spine杂志01上半期摘要翻译课件

indexBasicScienceEffectofPolyetherEtherKetoneonTherapeuticRadiationtotheSpine:APilotStudy聚醚醚酮树脂PEEK对脊柱放射治疗的影响：初步研究DeletionofOpgLeadstoIncreasedNeovascularizationandExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因导致腰椎间盘中炎症细胞因子的表达和新生血管形成的增加indexCervicalSpineComplicationandReoperationRatesFollowingSurgicalManagementofCervicalSpondyloticMyelopathyinMedicareBeneficiaries医疗保险受益人髓性颈椎病手术治疗后的并发症和再手术率EfficacyofDiffusionTensorImagingIndicesinAssessingPostoperativeNeuralRecoveryinCervicalSpondyloticMyelopathy扩散张量成像指数在评估颈椎脊髓病性脊髓病术后神经恢复的成效RoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395Cases在ACDF治疗髓性或根性颈椎病术中常规使用神经监护是可疑的：回忆15,395例indexClinicalCaseSeriesRoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395Cases在ACDF治疗髓性或根性颈椎病术中常规使用神经监护是可疑的：回忆15,395例DermalDiscolorationsandBurnsatNeuromonitoringElectrodesinPediatricSpineSurgery儿科脊柱手术使用神经电极导致皮肤色素沉着和烧伤PreventiveEffectofDynamicStabilizationAgainstAdjacentSegmentDegenerationAfterPosteriorLumbarInterbodyFusion动态稳定对后路腰椎间融合后相邻节段退变的预防效果LumbarDegenerativeSpondylolisthesis:ChangesinSurgicalIndicationsandComparisonofInstrumentedFusionWithTwoSurgicalDecompressionProcedures腰椎退行性脊椎滑脱：手术适应症的变化和两种减压手术的比较INDEXDeformityDiscrepancyBetweenStandingPostureandSagittalBalanceDuringWalkinginAdultSpinalDeformityPatients成年脊柱畸形患者行走和站立姿势矢状平衡之间的差异FunctionandClinicalSymptomsaretheMainFactorsthatMotivateThoracolumbarAdultScoliosisPatientstoPursueSurgery功能和临床病症是促使成人胸腰椎脊柱侧凸患者进行手术的主要因素INDEX

EpidemiologyFrequencyandRiskFactorsforAdditionalLesionsintheAxialSpineinSubjectsWithChordoma:IndicationsforScreening脊柱脊索瘤患者脊柱轴向其他病变的频率和危险因素HealthServicesResearchTheInfluenceofRaceonShort-termOutcomesAfterLaminectomyand/orFusionSpineSurgery种族对椎板切除和/或融合脊柱手术后短期结果的影响INDEXLiteratureReviewASystematicReviewoftheSoft-TissueConnectionsBetweenNeckMusclesandDuraMater:TheMyoduralBridge连接颈部肌肉和硬脑膜之间的软组织的系统评价：肌肉桥OutcomesComparisonofOutcomesofSingle-LevelAnteriorCervicalDiscectomyWithFusionandSingle-LevelArtificialCervicalDiscReplacementforSingle-LevelCervicalDegenerativeDiscDisease单节段前路颈椎椎间盘切除融合术和单节段颈椎椎间盘置换术对单节段颈椎退行性椎间盘疾病的预后比较INDEXPerioperativeComplicationsin155PatientsWhoUnderwentObliqueLateralInterbodyFusionSurgery:PerspectivesandIndicationsFromaRetrospective,MulticenterSurvey155例OLIF患者的围手术期并发症SurgicalSiteInfectionsinPosteriorLumbarSurgery:AControlled-CohortStudyofEpiduralSteroidPaste后路腰椎手术切口感染：控制性队列研究硬膜外类固醇使用CanadianConsensusforthePreventionofBloodLossinSpineSurgery加拿大对预防脊柱手术出血的共识MetallosisPresentingasaProgressiveNeurologicDeficitFourYearsAfteraPosteriorSpinalFusionforAdolescentIdiopathicScoliosis:ACaseReport金属沉着导致青少年特发性脊柱侧凸后路脊柱融合术四年后渐进性的神经功能障碍：病例报告TITLEEffectofPolyetherEtherKetoneonTherapeuticRadiationtotheSpine:APilotStudy聚醚醚酮树脂PEEK对脊柱放射治疗的影响：初步研究StudyDesign.Cadavericmodel.研究设计：尸体模型。ABSTRACTObjectives.TocomparetheeffectofPEEK

versus

conventionalimplantsonscatterradiationtoasimulatedtumorbedinthespine目的：比较PEEK与传统植入物对脊柱模拟放射治疗的影响ABSTRACTSummaryofBackgroundData.Giventhehighlyvasculaturenatureofthespine,itisthemostcommonplaceforbonymetastases.Aftersurgicaltreatmentofaspinalmetastasis,adjuvantradiationtherapyistypicallyadministered.Radiationdosingisprimarilylimitedbytoxicitytothespinalcord.Thescattereffectcausedbymetallicimplantsdecreasestheaccuracyofdosingandcanunintentionallyincreasetheeffectivedoseseenbythespinalcord.Thisrepresentsadose-limitingfactorfortherapeuticradiationpostoperatively.背景资料概述：由于椎体的血运丰富，所以是骨转移最常发生的部位。脊柱转移癌的外科治疗后，通常需要辅助放射治疗。辐射剂量主要受脊髓毒性的限制。金属植入物引起的散射效应降低剂量的准确性，并可以无意中增加脊髓的有效剂量。这代表术后放射治疗的剂量限制因素。ABSTRACTMethods.Acadavericthoraxspecimenwasutilizedasametastatictumormodelwithtwoseparatethree-levelspineconstructs(oneupperthoracicandonelowerthoracic).Eachconstructwasexaminedindependently.Allfourgroupscomparedincludedidenticalposteriorinstrumentation.Theanteriorconstructsconsistedofeither:ananteriorpolyetheretherketone(PEEK)cage,ananteriortitaniumcage,ananteriorbonecementcage(polymethylmethacrylate),oracontrolgroupwithposteriorinstrumentationalone.Eachconstructhadsixthermoluminescentdetectorstomeasuretheradiationdose.方法：使用尸体胸部标本作为具有两个完整脊柱三柱构造〔一个上胸椎和一个下胸椎〕的转移性肿瘤模型。独立地检测每个构建体。所有四组比较包括相同的后路内固定物。前柱固定使用：前聚醚醚酮〔PEEK〕，钛笼，骨水泥笼〔聚甲基丙烯酸甲酯〕或仅有后路内固定的对照组。每个构建体用六个热释光检测器以测量辐射剂量。ABSTRACTResults.Themeandosewassimilaracrossallconstructsandlocations.Therewasmorevariabilityintheupperthoracicspineirrespectiveoftheconstructtype.ThePEEKconstructhadamoreuniformdosedistributionwithastandarddeviationof9.76.Thestandarddeviationoftheothersconstructswas14.26forthecontrolgroup,19.31forthetitaniumcage,and21.57forthecement(polymethylmethacrylate)construct.结果：所有构建体和位置的平均剂量相似。无论内固定类型如何，上胸椎存在更多的变异性。PEEK构建体具有更均匀的剂量分布，标准偏差为9.76。其他构建体的标准偏差：对照组为14.26，钛笼为19.31，骨水泥〔聚甲基丙烯酸甲酯〕构建体为21.57。ABSTRACTConclusion.ThePEEKinter-bodycageresultedinasignificantlymoreuniformdistributionoftherapeuticradiationinthespinewhencomparedwiththeotherconstructs.Thismayallowfortheapplicationofhighereffectivedosingtothetumorbedforspinalmetastaseswithoutincreasingspinalcordtoxicitywitheitherfractionatedorhypofractionatedradiotherapy.结论：与其他构建体相比，PEEK笼手术后放射治疗的辐射在脊柱中有更显着均匀的分布。这可以允许对脊柱转移肿瘤施加更高的有效剂量，而不增加放疗的脊髓毒性。SampleradiationplanningmodelcreatedfromaplanningCTscanforoneofourcadavericspecimens.Theseparateiso-denselinescanbeseenwiththepercentageofthetotaldoseadministered.Theyellowareaisthespinalcordthathasbeenselectedduringtheradiationplanningasanareatoprotect.Notetherediso-denseline's,representing100%dose,lackofuniformdistributioninthePMMAconstructanditsoverlapwiththespinalcord.Aclinicalphotographofarepresentativeconstructwiththeposteriorspinalrods(bluearrow),thecircumferentiallydecompressedspinalcord(whitearrow),andthePMMAanteriorconstruct(yellowarrow).

B,Aclinicalphotographafterthesensorswereplacedintheirrespectivetrocarandthenplacedintheback.Thetrocarswereplacedthroughtheskintoallowformoresecurepositioning.Eachtrocarwaslabeledforaccuraterecoveryofthesensorfromitscorrespondinglocation..AcartonrepresentationoftheTLDsensorplacementlocation.EachTLDsensorplacementwasconfirmedvisuallybeforeclosingtheincisionandfillingitwiththephantommaterial.RepresentativeimagesfromacompleteplanningCTscanwithbeamanglesandiso-denselinesillustrated.Coronal,sagittal,axial,and3Dimagesareincluded.Thephantomcanbeseeingfillingthelungs.Thelowerconstructdosingwasplannedseparately.ArepresentativeT2sagittalMRIofapatientafterposteriorinstrumentationandanteriorreconstructionwithaPEEKcage.Notethescatterwiththepediclesscrews(redarrows).ThePEEKcagehasminimalscatteraffectingtheimagingsequence(yellowarrow).

RepresentativeaxialCTscanimagesdemonstratingthedifferenceinscattereffectfromametalanteriorconstruct(A)

versus

aPEEKanteriorconstruct(B).*Despiteadvances,metastaticdiseasecontinuestoaffectthespineanditcancausesymptomsfrompainandweaknesstocompleteparalysisleadingtosignificantmorbidityanddisability*尽管取得进展，但转移性疾病任然影响脊柱，并且可引起疼痛和无力，甚至完全瘫痪*ThePEEKinterbodycageresultedinasignificantlymoreuniformdistributionoftherapeuticradiationinthespinewhencomparedwiththeotherconstructsinacadavericspinemodel.*与尸体脊柱模型中的其他内固定构造相比，PEEK椎间融合器的治疗辐射在脊柱中有更加显着均匀的分布。*Thisknowledgemayallowfortheapplicationofhighereffectivedosingtothetumorbedforspinalmetastaseswithoutincreasingspinalcordtoxicitywitheitherfractionatedorhypofractionatedradiotherapy.*这种知识可以对脊柱转移的肿瘤应用更高的有效剂量，而不增加放疗的脊髓毒性。

TITLEDeletionofOpgLeadstoIncreasedNeovascularizationandExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因导致腰椎间盘中炎症细胞因子的表达和新生血管形成的增加StudyDesign.NeovascularizationandexpressionofinflammatorycytokineswereexaminedinOsteoprotegerin(Opg)knockout(KO)micethatshowintervertebraldisc(IVD)degeneration.研究设计：研究骨保护素〔Opg〕敲除〔KO〕小鼠的椎间盘〔IVD〕变性模型中炎症细胞因子的表达和新血管的形成。ABSTRACTObjective.TheaimofthisstudywastoclarifythepathologicalchangesinlumbarIVDdegenerationinOpgKOmice.目的：本研究的目的是说明OpgKO小鼠腰椎IVD变性的病理变化。ABSTRACTSummaryofBackgroundData.OsteoporosisisacontroversialriskfactorforIVDdegeneration.DeletionofOpgresultedinIVDdegenerationinmice.NeovascularizationandinflammatorycytokinesarekeyfactorsinIVDdegeneration.背景数据概述：骨质疏松是IVD变性的有争议的风险因素。敲除Opg导致小鼠中的IVD变性。新血管形成和炎症细胞因子是IVD变性的关键因素。ABSTRACTMethods.OpgKOmiceandtheirwild-type(WT)littermateswereeuthanized.LumbarIVDswereharvested.SafraninO/FastGreenstainingwasperformedtoexaminethepathologicalchanges.Microcomputedtomographic(micro-CT)analysiswasperformedtodeterminethestructuralchangesatthejunctionoflumbarIVDcartilageandvertebrae.Tartrate-resistantacidphosphatase(TRAP)stainingwasperformedtoevaluateosteoclastformation.ProteinexpressionofvascularendothelialgrowthfactorA(VEGF-A),CD31,VE-cadherin,CD34,interleukin-1β(IL-1β),andtumornecrosisfactorsα(TNF-α)wereanalyzedbyimmunohistochemistry(IHC)assays.GeneexpressionsofIL-1β,IL-6,andTNF-αwereanalyzedbyreal-timepolymerasechainreaction(RT-PCR).方法：将OpgKO小鼠及其野生型〔WT〕同窝小鼠安乐死。获取腰部IVD。进行SafraninO/FastGreen染色以检查病理变化。进行微计算机断层扫描〔micro-CT〕分析以确定腰椎IVD软骨和椎骨的连接处的结构变化。进行酒石酸盐抗性酸性磷酸酶〔TRAP〕染色以评价破骨细胞形成。通过免疫组织化学〔IHC〕测定分析血管内皮生长因子A〔VEGF-A〕，CD31，VE-钙粘蛋白，CD34，白细胞介素-1β〔IL-1β〕和肿瘤坏死因子α。通过实时聚合酶链反响〔RT-PCR〕分析IL-1β，IL-6和TNF-α的基因表达。ABSTRACTResults.In12-week-oldOpgKOmice,newbonewasformedintheendplatecartilageoflumbarIVDsandthisbecamemoreobviousin24-week-oldOpgKOmice.Three-dimensional(3D)μCTreconstructionanalysesshowedthattheedgesoftheL4andL5vertebraewereruggedwithbonemarrowcavitiesinit.ProteinexpressionofVEGF-A,CD31,VE-cadherin,andCD34wasincreasedintheendplateandgrowthplateoflumbarIVDsofOpgKOmice.GeneexpressionofIL-1β,IL-6,andTNF-αaswellasproteinexpressionofIL-1βandTNF-αwerehighlyexpressedinthelumbarIVDsofOpgKOmice.结果：在12周龄的OpgKO小鼠中，腰椎IVD的终板软骨中形成新骨，这在24周龄的OpgKO小鼠中变得更明显。三维〔3D〕μCT重建分析显示，L4和L5椎骨的边缘与骨髓腔骨质增生。在OpgKO小鼠的腰椎IVD的终板和生长板中VEGF-A，CD31，VE-钙粘着蛋白和CD34的蛋白表达增加。IL-1β，IL-6和TNF-α的基因表达以及IL-1β和TNF-α的蛋白表达在OpgKO小鼠的腰部IVD中高度表达。ABSTRACTConclusion.DeletionofOpgleadstoincreasedneovascularizationandexpressionofinflammatorycytokinesinthelumbardiscinOpgKOmice,whichmayplayimportantrolesinIVDdegeneration.结论：Opg的缺失导致OpgKO小鼠腰椎间盘的新血管形成和炎症细胞因子的表达增加，这可能在IVD变性中起重要作用。Newbonewasformedintheendplatecartilageofthelumbar4/5IVDsin

Opg

KOmice.

(A)

SafraninOandFastGreenstainingshowedthatthenewbonewasfoundattheedgeoftheendplatecartilagein12-week-old

Opg

KOIVDs(arrow,middlepanel),andwasdevelopedthroughouttheendplatecartilagein24-week-old

Opg

KOIVDs(arrowheads,rightpanel).Thegrowthplatebecamethinner(arrow,rightpanel).

(B)

Newboneformationwasquantifiedbytheratioofnewboneareaandendplatecartilageareainlumbar4/5IVDs.Inboth12-week-oldand24-week-oldmice,newboneformationinendplatecartilageof

Opg

KOIVDswassignificantlyincreasedthanthatofWTIVDs(P

<0.01).n=3.

(C)

3Dreconstructionanalysisfromthetransversepositionshowedthatin12-week-old

Opg

KOmice,newcavitiesappearedontheedgesoftheL4andL5vertebrae.In24-week-old

Opg

KOmice,thevertebraebecameevenruggedwithalotofcavitiesinit(pixelsize:906x906).*DeletionofOpgleadstoincreasedneovascularizationinlumbarintervertebraldiscofmice.*DeletionofOpgleadstoincreasedexpressionofinflammatorycytokinesinlumbarintervertebraldiscofmice.*LumbarIVDdegenerationinOpgKOmicecouldbeacceleratedbytheinteractionsamongosteoclastformation,inflammatorycytokines,andneovascularization.*敲除Opg导致小鼠腰椎间盘增加新血管形成。*敲除Opg导致小鼠腰椎间盘中炎症细胞因子的表达增加。*OpgKO小鼠的腰椎IVD变性可以通过破骨细胞形成，炎症细胞因子和新血管形成之间的相互作用而加速。TitleComplicationandReoperationRatesFollowingSurgicalManagementofCervicalSpondyloticMyelopathyinMedicareBeneficiariesDepartmentofOrthopaedicSurgery,JohnsHopkinsHospital,Baltimore,MD医疗保险受益人髓性颈椎病手术治疗后的并发症和再手术率StudyDesign.Retrospectivedatabasereview.研究设计：回忆性数据库审查。ABSTRACTObjective.Tocomparecomplicationandreoperationratesafteranteriorcervicaldiscectomyandfusion(ACDF),posteriorcervicalfusion(PCFs),andanteriorcervicalcorpectomyandfusion(ACCF)forcervicalspondyloticmyelopathy(CSM)usingalargenationaldatabaseofMedicarebeneficiaries.目的：使用国家医疗保险受益人的大型国家数据库，比较颈椎前路椎间盘切除融合术和颈椎后路融合术〔PCF〕，颈椎前路椎体融合术〔ACCF〕治疗颈椎髓性颈椎病〔CSF〕的并发症和再手术率。ABSTRACTSummaryofBackgroundData.CSMisthemostcommoncauseofmyelopathyinpatientsover55yearsandisconsideredthemostcommoncauseofspinalcorddysfunctionintheworld.SurgicaltreatmentincludesACDF,PCF,orACCFprocedures.背景资料概述：CSM是55岁以上患者中脊髓压迫最常见的原因，并且被认为是世界上导致脊髓功能障碍的最常见原因。手术治疗包括ACDF，PCF或ACCF。ABSTRACTMethods.ThePearlDiverdatabase(2005–2021)wasutilizedtodeterminerevisionratesaftersurgicaltreatmentofCSMbyoneoftheaforementionedsurgicaltreatments.Specifically,1to2levelACDF,ACCF,andPCFand3+levelPCFcohortswereincluded.Eachcohortwasstratifiedbytheageof65years.Survivorshipcurvesweregraphedandcompared.方法：使用PearlDiver数据库〔2005-2021〕确定上述手术治疗的CSM患者的返修率。具体来说，包括1至2阶段ACDF，ACCF和PCF和3+PCF队列。每个队列按65岁分层。绘制并比较存活曲线。ABSTRACTResults.Ofthepatientsyoungerthan65yearsofage,therewere10,557patientstreatedwith1to2levelACDFprocedures,1319patientswith1to2levelPCFprocedures,1203patientswith1to2levelACCFprocedures,and2312patientstreatedwith3+levelPCFprocedures.Oftheelderlypatients,24,310patientsweretreatedwith1to2levelACDFs,4776with1to2levelPCFprocedures,3109with1to2levelACCFs,and7760with3+levelPCFs.Patientsyoungerthan65yearsofageweresignificantlymorelikelytohaveareoperationprocedure,thanthose65yearsorolderwhenanalyzingACCF,ACDF,and3+levelPCFprocedures.ACCFsweresignificantlymorelikelythanACDFstorequirereoperation.PatientstreatedwithPCFwereconsistentlymorelikelytohavenondysphagia-relatedcomplicationsthanthosetreatedwithACDF.Ratesoftransfusion,dysphagia,andhematoma/seromaformationweresignificantlyincreasedwithACCFcomparedwithACDFwithintheelderlypopulation.结果：在65岁以下的患者中，有10,557例患者接受1〜2阶段的ACDF手术，1319例患者接受1〜2阶段的PCF手术，1203例患者接受1〜2阶段的ACCF手术，2312例患者接受3+级PCF程序。在老年患者中，24,310例患者接受1〜2阶段的ACDF治疗，4776例接受1〜2阶段的PCF手术，3109例接受1〜2阶段的ACCF，7760例接受3〜4阶段的PCF。65岁以下的患者ACCF，ACDF和3+级PCF比65岁或更大的患者明显更有可能进行再次手术。ACCF明显比ACDF更可能需要再次手术。PCF治疗的患者比用ACDF治疗的患者更可能患有非吞咽困难相关的并发症。输血，吞咽困难和血肿形成率在老年人口中的ACDF组显着增加。ABSTRACTConclusion.TheelderlyaresignificantlylesslikelytohavearevisionsurgeryaftersurgicaltreatmentforCSM.PatientstreatedwithACCFaremorelikelytoneedarevisionthanthosetreatedwithACDF.结论：老年人在CSM手术治疗后进行返修手术的可能性显着降低。用ACCF治疗的患者比用ACDF治疗的患者更可能需要翻修。*PatientstreatedwithACCFaremorelikelytoneedrevisionsurgerythanthosetreatedwithACDForPCF.*ThereisnosignificantdifferenceinrevisionratewhencomparingACDFandPCFprocedures.*Theelderlyweresignificantlylesslikelythanyoungerpatientstohavearevisionsurgerywhenconsideringallsurgeries.*PCFisassociatedwithgreatercomplicationrates,thoughlowerdysphagiarates.*ACCF治疗的患者比ACDF或PCF治疗的患者更可能需要翻修手术。*当比较ACDF和PCF程序时，翻修率没有显着差异。*在考虑所有手术时，老年人比年轻患者进行翻修手术的可能性显着降低。*PCF与较高的并发症发生率相关，但吞咽困难率较低。

TITLEEfficacyofDiffusionTensorImagingIndicesinAssessingPostoperativeNeuralRecoveryinCervicalSpondyloticMyelopathyDepartmentofspinesurgery,GangaHospital,Coimbatore,India.扩散张量成像指数在评估颈椎脊髓病性脊髓病术后神经恢复的成效StudyDesign.Prospectiveobservationalcohortstudy.研究设计：前瞻性观察性队列研究。ABSTRACTObjective.Theaimofthisstudywastoanalyzetheefficacyofdiffusiontensorimaging(DTI)anisotropyindicesinpredictingthepostoperativerecoveryincervicalspondyloticmyelopathy(CSM)patientsandtodescribepostoperativechangesintheDTIindicesbasedonneurologicalrecoveryaftersurgery.目的：本研究的目的是分析扩散张量成像〔DTI〕各向异性指数在预测颈髓性脊髓病〔CSM〕患者的术后恢复的效果，并描述手术后神经恢复的DTI指数的术后变化。

ABSTRACTSummaryofBackgroundData.SurgicalresultsofCSMareunpredictableandcannotbeestimatedbasedonpreoperativeMRI.DTIindiceswerefoundtohavegoodsensitivitytodetectchangesinCSM,buttheirefficacyinpredictingpostoperativerecoveryandpostoperativechangesinDTIindiceshasnotbeenstudiedbefore.背景资料总结：CSM的手术结果是不可预测的，不能基于术前MRI进行估计。DTI指数具有良好的敏感性以检测CSM的变化，但DTI指数术后变化在预测术后恢复的成效尚未进行过研究。ABSTRACTMethods.Thirty-fivepatientswhounderwentsurgicaldecompressionforcervicalspondyloticmyelopathyunderwentDTIevaluationpreoperativelyandpostoperativelyat12months.DTIindices—fractionalanisotropy,apparentdiffusioncoefficient(ADC),relativeanisotropy,volumeratio,andeigenvectors(E1,E2,andE3)—wereobtainedandclinicalevaluationsweremadepreoperativelyand12monthspostoperatively.方法：35例颈椎病接受手术减压的患者术前和术后12个月进行DTI评估。获得DTI指数-分数各向异性，表观扩散系数〔ADC〕，相对各向异性，体积比和特征向量〔E1，E2和E3〕，并在术前和术后12个月进行临床评价。ABSTRACTResults.Twenty-sixpatientswereavailableforfinalfollow-upat12months.Twentypatientsshowedimprovementbyatleast1Nurickgrade,fivemaintainedthepreoperativeNurickgradestatusandonepatientwasnotedtohavedeteriorationby1grade.ThepreoperativeDTIvaluescouldnotpredictneurologicalrecoverypatternspostoperatively.AlthoughconventionalMRIshowedadequatedecompressioninallpatientsirrespectiveoftheclinicaloutcome,DTIindicesshowedvariableresults.ThereweresignificantimprovementsinpostoperativeDTIindicesforADC(P

=0.002),E1(P

<0.001),andE2(P

=0.012)valuesinpatientswhoshowedneurologicalrecoveryat12months.PostoperativeDTIindicesforcoefficientsADC,E1,andE2inneurologicallystatic/worsenedindividualsremainedunchangedorinsignificant(P

=0.05)结果：在12个月时有26名患者获得了最终随访。20例患者表现出至少1级的Nurick改善，5例维持术前Nurick分级状态，1例患者1级恶化。术前DTI值无法预测术后神经恢复。尽管常规MRI在所有患者中显示充分的减压，而不管临床结果如何，但DTI指数显示可变的结果。在12个月时显示神经恢复的患者中，ADC〔P=0.002〕，E1〔P<0.001〕和E2〔P=0.012〕值的术后DTI指数有显着改善。在神经静态/恶化个体中，ADC系数，E1和E2的术后DTI指数保持不变或不显着〔P=0.05〕ABSTRACTConclusion.TheDTIindicesweresensitiveenoughtoindicatepostoperativeneurologicalrecoveryobservedfollowingsurgery.PreoperativeDTIevaluationcouldnotpredictpostoperativerecoveryforpatientswithcervicalspondyloticmyelopathy.结论：DTI指数足够敏感预测手术后观察到神经恢复。术前DTI评估无法预测髓性颈椎病患者的术后恢复。

*PostoperativeDTIindicesweresensitivetodifferentiatepostoperativeclinicaloutcomefollowingsurgery,showingcomparablechangewithrecoveryandnosignificantchangewasseeninpatientswhoshowednorecoveryorworsenedaftersurgery.*StatisticallysignificantimprovementwasnotedinDTIindicesvaluesforADC,EigenvectorsE1andE2at12monthsfollowingsurgeryinthepatientsshowingneurologicalrecovery.*ThoughpostoperativeMRIshowedsatisfactorydecompressioninallsurgicallytreatedpatientspostoperativeDTIindicesshowedvariableresults.*PreoperativeDTIcouldnotpredictwhichpatientwouldshowclinicalrecoveryfollowingsurgicaldecompression.*术后DTI指数对手术后的临床结果敏感，显示与恢复相当的变化，在手术后未恢复或恶化的患者中未见显着变化。*在显示神经恢复的患者中，在手术后12个月的ADC，特征向量E1和E2的DTI指数值中观察到统计学显着的改善。*虽然术后MRI显示所有手术治疗患者的减压良好，术后DTI指数显示可变的结果。*术前DTI无法预测患者在手术减压后的临床恢复

磁共振弥散张量成像

〔diffusiontensorimaging,DTI〕实现活体观察组织结构的完整性和连通性，利于对各种疾病的引起的白质纤维束的损害程度及范围的判断。可用于显示脑白质内神经传导束的走行方向，实现对人的中枢神经纤维精细成像。MR图像的信号：组织T1、T2驰豫时间、H1的密度、分子弥散运动DTI的根本原理：利用扩散敏感梯度脉冲将水分子弥散效应扩大，来研究不同组织中水分子扩散运动的差异〔扩散加权相DWI〕。DTI可利用扩散敏感梯度从多个方向对水分子的扩散各向异性进行量化，因此有可能反映组织内的细微结构及病理生理改变。扩散张量成像(difusiontensorimaging，DTI)可以观察脊髓病变及再生修复的动态过程，进行组织微观结构改变的定量分析，纤维束示踪成像技术可以立体展现白质纤维束的形态表观扩散系数(apparentdifusioncoefficient，DCADC值越大，说明水分子的弥散能力越强；三个互相垂直方向的ADC值的平均数是平均扩散率(meandisivity，MD)，它不受方向影响；各向异性包括局部各向异性(fractionanisotropy，FA)和相对各向异性(relativeanisotropy，RA)FA、RA都是非矢量值(数值，无方向性)，取值范围为是0～1既组织结构排列越规律紧密，组织的各向异性越强，各向异性系数越大张量方向由于弥散张量具有方向性，可以从弥散张量所含信息中显示出纤维方向的图，利用纤维束示踪成像技术，立体展现白质纤维束的形态TheAssessmentofNeuronalStatusinNormalandCervicalSpondyloticMyelopathyUsingDiffusionTensorImaging弥散张量成像在正常和脊髓型颈椎病对神经元的状态的评价STUDYDESIGN:Aprospectiveobservationalanalysisofdiffusiontensorimaging(DTI)datametricscollectedfromcontrolandpatientswithcervicalspondyloticmyelopathy(CSM).研究设计：收集脊髓型颈椎病〔CSM〕的弥散张量成像〔DTI〕数据前瞻性观察分析。AbstractOBJECTIVE:TheaimsweretostudytheuseofDTIinCSMandtoprobewhetherDTIdatametricsandtractographywillcorrelatewithmagneticresonanceimagingandclinicalfindings.目的：目的是研究在CSM患者中使用DTI和探讨DTI跟踪技术磁共振成像和临床表现相关。AbstractSUMMARYOFBACKGROUNDDATA:Magneticresonanceimagingisthecurrent"goldstandard"intheassessmentofcordstatusinCSM;however,variousparameterssuchasextentofcompressionandpresenceofsignalintensitychangesdonotcorrelatewellwithclinicalstatus.DTIisanovelinvestigationtoolwithprovenapplicationsinbrainpathologiesbutisnotroutinelyusedinspinalcordevaluation.背景资料概述：磁共振成像是在目前CSM状况评估的“金标准〞;然而，各种参数与临床情况相关性不是很好。DTI是一种新型的检测方式，常用在颅脑的诊断中，但在脊柱脊髓的诊断中不常使用。AbstractMETHODS:PatientswithCSM(n=35)whorequiredsurgicaldecompression(meanage=48yr)and40normalindividuals(meanage=38yr)wereincluded.DiffusionTensorImagingofthecervicalspinewasobtainedusinga1.5Tmagneticresonanceimage.Apparentdiffusioncoefficient,fractionalanisotropy,andeigenvalues(E1,E2,andE3)wereobtainedateachcervicallevel.TheDTIdatametricsofCSMpatientswerecomparedwithnormalvolunteersandcorrelatedwithindividualandgroupedNurickgrades,whichindicatetheneurologicalstatusofpatients.方法：35名需要手术减压的CSM患者〔平均年龄=48岁〕和40名正常人〔平均年龄=38岁〕纳入研究。颈椎的弥散张量成像是使用1.5T磁共振图像获得。获取每个节段的表观扩散系数，分数各向异性，和特征值〔E1，E2和E3〕的数据。CSM患者的DTIdatametrics与正常人进行了比较，并和Nurick等级关联起来。AbstractRESULTS:TherewassignificantdifferenceinDTIdatametricsbetweenpatientswithmyelopathyandcontrol(P<0.05),withdecreaseinfractionalanisotropy(0.49±0.081vs.0.53±0.07)andincreaseinapparentdiffusioncoefficient(1.8±0.315vs.1.44±0.145)andeigenvalues(E1:2.82±0.395vs.2.37±0.221,E2:1.64±0.39vs.1.18±0.198,E3:0.956±0.277vs.0.76±0.142).Therewasalsoasignificantdifferencebetweenincreasinggradesofmyelopathywhenindividualsweregroupedas-control,self-ambulant(Nurickgrades1and2),anddependent(Nurickgrades3,4,and5).结果：在CMS和对照组中DTIdatametrics存在显著差异〔P<0.05〕，各向异性分数降低〔0.49±0.081与0.53±0.07〕，表观扩散系数〔1.8±0.315与1.44±0.145〕和特征值增加〔E1：2.82±0.395与2.37±0.221，E2：与0.198±，E3：0.956±0.277与0.76±0.142〕。根据Nurick等级得分的不同，脊髓的MRIDTI也不同。1.Tractographypatterns:(A)normal,(B)waisting,(C)partiallyinterrupted,and(D)completelyinterrupted.Arrowsshowcompressedregions.AbstractCONCLUSION:ThestudyshowsthatDTIisapromisingandusefulinvestigationaltoolinevaluationofCSM.TherewasasignificantdifferenceinallDTIvaluesbetweencontrolandpatientswithCSM,andtherewasasignificanttrendofchangeinvaluesbetweencontrol,self-ambulant,anddependentpatients.Ourresultsencouragefurtherinvestigationofthisimportantmodality.结论：该研究说明，DTI是评价CSM的一个有前途的和有用的研究性的工具。对照组和CMS组的DTI数值是显著不同的，并且与Nurick等级得分有关系。我们的研究结果指导下一步的继续研究。TITLERoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395CasesUCLAMedicalCenter,DepartmentofOrthopaedicSurgery,LosAngeles,CA在ACDF治疗髓性或根性颈椎病术中常规使用神经监护是可疑的：回忆15,395例StudyDesign.Aretrospectivedatabasestudy.研究设计：回忆性数据库研究。ABSTRACTObjective.Thegoalofthisstudywasto(1)evaluatethetrendsintheuseofintraoperativeneuromonitoring(ION)foranteriorcervicaldiscectomyandfusion(ACDF)surgeryintheUnitedStatesand(2)assesstheincidenceofneurologicalinjuriesafterACDFswithandwithoutION.目的：本研究的目的是〔1〕评估在美国使用术中神经监护〔ION〕用于前颈椎间盘切除术和融合〔ACDF〕手术的趋势，以及〔2〕评估ACDF后神经损伤的发生率有和没有ION。

ABSTRACTSummaryofBackgroundData.Somatosensory-evokedpotentials(SSEPs)andmotor-evokedpotentials(MEPs)arethecommonlyusedIONmodalitiesforACDFs.ControversyexistsontheroutineuseofIONforACDFsandthereislimitedliteratureonnationalpracticepatternsofitsuse.背景数据的概述：体感诱发电位〔SSEP〕和运动诱发电位〔MEP〕是ACDF常用的ION方式。关于ION用于ACDF的常规使用存在争议，并且关于其使用的国家实践模式的文献有限。

ABSTRACTMethods：AretrospectivereviewwasperformedusingthePearlDiverPatientRecordDatabasetoidentifycasesofspondyloticmyelopathyandradiculopathythatunderwentACDFfrom2007to2021.ThetypeofIONmodalityusedandtheratesofneurologicalinjuryaftersurgerywereassessed.方法：使用PearlDiver患者记录数据库进行回忆性评估，以确定2007年至2021年期间接受ACDF的髓性颈椎病和根性颈椎病的病例。评估使用ION方式类型和手术后神经损伤的发生率。pearldiver已经建立了一个世界上最大的医疗保健数据库超过40亿符合HIPAA病人记录。在这个根底上，pearldiver能够提供医院、医务人员、医疗设备公司高管、分析师和监管机构的关键见解和可操作的信息。PearlDiverhaspartneredwithComprehensiveHealthInsightstointegrateHumana’s〔医疗保险巨头〕fullclaimsdatabaseintothePearlDiverresearchprogram.AsofJuly,2021Humanarepresents20.9millionpatientsthroughoutthedurationofthesetincludingclaimsfrom2007throughQ32021.Nosamplingisperformedonthisdata.ResearchisconductedoverthefullsetincludingcommercialandMedicareadvantagepopulations.Whilede-identifiedandHIPAAcompliant,thisresearchsetisfullycapableoflongitudinalresearchbaseduponuniquepatientidentifiercodes.ResearchcanbeperformedutilizinganyoneorcombinationofidentifiablefieldsontheclaimrecordprocessedbyHumana.Fieldsincludebutarenotlimitedto;ICD-9&ICD-10diagnosiscoding,DRGproceduralcoding,ICD-9&ICD-10proceduralcoding,CPTproceduralcoding,prescriptionNDCcoding,labrecordLOINCcoding,dischargestatus