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Wen-Chao Liu, Liang Wen, Tao Xie, Hao Wang, Jiang-Biao Gong and Xiao-Feng Yang

OBJECTIVE

Erythropoietin (EPO) exerts a neuroprotective effect in animal models of traumatic brain injury (TBI). However, its effectiveness in human patients with TBI is unclear. In this study, the authors conducted the first meta-analysis to assess the effectiveness and safety of EPO in patients with TBI.

METHODS

In December 2015, a systematic search was performed of PubMed, Web of Science, MEDLINE, Embase, the Cochrane Library databases, and Google Scholar. Only English-language publications of randomized controlled trials (RCTs) using EPO in patients with TBI were selected for analysis. The assessed outcomes included mortality, favorable neurological outcome, hospital stay, and associated adverse effects. Continuous variables were presented as mean difference (MD) with a 95% confidence interval (CI). Dichotomous variables were presented as risk ratio (RR) or risk difference (RD) with a 95% CI. Statistical heterogeneity was examined using both I2 and chi-square tests.

RESULTS

Of the 346 studies identified in the search, 5 RCTs involving 915 patients met the inclusion criteria. The overall results demonstrated that EPO significantly reduced mortality (RR 0.69, 95% CI 0.49–0.96, p = 0.03) and shortened the hospitalization time (MD −7.59, 95% CI −9.71 to −5.46, p < 0.0001) for patients with TBI. Pooled results of favorable outcome (RR 1.00, 95% CI 0.88–1.15, p = 0.97) and deep vein thrombosis (DVT; RD 0.00, 95% CI −0.05 to 0.05, p = 1.00) did not show a significant difference.

CONCLUSIONS

The authors suggested that EPO is beneficial for patients with TBI in terms of reducing mortality and shortening hospitalization time without increasing the risk of DVT. However, its effect on improving favorable neurological outcomes did not reach statistical significance. Therefore, more well-designed RCTs are necessary to ascertain the optimum dosage and time window of EPO treatment for patients with TBI.

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Shu-Guang Gao, Guang-Hua Lei, Hong-Bo He, Hua Liu, Wen-Feng Xiao, Ting Wen, Jie-Yu Liang and Kang-Hua Li

Object

With the increasing advocacy for total disc replacement (TDR) as a potential alternative to fusion in the management of lumbar degenerative disc disease, intradiscal pressures (IDPs) and facet joint stresses at the adjacent levels of spine have generated considerable interest. The purpose of this study was to compare adjacent-level IDPs and facet joint stresses among TDR, discectomy, and fusion.

Methods

Ten fresh human cadaveric lumbar specimens (L2–S1) were subjected to an unconstrained load in axial torsion, lateral bending, flexion, and extension by using multidirectional flexibility test. Four surgical treatment modes—control (disc intact), discectomy, TDR, and fusion—were tested in sequential order at L4–5. During testing, the IDPs and facet forces following each treatment were calculated at the adjacent vertebral levels (L3–4 and L5–S1).

Results

Intradiscal pressures and facet force pressures were similar between the intact condition and the TDR reconstruction at the L3–4 and L5–S1 levels under all loading conditions (p > 0.05). Compared with the intact and TDR groups, the discectomy and fusion groups had higher IDPs at the L3–4 and L5–S1 levels under all loading conditions (p < 0.05). No significant difference in the facet force pressure was noted among the intact, discectomy, and TDR groups at the L3–4 and L5–S1 levels under any loading conditions (p > 0.05). However, the facet force pressure produced for fusion was significantly higher than the mean values obtained for the intact, discectomy, and TDR groups at the L3–4 and L5–S1 levels under all loading conditions (p < 0.05).

Conclusions

Lumbar TDR maintained adjacent-level IDPs and facet force pressures near the values for intact spines, whereas adjacent-level IDPs tended to increase after discectomy or fusion and facet forces tended to increase after fusion.

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Junxiang Wen, Yingchao Han, Song Guo, Mingjie Yang, Lijun Li, Guixin Sun, Jun Wang, Fangqiong Hu, Jing Liang, Li Wei, Qi Zhou, Weibin Zhang and Jun Tan

The authors studied restoration of respiratory function in rabbits, using the recurrent laryngeal nerve to restore function after the phrenic nerve had been severed. The results of this animal study are encouraging and suggest that a similar technique could possibly be used to help patients with severe cervical spinal cord injuries.

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Yu-Shu Yen, Peng-Yuan Chang, Wen-Cheng Huang, Jau-Ching Wu, Muh-Lii Liang, Tsung-Hsi Tu and Henrich Cheng

Object

The goal of the study was to report a series of consecutive patients who underwent endoscopic transnasal odontoidectomy (ETO) without resection of nasal turbinates. The techniques for this minimally invasive approach are described in detail.

Methods

The authors conducted a retrospective review of consecutive patients who underwent ETO for basilar invagination. All the patients had myelopathy caused by compression at the cervicomedullary junction, which required surgical decompression. Preoperative and postoperative data, including those from radiographic and clinical evaluations, were compared. Morbidity and mortality rates for the procedure are also reported in detail.

Results

Thirteen patients (6 men and 7 women) with a mean age of 52.7 years (range 24–72 years) were enrolled. The basilar invagination etiologies were rheumatoid arthritis (n = 5), trauma (n = 4), os odontoideum (n = 2), ankylosing spondylitis (n = 1), and postinfectious deformity (n = 1). The average follow-up duration was 51.2 months (range 0.3–105 months). One patient died 10 days after the operation as a result of meningitis caused by CSF leakage. Among the other 12 patients, the average postoperative Nurick grade (3.2) was significantly improved over that before the operation (4.1, p = 0.004). The mean (± SD) duration of postoperative intubation was 1.5 ± 2.1 days, and there was no need for perioperative tracheostomy or nasogastric tube feeding. There also was no postoperative velopharyngeal insufficiency. There were 6 (46%) intraoperative and 2 (15%) postoperative CSF leaks in the 13 patients in this series.

Conclusions

ETO is a viable and effective option for decompression at the ventral cervicomedullary junction. This approach is minimally invasive and causes little velopharyngeal insufficiency. The pitfall of this approach is the difficulty in repairing dural defects and subsequent CSF leakage.