| Chapter Two Compensatory modulation for severe global sagittal imbalance:significance of cervical compensation on quality of life in thoracolumbar kyphosis secondary to ankylosing spondylitisObjective:To investigate the cervical compensation pattern and to clarify relationships between cervical compensation and quality of life(QOL)in ankylosing spondylitis(AS)patients with thoracolumbar kyphosis.Methods:A cross-sectional study of consecutive AS patients with thoracolumbar kyphosis was performed.Forty-four patients with hyperlordotic cervical spine were assigned to group A and sixteen with kyphotic cervical spine in group B.Sagittal parameters were measured and compared,including T1 slope,cervical lordosis(CL),cervical sagittal vertical axis(C-SVA),global SVA and global kyphosis(GK).Independent factors for cervical compensation were identified.In order to exclude confounding variables while comparing QOL between patients with hyperlordotic and kyphotic cervical spine,thirty-one patients were selected as group A-1,similar to thirteen patients in group B-1 in the distribution of matching variables such as age.gender,course of disease.GK.global SVA and radiographic progression assessment for AS.The QOL was assessed by Neck Disability Index(NDI)and other indices.Results:Mean C-SVA was significantly lower in group A than in group B,whereas mean T1 slope,global SVA and GK were significantly larger in group A.T1 slope(36.0%)was the independent factor for cervical lordosis.T1 slope was correlated with CL,GK and global SVA in group A.Group A-1 showed lower NDI score.CL(59.6%)independently affects NDIConclusions:Notable cervical compensation exists in AS patients with thoracolumar kyphosis.The cervical compensation responsive to global imbalance was mediated by T1 slope.AS patients with hyperlordotic cervical spine present with better QOL than patients with kyphotic cervical spine.Chapter Three Can T1 slope exceed the margin of thoracic inlet angle?An evidence of cervical compensation in ankylosing spondylitis patients with hyperlordotic cervical spineObjective:By comparing the radiographic characteristics of AS patients with T1 slope>TIA and normal hyperlordotic cervical spine,this study aims to provide direct evidence of cervical compensation and role of cervicothoracic structure in cascade of compensation in AS patients with thoracolumbar kyphosis.Methods:A retrospective review of consecutive AS patients with thoracolumbar kyphosis underwent surgical correction at our institution from January 2008 to December 2014 was performed.Among thirty-six patients with hyperlordotic cervical spine,the presence of T1 slope>TIA was found in three patients(group A).The rest thirty-three patients were with normal hyperlordotic cervical spine(group B).Spinopelvic and cervical sagittal parameters were measured and compared between the two groups,such as T1 slope,TIA,cervical sagittal vertical axis(C-SVA),cervical lordosis(CL)and pelvic tilt(PT).TIA-T1 slope mismatch,TIA-CL mismatch were also defined and compared between the two groups.Results:Thirty-three AS patients had normal hyperlordotic cervical spine and three were with T1 slope>TIA.Mean T1 slope,cervical SVA and PT were significantly larger in group A than in group B.whereas mean TIA.TIA-T1 slope mismatch and TIA-CL mismatch were significantly smaller in group A.T1 slope was significantly correlated with CL,GK and global SVA.TIA-CL mismatch was significantly associated with CL and PT.Conclusion:T1 slope can exceed the margin of TIA.TIA demonstrates potential of cervical compensation.A mismatch between cervical lordosis and TIA is the key to initiate compensation in the cervicothoracic structureChapter Four Serum level of novel osteoimmunological marker Semaphorins 3A in patients with severe thoracolumbar kyphosis secondary to ankylosing spondylitis:a hypothesis that immunoregulation is related to the pathogenesis of new bone formation in ankylosing spondylitisObjective:To identify novel serum markers in the immunoregulation and pathogenesis of new bone formation in ankylosing spondylitis(AS).Compared with normal control,measure the level of semaphorins 3A(Sema 3A)in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis(AS).A hypothesis is brought that Sema A participate in the immunoregulation of T helper 17(Th17)cells related inflammatory process and the pathogenesis of new bone formation in AS.Methods:Fifty-nine untreated male AS patients and 61 age-matched male normal controls were recruited.Approved by the institutional review board,venous blood of all subjects was drawn from just above the elbow with patients' consent.Enzyme linked immunosorbent assay-sandwich techniquewas applied.Prepare all reagents before starting assay procedure.Add serum sample,standard,horseradish peroxidase(HRP)-conjugate reagent in sequence to each well coated with antibody to serum sample,then cover with an adhesive strip and incubate.Aspirate each well and wash.Add chromogen solution,gently mix and incubate while protected from light.Then add Stop Solution.After the color in the wells changes from blue to yellow,read the Optical Density(O.D.)at 450 nm using a microtiter plate reader,and calculate the results from a plotted standard curve.Serum Sema 3A,tumor necrosis factor-a(TNF-?),and interleukin-21(IL-21)levels were evaluated using enzyme-linked immunosorbent assay analysis(ELISA)in both AS patients and normal controls.Results:Serum level of Sema 3A.TNF-? and IL-21 were all higher in AS patients compared with normal control(47.5±5.3 ng/ml vs 40.2 ± 4.0 ng/ml.182.6±38.1 pg/ml vs 47.5 ± 7.7 pg/ml,190.3 ± 29.8 pg/ml vs 93.3 ± 21.0 pg/ml,p<0.01).Conclusion:Serum level of Sema 3A.TNF-? and IL-21 were all higher in AS patients compared with normal control.Sema 3A was a potential novel putative factor n the immunoregulation of inflammatory response and pathogenesis of new bone formation in AS. |
PDF Full Text Request