Nano-hydroxyapatite/Polyamide 66 cage in anterior cervical corpectomy and fusion: a comprehensive systematic review and meta-analysis

OBJECTIVE

This study aimed to conduct a meta-analysis to compare the effectiveness and safety between titanium mesh cage (TMC) and nano-hydroxyapatite/polyamide 66 cage (n-HA/PA66) in the surgical treatment of cervical spondylotic myelopathy (CSM) through anterior cervical corpectomy and fusion (ACCF).

MATERIALS AND METHODS

We implemented a comprehensive search strategy across multiple databases, including Wanfang, China Knowledge Network, China Biomedical Literature Database, Wipu, PubMed, Cochran, Embase, and Web of Science. To ensure a thorough examination of available literature, the databases were searched from their inception to January 2023. Two independent researchers evaluated the quality of the included studies by using established criteria. We used RevMan 5.4 (Review Manager Web, The Cochrane Collaboration, Copenhagen, Denmark) to facilitate data extraction and analysis.

RESULTS

This analysis included seven controlled clinical studies. The meta-analysis results showed no statistically significant differences between the two groups in terms of operating time, intraoperative bleeding, preoperative Japanese Orthopedic Association (JOA) score, preoperative visual analog scale (VAS) score, preoperative and final follow-up C2-7 Cobb angles, and intervertebral fusion rate (p > 0.05). However, a significant difference was observed between the two groups in terms of the final follow-up JOA [MD = 0.77, 95% CI (0.58, 0.97), p < 0.00001], VAS [MD = -0.50, 95% CI (-0.71, -0.30), p < 0.00001], and sedimentation rate [RR = 0.30, 95% CI (0.18, 0.48), p < 0.00001].

CONCLUSIONS

The use of n-HA/PA66 in ACCF for treating CSM is safe and effective treatment with positive clinical efficacy. In addition, n-HA/PA66 has both effective clinical efficacy and significantly lower fusion settling rates compared to TMC.

[Rapid effects of hydrocortisone on the cholinergic synaptic transmission of B neurons in bullfrog sympathetic ganglia]

Rapid effects of hydrocortisone 21-hemisuccinate (F-suc) on cholinergic synaptic transmission of B neurons in bullfrog sympathetic ganglia (BFSG) were studied with intracellular recording technique in vitro. The main results are as follows: (1) F-suc blocked cholinergic synaptic transmission of 52 B neurons within 0.5-3 min, which was concentration-dependent and partially suppressed by the cytoplasm receptor antagonist of steroid hormones, RU38486; (2) after protein synthesis was suppressed by actidione, the above effect persisted; and (3) the effect of F-suc could be potentiated by atropine. All these results suggest that the F-suc induced rapid effects of cholinergic synaptic transmission of B neurons in BFSG may be mediated by non-genomic mechanisms.

[Rapid effect of glucocorticoid on excitatory postsynaptic potential of B cells in bullfrog paravertebral ganglia]

In the present study, the rapid effect of hydrocortisone 21-hemisuccinate (F-suc) on the amplitude of f-EPSP of B cells in isolated bullfrog sympathetic ganglia was examined with the use of intracellular recording technique. It was found that the amplitude of f-EPSP of B cells was decreased by F-suc, with a latency less than 3 min after the beginning of perfusion of F-suc. The inhibition of F-suc was concentration-dependent and could be blocked by the antagonist of intracellular glucocorticoid receptor RU38486, but not by the protein synthesis inhibitor actidione. These findings suggest that the inhibition of f-EPSP of B cells by F-suc is probably mediated through a nongenomic mechanism.