Anterior debridement and bone grafting with posterior instrumentation may not be the best choice for treating patients with spinal tuberculosis. Single posterior debridement/bone grafting/instrumentation for single-segment of thoracic or lumbar spine tuberculosis produced good clinical results, except in patients who had a psoas abscess.

Background: CTLA-4 is a well-studied immune checkpoint protein that negatively regulates T cell-mediated immune responses. However, the expression of CTLA-4 in glioma and the effects of CTLA-4 on prognosis in patients with glioma have not yet been examined. Methods: We investigated the protein level of CTLA-4 in human glioma samples, extracted genetic and clinical data from 1024 glioma patients to characterize CTLA-4 expression and its relationship with immune functions in gliomas. R language was used for statistical analysis. Results: Higher CTLA-4 expression was found in patients with higher grade, isocitrate dehydrogenase (IDH)-wildtype, and mesenchymal-molecular subtype gliomas than in patients with lower grade, IDH-mutant, and other molecular subtype gliomas. Further analysis showed that there was a strong positive correlation between CTLA-4 and the specific marker gene expression of immune cells, including CD8 + T cells, regulatory T cells, and macrophages in both databases, suggesting that higher CTLA-4 expression in the glioma microenvironment induced greater immune cell infiltration compared with that in gliomas with lower CTLA-4 expression. We further explored the associations between CTLA-4 and other immune-related molecules. Pearson correlation analysis showed that CTLA-4 was associated with PD-1, CD40, ICOS, CXCR3, CXCR6, CXCL12 and TIGIT. Patients with glioma with lower CTLA-4 expression exhibited significantly longer overall survival. Thus, these findings suggested that increased CTLA-4 expression conferred a worse outcome in glioma. Conclusions: In summary, our findings revealed the expression patterns and clinical characteristics of CTLA-4 in glioma and may be helpful for expanding our understanding of antitumor immunotherapy in gliomas.

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Study design: Retrospective case-control study. Objectives: To analyze the results of two surgical treatments for lower lumbar tuberculous spondylitis with neurological deficits in the aged. Methods: We studied 33 cases of lower lumbar spinal tuberculous spondylitis treated in our center from January 2006 to October 2010. The cases were divided into two groups: 16 cases (group A) underwent single-or two-stage anterior debridement, bone grafting and posterior instrumentation, and 17 cases (group B) underwent single-stage posterior debridement, decompression, interbody fusion and instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Results: Patients were followed for a mean of 41.3 months (range 36-48 months). The average operative durations were 276.9 ± 23.8 and 193.8 ± 22.5 min in groups A and B, respectively. The average hospital stay was 18.2 ± 3.2 days for group A and 13.4 ± 1.6 days for group B. Average intraoperative blood loss for groups A and B was 1187.5 ± 163.0 and 804.7 ± 134.1 ml, respectively. Operative complications affected four patients in group A and one in group B. Solid fusion occurred at 12 months in the other 32 cases. Neurological status was significantly improved in all cases. Kyphosis was significantly corrected after surgical management, but loss of correction occurred in both groups. Conclusion: Single-stage posterior debridement, decompression, interbody fusion and instrumentation might be a better surgical treatment than combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged, offering fewer complications and a better quality of life.

Posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.