Reconstructing Nanohydroxyapatite Prosthesis Based on CT-Scanning Data and Its Application in Spinal Injury

This study investigated the nanohydroxyapatite (nHA) prosthesis application effect based on CT-scanning data in spinal injury. This study chose 26 spinal injury patients treated in our hospital from September 2017 to September 2018, who were randomly divided into two groups. nHA prosthesis based on CT-scanning data was implanted in the nHA group, whereas titanium mesh was implanted in the titanium mesh group. Consequently, osteoblasts were cultured to test the biological activity of nHA and titanium alloy. In cell tests, we found osteoblasts could better adhere to nHA, and proliferation and activity were higher when planted on nHA material. After surgical treatment, all patients’ spinal symptoms (VAS score, JOA score, and Cobb angle) had improved and did not cause obvious inflammatory foreign body reactions. During a two-year follow-up, the fusion time and support settlement in the nHA group was lower, and the vertebral fusion rate and ASIA score were higher than those in the titanium mesh group. Thus, CT-scanning data could further improve the vertebral fusion rate in the nHA group. Consequentially, nHA prosthesis based on CT-scanning data is a better choice for spinal injury therapy.

Temperature Significantly Regulates Gene Expressions of Vertebrae Chondrocytes and Osteoblasts in Juvenile Golden Pompano (Trachinotus ovatus)

To elucidate the possible molecular reaction of vertebral fusion in juvenile golden pompano at high temperature, we examined the changes in growth, vertebral fusion incidence, histological differences and transcription levels of genes related to bone development in juvenile golden pompano at 27 and 33°C for 30 days, respectively. The growth rate of juvenile fish was faster when the water temperature was 33°C, but the incidence of vertebral fusion was higher. Prolonged high water temperature reduced the osteogenic layer in the growth zone of the vertebral endplate and the elastic externa. The endplate growth areas of the fused vertebrae were transformed into cartilage tissue, which was then remodeled into bone. The intervertebral notochord tissue was transformed into bone and the intervertebral space disappeared. In normal phenotypes of vertebrae, short-term high temperature could promote the expression of genes related to cartilage differentiation and maturation, as well as genes related to osteoblastic differentiation. With the increase of culture time, the expression of genes related to cartilage and osteogenesis development was inhibited. In fused vertebrae, cartilage proliferation was enhanced, osteogenic differentiation was inhibited, and matrix mineralization may be enhanced. Genes associated with the development of chondrocytes and osteoblasts in the vertebrae of juvenile Trachinotus ovatus were significantly regulated by temperature and time. The results may contribute to further understanding of the occurrence of vertebral fusion at high temperature.

Lumbosacral Fusion Using Instrumented Cage Distraction–Fixation in a Dog with Degenerative Lumbosacral Stenosis

This study aimed to assess the long-term outcome and intervertebral fusion following surgical distraction and stabilization using an intervertebral cage and pedicle screw and rod fixation (PSRF) in a dog with severe degenerative lumbosacral stenosis (DLSS).Degenerative lumbosacral stenosis is a common disorder in large breed dogs and has a multifactorial origin. Surgical treatment by dorsal laminectomy and discectomy results in decompression of neural structures, but when distraction–fixation is applied, the ultimate goal is vertebral fusion. A 4-year-old male neutered Leonberger, presented with DLSS and pre-existent chronic discospondylitis, was treated by dorsal laminectomy, partial discectomy, curettage of the end plates, distraction with an intervertebral spacer (SynCage), and PSRF. At 26 months after surgery, the Helsinki pain score and neurological Griffith score were improved; however, the dog passed away shortly thereafter due to an unrelated disorder. The lumbosacral segment became available for computed tomography (CT), micro-CT and histopathology. On CT, bone volume through the largest hole of the cage was 91.0% and for compact bone 76.1%. Micro-CT and histopathology revealed vertebral fusion. Distraction–fixation using an intervertebral spacer and PSRF was well-accepted in this dog with severe DLSS, and the dog had a good clinical outcome with long-term follow-up. CT, micro-CT and histopathology showed evidence of vertebral fusion.

Inherited Factor XII Deficiency—What Is the Real Concern for Neuroanesthesiologist: Bleeding or Clotting

Factor XII deficiency is a rare disorder that can complicate the perioperative management of a patient. Factor XII plays an important role in the activation of intrinsic pathway of coagulation; the deficiency, therefore, results in prolongation of activated partial thromboplastin time (aPTT). This aPTT prolongation is expected to cause increased bleeding during surgery. However, on the contrary, in vivo isolated factor XII deficiency is associated with increased risk of thromboembolism (this risk being higher than the risk of bleeding). We report the perioperative management of a patient with factor XII deficiency who underwent cervical vertebral fusion (C1–C2) for atlantoaxial dislocation.

Computed Tomographic Evaluation of Adjacent Segment Motion after Ex Vivo Fusion of Equine Third and Fourth Cervical Vertebrae

Objective Surgical fusion of vertebral segments is a treatment option for horses with cervical stenotic myelopathy or cervical fracture.Degenerative disease affecting adjacent vertebral segments is a reported complication following surgical vertebral fusion in other species, termed adjacent segment disease. The aim of this study was to evaluate the impact of cervical vertebral fusion on the biomechanics of adjacent vertebral segments in the horse. Study Design Neck specimens of 12 horses were assessed using computed tomographic imaging. Range of motion (ROM) was determined by measuring the maximum sagittal flexion, extension and lateral bending between C2 and C5. C3/4 was subsequently fused using a standard locking compression plate and locking head screws and computed tomographic scans and ROM measurements were repeated. Results Prior to intervertebral fusion, a significant increase in ROM along the vertebral segments from cranial to caudal was observed. Range of motion measurements of C3/4 decreased significantly after fusion (p = 0.01).Range of motion of the adjacent segments (C2/3 and C4/5) did not change significantly after fusion. Conclusion Fusion of one cervical intervertebral joint did not affect the ROM of the adjacent vertebral segments. Further research investigating the implications of vertebral fusion on the intervertebral pressure in the equine patient is indicated.