Reciprocal change of occipitocervical parameters after anterior cervical discectomy and fusion

To evaluate the reciprocal changes in occipitocervical parameters according to the recovery of cervical lordosis (CL) after anterior cervical discectomy and fusion (ACDF) in patients with sagittal imbalance. Sixty-five cases that underwent ACDF were followed. They were divided according to the recovery of the CL: Group 1 (ΔCL > 5°, 30 cases) and Group 2 (ΔCL < 5°, 35 cases). The following parameters were measured: occiput-cervical inclination (OCI), CL, occiput-C2 angle (OC2A), distance between external occipital protuberance and spinous process of C2 (OC2D), distance between spinous processes of C2 and C7 (C27D), and shortest distance between the plumb line of C2 body and posterosuperior corner of C7 (C27SVA). Overall, all parameters changed significantly after ACDF. Preoperative CL and preoperative C27D showed a correlation with ΔCL. ΔCL was negatively correlated with ΔC27D and ΔC27SVA. In Group 1, CL increased from − 2.60 ± 1.88° to 11.57 ± 1.83°, OC2A decreased from 23.96 ± 2.05° to 19.87 ± 1.36°, OC2D increased from 82.96 ± 1.48 mm to 86.50 ± 1.81 mm, C27D decreased from 95.61 ± 2.66 mm to 87.01 ± 2.50 mm, and C27SVA decreased from 24.14 ± 2.20 mm to 17.06 ± 2.14 mm. In Group 2, only OCI decreased significantly after ACDF. ACDF can increase CL postoperatively in patients with cervical sagittal imbalance. Patients with significant CL recovery after ACDF showed a reciprocal change in occipitocervical parameters. (OC2A, OC2D).

Thoracic Reciprocal Change Can Be Predicted Before Surgery in Adult Spinal Deformity

Study Design: Retrospective cohort study. Objective: Analysis of postoperative sagittal alignment of the unfused spine is lacking in patients with adult spinal deformity (ASD). The present study aims to evaluate the efficacy of the whole spine full-flexion lateral radiograph to predict the reciprocal change of the unfused spine after correction surgery. We hypothesized that the novel parameter (T1-UIV angle: angle between the upper vertebral endplate of the T1 and the upper vertebral endplate of the upper instrumented vertebra) of the preoperative whole spine full-flexion lateral radiograph is similar to that of the postoperative lateral radiograph if the patient has the ideal sagittal alignment. Methods: Twenty-six ASD patients who underwent correction surgery with a minimum 2-year follow-up were enrolled and separated into the Ideal and Non-Ideal groups according to the Scoliosis Research Society (SRS)-Schwab classification of the final follow-up radiograph. Radiographic parameters, including T1-UIV of the preoperative whole spine full-flexion lateral radiograph, were obtained. Results: Thirteen patients were included in the Ideal group and 13 were in Non-Ideal group. Preoperative T1-UIV of the whole spine full-flexion lateral radiograph exhibited significant correlations with the T1-UIV angles of the postoperative and final follow-up radiographs ( r = 0.64, P < .01, y = 0.800 x + 8.012, and r = 0.69, P < .01, y = 0.857 x + 2.960, respectively). Interestingly, this correlation was stronger for the Ideal group ( r = 0.77, P < .01, y = 1.207 x − 1.517, and r = 0.89, P < .01, y = 0.986 x + 0.694, respectively). Conclusion: A novel radiographic strategy (T1-UIV of preoperative the whole spine full-flexion lateral radiograph) could estimate the postoperative alignment of the unfused spine correctly.

Computational Identification of Gene Networks as a Biomarker of Neuroblastoma Risk

Neuroblastoma is a common cancer in children, affected by a number of genes that interact with each other through intricate but coordinated networks. Traditional approaches can only reconstruct a single regulatory network that is topologically not informative enough to explain the complexity of neuroblastoma risk. We implemented and modified an advanced model for recovering informative, omnidirectional, dynamic, and personalized networks (idopNetworks) from static gene expression data for neuroblastoma risk. We analyzed 3439 immune genes of neuroblastoma for 217 high-risk patients and 30 low-risk patients by which to reconstruct large patient-specific idopNetworks. By converting these networks into risk-specific representations, we found that the shift in patients from a low to high risk or from a high to low risk might be due to the reciprocal change of hub regulators. By altering the directions of regulation exerted by these hubs, it may be possible to reduce a high risk to a low risk. Results from a holistic, systems-oriented paradigm through idopNetworks can potentially enable oncologists to experimentally identify the biomarkers of neuroblastoma and other cancers.

Teacher Equity and Cultural Implications for Educational Administration

Monumental shifts in education, in situations of leading global changes in the local culture, trigger profound repercussions on teachers. In view of reconstructionism, this article enquires into the evolving nuances of administrative reforms, unfolding the cultural links and reciprocal influences between teacher equity and educational administration. On the premise that reforms are triggers of administrative development, it positions teacher equity—a flexible individualization in a networked relationship—both as an enabling platform and as a cultural tool, to maintain a system in action. It argues that impacting change is envisaged as an arduous initiative when competing interests thrive within the system. To maintain administrative coherence and teaching force productivity, people’s perspectives and responses to change are coherent for the advancement and benefit of the entire system. Developing learning capacities such as adaptation and reconstruction form the critical core of an equity-driven culture. Such is a reiterated call for reciprocal change, a catalytic stimulus generative of equitable pathways that, more often than not, remain unscathed and oblivious to culturally diverse groups. As scholars and experts in administration and development studies grapple with complicated notions about policy reforms and pragmatic practices, this exposition rouses resilience in the discipline, as implicated in the pretext of greater autonomy and accountability. Essentially, it dispels scholarly revulsions and nuances, while newer investigative tools and culturally responsive reforms are underway to be explored and articulated, respectively.

In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?

Study Design: Retrospective single-center study. Objective: Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis. Methods: Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the normal anatomical relationship between thoracic and lumbar curves. Patients were stratified based on postoperative instrumentation: “Thoracic Fusion” = complete fusion of thoracic spine; “Lumbar Fusion” = complete fusion of lumbar spine; and “Complete Fusion” = fusion from sacrum to at least T5. Bivariate correlations and regression analysis were used to evaluate the relationship between change in thoracic kyphosis (ΔTK) and change in spinopelvic mismatch (ΔPI-LL; pelvic incidence-lumbar lordosis) before and after fusion. Analyses were repeated in “Lumbar Fusion” patients with flexible preoperative thoracic spines. Results: For asymptomatic volunteers, the natural anatomical relationship between TK and LL was found to be TK = 41% of LL ( r = 0.425, P < .001). A total of 153 of 167 adult spinal deformity patients were included (62 years old, 26.7 kg/m2, 78% female). Mean follow-up was 11.5 ± 6.8 months. “Thoracic Fusion” group showed no alteration in the natural relationship between TK and LL (ΔTK = 39% ΔPI-LL), whereas “Lumbar Fusion” group had a reduction in reciprocal change (ΔTK = 34% ΔPI-LL) although a subanalysis of patients in the “Lumbar Fusion” group with flexible thoracic spines showed a marked compensation in reciprocal change with (ΔTK = 58% ΔPI-LL). Conclusion: The relationship between ΔTK and ΔPI-LL is dependent on level instrumented. “Thoracic Fusion” drives change in LL while this relationship is affected by TK’s natural stiffness in “Lumbar Fusion” patients.