Roflumilast inhibits neuronal ferroptosis via AMPK/Nrf2/HO-1 signaling and promotes motor function recovery after spinal cord injury in rats

Spinal cord injury (SCI) is a serious central nervous system disease. Ferroptosis is one of the major causes of spinal cord neurological loss, and targeting ferroptosis is a promising therapeutic strategy. Roflumilast has shown promising applications in the treatment of neurological diseases due to its potent anti-inflammatory and anti-oxidative stress effects. This study aimed to investigate whether roflumilast could inhibit neuronal ferroptosis to improve motor function after SCI in rats. In vitro experiments, we found that roflumilast significantly increased cell survival in an in vitro ferroptosis model, improved mitochondrial function, reduced intracellular iron, reactive oxygen species (ROS), and lipid peroxides accumulation as well as the expression of the pro-ferroptosis proteins, long-chain acyl-coenzyme A synthase 4 (ACSL4), and prostaglandin-endoperoxide synthase 2 (PTGS2), and increased the expression of ferroptosis-inhibitory protein glutathione peroxidase 4 (GPX4), and ferritin heavy chain 1 (FTH1) expression. Mechanistically, these protective effects were achieved by activating AMP-dependent protein kinase (AMPK)/nuclear factor E2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling and were attenuated when AMPK signaling was blocked. In vivo experiments, roflumilast attenuated spinal cord tissue damage, increased the number of motor neuron survivors, and improved motor function after SCI in rats. Overall, activation of AMPK/Nrf2/HO-1 signaling by roflumilast attenuated neuronal ferroptosis and improved motor function after SCI in rats.

Treatment of thoracolumbar fractures with severe collapse of the anterior and middle columns via balloon-assisted endplate reduction, transpedicular bone grafting and pedicle screw fixation

PURPOSE

Thoracolumbar fractures involving severe collapse of the anterior and middle columns are difficult to reduce via posterior surgery. Therefore, we evaluated the effectiveness of balloon-assisted endplate reduction (BAER), transpedicular bone grafting, and pedicle screw fixation for this type of thoracolumbar fracture.

METHODS

This retrospective study included 87 patients with thoracolumbar fractures involving severe collapse of the anterior and middle columns treated from January 2020 to January 2022. Among them, 37 patients were treated via BAER, transpedicular bone grafting and pedicle screw fixation (Group A). Another 50 patients were treated via preoperative postural reduction combined with posterior pedicle screw fixation (Group B). Routine patient follow-ups were conducted to record the degree of vertebral height maintenance via X-ray and computed tomography (CT) images. The visual analog scale (VAS) score for low back pain and the Oswestry Disability Index (ODI) score were recorded.

RESULTS

The operative time, blood loss and hospitalization cost were greater in Group A. Significant clinical improvements in the ODI, VAS score, AVBH, MVBH and VWA were achieved in the two groups after surgery. However, the improvements in the AVBH, MVBH and VWA were significantly greater in Group A. During the final follow-up, the VAS and ODI scores in Group A were lower. The spinopelvic parameters at the sagittal position did not significantly differ between the two groups at any time.

CONCLUSIONS

The technique comprising BAER, transpedicular bone grafting, and pedicle screw fixation to treat thoracolumbar fractures with severe collapse of the anterior and middle columns is feasible and provides advantages.

Decoding the immune landscape in Ewing sarcoma pathogenesis: The role of tumor infiltrating immune cells and immune milieu

Ewing sarcoma (EwS) is the second most prevalent pediatric bone malignancy, characterized by its aggressive behavior and unfavorable prognosis. The tumor microenvironment (TME) of EwS is shaped by immunosuppressive components, including myeloid-derived suppressor cells, tumor-associated macrophages, and immune checkpoint molecules such as PD-1/PD-L1 and HLA-G. These elements impair anti-tumor immune responses by modulating the function of tumor-infiltrating immune cells, such as regulatory T cells (Tregs), CD8+ T cells, and natural killer cells. Chemokines, including CXCL9 and CXCL12, and cytokines, such as transforming growth factor-beta and interleukin-10, further contribute to immune suppression and promote metastatic dissemination. Recent advances in immunotherapy have highlighted the therapeutic potential of modulating immune cells and signaling pathways to enhance anti-tumor immunity. This review provides a comprehensive analysis of the complex immune landscape within the EwS TME, focusing on the mechanistic roles of key immune components and their potential as therapeutic targets. Understanding these interactions could pave the way for innovative treatment strategies to improve clinical outcomes in patients with EwS.

Tumor immune evasion and the Let-7 family: insights into mechanisms and therapies

Tumor immune evasion is a complex and adaptive mechanism that allows cancer cells to escape immune detection and destruction, contributing to malignancy progression and poor therapeutic outcomes. This review article explores the integral role of the let-7 family of microRNAs (miRNAs) in mediating tumor immune evasion, particularly how these regulators influence the tumor microenvironment (TME) and immune cell functionality. The let-7 family, known for its tumor-suppressive roles, modulates key immune checkpoints, including PD-L1, and pathways linked to immune response regulation, such as the STAT3/SOCS axis, impacts macrophage polarization and modulates immune cell function. Dysregulation of let-7 miRNAs can enhance tumor immune evasion through mechanisms such as downregulating major histocompatibility complex (MHC) expressions, promoting immunosuppressive cell populations, and manipulating metabolic pathways, which together establish an immunosuppressive TME. Conversely, specific let-7 members show potential in restoring anti-tumor immunity by reversing immune suppression and improving T cell responses. By synthesizing current research, this article underscores the dual role of let-7 in both promoting and inhibiting tumor immune evasion, suggesting their potential as therapeutic targets and biomarkers in cancer immunotherapy. Future studies on the context-dependent roles and advanced delivery systems for let-7-targeting therapies are crucial for enhancing immunotherapeutic efficacy and improving patient outcomes across malignancies.

Lumbar Fusion With Micro- & Nano-Textured, 3D Printed Porous Titanium Versus PEEK Interbody Cages in TLIF: A Single-Blinded, Randomized Controlled Trial

Study DesignProspective, randomized controlled study.ObjectiveAssess early radiological outcomes in transforaminal lumbar interbody fusion (TLIF) with 3D-printed porous titanium (3DPPT) compared to PEEK.MethodsSingle-blinded prospective, randomized controlled trial comparing 1-2 level TLIF with micro- & nano-textured, 3DPPT vs PEEK cages from 11/2021 to 5/2023. Interbody fusion was assessed on CT at 6 months according to Brantigan and Steffee method, modified to describe the Fraser definition of locked pseudoarthrosis [(BSF) scale]. Primary outcome was radiographic fusion at 6 months. ResultsInitial study protocol included 70 total patients but was ended early given the significance on interim analysis. Amongst 17 patients with 25 interbody levels implanted, 10 3DPPT and 15 PEEK cages were implanted. 3DPPT levels had a significantly higher rate of successful fusion (BSF-3) at 6 months compared with PEEK (100% vs 0.0%, P < 0.001). The posterior probability that 3DPPT increased the odds of fusion versus PEEK was > 99.9%, indicating a near-certain beneficial effect. Using a Bayesian mixed-effects model, the predicted probability of 6-month BSF-3 fusion was 9.0% for PEEK and 91.2% for 3DPPT. There were no significant differences in lumbar pathologies, level of fusion, number of fused levels, cage height, length of hospital stay, surgery duration, postoperative complications, subsidence, or reoperations.ConclusionsThe rate of successful lumbar interbody fusion at 6 months was significantly higher in 3DPPT levels compared to PEEK. 3DPPT may accelerate the rate and quality of bony fusion. Additional studies are needed to further delineate the impact of these radiographical findings on long-term clinical outcomes.

Let-7 Family as a Mediator of Exercise on Alzheimer's Disease

Memory loss, and behavioral impairments. Hallmark pathological features include amyloid-beta (Aβ) plaques, tau neurofibrillary tangles, chronic inflammation, and impaired neuronal signaling. Physical exercise is increasingly recognized as a non-pharmacological intervention to attenuate Alzheimer's disease (AD) risk and progression by enhancing neuroplasticity, improving mitochondrial function, and modulating immune responses. The let-7 family of microRNAs is critically involved in AD pathology. Elevated levels of let-7b and let-7e have been reported in the cerebrospinal fluid of AD patients, with let-7b levels correlating positively with total tau and phosphorylated tau concentrations. Overexpression of let-7a enhances Aβ-induced neurotoxicity, increases neuronal apoptosis by up to 45%, and alters autophagy-related signaling via the PI3K/Akt/mTOR pathway, as shown by 1.8-fold increases in LC3-II/I ratios and 2.2-fold upregulation of Beclin-1 expression. Exercise modulates let-7 expression in a tissue-specific and context-dependent manner. Aerobic training reduces skeletal muscle expression of let-7b-5p by 30-35%, while increasing its suppressor Lin28a by 40%, thereby improving mitochondrial respiration. Overall, modulation of let-7 by exercise influences neuronal survival, autophagy, and inflammation, offering a potential mechanism through which physical activity exerts neuroprotective effects in AD. Quantitative characterization of let-7 expression patterns may support its use as a diagnostic and therapeutic biomarker, though further research is needed to establish optimal modulation strategies.

The Antiaging Potential of Dietary Plant-Based Polyphenols: A Review on Their Role in Cellular Senescence Modulation

Aging is a complex biological process characterized by a progressive decline in physiological functions and an increased risk of chronic diseases. A key mechanism of this process is cellular senescence, the permanent arrest of the cell cycle in response to stress or damage, which contributes to the accumulation of dysfunctional cells in tissues. Recent research has highlighted the role of polyphenols, bioactive compounds present in numerous plant-based foods, in positively modulating these processes. Polyphenols exert antioxidant effects, regulate gene expression and improve mitochondrial function, helping to delay cellular aging and prevent age-related diseases. In addition, some polyphenols exhibit senolytic properties, selectively eliminating senescent cells and promoting tissue regeneration. This review summarizes the current evidence on the effects of polyphenols on aging and cellular senescence, exploring the underlying molecular mechanisms and discussing their potential in nutritional strategies aimed at promoting healthy aging.

Comparison of clinical efficacy between Percutaneous Endoscopic Large channels nerve decompression through Translaminar approach and Percutaneous Endoscopy Conventional channels nerve decompression through Transforaminal approach for the treatment of degenerative L4/5 spinal stenosis: a retrospective study

OBJECYTIVE

Percutaneous endoscopic surgery via the interlaminar approach and transforaminal approach are commonly used for the treatment of degenerative lumbar spinal stenosis, and in order to compare the clinical efficacy of Percutaneous Endoscopic Large channel Translaminar approach (PEL-TL) and Percutaneous Endoscopy Conventional channels Transforaminal approach (PEC-TF) in the treatment of degenerative L4/5 spinal stenosis.

METHOD

A retrospective analysis was conducted on 124 patients who underwent percutaneous endoscopic single segment unilateral decompression surgery for degenerative L4/5 spinal stenosis in our hospital from January 2020 to January 2023. They were divided into PEL-TL group and PEC-TF group according to different surgical methods. Recording general information of two groups of patients, including age, gender, course of disease, and length of hospital stay. Recording the surgical time, C-arm fluoroscopy frequency, incidence and type of complications for two groups of patients. CT was used to measure the Lateral Recess Angle (LRA), and MRI was used to measure the Dural Sac Cross sectional Area (DSCA) to evaluate the degree of lateral recess stenosis and compare the neurological decompression between the two groups. Using the White Panjabi scoring system (WP) to evaluate local stability before and 3 months after surgery. Recording the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) for preoperative and postoperative hip and lower limb pain in two groups of patients. Evaluateing the efficacy using the modified Macnab criteria one year after surgery.

RESULTS

There was no statistically significant difference in general information between the two groups of patients (P > 0.05). The surgery time in the PEL-TL group was shorter than that in the PEC-TF group (P < 0.05). The number of C-arm fluoroscopy in the PEL-TL group was significantly lower than that in the PEC-TF group (P < 0.05). There was no statistically significant difference in the incidence of complications between the two groups of patients (11.1% in the PEL-TL group and 14.3% in the PEC-TF group) (P > 0.05). The postoperative recurrence rate of PEL-TL is lower than that of PEC-TF (P < 0.05). All enrolled patients were followed up regularly for 1 year. There was no significant difference in preoperative LRA and DSCA between the two groups of patients (P > 0.05). After 1 year of surgery, LRA and DSCA in both groups were significantly larger than before (P < 0.05). There was no statistically significant difference in postoperative DSCA between the two groups, but LRA in the PEL-TL group was more significantly larger than that in the PEC-TF group (P < 0.05). There was no statistically significant difference in preoperative and postoperative WP between the two groups of patients, and there was no significant difference in WP in two groups. The ODI scores and the VAS scores of buttock and lower limb pain at each follow-up time point after surgery in both groups of patients showed significant improvement compared to before surgery. There was no statistically significant difference in functional scores between the two groups at each follow-up time point (p > 0.05). One year after surgery, the efficacy was evaluated using the modified Macnab criteria. Among them, in the PEL-TL group, 36 cases were excellent and 14 cases were good, with an excellent and good rate of 92.6%. In the PEC-TF group, 48 cases were excellent and 16 cases were good, with an excellent and good rate of 91.4%. There was no statistically significant difference between the two groups (p > 0.05).

CONCLUSION

Both surgical methods can achieve satisfactory clinical efficacy in treating degenerative lumbar 4/5 spinal stenosis. PEL-TL has fewer C-arm fluoroscopy times, wider decompression range, shorter surgical time, and lower recurrence rate during surgery, while PEC-TF can be routinely performed under local anesthesia to reduce anesthesia risk.

CD44 knockdown alters miRNA expression and their target genes in colon cancer

Introduction

Metastasis formation poses a significant challenge to oncologists, as it severely limits the survival of colorectal cancer (CRC) patients. Recently, we demonstrated that CD44 promotes spontaneous distant metastasis in a CRC xenograft model. The depletion of CD44 was associated with reduction in hypoxia, EMT, as well as improved mitochondrial metabolism in primary tumor. Collectively, these effects decreased the metastatic potential of the CRC xenograft tumors under investigation. In this study we explore the molecular mechanisms by which CD44 knockdown (kd) leads to such substantial changes of tumor properties.

Methods

Using miRNA-Seq data combined with bioinformatic analysis, we investigated the role of miRNA expression changes in the metastasis prevention observed with CD44 kd.

Results

Among the differentially expressed miRNAs, three members of Let-7 family (let-7a-5p, let-7b-5p, and let-7c-5p), two isoforms of miR-203a (canonical miR-203a-3p and its +1 5'-isoform), miR-101-3p, miR-200b-3p|+1 5'-isoform, miR-125a-5p, and miR-185-5p were identified as potentially involved in regulating CD44-mediated metastasis. Gene set analysis of differentially expressed mRNA targets of these miRNAs, along with an examination of key regulators driving the observed changes in both mRNA and miRNA expression profiles, suggests that the CD44-STAT3-Let-7 miRNA axis as one of the most relevant in regulation of colon cancer metastasis via the CD44 receptor.

Discussion

Our findings suggest a regulatory relationship between CD44, Let-7 miRNAs, and STAT3 in HT-29 tumors. Additionally, we propose the potential involvement of both isoforms of miR-203a (canonical and its +1 5'-isoform) in this regulatory network and suggest a role for miR-101-3p and miR-125a-5p in metastasis regulation through CD44 kd.

Evaluating the Predictive Value of K-Line Conversion in Surgical Outcomes for K-Line Negative Cervical Ossification of the Posterior Longitudinal Ligament (OPLL): Laminectomy with Fusion versus Laminoplasty

BACKGROUND CONTEXT

Laminectomy with fusion (LF) and laminoplasty are common treatments for K-line negative cervical ossification of the posterior longitudinal ligament (OPLL). However, the clinical significance of postoperative K-line conversion from negative to positive remains unclear.

PURPOSE

To determine whether converting a K-line from negative to positive improves surgical outcomes in patients with cervical OPLL by comparing LF and laminoplasty.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Patients with cervical myelopathy due to K-line negative OPLL who underwent LF or laminoplasty, with ≥1 year of follow-up.

OUTCOME MEASURES

Primary outcomes included neck and arm pain visual analog scale (VAS) scores, neck disability index (NDI), Japanese Orthopedic Association (JOA) score, JOA recovery rate, and radiographic parameters (C2-C7 lordosis, modified K-line interval).

METHODS

We compared radiographic and clinical outcomes between the two groups.

RESULTS

Among 85 patients with K-line-negative OPLL (39 LF, 46 laminoplasty), postoperative K-line conversion occurred significantly more frequently in the LF group (56.4% vs. 16.8%; p <0.001). Although laminoplasty better preserved cervical range of motion and reduced neck pain, LF provided superior neurologic outcomes, as indicated by higher final JOA scores and recovery rates. Patients who achieved K-line conversion had significantly higher rates of favorable clinical outcomes compared to those who did not (58.1% vs. 27.7%; p=0.019). Multivariate regression analyses further demonstrated that K-line conversion independently predicted favorable clinical outcomes (odds ratio [OR]: 3.900; p = 0.023), and LF was significantly associated with a higher likelihood of K-line conversion compared to laminoplasty (OR: 3.683; p = 0.033).

CONCLUSION

In patients with K-line-negative cervical OPLL, postoperative conversion to K-line-positive status is significantly associated with improved neurological outcomes. Although laminoplasty provides advantages regarding neck pain relief and motion preservation, LF more reliably facilitates K-line conversion and suppresses kyphosis, leading to superior clinical outcomes. Careful preoperative evaluation of cervical alignment, combined with surgical strategies aimed at promoting K-line conversion, may optimize surgical results.

LEVEL OF EVIDENCE

III.

Accuracy and Safety Assessment of Subaxial Cervical Pedicle Screw Instrumentation: A Systematic Review

BACKGROUND CONTEXT

Given increasing use of both cervical pedicle screw (CPS) fixation in the subaxial cervical spine (C3-C7) and emerging navigation technologies, a quantitative profile of safety and accuracy remains wanting. Compared with lateral mass instrumentation of this region, CPS fixation shows superior biomechanical properties but poses higher risk of complications because of the narrow cervical pedicle width and proximity to neurovascular structures.

PURPOSE

This systematic review quantifies the accuracy and safety of all types of subaxial CPS insertion, with or without navigation or template-based methods, to weigh the strengths and limitations of each technique.

STUDY DESIGN

Systematic review according to PRISMA guidelines.

PATIENT SAMPLE

Patients who underwent CPS instrumentation since its introduction.

OUTCOME MEASURES

Primary and secondary outcomes in our review included pedicle screw breach in the subaxial cervical spine determined on intra- or postoperative imaging, and screw-related operative complications, respectively.

METHODS

Following the PRISMA guidelines, our literature search of PubMed, Cochrane, and Scopus databases identified 3,312 clinical studies (1980-2024) using subaxial CPS that assessed for screw accuracy. After full-text analysis, data extracted included number of CPS, level of placement, number of patients, indications, insertion techniques, accuracy assessment method, classification of accuracy, breach rate, complication rate, and study origin.

RESULTS

The 73 studies included in final analysis from Asia (80%), Europe (12%) and North America (8%) yielded 14,118 CPS in 3,342 patients (1999-2024). Accuracy rates were 85.3% for 10,108 CPS placed with non-navigated techniques (free-hand and fluoroscopy), 82.7% for 3,067 with navigation techniques, and 96.3% for 943 CPS placed using 3D templates. Complication rates were 1.1%, 2.1%, and zero, respectively.

CONCLUSION

Our comprehensive review of more than 14,000 subaxial CPSs inserted found rates of high 84% overall accuracy and low 1.2% perioperative complications (i.e., attributed to a misplaced screw). With biomechanical advantages superior to lateral mass screws, our quantitative findings support consideration for CPS instrumentation in select patients by experienced surgeons.

Relationship between the course of postoperative pelvic axis rotation and shoulder balance in patients with Lenke types 1 and 2 adolescent idiopathic scoliosis

Background

Posteroanterior radiographs of patients with adolescent idiopathic scoliosis (AIS) show bilateral differences in the iliac wings. This is due to pelvic axis rotation (PAR) associated with scoliosis. We often encounter cases wherein the PAR changes with surgery and postoperatively. We investigated the course of preoperative PAR and the relationship between PAR and shoulder balance in patients with Lenke 1,2 AIS.

Methods

In total, 28 patients with Lenke 1,2 AIS undergoing scoliosis correction were included. The PAR and shoulder parameters were measured on posteroanterior radiographs. The correlation between the measured parameters and the extent of changes in each parameter was also examined.

Results

Eleven patients (39.3 %) underwent preoperative PAR. Six patients (21.4 %) showed a greater change in PAR from 1 week to 2 years postoperatively. The rotation did not change significantly from preoperatively to immediately postoperatively but changed during the first three months postoperatively. The rotation group had significantly more balanced shoulders at 2 years (P = 0.025). The rotation group had a greater change in shoulder balance in the postoperative course significantly (P < 0.05). The extent of change in pelvic rotation from 1 week to 2 years postoperatively correlated with the extent of change in shoulder balance.

Conclusion

The PAR in patients with Lenke 1,2 AIS significantly changed during 3 months postoperatively. Patients with Lenke 1,2 AIS with preoperative PAR can be expected to have postoperative shoulder rebalancing.

Analysis of adverse sagittal alignment after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy with local kyphosis

The aim of this study was to identify relevant factors associated with sagittal malalignment, which refers to the loss of lordosis or recurrence of kyphosis following an anterior cervical approach. Degenerative cervical kyphosis has increasingly attracted clinical attention, but there are few studies about the classification of local kyphosis and risk factors of adverse sagittal alignment (ASA) after anterior surgery. The study retrospectively reviewed 82 patients with degenerative cervical myelopathy and local kyphosis who underwent anterior cervical discectomy and fusion (ACDF) between January 2019 and December 2021. The patients' baseline characteristics and postoperative assessments were reviewed using electronic medical records from a single-institution database. Based on the postoperative ASA, the patients were divided into the maintaining and adverse groups. Bivariate and multivariate statistical analyses were performed to predict related factors of the ASA. Comparing the two groups, advanced age (p = 0.019), the classification of local kyphosis (p = 0.001), and preoperative thoracic 1 (T1) slope angle (p < 0.001), C2-7 sagittal vertical axis (SVA) (p < 0.001), C2-7 range of motion (ROM) (p = 0.001), and postoperative adjacent segment degeneration (ASD) (p = 0.009), neck disability index (NDI) (p < 0.001), visual analogue score (VAS) (p < 0.001) were significantly different. Multiple linear regression analysis results for relevant factors of the change of local and C2-7 kyphosis showed classification of kyphosis (p = 0.007 and p = 0.563, respectively), T1 slope angle (p = 0.018 and p = 0.004, respectively), C2-7 SVA (p = 0.109 and p = 0.017, respectively), C2-7 ROM (p = 0.028 and p = 0.007, respectively). Our data suggest that postoperative ASA affects recovery of neck pain, and is related to preoperative T1 slope, C2-7 SVA, C2-7 ROM, and the classification of kyphosis.

A new predictive factor for postoperative neurological deficits in patients with severe post-tuberculous kyphosis: the deformity angular distance ratio

PURPOSE

To investigate the effectiveness of sagittal deformity angular distance ratio (S-DADR; sagittal Cobb angle divided by the distance, in centimeters, between the midpoint of the upper endplate of the upper end vertebrae and the midpoint of the lower endplate of the lower end vertebrae) in evaluating neurological risks in patients with post-tuberculous kyphosis (PTK).

METHODS

A consecutive series of 102 patients with PTK who underwent corrective surgery between September 2010 and June 2024 were included. Measurements derived from preoperative radiographs were utilized to compute S-DADR. Potential risk factors of postoperative neurological deficits (PNDs) were assessed through univariate and multivariate analyses. Binary logistic regression was used to model the relationship between identified independent risk factors and PNDs, and the model was evaluated by the area under receiver operating characteristic curve (AUC).

RESULTS

The mean age of the 102 patients was 49.5 ± 12.1 years, and the incidence of PNDs was 22.5%. Univariate logistic regression revealed a positive correlation between the incidence of PNDs and S-DADR (OR = 1.103, P = 0.003), preoperative sagittal Cobb angle (OR = 1.025, P = 0.007), number of vertebrae resected (OR = 1.661, P = 0.024), operative time (OR = 1.005, P = 0.048) and total instrumented vertebrae (OR = 1.391, P = 0.014). Multivariate logistic regression identified S-DADR (OR = 1.091, P = 0.025) as an independent factor of PNDs. Patients with S-DADR ≥ 21.4 exhibited a 30% incidence of PNDs, which increased to 50% with an S-DADR of 30.0. The overall predictive performance of S-DADR (AUC = 0.720) for PNDs was deemed satisfactory.

CONCLUSIONS

S-DADR can be used to quantify the severity of the deformity in patients with PTK, which is an independent risk factor for PNDs during corrective surgery. Patients with S-DADR ≥ 21.4 face a 30% incidence of developing PNDs after corrective surgery.

The potential crosstalk genes and molecular mechanisms between systemic lupus erythematosus and periodontitis

Background

Several studies have demonstrated an increased risk of periodontitis (PD) among patients diagnosed with systemic lupus erythematosus (SLE). However, the underlying common mechanism between them remains incompletely understood. Accordingly, the aim of this study is to examine diagnostic biomarkers and potential therapeutic targets for SLE and PD by leveraging publicly accessible microarray datasets and transcriptome analysis.

Method

Datasets pertaining to SLE and PD were retrieved from the Gene Expression Omnibus (GEO) database, and subsequently analyzed for differentially expressed genes (DEGs). Key gene modules were identified through weighted gene co-expression network analysis (WGCNA), and shared genes were obtained by overlapping key genes between DEGs and WGCNA. These shared genes were subsequently subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, leading to the establishment of a Protein-Protein Interaction (PPI) network. Random forest (RF) and Least Absolute Shrinkage and Selection Operator (Lasso) regression were employed to identify key hub genes. Receiver operating characteristic (ROC) curves were generated using a new validation dataset to evaluate the performance of candidate genes. Finally, levels of immune cell infiltration in SLE and PD were assessed using CIBERSORTx.

Results

A total of 50 core genes were identified between the genes screened by WGCNA and DEGs. Functional enrichment analysis revealed that these genes are primarily associated with the PI3K-Akt and B-cell receptor signaling pathways. Additionally, using machine learning algorithms and ROC curve analysis, a total of 8 key genes (PLEKHA1, CEACAM1, TNFAIP6, TCN2, GLDC, GNG7, LY96, VCAN) were identified Finally, immune infiltration analysis highlighted the significant roles of neutrophils, monocytes, plasma cells, and gammadelta T cells (γδ T cells) in the pathogenesis of both SLE and PD.

Conclusion

This study identifies 8 hub genes that could potentially serve as diagnostic markers for both SLE and PD, highlighting the importance of VCAN and LY96 in diagnosis. Moreover, the involvement of the PI3K-Akt signaling pathway in both diseases suggests its significant role. These identified key genes and signaling pathways lay the groundwork for deeper comprehension of the interplay between SLE and PD.

The effectiveness and safety of staged halo-pelvic traction combined with posterior spinal fusion in the treatment of severe rigid spine deformity: a prospective cohort study

BACKGROUND

Severe rigid spinal deformities present significant challenges in correction surgery due to complexity and associated comorbidities. To mitigate the surgical risks, preoperative halo-pelvic traction (HPT) have been employed. This study aims to evaluate the effectiveness and safety of staged HPT combined with posterior spinal fusion (PSF) in the treatment of severe rigid spine deformity.

METHODS

This is a prospective cohort study. From 2020 to 2022, 61 consecutive patients (mean age 26.2 years) with severe rigid spine deformity who underwent staged HPT combined with PSF with a minimum 24-month follow-up were recruited. Radiographic parameters, clinical information, pulmonary functions tests, and perioperative complications were recorded.

RESULTS

The mean preoperative coronal Cobb angle was 114.2° ± 38°, and the mean MK was 105.8° ± 34.7°. Following the HPT ( mean duration 19.2 weeks), the mean coronal Cobb angle were corrected to 55.3° post-traction (50.6%) and 47.4° after PSF (58.3%); the mean MK angle were corrected to 52.6° post-traction (49.5%) and 38.1° after PSF (63.4%). The overall complication rate during HPT was 16.4%, while surgery-related complications were 18.0%, with no permanent neurological deficits observed.

CONCLUSION

Staged HPT combine with PSF is effective and safe for patients with severe rigid spine deformities. HPT could mitigate the severity of spine deformity, minimize the need for invasive three-column osteotomies, and reduce the risk of complications for correction surgery.

An in vivo 3-dimensional kinematics study of the cervical vertebrae under physiological loads in patients with cervical spondylosis

BACKGROUND CONTEXT

Studies of in vivo kinematic differences between healthy individuals and those with cervical spondylosis (CS) have been reported, but only movements under nonphysiological loads have been investigated. Differences in the in vivo, cervical kinematics between healthy individuals and those with CS are unknown.

PURPOSE

To investigate the in vivo, cervical kinematics of patients with CS under physiological loads.

STUDY DESIGN

This was a retrospective, case-controlled study that used three-dimensional (3D) to 3D registration techniques combined with conical beam computed tomography (CBCT) to investigate the cervical kinematics of patients with CS.

PATIENT SAMPLE

Twenty individuals diagnosed with CS were selected for study participation and matched with 20 participants who did not have CS and were in good health.

OUTCOME MEASURES

Pfirrmann grading, intervertebral range of motion (ROM), kinematics and cross-sectional area of posterior neck muscles (CAPNM).

METHODS

All study participants underwent seven CBCT scans of their cervical vertebrae. The 3D segmental motion features of the vertebra in vivo were calculated using 3D-to-3D volume registration to overlay images of the vertebra at each functional position. The 3D range of motion (ROM) of each cervical segment was expressed with six degrees of freedom using Euler angles and translated onto a coordinate system. A kinematic subgroup analysis was conducted based on the severity of symptoms within the CS group, and differences in muscle volume between the CS and control groups were also evaluated. Project supported by the National Natural Science Foundation of China (Grant No. 81960408,82260445), Key Project of Jiangxi Provincial Natural Science Foundation (Grant No. 20242BAB26125), Clinical Cultivation Project of The First Affiliated Hospital of Nanchang University (Grant No. YFYLCYJPY 20220203).The authors declare no conflict of interest in preparing this article.

RESULTS

The CS group exhibited noticeable reductions in the primary rotational ROMs of left-right rotation at C4-C5, C5-C6, C6-C7, C4-C7, and C1-C7 compared to the controls. During left-right bending, there were no significant differences in the primary ROMs, coupled translations, or rotations between the two groups. However, compared to controls, the CS group had significantly lower primary ROMs for C4-C7, C1-C7 and C5-C6 during flexion-extension. During left-right rotation, the primary rotations and coupled lateral bending at C6-C7 were significantly increased in the mild CS group compared to the moderate CS group. In the mild CS group, the primary ROM of the C4-C5 and C5-C6 during flexion-extension was significantly greater than that of the moderate CS group.

CONCLUSIONS

For the first time, the in vivo 3D kinematics of the cervical spine during head movement under physiological load in CS individuals have been adequately described and compared with healthy cervical vertebrae, which can be used as a reference point for future studies. The application of CBCT helps to obtain accurate and precise movement information of CS patients and effectively enhance the evaluation results obtained from imaging information.

Proposal of a new score system (Cervical Surgical Score) for management of degenerative cervical myelopathy

BACKGROUND

To date, no shared algorithms with the aim of guiding surgical strategy in complex cases of degenerative cervical myelopathy (DCM) exist. Our purpose is to present the Cervical Surgical Score (CSS) which could help in identifying complex DCM cases, suggesting a surgical strategy.

METHODS

We created the CSS based on multidisciplinary and literature-focused discussions, based on eight parameters including number of levels of cervical pathology and myelopathy, type and predominance of compression and grade of clinical myelopathy. We prospectively enrolled surgical DCM patients in a 15-months period, collecting clinical and radiological data. During outpatient clinic a specific surgical indication was offered to DCM patients. To validate the score, each outpatient clinic surgical indication was compared a posteriori to the one that resulted from multidisciplinary CSS scoring, focusing on patients for which both an anterior and posterior approach were considered suitable.

RESULTS

A total of 100 patients operated on for DCM at our Institution between December 2021 and February 2023 were prospectively enrolled. In 53% of patients the pathology was present at more than two levels. According to CSS calculation, 14% of patients resulted in the "grey zone", where both an anterior and posterior approach were deemed feasible. Among them, in 42.8% of cases the CSS allowed a modification of the originally planned surgery. Looking at outcome, an improvement of m-JOA score in 62% of patients was disclosed.

CONCLUSIONS

This preliminary study showed the reliability and usefulness of CSS in detecting complex DCM cases, requiring further analysis by expert spine surgeons, suggesting a surgical strategy.

Comparative efficacy and safety of high-dose versus low-dose tranexamic acid in adolescent idiopathic scoliosis: A systematic review and meta-analysis

OBJECTIVE

The objective of this meta-analysis was to evaluate the comparative effectiveness and safety of high-dose versus low-dose tranexamic acid (TXA) in adolescents undergoing treatment for idiopathic scoliosis.

METHODS

A comprehensive literature search was conducted across PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases up to March 2024. We sought to identify randomized controlled trials (RCTs) and retrospective controlled studies (RCSs) assessing the impact of high-dose compared to low-dose TXA on perioperative blood loss and transfusion requirements in spinal fusion procedures for adolescent idiopathic scoliosis. The study was registered in INPLASY (Registration number: INPLASY202480018).

RESULTS

Our meta-analysis included data from six studies: two high-quality RCTs and four lower-quality RCSs, comprising a total of 611 participants. Subgroup analysis revealed that high-dose TXA significantly reduced intraoperative blood loss and transfusion rates in RCSs, whereas no significant differences were observed in RCTs. The combined findings showed that high-dose TXA was associated with a significant reduction in intraoperative blood loss [weighted mean difference (WMD) =  -215.48, 95% confidence interval (CI) (-367.58, -63.37), P <  0.001], as well as a decreased likelihood of transfusion [risk ratio (RR) =  0.40, 95% CI (0.30, 0.53), P <  0.001]. Operative time did not differ significantly, and no thromboembolic events were reported in either treatment group. The differences between high and low doses varied widely across studies.

CONCLUSION

This meta-analysis indicates that high-dose TXA does not significantly reduce intraoperative blood loss, transfusion rates, or operative time compared to low-dose TXA in adolescent idiopathic scoliosis. While RCSs showed some benefit, our analysis places more emphasis on the results from RCTs, which did not show significant differences. Further high-quality RCTs are needed to confirm its effectiveness and safety.

Serotonergic Antidepressants Are Associated With Higher Rates of Hematoma After Anterior Cervical Spine Surgery: A Large Propensity-Matched Cohort Analysis

STUDY DESIGN

Large database propensity-matched retrospective cohort analysis.

OBJECTIVE

This study aimed to investigate the potential effects of serotonergic antidepressants on outcomes after anterior cervical spine surgery. It was hypothesized that the perioperative use of serotonergic antidepressants would be associated with higher rates of hematoma formation and worse outcomes after anterior cervical spine surgery.

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been associated with worse outcomes after orthopedic procedures.

MATERIALS AND METHODS

A retrospective cohort analysis was performed using TriNetX, an aggregated and de-identified electronic health record platform. Patients who underwent anterior cervical surgery were included through Current Procedural Terminology codes and the International Classification of Disease, 10th Revision, encounter diagnosis codes. Cohorts were 1:1 propensity-matched across 7 demographic and medical comorbidity parameters, and outcomes were compared. The incidence of adverse outcomes, as well as health care utilization, within 14 days, 30 days, 90 days, and 2 years postoperatively was evaluated.

RESULTS

Following propensity matching, each cohort consisted of 9249 patients, for a total of 18,498 patients included in the final statistical analysis. SSRIs/SNRIs were associated with higher odds of hematoma formation within 7 days [0.69% vs . 0.46%, odds ratio (OR): 1.5 (95% CI: 1.02-2.2), P = 0.04] and within 14 days postoperatively [0.81% vs . 0.52%, OR: 1.6 (95% CI: 1.1-2.3), P = 0.01]. Within 30 and 90 days, SSRIs/SNRIs were associated with a higher risk of emergency department utilization [30 d, OR: 1.30 (1.1-1.4); 90 d, OR: 1.3 (1.2-1.4)] and irrigation & debridement (I&D; 30 d, OR: 1.9 (1.2-3.0)]. SSRIs/SNRIs were also associated with a significantly higher risk of I&D within 2 years [OR: 1.3 (1.1-1.6)].

CONCLUSION

The use of serotonergic antidepressants perioperatively was associated with higher odds and risk of numerous outcomes, including hematoma formation, emergency department utilization, and the need for irrigation and debridement. Future prospective studies are required to confirm these results.

LEVEL OF EVIDENCE

Level III-retrospective cohort analysis.

Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis: Analysis of Sagittal Radiographic Parameters - A Randomized Controlled Trial

Study DesignRandomized controlled trial.ObjectivesTo compare the effect of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) on sagittal radiographic parameters in patients with low-grade isthmic spondylolisthesis. Additionally, to explore the correlation between changes in these parameters and clinical outcomes.MethodsForty-six consecutive patients with single-level low-grade isthmic spondylolisthesis were initially enrolled. They were randomly assigned to undergo either PLF or PLIF. Patients were followed up for at least 24 months. Radiographic outcomes included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, sagittal vertical axis, T1 pelvic angle, slip angle, slip degree and disc height. Clinical outcomes were assessed by the Oswestry Disability Index (ODI) and visual analogue scale (VAS).ResultsFour participants were lost to follow-up. Of the remaining 42 patients, 29 were female. The mean age was 40.23 ± 10.25 years in the PLF group and 35.81 ± 10.58 years in the PLIF group. There was a statistically significant greater correction of all radiographic parameters in the PLIF group. The ODI and VAS improved significantly in both groups, with no significant differences between the two groups. Changes in the ODI and VAS were significantly correlated with changes in disc height, slip angle and lumbar lordosis.ConclusionsIn patients with low-grade isthmic spondylolisthesis, PLIF demonstrates superior efficacy compared to PLF in correcting sagittal radiographic parameters. Nevertheless, this distinction does not seem to influence short-term clinical results. Restoring disc height, correcting the slip angle, and reestablishing normal lumbar lordosis are crucial steps in the surgical management of isthmic spondylolisthesis.

The Impact of the Lowest Instrumented Vertebra on the Correction of the Minor Curve During Selective Fusion in Patients With Adolescent Idiopathic Scoliosis

STUDY DESIGN

Retrospective single-center data analysis.

OBJECTIVE

The aim of this investigation was to give advises for choosing the LIV in selective fusion to reach the best correction of the minor curve and sagittal profile.

SUMMARY OF BACKGROUND DATA

Scoliotic curves can be classified as structural or nonstructural. If selective fusion is performed, the nonstructural curves are not instrumented. The choice of the lowest instrumented vertebra (LIV) and the impact of different levels of the LIV on the correction of the minor curve in the frontal profile and on the sagittal balance is under debate.

METHODS

Forty-seven consecutive patients treated by posterior instrumented fusion were included in this retrospective investigation. Impact of the level of the LIV with regard to distance to end vertebra (EV), to the stable vertebra (StV), to the sagittal infliction point (IP), and to the apex of the lumbar lordosis on the correction of the minor curve was analyzed.

RESULTS

Distance of LIV to EV was significant with regard to correction of the minor curve if it was more than 5 levels ( P <0.001). Distance of LIV to StV was significant with regard to correction of the minor curve if it was more than 4 levels ( P <0.01). Distance of LIV to IP was significant with regard to correction of the minor curve if it was more than 2 levels ( P <0.01).

CONCLUSIONS

Choosing a LIV that was more than 2 levels higher or lower than the sagittal infliction point showed a significantly higher correction of the minor curve. We therefore recommend to keep that distance when LIV is chosen.

Isonardosinone attenuates osteoclastogenesis and OVX-induced bone loss via the MAPK/NF-κB pathway

Osteoporosis is a globally prevalent metabolic bone disease that manifests itself as a decrease in bone mineral density and deterioration of bone structure, which reduces overall bone strength and increases fracture risk. However, the effect of anti-inflammatory isonardosinone (the active ingredient in Nardostachys chinensis) on osteoclastogenesis is unknown. We first predicted the main pathways and targets of ISO action in osteoporosis by network pharmacology. CCK-8 was used to test whether ISO affects cell proliferation of BMMs (osteoclast precursor cells) and to determine the safe action concentration. TRAcP and F-actin staining were used to characterise the inhibitory effect on osteoclast differentiation. RT-PCR and WB were used to examine changes in the relative expression of genes and proteins generated by osteoclasts under isopinacolone treatment, and we examined its effects on the RANKL-activated MAPK and NF-κB signaling pathways. An ovariectomy-induced osteoporosis model was constructed to assess the in vivo therapeutic effects of ISO. CCK-8 results showed that ISO had no cytotoxic or proliferative effects on BMMs at concentrations below 30 μM; TRAcP staining showed that ISO suppressed osteoclastogenesis in a concentration- and time-gradient-dependent manner; and F-actin staining showed that ISO suppressed osteoblast skeleton formation and expansion; RT-PCR and Western Blot assays showed that ISO suppressed the expression of CTSK, NFATC1, MMP9, C-Fos, and ACP5, inhibited the phosphorylation of JNK, P38, and ERK, and reversed the degradation of IκB-α, especially within 15 min. The in vivo results indicated that ISO has therapeutic effects on osteoporosis by improving bone microstructure to rescue bone loss. Taken together, these results lead to the conclusion that ISO is an attractive drug development strategy for the treatment of osteoporosis by effectively suppressing osteoclastogenesis through the MAPK/NF-κB signaling pathway, thereby reversing the bone loss associated with ovariectomy in vivo.

A narrative review of papillary thyroid carcinoma-related long non-coding RNAs and their relevance to malignant tumors

Background and Objective

In recent years, research on the relationship between papillary thyroid carcinoma (PTC) and long non-coding RNAs (lncRNAs) has been burgeoning. However, there has not been an analysis of the regulatory mechanisms of these lncRNAs in all tumors, nor a comprehensive categorization and comparison of these mechanisms. This review aims to uncover whether PTC-related lncRNAs also play an important role in other tumors and to identify a common pattern of action.

Methods

We conducted a statistical analysis of lncRNAs related to PTC that have been reported during the period from Jan 2022 to May 2024 through searching in the Embase, Web of Science, and PubMed databases, focusing on those with greater research value. Using them as the focal points of our study, we compiled data on their different regulatory mechanisms across various malignant tumors, emphasizing key findings.

Key Content and Findings

This comprehensive analysis not only provides valuable insights into potential regulatory mechanisms of these lncRNAs in PTC but also serves as a reference for exploring their broader regulatory networks within cancer. The principal discovery is that lncRNAs associated with PTC can competitively interact with microRNAs (miRNAs). This interaction influences miRNA-targeted messenger RNA (mRNA) and the expression of cancer-related proteins, ultimately facilitating the progression of PTC as well as other malignant tumors.

Conclusions

The lncRNAs associated with PTC exert regulatory functions in other malignancies as well and possess similar regulatory mechanisms. This provides a molecular basis for the future development of relevant targeted therapies.

Minimally Invasive Transpedicular Posterolateral Approach (MITPA) Corpectomy in the Treatment of Traumatic or Metastatic Vertebral Collapse With Kyphosis

Study DesignRetrospective observational cohort study.Vertebral body collapse with subsequent kyphosis, compression of neural structures usually requires surgical treatment; spinal fixation, corpectomy, decompression and realignment of the spine.The objective was to present results of corpectomies using a unilateral minimally invasive posterolateral transpedicular approach (MITPA) in patients with metastatic or posttraumatic kyphosis.Material and MethodsThe study included 28 patients: 23 with osteolytic vertebral body metastases, 5 posttraumatic kyphosis. All patients were operated by 2 surgeons, all had percutaneous pedicle fixation and unilateral single-level corpectomy using MITPA, followed by insertion of an expandable cage. Perioperative parameters were noted and radiological analysis based on CT performed before, after surgery and on the last follow up in 12 months.ResultsThe mean age of patients was 62 years, average length of surgery 263 min, with mean EBL 648 mL and average length of hospital stay 9.3 days. The local kyphosis, measured on end-plates of adjacent vertebrae, was corrected by 14.3° (from 13.1° [±9] to -1.2° [±8], P < .05). Complications occurred in 11 patients (39%), most of them minor, only 2 complications were major (7%): 1 deteriorated neurological deficit and 1 deep vein thrombosis. In 8 cases of preoperative paresis, 7 showed postoperative neurological improvement. In 12 months follow up, no serious mechanical complications were observed, beside minor cage subsidence in 5 cases and adjacent vertebral fracture. The anterior fusion was noted in all cases followed.ConclusionsMITPA corpectomy allows for significant correction of kyphosis, both in metastatic and posttraumatic vertebral body collapse with relatively low rate of major complications.

Comparison of Anterior Surgery Versus Posterior Surgery for the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis

STUDY DESIGN

A meta-analysis.

OBJECTIVE

To evaluate the impact of anterior versus posterior surgical approaches on outcomes in MCSM.

BACKGROUND

Multilevel cervical spondylotic myelopathy (MCSM) is the most common cause of spinal cord dysfunction, and the clinical effectiveness of anterior versus posterior surgical approaches remains elusive.

METHODS

A comprehensive search was conducted across electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, to evaluate the effects of anterior surgery versus posterior surgery on outcomes, such as Japanese Orthopedic Association (JOA) score, neck disability index (NDI) score, neck visual analog scale (VAS), blood loss, operation time, length of stay, cervical range of motion, cervical Cobb angle, and complications. The baseline characteristics of the included studies were assessed using the Newcastle-Ottawa Scale score to measure the risk of bias.

RESULTS

In this meta-analysis, 14 retrospective and 6 prospective cohort studies, involving 2712 patients, were included. The analysis indicated no significant difference between the 2 groups in preoperative JOA score, postoperative JOA score, JOA recovery rate, postoperative neck VAS score, operation time, preoperative range of motion (ROM), or SF-36 score (P=0.95, 0.15, 0.20, 0.31, 0.94, 0.33, and 0.43, respectively). However, the NDI score and blood loss were significantly lower in the anterior surgery group compared with the posterior surgery group (P<0.04, P=0.0003). The anterior surgery group was also associated with shorter length of stay (P<0.00001), while had higher rates of complications (P=0.04). C2-7 Cobb angle and postoperative ROM were significantly lower in the anterior surgery group than those in the posterior surgery group (P=0.0002 and 0.01, respectively).

CONCLUSION

This meta-analysis found no clear advantage of 1 surgical approach over the other for MCSM in terms of neurological function recovery, as measured by JOA scores. The anterior approach was associated with improved NDI scores, lower blood loss, shorter length of stay, and better recovery of cervical lordosis, accompanied by limited postoperative mobility. Careful consideration should be given to potential complications, including dysphagia with the anterior surgery, axial pain, and C5 palsy with the posterior surgery.

A Comparative Analysis of Revision Rates in Surgical Treatments for Lumbar Isthmic Spondylolisthesis

Study DesignRetrospective Cohort Study.ObjectiveIsthmic spondylolisthesis is frequently encountered in spine surgical practice, though there is a significant variation in surgical management strategies. We sought to evaluate revision rates between patients who underwent anterior-approach lumbar interbody fusion (ALIF) alone, posterolateral fusion (PLF) alone, PLIF/TLIF, and ALIF+PSF.MethodsThis retrospective study utilized a large commercial insurance claims database of patients ≤65 years-old. Patients with isthmic spondylolisthesis who underwent single-level instrumented arthrodesis were included, and those who underwent revision surgery, surgery for deformity, multi-level surgery, or surgery for traumatic, infectious, or neoplastic etiologies were excluded, as determined by ICD-10-CM and CPT codes. Patients were assigned to surgical cohorts of ALIF alone, PLF alone, PLIF/TLIF, and ALIF+PSF based on CPT codes. Additional independent variables included age, sex, decompression at index surgery, and region. The primary outcome was revision arthrodesis or decompression, defined using CPT codes. Kaplan-Meier analysis and Cox Proportional Hazards regression were utilized to assess differences in revision occurrence between cohorts.Results1014 patients who underwent single-level arthrodesis for isthmic spondylolisthesis were included. The mean age was 48.6 years, with a mean follow-up of 637.6 days. The majority of patients underwent PLIF/TLIF (60.6%, n = 614), followed by ALIF+PSF (18.5%, n = 188), PLF alone (14.4%, n = 146), and ALIF alone (6.5%, n = 66). The 5-year revision-rate was 11.0% for all patients in the Kaplan-Meier analysis. In multivariable analysis adjusting for confounding factors, ALIF-alone demonstrated significantly higher occurrence of revision compared to both ALIF+PSF (HR 5.0, P = 0.0026) and PLIF/TLIF (HR 5.8, P < 0.0001) groups. Similarly, PLF alone demonstrated significantly higher occurrence of revision surgery compared to PLIF/TLIF (HR 2.4, P = 0.0379) while other comparisons were not statistically significant.ConclusionsIn this analysis of single-level arthrodesis for isthmic spondylolisthesis, patients who underwent ALIF alone had higher revision rates than those who underwent PLIF/TLIF and ALIF+PSF surgery, and those who underwent PLF alone had higher revision rates than those who underwent PLIF/TLIF. Surgical strategies providing both anterior and posterior column support resulted in lower real-world revision rates.

Regulating macrophage phenotypes with IL4I1-mimetic nanoparticles in IDD treatment

Intervertebral disc degeneration (IDD) is a degenerative spinal condition characterized by disc structural damage, narrowing of joint spaces, and nerve root compression, significantly reducing patients' quality of life. To address this challenge, a novel therapeutic strategy was developed using cellulose supramolecular hydrogel as a carrier to deliver IL4I1-modified MΦ membrane biomimetic nanoparticles (CHG@IL4I1-MNPs) to target tissues. This hydrogel exhibits excellent biocompatibility and mechanical properties while enabling sustained drug release in the degenerative disc microenvironment, enhancing therapeutic outcomes. CHG@IL4I1-MNPs effectively regulate MΦ polarization by promoting M2 MΦ activation, thereby improving immune microenvironment balance. Animal studies demonstrated that CHG@IL4I1-MNPs alleviated symptoms of IDD, reduced inflammation, and supported tissue repair, highlighting its potential to reduce reliance on long-term medication and improve quality of life. The strategy uniquely combines nanoparticle technology with immunomodulation, achieving precise targeting of MΦs. Beyond IDD, this approach offers potential applications in other immune-related diseases, providing a versatile platform for nanomedicine. This study introduces an innovative method to treat IDD and advances the integration of immunotherapy and nanotechnology, offering both clinical benefits and new directions for future research. These findings hold strong potential for improving patient outcomes and expanding treatment options for related diseases.

Application of Repeated Foraminoplasty in Percutaneous Endoscopic Transforaminal Discectomy for Lumbar Disc Herniation Patients with Lumbar Foraminal Stenosis

BACKGROUND

A sufficient foraminoplasty is critical in percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation (LDH), which may affect the progress of surgery. This study assessed repeated foraminoplasty (RF) applied in PETD for patients with LDH and lumbar foraminal stenosis.

METHODS

This study enrolled 133 patients with LDH and lumbar foraminal stenosis who underwent PETD; patients were assigned to traditional foraminoplasty (TF) and RF groups. Intervertebral foramen enlargement and ratio of nerve roots completely exposed were compared between the 2 groups. Perioperative indicators were assessed for surgical efficiency and safety. Visual analog scale score, Oswestry Disability Index score, and MacNab criteria were used to evaluate clinical outcomes.

RESULTS

Anterior-posterior diameter increase of intervertebral foramen (P < 0.001) and ratio of the nerve roots completely exposed (P = 0.032) in the RF group were significantly greater than those in the TF group. The decompression time and total operative time of the patients who underwent RF were significantly shorter compared with patients who underwent TF (P < 0.001). With respect to evaluation of clinical efficacy, the visual analog scale score of leg pain in the TF group was greater than that in the RF group only on the first day postoperatively (P = 0.031).

CONCLUSIONS

Repeated foraminoplasty applied in PETD for patients with LDH and lumbar foraminal stenosis might improve intervertebral foramen enlargement in anterior-posterior diameter, exposure of nerve roots, surgical efficiency, and immediate relief of leg pain after surgery.

Reduced Vertebral Hounsfield Unit Values in the Bridging Group of Ossification-Related Segments in Patients with Ossification of the Posterior Longitudinal Ligament of the Cervical Spine

BACKGROUND

Increased systemic bone mineral density has been reported in patients with ossification of the posterior longitudinal ligament (OPLL). This study investigated the differences in vertebral Hounsfield unit (HU) values between the bridged and nonbridged groups of patients with OPLL of the cervical spine at the ossification-related segments.

METHODS

A total of 436 ossification-related segments from 157 patients were involved in the study. X-ray and computed tomography scans were used to assess the segmental cervical range of motion (ROM), C2-7 Cobb angle, K-line, ossification thickness, maximum canal occupancy, HU values, and presence and type of OPLL.

RESULTS

In terms of imaging parameters, HU values were significantly higher in the OPLL group (P < 0.001), whereas the ROM was greater in the control group (P < 0.05). In the OPLL group, the K-line positive group had a better C2-7 Cobb angle and greater T1 slope. The ossification-related segments were divided into bridging and nonbridging groups, with smaller vertebral HU values, thicker ossification lesions, greater canal occupation, and reduced interbody mobility in the bridging group. However, we found no significant correlation among segmental ROM, ossified material thickness, maximum canal occupancy of the ossified material, and segmental HU values.

CONCLUSIONS

We found that the mean HU value of the cervical spine in patients with OPLL was higher than that of the control group, and the ROM was smaller than that of the control group, with the smallest ROM in the continuous type. In the ossification-related segments, the bridging group exhibited lower vertebral HU values, reduced segmental mobility, and thicker ossification thickness.

Full-endoscopic lumbar spine discectomy: Are We Finally There? A Meta-Analysis of Its Effectiveness Against Non-microscopic Discectomy, Microdiscectomy and Tubular Discectomy

BACKGROUND CONTEXT

Full-endoscopic lumbar discectomy (FELD) has gained increasing attention as a minimally invasive alternative to conventional microdiscectomy (MD), tubular discectomy (MED), and open non-microscopic discectomy (OD) Despite significant technological advancements in endoscopic techniques over the past decade, it is not yet clear whether FELD offers a definitive advantage over traditional methods.

PURPOSE

This study aims to perform a meta-analysis of available publications to assess whether the superiority of endoscopic treatment over traditional open and minimally invasive endoscopic surgical techniques can be more conclusively established. The central question driving this meta-analysis was: Are we finally there?

STUDY DESIGN/SETTING

Meta-analysis study included adult patients (≥18 years old) with symptomatic lumbar disc herniation (LDH) without concurrent lumbar spinal stenosis METHODS: A systematic review was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized or nonrandomized controlled trials published between 2013 and 2024. The quality of randomized controlled trials and cohort studies was assessed using the Revised Cochrane risk-of-bias tool and Newcastle-Ottawa Scale, respectively. Included studies reported on at least one of the following outcomes: (1) adverse effects, (2) operative parameters, (3) bed and hospital stay, and (4) clinical indices (postoperative values). Mean differences (MDs) or odds ratios (ORs) were used to compare treatment effects between FELD and MD, MED, or OD.

RESULTS

FELD demonstrated several advantages, particularly in short-term pain (within 6 months postoperatively) relief and faster patient (length of bed stay 1-2 days) mobilization, while maintaining comparable risks of recurrence, reoperation, and complications relative to traditional techniques. However, there is substantial heterogeneity in the data and a limited number of prospective trials.

CONCLUSIONS

More well-designed, prospective randomized trials are necessary, with a focus on radiological outcomes and comprehensive cost analyses including societal costs. Only through such robust data can we determine whether FELD truly represents a new gold standard for lumbar discectomy. Are we finally there? We are certainly closer, but much remains to be addressed.

Therapeutic potential of flavonoids in neuroprotection: brain and spinal cord injury focus

Flavonoids in fruits, vegetables, and plant-based drinks have potential neuroprotective properties, with clinical research focusing on their role in reducing oxidative stress, controlling inflammation, and preventing apoptosis. Some flavonoids, such as quercetin, kaempferol, fisetin, apigenin, luteolin, chrysin, baicalein, catechin, epigallocatechin gallate, naringenin, naringin, hesperetin, genistein, rutin, silymarin, and daidzein, have been presented to help heal damage to the central nervous system by affecting key signaling pathways including PI3K/Akt and NF-κB. This review systematically analyzed articles on flavonoids, neuroprotection, and brain and spinal cord injury from primary medical databases like Scopus, PubMed, and Web of Science. Flavonoids enhance antioxidant defenses, reduce pro-inflammatory cytokine production, and aid cell survival and repair by focusing on specific molecular pathways. Clinical trials are also exploring the application of preclinical results to therapeutic approaches for patients with spinal cord injury and traumatic brain injury. Flavonoids can enhance injury healing, reduce lesion size, and enhance synaptic plasticity and neurogenesis. The full potential of flavonoids lies in their bioavailability, dose, and administration methods, but there are still challenges to overcome. This review explores flavonoid-induced neuroprotection, its clinical implications, future research opportunities, and molecular mechanisms, highlighting the potential for innovative CNS injury therapies and improved patient health outcomes.

Investigation of spinopelvic sagittal alignment and its correlations in asymptomatic pediatric populations

The sagittal alignment of the cervical spine and its relationship with spinopelvic parameters plays a crucial role in maintaining overall postural balance. This study aims to provide normative values for these parameters in asymptomatic pediatric subjects, aiding in the enhancement of treatment and evaluation strategies for spinal deformities and disorders. Conducted at the Third Hospital of Hebei Medical University, this retrospective study included 307 asymptomatic pediatric volunteers aged 4-18 years, screened for scoliosis from January 2021 to July 2023. Participants underwent whole-length EOS examinations following a standard protocol. Radiographic measurements of cervical and spinopelvic parameters were taken, and statistical analyses were performed using SPSS software to assess variations by age and gender. Normative values for cervical sagittal and spinopelvic parameters were established, demonstrating significant differences based on age and sex. Key findings include a strong correlation between the C2-7 Cobb angle and T1 and C7 slopes, with an observed increase in cSVA particularly pronounced in boys. Age and gender significantly influenced the normative values of these parameters, suggesting the importance of considering these factors in pediatric spinal assessments. This study establishes crucial normative values for cervical and spinopelvic parameters in a large pediatric cohort, highlighting the influence of age and sex on spinal sagittal alignment. The findings underscore the necessity of tailoring spinal assessment approaches in pediatric populations to improve the clinical evaluation and management of spinal health, providing a foundational benchmark for future research in pediatric spinal deformities and disorders.

Rod Contour Angle and Postoperative Thoracic Kyphosis: Key Predictors of Proximal Junctional Kyphosis in Pediatric Neuromuscular Scoliosis after Spinopelvic Fusion

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

Proximal junctional kyphosis (PJK) is a postoperative complication in spinal deformity surgery causing pain, functional deterioration, and potential revision surgery, with challenges in the neuromuscular scoliosis (NMS) population. We investigated the incidence, risk factors, and clinical impact of PJK in nonambulatory pediatric NMS patients following spinopelvic fusion.

METHODS

Seventy-two NMS patients who underwent spinopelvic fusion from the upper thoracic vertebra to the pelvis were reviewed, with a minimum 2-year follow-up. Radiographic measurements and clinical data were analyzed to identify PJK predictors and evaluate outcomes. PJK was defined as a proximal junctional angle (PJA) ≥10° and an increase of ≥10° from preoperative measurements. Statistical analyses included t-tests, ROC curve analysis, logistic regression, and linear regression.

RESULTS

The incidence of PJK was 25%. Significant predictors included rod contour angle (RCA) (odds ratio [OR]: 1.11, P = 0.04), postoperative T2-T12 kyphosis (OR: 1.04, P = 0.043), and the difference between postoperative T2-T12 kyphosis and RCA (OR: 1.04, P = 0.021). A bidirectional relationship between pre- and postoperative PJA was observed. Lower preoperative PJA was associated with an increased risk of PJK (area under the curve [AUC]: 0.78, P < 0.001). Conversely, high preoperative PJA tended to decrease after surgery. No revision surgeries were performed for PJK.

CONCLUSION

This study reveals a 25% incidence of PJK in NMS patients undergoing spinopelvic fusion. Preoperative radiographic evaluation warrants particular attention in cases exhibiting decreased PJA values. Furthermore, meticulous intraoperative optimization of PJA, RCA, and thoracic kyphosis appears crucial for minimizing PJK occurrence.

Predicting Surgical and Non-surgical Curvature Correction by Radiographic Spinal Flexibility Assessments for Patients With Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

STUDY DESIGN

Systematic Review and Meta-analysis.

OBJECTIVES

This systematic review and meta-analysis aimed to: (1) synthesize the prevalent application ratios of 2 radiographic spinal flexibility assessment methods in AIS patients treated with PSF or bracing; and (2) quantitatively evaluate the accuracy of these methods in predicting post-intervention correction outcomes.

METHODS

A systematic search was conducted across 5 electronic databases: CINAHL, Embase, Ovid, PubMed, and Web of Science. Meta-analyses were performed to investigate the accuracy of the spinal flexibility rate in predicting the post-intervention correction rate in AIS patients treated with PSF surgery or bracing, using RevMan 5.4.1 software.

RESULTS

The results of 31 studies, involving 1868 AIS patients, showed that the side-bending method was utilized more frequently than the fulcrum-bending method in both treatments. Meanwhile, the spinal flexibility evaluated by the fulcrum-bending method may provide a more accurate prediction of post-surgical correction compared to the side-bending approach, particularly for main curves. For the bracing treatment, only a few studies have preliminarily reported good capability of the side-bending method in predicting the initial in-brace correction.

CONCLUSIONS

This review quantitatively assessed the clinical application ratio and effectiveness of side-bending and fulcrum-bending radiographs in predicting post-intervention curve corrections in AIS patients undergoing surgical or bracing treatments. The results of the current review supported to adopt the fulcrum-bending approach for AIS patients undergoing PSF surgery with main thoracic curves, and the side-bending approach for those with thoracolumbar/lumbar curves. For patients receiving bracing treatment, further research is still needed to confirm the clinical value of the side-bending method.

Clinical applications of 3D printing in spine surgery: a systematic review

PURPOSE

The objective of this systematic review is to present a comprehensive summary of existing research on the use of 3D printing in spinal surgery.

METHODS

The researchers conducted a thorough search of four digital databases (PubMed, Web of Science, Scopus, and Embase) to identify relevant studies published between January 1999 and December 2022. The review focused on various aspects, including the types of objects printed, clinical applications, clinical outcomes, time and cost considerations, 3D printing materials, location of 3D printing, and technologies utilized. Out of the 1620 studies initially identified and the 17 added by manual search, 105 met the inclusion criteria for this review, collectively involving 2088 patients whose surgeries involved 3D printed objects.

RESULTS

The studies presented a variety of 3D printed devices, such as anatomical models, intraoperative navigational templates, and customized implants. The most widely used type of objects are drill guides (53%) and anatomical models (25%) which can also be used for simulating the surgery. Custom made implants are much less frequently used (16% of papers). These devices significantly improved clinical outcomes, particularly enhancing the accuracy of pedicle screw placement. Most studies (88%) reported reduced operation times, although two noted longer times due to procedural complexities. A variety of 3DP technologies and materials were used, with STL, FDM, and SLS common for models and guides, and titanium for implants via EBM, SLM, and DMLS. Materialise software (Mimics, 3-Matic, Magics) was frequently utilized. While most studies mentioned outsourced production, in-house printing was implied in several cases, indicating a trend towards localized 3D printing in spine surgery.

CONCLUSIONS

3D printing in spine surgery, a rapidly growing area of research, is predominantly used for creating drill guides for screw insertion, anatomical models, and innovative implants, enhancing clinical outcomes and reducing operative time. While cost-efficiency remains uncertain due to insufficient data, some 3D printing applications, like pedicle screw drill guides, are already widely accepted and routinely used in hospitals.

Risk Factors for Postoperative Shoulder Imbalance in Patients With Lenke Type 1 and 2 Scoliosis Treated Using the Vertebral Coplanar Alignment Technique

STUDY DESIGN

This was a multicenter retrospective cohort study.

OBJECTIVE

We investigated the incidence of postoperative shoulder imbalance (PSI) and its risk factors in patients with Lenke types 1 and 2 scoliosis corrected using vertebral coplanar alignment (VCA).

SUMMARY OF BACKGROUND DATA

PSI in scoliosis affects patient quality of life. While other correction methods have reported a high correction rate for the main thoracic curve (MTC) in relation to PSI, this correlation has not been confirmed for the VCA technique.

MATERIALS AND METHODS

We studied 176 patients with Lenke types 1 and 2 scoliosis who underwent posterior corrective fusion surgery using the VCA technique at 11 institutions. At 2 years postoperatively, patients were divided into two groups based on radiographic shoulder height (RSH): PSI- (RSH<2 cm) and PSI+ (RSH ≥2 cm) groups. We analyzed the risk factors for PSI.

RESULTS

The overall incidence of PSI 2 years postoperatively was 11.4% (20/176), with 9.2% (11/119) and 15.8% (9/57) in patients with Lenke types 1 and 2, respectively. Contrary to a previous study, a high MTC correction rate did not emerge as a risk factor for PSI. Instead, preoperative left shoulder elevation, low postoperative thoracic kyphosis, greater T1 tilt, and high apical vertebral body-to-rib ratio were associated with PSI in patients with Lenke type 1. Preoperative left shoulder elevation and a low postoperative proximal thoracic curve (PTC) correction rate were identified as risk factors for PSI in patients with Lenke type 2.

CONCLUSION

Our results suggest that proper PTC correction, rather than compromising MTC correction, may help prevent PSI in the VCA technique. This method is particularly advantageous for addressing Lenke type 1 scoliosis and yields favorable outcomes in shoulder balance. Patients with preoperative left shoulder elevation, especially Lenke type 2, are at high risk of developing PSI.

LEVEL OF EVIDENCE

Level 4.

Cervical spondylotic myelopathy and radiculopathy: a stepwise approach and comparative analysis of surgical outcomes: a narrative review of recent literature

Selecting the optimal surgical treatment for multilevel cervical spondylotic myelopathy and radiculopathy significantly affects symptom improvement, postoperative prognosis, and quality of life. Proper patient selection and precise surgical execution are crucial for achieving successful outcomes, considering the favorable natural course of cervical radiculopathy. Several factors must be considered, including the number of affected segments, spinal alignment, kyphosis degree, stiffness, and surgeon expertise, when determining the surgical approach for cervical spondylotic myelopathy. An anterior approach is commonly used in cases that involve fewer than three segments with mild kyphosis, whereas posterior laminoplasty or anterior cervical discectomy and fusion (ACDF) are effective for cases with more than three segments with maintained lordosis. Both the degree of stiffness and spinal cord compression need to be considered for cases with kyphotic deformity. ACDF may be suitable when anterior structures are the primary source of compression and mild kyphosis is present. The decision between laminoplasty or laminectomy and fusion depends on the kyphosis degree for multilevel compression with kyphosis. An evaluation of cervical rigidity is required for severe kyphosis, and posterior laminectomy and fusion may be effective for flexible kyphosis, whereas a staged posterior-anterior-posterior approach may be required for rigid kyphosis to address both deformity and neural compression. This review summarizes recent research and presents illustrative cases of optimal surgical decision-making for various cervical spondylotic radiculopathy and myelopathy presentations.

Incidence of and Factors Associated with Spontaneous Correction of Postoperative Shoulder Imbalance in Adolescent Idiopathic Scoliosis Patients: A Retrospective Cohort Study

Background

As far as we know, no study has investigated spontaneous postoperative shoulder imbalance (PSI) correction in adolescent idiopathic scoliosis (AIS) patients. The objective is to assess the incidence of and associated factors for spontaneous PSI correction in AIS patients.

Methods

The study evaluated 144 postoperative AIS patients with PSI aged 10-20 years between 2010 and 2018. An analysis included demographic data and radiographic measurements (Risser grading, Lenke type, upper instrumented vertebra [UIV], and lowest instrumented vertebra [LIV]). Preoperative, postoperative, and follow-up radiographs were evaluated for shoulder parameters: radiologic shoulder height (RSH); T1 tilt angle; clavicle angle (CA); proximal thoracic curve (PTC), main thoracic curve (MTC), and lumbar curve (LC) Cobb measurements; and apical vertebral translation (AVT) of the PTC, MTC, and LC.

Results

Spontaneous PSI correction was observed in 99 (68.75%) patients. The spontaneous correction and nonspontaneous correction groups differed significantly in terms of Lenke-type preoperative LC (23° vs 26°; P = 0.091), postoperative LC (11° vs 8°; P = 0.013), LC at follow-up (13.5° vs 9°; P = 0.028), postoperative AVT of LC (- 0.8° vs - 0.4°; P = 0.033), AVT of LC at follow-up (- 0.7° vs - 0.1°; P = 0.091), PTC at follow-up (16° vs 20°; P = 0.019), and AVT of PTC at follow-up (0° vs -0.3°; P = 0.029). Multivariate analysis identified postoperative T1 tilt and postoperative LC as significantly associated with PSI correction.

Conclusions

The incidence of spontaneous PSI correction is high. Postoperative T1 tilt and postoperative LC are significantly associated with spontaneous PSI correction.

Signaling pathways and targeted therapies in Ewing sarcoma

Ewing sarcoma, the second most prevalent malignant bone tumor with potential occurrence in soft tissues, exhibits a high level of aggressiveness, primarily afflicting children and adolescents. It is characterized by fusion proteins arising from chromosomal translocations. The fusion proteins induce aberrations in multiple signaling pathways and molecules, constituting a key event in oncogenic transformation. While diagnostic and therapeutic modalities have advanced in recent decades and multimodal treatments, including surgery, radiotherapy, and chemotherapy, have significantly improved survival of patients with localized tumors, patients with metastatic tumors continue to face poor prognoses. There persists a pressing need for novel alternative treatments, yet the translation of our understanding of Ewing sarcoma pathogenesis into improved clinical outcomes remains a critical challenge. Here, we provide a comprehensive review of Ewing sarcoma, including fusion proteins, various signaling pathways, pivotal pathogenetic molecules implicated in its development, and associated targeted therapies and immunotherapies. We summarize past endeavors, current advancements, and deliberate on limitations and future research directions. It is envisaged that this review will furnish novel insights into prospective treatment avenues for Ewing sarcoma.

Preoperative halo-pelvic traction leading to near-complete airway obstruction in a child with severe thoracic lordosis and scoliosis: a case report

BACKGROUND

Halo-pelvic traction is a relatively safe treatment for preoperative spinal deformity correction in patients with severe scoliosis. Common device-related complications include local infection, back discomfort, and nerve compression symptoms. However, there are potential risks of mechanical compression of bronchial structures, especially in patients with severe thoracic lordosis and scoliosis, which can lead to life-threatening airway obstruction.

CASE PRESENTATION

A 11-year-old boy diagnosed with neurofibromatosis received preoperative halo-pelvic traction for forty days with a Cobb angle reduced from 99° to 51°. On operation day, he experienced near-complete airway obstruction and hypoxemia post-anesthesia induction, which was successfully resolved by releasing the traction. The posterior correction surgery was performed as scheduled and the child was extubated uneventfully.

CONCLUSIONS

Airway obstruction is a rare but severe complication of halo-pelvic traction, emphasizing the importance of careful airway management and continuous monitoring in pediatric patients with spinal deformities. Ensuring thorough preoperative evaluations and being prepared for potential airway emergencies are crucial steps in optimizing patient outcomes during such complex orthopedic interventions.

Movement control of the cervical spine declines with aging: a cross-sectional study

BACKGROUND

Previous studies suggest that cervical spine position sense declines with age, while the relationship between aging and cervical spine movement control remains unknown.

OBJECTIVE

To investigate the relationship between age and cervical spine movement control in asymptomatic adults.

METHODS

One hundred five asymptomatic adults (21-79 years old) were included. The Butterfly test (performed with an inertial measurement unit) was used to assess movement control of the cervical spine, in which participants tracked an unpredictable moving target with active head and neck movements at three different movement path difficulty levels (3 repetitions each). The determined parameters were amplitude accuracy (AA), time on target (ToT), undershoot (U) and overshoot (O). Spearman's rank correlation coefficient and simple linear regression analysis were used to assess the relationship between age and each parameter.

RESULTS

A significant relationship was demonstrated between advancing age and the AA, ToT and U parameters for all three movement path difficulty levels (p ≤ .001), but not for the O parameter (p > .05). Advancing age explained 19.8-30.4%, 24.5-30.8% and 33.7-37.2% of the variance in the AA, ToT, and U parameters, respectively.

CONCLUSION

The results suggest that cervical spine movement control declines with aging in an asymptomatic population. Clinicians may need to monitor potential deficits in cervicocephalic kinesthesia in older asymptomatic adults, as these impairments may have a considerable impact on their functional abilities.

RNAi-based ALOX15B silencing augments keratinocyte inflammation in vitro via EGFR/STAT1/JAK1 signalling

Arachidonate 15-lipoxygenase type B (ALOX15B) peroxidises polyunsaturated fatty acids to their corresponding fatty acid hydroperoxides, which are subsequently reduced into hydroxy-fatty acids. A dysregulated abundance of these biological lipid mediators has been reported in the skin and blood of psoriatic compared to healthy individuals. RNAscope and immunohistochemistry revealed increased ALOX15B expression in lesional psoriasis samples. Using a cytokine cocktail containing IL-17A, interferon-gamma and tumour necrosis factor-alpha to produce a psoriasis-like phenotype, a role for ALOX15B in human epidermal keratinocyte inflammation was investigated. siRNA-mediated silencing of ALOX15B increased CCL2 expression and secretion. In addition to CCL2, secretion of CCL5 and CXCL10 were elevated in skin equivalents treated with lipoxygenase inhibitor ML351. Inhibition of the JAK1/STAT1 pathway reversed the enhanced CCL2 expression found with ALOX15B silencing. Previous studies have linked epidermal growth factor receptor (EGFR) inhibition with the upregulation of cytokines including CCL2, CCL5 and CXCL10. ALOX15B silencing reduced EGFR expression and inhibition of EGFR signalling potentiated the effect of ALOX15B silencing on increased CCL2, CCL5 and CXCL10 expression. Confirming previous findings, gene expression of cholesterol biosynthesis genes was reduced via reduced ERK phosphorylation. Reduced ERK phosphorylation was dependant on EGFR and NRF2 activation. Furthermore, plasma membrane lipids were investigated via confocal microscopy, revealing reduced cholesterol and lipid rafts. This study suggests a role for ALOX15B in keratinocyte inflammation through modulation of lipid peroxidation and the EGFR/JAK1/STAT1 signalling axis.

Socioeconomic Status Impacts Length of Stay and Nonhome Discharge Disposition After Posterior Cervical Decompression and Fusion

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy.

SUMMARY OF BACKGROUND DATA

The effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored. By understanding the impact of socioeconomic status (SES) on PCDF outcomes, disparities in care can be addressed.

MATERIALS AND METHODS

Retrospective review of 554 patients who underwent PCDF for cervical spondylotic myelopathy between 2017 and 2022. SES was assessed using DCI obtained from patient zip codes. Patients were stratified into quintiles from Prosperous to Distressed based on DCI. Bivariate analyses and multivariate regressions were performed to evaluate the associations between social determinants of health and surgical outcomes, including length of stay, home discharge, complications, and readmissions.

RESULTS

Patients living in at-risk/distressed communities were more likely to be Black (53.3%). Patients living in at-risk/distressed communities had the longest hospitalization (6.24 d vs. prosperous: 3.92, P =0.006). Significantly less at-risk/distressed patients were discharged home without additional services (37.3% vs. mid-tier: 52.5% vs. comfortable: 53.4% vs. prosperous: 56.4%, P <0.001). On multivariate analysis, residing in an at-risk/distressed community was independently associated with nonhome discharge [odds ratio (OR): 2.28, P =0.007] and longer length of stay (E:1.54, P =0.017).

CONCLUSIONS

Patients from socioeconomically disadvantaged communities experience longer hospitalizations and are more likely to be discharged to a rehabilitation or skilled nursing facility following PCDF. Social and economic barriers should be addressed as part of presurgical counseling and planning in elective spine surgery to mitigate these disparities and improve the quality and value of health care delivery, regardless of socioeconomic status.

Strategizing Simultaneous Spinal Osteotomy and Total Hip Replacement in Ankylosing Spondylitis

OBJECTIVE

Ankylosing spondylitis (AS) is a debilitating rheumatic condition that significantly impairs mobility and quality of life through chronic inflammation and spinal fusion. The aim of this study is to investigate the optimal sequencing of spinal osteotomy and total hip replacement (THR) as treatment options, a topic that remains a subject of debate among medical professionals.

METHODS

In a retrospective cohort study spanning from 2017 to 2021, we assessed adult patients with AS who underwent both spinal osteotomy and THR, outcome measures involved radiographic assessments like Global Cobb angle, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), as well as clinical metrics such as the Harris hip score. For the same surgical group, paired t-tests were performed for pre- and postoperative data, while independent sample t-tests were used for comparing different surgical groups. The study aims to elucidate the optimal sequencing of these surgical procedures based on these comprehensive metrics.

RESULTS

Among the 14 patients included, demographic and clinical variables were comparable between the two procedural groups. At the 3-month follow-up, all major metrics showed significant postoperative improvements. Specifically, the Global Cobb angle reduced from 98.88 ± 38.54 to 54.48 ± 18.14 (p = 0.018), and the Harris hip scores, evaluated at the 3-month follow-up, dramatically increased from 15.14 ± 10.12 to 72.57 ± 14.12 (p = 0.001). Furthermore, the Spine First Group exhibited more pronounced changes in pelvic parameters (p = 0.009), albeit at the expense of longer operation times and increased blood loss. No major complications were encountered.

CONCLUSIONS

Contrary to the prevalent belief that spinal osteotomy should precede THR, our study argues that under certain conditions, opting for hip surgery first can be both viable and advantageous. This approach may mitigate the risk of complications and even facilitate subsequent spinal surgery. Surgical decisions must be highly tailored, focusing on patient-specific needs and anatomical considerations. The ultimate goal remains consistent: to improve patients' functional abilities in daily activities and thereby enhance their overall quality of life.

MRI-based endplate bone quality score independently predicts cage subsidence after anterior cervical corpectomy fusion

BACKGROUND

To reduce the amount of radiation that patients receive during surgery, surgeons can evaluate the quality of the bone prior to surgery using computed tomography (CT) or dual-energy X-ray absorptiometry. Recently, lumbar spine vertebral bone quality has been evaluated using an MRI-based scoring system. However, few studies have investigated the connection between cage subsidence in patients following cervical interbody fusion and site-specific MRI bone evaluation. It is unknown how cage subsidence following anterior cervical corpectomy decompression and fusion is related to MRI-based endplate bone quality assessment.

PURPOSE

To create a similar MRI-based cervical spine scoring system (C-EBQ) and to investigate the predictive value of the MRI cervical endplate bone quality (C-EBQ) score for cage subsidence after ACCF.

METHODS

The patients' demographic, surgical, and radiological data were collected. Cage subsidence was defined as fusion segment height loss ≥ 3 mm. Multivariate logistic regression models were developed to determine correlations between potential risk factors and subsidence, and simple linear regression analyses of statistically significant indicators were performed.

RESULTS

Among the patients who underwent single-level ACCF, 72 met the requirements for inclusion. The C-VBQ scores also improved from 2.28 ± 0.12, indicating no subsidence, to 3.27 ± 0.35, which indicated subsidence, and the C-EBQ scores improved in both the nonsubsidence group (1.95 ± 0.80) and the subsidence group (2.38 ± 0.54). There was a statistically significant difference (p < 0.05) among the groups. Higher C-EBQ scores were strongly correlated with subsidence in the multivariate analysis (odds ratio [OR] = 17.249, 95% CI = 2.269 to 7.537, P < 0.001), and the C-VBQ score was the major independent predictor of subsidence following ACCF ([OR] = 4.752, 95% CI = 3.824 to 8.781, P < 0.05). The C-EBQ score outperformed the C-VBQ score (75.6%) in terms of predictive accuracy, with a ROC curve indicating an 89.4% score.

CONCLUSIONS

After ACCF, cage subsidence was strongly correlated with higher C-EBQ scores on preoperative MRI. Assessing C-EBQ before ACCF may be a useful way to estimate the likelihood of postoperative subsidence.

Influence of the type of atlantoaxial dislocation secondary to os odontoideum on sagittal alignment and balance of the subaxial cervical spine after posterior atlantoaxial fusion

OBJECTIVE

This retrospective study aims to investigate the effect of the type of atlantoaxial dislocation due to os odontoideum on the sagittal alignment and balance of the cervical spine after posterior atlantoaxial fusion.

METHODS

Data of 48 consecutive patients who underwent posterior C1-C2 fusion to treat atlantoaxial dislocation/instability due to os odontoideum were retrospectively reviewed. Radiographic variables, namely the T1 slope (T1S), C1-C2 angle, C2-C7 angle, C1-C2 sagittal vertical axis (SVA), C2-C7 SVA, and modified atlas-dens interval (MADI), were measured preoperatively, immediate postoperatively, and at final follow-up. Patients were divided into three groups based on the preoperative MADI. Differences within and between groups in radiographic variables and relationships between the investigated variables were analyzed.

RESULTS

The MADI was correlated with the preoperative to postoperative changes in the C1-C2 angle (r = 0.776, P < 0.05) and C2-C7 angle (r = - 0.357, P < 0.05). In the group with anterior atlantoaxial dislocation, the C1-C2 angle and C2-C7 SVA were significantly enlarged at final follow-up (P < 0.05), while the C2-C7 angle was significantly reduced (P < 0.05). The changes in C1-C2 angle and C2-C7 angle were opposite between the posterior group and the anterior dislocation group.

CONCLUSION

The direction/type of atlantoaxial subluxation correlates with the changes in lower cervical curvature after atlantoaxial fusion. Patients with atlantoaxial posterior dislocation and atlantoaxial instability are less likely than those with atlantoaxial anterior dislocation to develop loss of lordosis after posterior atlantoaxial fusion.

Curve progression following selective and nonselective spinal fusion for adolescent idiopathic scoliosis: are selective fusions stable?

PURPOSE

The purpose of this study is to compare postoperative outcomes between selective and non-selective fusions longitudinally over the first five postoperative years.

METHODS

Patient parameters were retrieved from a multicenter, prospective, database. Patients with Lenke 1-6, B and C deformities were included. Patients were stratified into 2 groups: selective fusion (SF), if the last instrumented vertebra (LIV) was at or cranial to the lumbar apex, or non-selective fusion (NSF). Differences in coronal and sagittal radiographic outcomes were assessed with generalized linear models (GLMs) at 1-, 2- and 5- year postoperative outcomes. Five-year postoperative categorical radiographic outcomes, flexibility, scoliosis research society scores (SRS), and reoperation rates were compared between groups. Matched cohorts were created for subgroup analysis.

RESULTS

416 (SF:261, NF:155) patients, including 353 females were included in this study. The mean preoperative thoracic and lumbar Cobb angles were 57.3 ± 8.9 and 45.3 ± 8.0, respectively. GLMs demonstrated greater postoperative coronal deformity in the SF group (p < 0.01); however, the difference between groups did not change overtime (p > 0.05) indicating a relatively stable postoperative deformity correction. The SF group had a greater incidence of lumbar Cobb ≥ 26 degrees (p < 0.01). The NSF group demonstrated worse forward and lateral flexibility at 5-year postoperative outcome (p < 0.05). There was no difference in postoperative SRS scores between the SF and NSF groups. Reoperation rates were similar between groups.

CONCLUSION

Selective fusion results in greater coronal plane deformity; however, this deformity does not progress significantly over time compared to non-selective fusion. Selective spinal fusion may be a beneficial option for a larger subset of patients than previously identified.

LEVEL OF EVIDENCE

III.

Three-dimensional kinematic analysis of the cervical spine following posterior atlantoaxial fusion under physiological loading: An in vivo study

BACKGROUND

This study aimed to analyze the three-dimensional cervical motion characteristics in patients who underwent posterior atlantoaxial fusion surgeries using cone beam computed tomography and 3D3D registration technology.

METHODS

The study selected 20 patients who underwent posterior atlantoaxial fusion surgery and 20 healthy people as the control group. All subjects underwent cone beam computed tomography scans of the occipital and cervical spine in 7 different functional positions, then 3D3D registration of Occipital-C7 was performed at each functional position to calculate the motion characteristics of each segment. The ranges of motion of the entire cervical spine and each segment were obtained in each functional position.

FINDINGS

In the experimental group, ranges of motion of C1-C7 in flexion-extension and left-right twisting were significantly lower compared to controls (41.9° ± 13.8° vs. 56.6° ± 11.6°, 29.3° ± 9.6° vs. 91.2° ± 13.7°, respectively, P < 0.05). In the occipital-atlas segment, range of motion in flexion-extension was significantly smaller in the experimental group than controls (10.7° ± 3.2° vs. 19.4° ± 4.2°, P < 0.001), but it was larger in twisting (5.3° ± 4.2° vs. 2.1° ± 1.8°, P < 0.05). The twisting range of motion of C2-C3 was 4.7° ± 2.0° in the experimental group and 3.1° ± 1.6° in the control group (P < 0.05). Additionally, the alteration in ranges of motion during flexion-extension was primarily characterized by less extension.

INTERPRETATION

The posterior atlantoaxial fusion surgery induced biomechanical changes in the cervical spine. Following the procedure, the movement of C1-C7 during flexion-extension and twisting was significantly lower, with varying degrees of impact on adjacent and lower cervical segments. Moreover, the surgery had a greater effect on cervical extension than flexion.

Screening of orthopedic medicines identifies raloxifene hydrochloride as a novel ferroptosis inhibitor for spinal cord injury therapy

Spinal cord injury (SCI) is a severe condition that can lead to irreversible central nervous system damage. Spinal cord injury patients frequently present with coexisting orthopedic conditions, and many of them also have underlying bone and joint diseases. Recent studies have identified ferroptosis as a significant contributor that exacerbates the progression of spinal cord injury. This study conducted a screening in common orthopedic medications, which includes anti-osteoporosis agents and calcium supplements, in order to identify potential ferroptosis inhibitors and investigate their therapeutic effects on spinal cord injury. Among the 8 drugs screened, raloxifene hydrochloride was found to significantly inhibit ferroptosis induced by RSL3 in neural cells. Subsequent studies confirmed its inhibitory effect on ferroptosis both in vitro and in vivo. It was also demonstrated that Nrf2 inhibitor Brusatol could reverse the anti-ferroptotic effect of Raloxifene hydrochloride in neural cells in vitro as well as its therapeutic effect on SCI in vivo, suggesting its inhibitory effect on ferroptosis is through Nrf2. This study identifies a novel ferroptosis inhibitor among orthopedic medicines and also confirms the therapeutic effect of Raloxifene hydrochloride on SCI. The results of the current study may provide reference for the clinical administration of SCI.