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Jian-Bin Chen, Ding Lei, Min He, Hong Sun, Yi Liu, Heng Zhang, Chao You, and Liang-Xue Zhou


The present study aimed to clarify the incidence and clinical features of disease progression in adult moyamoya disease (MMD) patients with Graves disease (GD) for better management of these patients.


During the past 18 years, 320 adult Chinese patients at West China Hospital were diagnosed with MMD, and 29 were also diagnosed with GD. A total of 170 patients (25 with GD; 145 without GD) were included in this study and were followed up. The mean follow-up was 106.4 ± 48.6 months (range 6–216 months). The progression of the occlusive lesions in the major intracranial arteries was measured using cerebral angiography and was evaluated according to Suzuki's angiographic staging. Information about cerebrovascular strokes was obtained from the records of patients' recent clinical visits. Both angiographic progression and strokes were analyzed to estimate the incidences of angiographic progression and strokes using Kaplan-Meier analysis. A multivariate logistic regression model was used to test the effects of sex, age at MMD onset, disease type, strokes, and GD on the onset of MMD progression during follow-up.


During follow-up, the incidence of disease progression in MMD patients with GD was significantly higher than in patients without GD (40.0% vs 20.7%, respectively; p = 0.036). The interval between initial diagnosis and disease progression was significantly shorter in MMD patients with GD than in patients without GD (p = 0.041). Disease progression occurred in both unilateral MMD and bilateral MMD, but the interval before disease progression in patients with unilateral disease was significantly longer than in patients with bilateral disease (p = 0.021). The incidence of strokes in MMD patients with GD was significantly higher than in patients without GD (48% vs 26.2%, respectively; p = 0.027). The Kaplan-Meier survival curve showed significant differences in the incidence of disease progression (p = 0.038, log-rank test) and strokes (p = 0.031, log-rank test) between MMD patients with GD and those without GD. Multivariate analysis suggested that GD may contribute to disease progression in MMD (OR 5.97, 95% CI 1.24–33.76, p = 0.043).


The incidence of disease progression in MMD patients with GD was significantly higher than that in MMD patients without GD, and GD may contribute to disease progression in MMD patients. The incidence of strokes was significantly higher in MMD patients with GD than in patients without GD. Management guidelines for MMD patients with GD should be developed.

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Hong-Lei Yi, Michael Faloon, Stuart Changoor, Thomas Ross, and Oheneba Boachie-Adjei


Achieving fusion at the lumbosacral junction poses many technical challenges. No data exist in the literature comparing radiographic or clinical outcomes between the different surgical techniques of transsacral fixation (TSF) with rods and transforaminal lumbar interbody fusion (TLIF) in conjunction with iliac fixation. The purpose of this study was to compare the clinical outcomes and radiographic fusions of TSF to TLIF in patients with adult spinal deformity undergoing long fusions across the lumbosacral junction.


Patients with primary adult spinal deformity who underwent long fusions from the thoracic spine across the lumbosacral junction with different approaches of interbody fusion at the L5–S1 level were reviewed. Patients were subdivided by approach (TSF vs TLIF). Fusion status at L5–S1 was evaluated by multiple radiographs and/or CT scans. Scoliotic curve changes were also evaluated preoperatively and at final follow-up. Clinical outcomes were assessed by Scoliosis Research Society Outcome Instrument 22 and Oswestry Disability Index scores.


A total of 36 patients were included in the analysis. There were 18 patients in the TSF group and 18 patients in the TLIF group. A mean of 14.00 levels were fused in the TSF group and 10.94 in the TLIF group (p = 0.01). Both groups demonstrated significant postoperative radiographic improvement in coronal parameters. The fusion rates for TSF and TLIF groups were 100% and 88.9%, respectively (p < 0.05). Eight patients in the TSF group had pelvic fixation with unilateral iliac screws, compared to 15 patients in the TLIF group (p = 0.015). No statistical differences in patients’ reported outcomes were seen between groups.


Despite similar clinical and radiographic outcomes between both groups, TSF required fewer iliac screws to augment stability of the lumbosacral junction while achieving a higher rate of fusion. This study suggests that TSF may decrease potential instrument-related complications requiring revision while decreasing operating room time and implant-related costs.