoma cells

MicroRNA-300 Regulates the Ubiquitination of PTEN through the CRL4BDCAF13 E3 Ligase in Osteosarcoma Cells

Cullins, critical members of the cullin-RING ubiquitin ligases (CRLs), are often aberrantly expressed in different cancers. However, the underlying mechanisms regarding aberrant expression of these cullins and the specific substrates of CRLs in different cancers are mostly unknown. Here, we demonstrate that overexpressed CUL4B in human osteosarcoma cells forms an E3 complex with DNA damage binding protein 1 (DDB1) and DDB1- and CUL4-associated factor 13 (DCAF13). In vitro and in vivo analyses indicated that the CRL4BDCAF13 E3 ligase specifically recognized the tumor suppressor PTEN (phosphatase and tensin homolog deleted on chromosome 10) for degradation, and disruption of this E3 ligase resulted in PTEN accumulation. Further analyses indicated that miR-300 directly targeted the 3′ UTR of CUL4B, and DNA hypermethylation of a CpG island in the miR-300 promoter region contributed to the downregulation of miR-300. Interestingly, ectopic expression of miR-300 or treatment with 5-AZA-2′-deoxycytidine, a DNA methylation inhibitor, decreased the stability of CRL4BDCAF13 E3 ligase and reduced PTEN ubiquitination. By applying in vitro screening to identify small molecules that specifically inhibit CUL4B-DDB1 interaction, we found that TSC01131 could greatly inhibit osteosarcoma cell growth and could disrupt the stability of the CRL4BDCAF13 E3 ligase. Collectively, our findings shed new light on the molecular mechanism of CUL4B function and might also provide a new avenue for osteosarcoma therapy