Detection And Analysis Of MicroRNA In Serum Of Patients With Adolescent Idiopathic Scoliosis AND Clinic Study Of Adult Degenerative Spinal Disease

Chapter 1 Detection and Analysis of MicroRNA in Serum of Patients with Adolescent Idiopathic ScoliosisObjectives:To investigate whether circulating miRNAs in serum could be a useful biomarker for detecting AIS.Methods:Serum was collected from 10 patients with AIS, and 10 age-and gender-matched normal persons. Then total RNA was isolated and tested with Exiqon miRNA Arrays. The slides were scanned and followed by data extraction. After statistical analysis we got the list of differential expressed microRNAs. Target gene and pathway prediction was made. The key miRNA was selected after comparative analysis combined with bioinformatic prediction. After that, differentially expressed miRNAs in 60 AIS serum samples compared to 60 healthy control serum samples validated was detected by quantitative RT-PCR. Data were analyzed using Student’s t test. The differences were considered statistically significant at p<0.05. Results:A list of differential expressed microRNAs was made by setting the hreshold of up/down regulated microRNAs as Foldchange>2 and P value<0.05.72 up-regulated miRNAs and 73 down-regulated miRNAs were detected in the AIS group VS control group. The key miRNAs were selected. For the AIS VS control group,11 up-regulated:hsa-miR-223-3p, hsa-miR-9-5p, hsa-miR-28-5p hsa-miR-27a-3p, hsa-miR-31-5p, hsa-miR-219a-1-3p, hsa-miR-142-3p hsa-miR-17-5p, hsa-miR-204-5p, hsa-miR-148b-3p, hsa-miR-144-5p.3 down-regulated:hsa-miR-183-5p, hsa-miR-130b-3p, hsa-miR-375. Differentially expressed miRNAs in AIS serum samples compared to healthy control serum samples validated was not found by quantitative RT-PCR. Conclusions:This is the first time to study comparative serum miRNA of AIS, and no difference of serum miRNA were detected between patients and normal persons in the present study.Chapter 2 The Change and Clinical Significance of Sagittal spino-pelvic parameters of adult isthmic spondylolisthesisObjectives:To compare the differences of spino-pelvic parameters between patients with isthmic spondylolisthesis of different grades, and to investigate the correlation between L5 incidence angle (L5I) and the percentage of spondylolisthesis.Methods:60 patients with L5-S1 isthmic spondylolisthesis (mean age,47years, range, 28 to 69 years) and age-matched control group of 77 normal adults (mean age,43.5 years, range,25 to 63 years) were recruted in this retrospective study. Parameters including slip distance (SD), slipping percentage(SP), pelvic incidence (PI), pelvic tilt (PT), sacral slope(SS), L5 incidence (L5I), lumbar-sacral angle (LSA), lumbar lordosis (LL), Sagittal Vertical Axis (SVA) were measured on the Long-cassette standing upright lateral radiographs of the spine and pelvis. Patients with spondylolisthesis were divided into two groups based on slipping percentage:Low grade:group A with SP<30% (30 cases of 60) and high grade:group B with SP>30% (30 cases of 60). Differences in sagittal parameters among groups were analyzed using independent samples t-test, and Pearsons’ correlation coefficients were used to investigate the relationship between spino-pelvic parameters and SP.Results:PI, PT, SS, and LL are larger (p<0.05) in subjects with isthmic spondylolisthesis than those in the control group, while LSA is significantly decreased. L5I is significantly greater in group B, as compared with control group, while there was no significant difference between group A and control group. Strong positive correlation between the SP and PI, PT, SS, SVA and negative correlation between SP and LSA were confirmed in all the patients with spondylolisthesis. SP shows a positive correlation with L5I in group B (p<0.05). However, SP presents no statistically significant correlation with L5I in group A. L5I demonstrates a positive correlation with PI and shows a inverse relation to LSA in the total isthmic spondylolisthesis group.Conclusions:Spino-pelvic parameters including PI, PT, SS and LL were significantly greater in adult patients with isthmic spondylolisthesis. L5I significantly increased in patients with relatively severer spondylolisthesis and showed postive correlation with slipping percentage in those patients which indicated that more attention should be paid to the improvement of L5I.Chapter 3 Lumbar Segmental Instability in Spondylolisthesis:Will It Change the Spino-pelvic Alignment?Objective:The goal of this study is to analyze the change of spino-pelvic alignment in isthmic spondylolisthesis (IS) with lumbar segmental instability.Methods:A total of 59 patients with L5/S1 IS were recruted in this study from December 2011 to September 2013. The average age of the cohort was 45.9 years of age (range,27 to 59 years). All the patients were divided into "dynamic group" and "static group" according to the sagittal translation (ST) on lumbar flexion-extension radiographs. The definition of "dynamic" or "static" spondylolisthesis was based on the instability on flexion/extension films. Patients with a ST variance greater than 3 mm were assigned to "dynamic" group, otherwise were assigned to "static" group. The following spino-pelvic parameters were measured:SVA, TK, LL, PI, PT, LSA, SD (spondy distance) and SP (slipping percentage). The VAS was used to assess back pain of patients.The independent-sample t test was used to compare the difference in spino-pelvic parameters between "dynamic" and "static" group.Results:Twenty (33.9%) and thirty-nine patients (66.1%) were identified as "dynamic" and "static" spondylolisthesis. Average ST were 1.1 mm and 5.1 mm for the "static" and "dynamic" spondylolisthesis, respectively. The SD and SP were siginificantly higher in "dynamic" group. Also, "dynamic" spondylolisthesis demonstrated increased PI,SS and L5I. And there were no difference between the two groups in terms of other parameters (SVA, TK, LL, PT, LSA)(P>0.05). [Conclusions] Increased PI and L5I might be involved in the occurrence of lumbar segmental instability for patients with isthmic spondylolisthesis. The spino-pelvic alignment of adult patients with isthmic spondylolisthesis would not be changed due to lumbar segmental instabilityChapter 4 Analysis of Complications after Long-Segment versus Short-Segment Fixation and Fusion for Adult Degenerative ScoliosisObjective:To investigate the complications following long-segment versus short-segment fixation and fusion for degenerative scoliosis (DS).Methods:From January 2007 to February 2012,94 patients with DS underwent posterior spinal fusion, whose clinical and imaging data were retrospectively reviewed. Long segment fixation was performed on 66 patients (70.2%). There were 11 males and 55 females, whose mean age was (59.1±9.9) years old and mean preoperative Cobb’s angle was (39.3±9.1) °. Short-segment fixation was performed on 28 patients (29.8%). There were 5 males and 23 females, whose mean age was (62.7±12.2) years old and mean preoperative Cobb’s angle was (18.5±6.4) °. Hospital records were reviewed for the patients’age, gender, number of decompression and fusion levels, intraoperative blood loss, operation time, postoperative hospital stay, coronal Cobb’s angle, coronal and sagittal balance, early perioperative complications (< 3 months after the surgery) and late complications (≥3 months after the surgery).Results:No statistically significant differences existed between the 2 groups in the age (P=0.081), gender (P=0.412) and number of decompression levels (P=0.067). The average numbers of fusion levels were 11.1±5.5 in the long-segment fusion group and 3.8±3.2 in the short-segment fusion group. The mean postoperative Cobb’s angles were (13.3±6.5) ° and (8.8±6.7)° respectively in each group. The mean operation time and postoperative hospital stay were (260.8±35.6) min and (6.7±5.5) days in the long-segment fusion group, which were obviously longer than (188.3±20.7) min and (4.9±3.8) days in the short-segment fusion group. There were statistically significant differences between the 2 groups (P<0.01). The mean blood loss was (2788.0±63.8) ml in the long-segment fusion group, which was obviously greater than (1642.0±49.9) ml in the short-segment fusion group. There were statistically significant differences between the 2 groups (P<0.01). The incidences of early complications, late complications and overall complications were 9.1% ,28.8% and 37.9% in the long-segment fusion group and 3.6%,25.0%,28.6% in the short-segment fusion group respectively. The most common complications included the breakage of internal fixation (8 cases,12.1%) and coronal imbalance (6 cases, 9.1%) in the long-segment fusion group, while, curve progression (2 cases,7.1%) and proximal adjacent segment disease (2 cases,7.1%) were more common in short-segment fusion group.Conclusions:Although the incidence of perioperative complications is lower in the short-segment fusion group, curve progression and proximal adjacent segment disease frequently occur. Deformity can be significantly improved with the treatment of long-segment fusion, but the risk of trunk lean and rod fracture is higher in the long-term follow-up, with longer operation time and greater intraoperative blood loss.