Purpose To assess the lumbar muscle conditions on the incidence of proximal junctional kyphosis (PJK) after long-level correction and instrumentation surgery for degenerative lumbar scoliosis (DLS) patients with a minimum 2-year follow-up. Methods Eighty-four DLS patients undergoing long instrumented fusion surgery (≥ 5 vertebrae) were retrospectively studied. According to the occurrence of PJK at the final follow-up, patients were divided into the PJK group and the Non-PJK group. Patient characteristics, surgical variables and radiographic parameters were analyzed statistically. The lumbar muscularity (cross-sectional area of muscle-disc ratio × 100) and fatty degeneration (signal intensity of muscle-subcutaneous fat ratio × 100) were evaluated on magnetic resonance imaging . Results The prevalence of PJK was 20.24%. Gender, age at surgery, body mass index, uppermost instrumented vertebrae level, fusions extending to the sacrum, and levels fused were not significantly different between the groups. Lower bone mineral density, smaller functional cross-sectional area (FCSA) of paraspinal extensor muscles (PSE), higher lean muscle-fat index and total muscle-fat index of PSE, greater preoperative thoracolumbar kyphosis (TLK), smaller preoperative sacral slope (SS), larger preoperative sagittal vertical axis were identified in PJK group. Logistic regression analysis showed that osteoporosis, preoperative TLK > 15°, SS > 24°, FCSA of PSE > 138.75, and total muscle-fat index of PSE > 4.08 were independently associated with PJK. The final follow-up VAS score for back pain was higher, and SRS-22 subcategories of pain, function, self-image, and total score were significantly lower in the PJK group. Conclusion Osteoporosis, lower lumbar muscularity and higher fatty degeneration, preoperative greater TLK and smaller SS were found to be strongly associated with the presence of PJK in DLS.

Background:Significant blood loss is still one of the most frequent complications in spinal surgery, which often necessitates blood transfusion. Massive perioperative blood loss and blood transfusion can create additional risks. Aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) are antifibrinolytics currently offered as prophylactic agents to reduce surgery-associated blood loss. The aim of this study was to evaluate the efficacy and safety of aprotinin, EACA, and low/high doses of TXA in spinal surgery, and assess the use of which agent is the most optimal intervention using the network meta-analysis (NMA) method.Methods:Five electronic databases were searched, including PubMed, Cochrane Library, ScienceDirect, Embase, and Web of Science, from the inception to March 1, 2018. Trials that were randomized and compared results between TXA, EACA, and placebo were identified. The NMA was conducted with software R 3.3.2 and STATA 14.0.Results:Thirty randomized controlled trial (RCT) studies were analyzed. Aprotinin (standardized mean difference [SMD]=−0.65, 95% credibility intervals [CrI;−1.25, −0.06]), low-dose TXA (SMD = −0.58, 95% CrI [−0.92, −0.25]), and high-dose TXA (SMD = −0.70, 95% CrI [−1.04, −0.36]) were more effective than the respective placebos in reducing intraoperative blood loss. Low-dose TXA (SMD = −1.90, 95% CrI [−3.32, −0.48]) and high-dose TXA (SMD = −2.31, 95% CrI [−3.75, −0.87]) had less postoperative blood loss. Low-dose TXA (SMD = −1.07, 95% CrI [−1.82, −0.31]) and high-dose TXA (SMD = −1.07, 95% CrI [−1.82, −0.31]) significantly reduced total blood loss. However, only high-dose TXA (SMD = −2.07, 95% CrI [−3.26, −0.87]) was more effective in reducing the amount of transfusion, and was significantly superior to low-dose TXA in this regard (SMD = −1.67, 95% CrI [−3.20, −0.13]). Furthermore, aprotinin (odds ratio [OR] = 0.16, 95% CrI [0.05, 0.54]), EACA (OR = 0.46, 95% CrI [0.22, 0.97]) and high dose of TXA (OR = 0.34, 95% CrI [0.19, 0.58]) had a significant reduction in transfusion rates. Antifibrinolytics did not show a significantly increased risk of postoperative thrombosis. Results of ranking probabilities indicated that high-dose TXA had the greatest efficacy and a relatively high safety level.Conclusions:The antifibrinolytic agents are able to reduce perioperative blood loss and transfusion requirement during spine surgery. And the high-dose TXA administration might be used as the optimal treatment to reduce blood loss and transfusion.

Background The Italian Spine Youth Quality of Life (ISYQOL) questionnaire is used to evaluate health-related quality of life in adolescents with Idiopathic Scoliosis. The study aimed to undertake the process of cultural adaptation of the ISYQOL questionnaire into Simplified Chinese. Methods Translate from Italian into Simplified Chinese. It involved 138 adolescents whose Cobb angle ranged between 20 and 40 degrees, 50 wearing the brace and 88 not wearing the brace. Statistical analysis calculated the reliability, floor effects, and ceiling effects of the ISYQOL. After that, construct validity was measured by analyzing the ISYQOL relationship Scoliosis Research Society-22 patient Questionnaire (SRS-22). Results There were no floor or ceiling effects in the ISYQOL questionnaire. Cronbach’s alpha coefficient evaluated for Internal consistency was 0.75 in the no-treated group and 0.88 in the brace-treated group. Intraclass correlation coefficients assessed with the use of the test-retest method were 0.72 in the no-treated group and 0.80 in the brace-treated group. A strong relationship exists between the ISYQOL measure and SRS-22 scores (rho = 0.62; p < 0.01), reflecting the high validity of the questionnaires. Both ISYQOL and SRS-22 scores showed no statistical difference between groups wearing and not wearing the brace (p > 0.05). Conclusions Trans-cultural validation in Chinses language showed the reliability and validity of the ISYQOL.

Background: The Brace Questionnaire (BrQ) is a tool developed to assess the health-related quality of life (HRQoL) among patients with adolescent idiopathic scoliosis (AIS) who receiving bracing as the primary treatment. It was initially developed and validated in Greek. The current study aimed to culturally adapt and psychometrically validate the BrQ in contemporary Chinese used in mainland China. Methods: Translation of the BrQ from the original Greek into Chinese was performed. This study involved 70 Chinese adolescents between 10 and 18 years of age with a diagnosis of AIS and a Cobb angle measuring between 20 and 40 degrees. All patients received the same kind of brace for more than 4 months. Statistical analyses included internal consistency and the floor and ceiling effects of the BrQ. Subsequently, convergent validity was evaluated by correlating the measures in the BrQ with those in the Scoliosis Research Society-22 Questionnaire (SRS-22). Results: There were no floor and ceiling effects observed with the Chinese version of BrQ. The intra-class correlation coefficient (ICC) was 0.967. Internal consistency as measured by Cronbach's alpha was 0.923. The global BrQ score correlated strongly with the SRS-22 total score (r=0.743, P<0.001). Most domain-level sub-scores from the BrQ correlated with the respective domain scores of SRS-22. Conclusions: Cross-cultural translation and validation demonstrated excellent reliability, high internal consistency and satisfactory concurrent validity of the Chinese version of BrQ.

Background: The Italian Spine Youth Quality of Life (ISYQOL) questionnaire is a tool used to evaluate health-related quality of life in adolescents with Idiopathic Scoliosis. The study aimed to undertake the process of cultural adaptation of the ISYQOL questionnaire into Simplified Chinese. Methods: The translation from Italian into Simplified Chinese was performed. It involved 138 adolescents whose Cobb angle ranged between 20-40 degrees, 50 wearing the brace and 88 not wearing the brace. Statistical analysis calculated the reliability, floor and ceiling effects of the ISYQOL. After that, construct validity was measured by analyzing the ISYQOL relationship Scoliosis Research Society-22 patient Questionnaire (SRS-22). Results: There were no floor or ceiling effects in ISYQOL questionnaire. Cronbach’s alpha coefficient evaluated for Internal consistency was 0.75 without the brace and 0.88 with the brace. Intraclass correlation coefficients assessed with the use of the test-retest method was 0.72 without the brace and 0.80 with the brace. A strong relationship exists between the ISYQOL measure and SRS-22 scores (rho=0.63; p< 0.01), reflecting the high validity of the questionnaires. Both ISYQOL and SRS-22 scores showed no statistical difference between groups with and without the brace (p>0.05). Conclusions: Trans-cultural validation in Chinses language showed the reliability and validity of the ISYQOL