OBJECTIVE:To preliminarily construct and validate a diagnostic model for Cervical Spine Instability (CSI) based on multimodal deep learning, and to develop an open-access, web-based prototype platform tailored for clinical scenarios. METHODS:Clinical data from 122 subjects were included, integrating three-position X-ray images and nine structured clinical variables. The model architecture featured an imaging branch built on ResNeXt50 and a clinical branch based on a Fully Connected Neural Network(FCNN), with cross-modal fusion performed at the feature level(ResNeXt50-FCNN). Modality ablation studies were conducted using two control groups:"Imaging-only"(ResNeXt50) and "Clinical-only"(FCNN). Evaluation metrics included Area Under the Receiver Operating Characteristic Curve(AUC), Average Precision(AP), Accuracy, Precision, Recall, F1-score, and Specificity. Grad-CAM was employed for attention visualization of the imaging branch, while SHAP(SHapley Additive exPlanations) was used to interpretglobal and individual feature contributions of the clinical branch. Finally, the optimal model was deployed via the Streamlit framework to create an interactive, clinically usable platform. RESULTS:The multimodal model achieved superior comprehensive performance on the validation set compared to the control groups, yielding an AUC of 0.964, AP of 0.973, Accuracy of 0.919, Precision of 0.875, F1-score of 0.933, and Specificity of 0.813. Ablation studies demonstrated that the fusion strategy significantly compensated for the insufficient sensitivity of the "Imaging-only" model and the low specificity of the "Clinical-only" model. Grad-CAM visualizations revealed that the model consistently focused on suspected abnormal structures across all three positions, effectively suppressing background interference. SHAP analysis identified age, limitation of flexion-extension, tenderness, gender, and headache as the primary contributing variables. The developed AI platform(https://cervical-instability-classifier.streamlit.app/) provides real-time outputs of diagnostic probabilities and visualizations of feature contributions. CONCLUSION:This study successfully constructed and preliminarily validated a CSI discrimination model based on multimodal deep learning, demonstrating promising diagnostic performance, interpretability, and potential for clinical application. However, given the limited sample size of this study, further external validation is required to confirm the model's generalizability and ultimate clinical utility.
OBJECTIVE:To compare the short-term efficacy of robot-assisted percutaneous pedicle screw fixation versus traditional percutaneous pedicle screw fixation in treating lumbar vertebral fractures, and to evaluate the differences in surgical benefits for different types of stable fractures based on AO classification. METHODS:A retrospective analysis was conducted on 47 patients with single-segment lumbar vertebral fractures admitted between January 2023 and December 2024. Patients were classified by AO type as stable fractures (A1/A2:22 cases) or unstable fractures (A3/B1-B2:25 cases);by surgical approach as robot-assisted percutaneous group (robot group) or conventional percutaneous group (traditional group). Among stable fractures, the robot group comprised 10 cases and the conventional group 12 cases;among unstable fractures, the robot group included 11 cases and the conventional group 14 cases. Perioperative parameters (operational time, intraoperative blood loss, postoperative hospitalization duration), visual analogue scale(VAS), Oswestry disability index(ODI), and anterior vertebral height(AVH) were compared between the two groups. RESULTS:All patients were followed up for 12 months. In stable fractures, the robot group exhibited significantly lower intraoperative blood loss (23.50±7.47) mL compared to the conventional group (32.50±9.65) mL (P=0.026), whereas no statistically significant differences were observed in operative time, postoperative hospitalization duration, VAS, ODI, and AVH scores at different time points before and after surgery between the two groups (all P>0.05). In unstable fractures, the robot group demonstrated superior surgical duration (64.09±11.36) min, intraoperative blood loss (27.73±12.92) mL, and postoperative hospitalization time (5.91±1.45) days compared to the conventional group (77.86±18.78) min, (46.79±20.34) mL, and (7.64±2.02) days, respectively, with all differences being statistically significant (P<0.05). On day 1 postoperatively, the VAS in the robotic group was (2.27±0.79) scores, significantly lower than that of the conventional group (3.43±0.94) scores (P=0.003), although no statistically significant difference was observed between the two groups at the 12 month after surgery (P=0.159). The ODI at day 1 and 12 months postoperatively were (26.55±6.56) and (8.27±2.10) respectively in the robot group, both significantly better than those of the conventional group (41.64±12.11) and (13.57±4.03), respectively (P<0.05). The AVH measurements at day 1 and 12 months postoperatively were (2.41±0.56) cm and (2.22±0.55) cm in the robot group, significantly higher than those of the conventional group (2.02±0.31) cm and (1.87±0.30) cm, respectively(P<0.05). CONCLUSION:For unstable lumbar fractures(A3/B1-B2), robot-assisted percutaneous pedicle screw fixation provides superior short-term analgesia, functional recovery, vertebral height reconstruction, and certain perioperative outcomes;for stable fractures (A1/A2), the clinical and imaging outcomes of both techniques are generally comparable, but the robotic approach offers perioperative advantages in reducing intraoperative bleeding.
OBJECTIVE:To investigate the clinical value and imaging evaluation of bone rongeur sliding positioning technique in precise laminotomy during posterior cervical spinal canal expansion and reconstruction surgery. METHODS:A retrospective analysis was conducted on the clinical data of 60 patients with cervical spondylotic myelopathy who underwent cervical posterior single-door laminoplasty with spinal canal expansion surgery for cervical spine treatment from October 2020 to December 2023, including 40 males and 20 females;age ranged from 39 to 78 years with a mean of (60.3±9.1)years;disease duration ranged from 1 to 120 months with a mean of (19.6±32.1) months. Among the 30 cases with concurrent ossification of the posterior longitudinal ligament of the cervical spine, 18 were focal-type, 7 were segmental-type, 2 were continuous-type, and 3 were mixed-type. The preoperative Modified Japanese Orthopaedic Association (mJOA) scores ranged from 7 to 14 wit a mean of (11.0±1.8) scores. MRI T2-weighted imaging revealed high signal intensity changes in the spinal cord in 31 cases; hypertension was present in 20 cases, and diabetes in 6 cases. The surgical decompression segments were as follows:C3-C7 in 31 cases, C3-C6 in 11 cases, C4-C7 in 14 cases, C4-C6 in 2 cases, C3-C5 in 1 case, and C5-C7 in 1 case. During the procedure, the bone rongeur sliding positioning technique was consistently employed for laminotomy. Based on CT data, the distance between the apexes of both pedicles, the width of the bilateral slits at the decompression level postoperatively, the distances from the slitting points to the medial wall of the spinal canal, as well as the transverse diameter of the spinal cord and the interlaminar space at the decompression level were measured. Functional assessment was performed using the mJOA classification system. RESULTS:CT measurements showed that the distance between bilateral pedicle peaks progressively increased from C3 to C7. In the postoperative decompression segments of C3-C5, the width of bilateral slots was greater than the distance between bilateral pedicle peaks(P<0.001), whereas in the postoperative decompression segments of C6-C7, the width of bilateral slots was smaller than the distance between bilateral pedicle peaks(P<0.05). The distance from the slotted points on both sides to the medial wall of the spinal canal remains relatively constant, ranging from 4.13 to 5.53 mm. MRI measurements indicate that the transverse diameter of the spinal cord was fairly consistent at the C3-C5 segments, whereas it showed a gradual decrease in the C6-C7 segments. In all MRI measurements, the interlaminal distance at the decompression levels of C3-C7 exceeded the spinal cord transverse diameter (P<0.001). All patients were followed up for a duration of 12 to 38 months with an average of (23.0±8.0) months. At the final follow-up, the mJOA score was (17.0±0.9), showing a significant improvement compared to preoperative levels with statistical significance(P<0.001). CONCLUSION:The posterior cervical laminoplasty with the sliding technique of bone rongeur provides a precise positioning method for slotting the lamina, thereby achieving a good spinal cord decompression effect.
Spinal cord injury (SCI) remains a significant challenge in modern medicine due to its complex pathophysiological mechanisms, the irreversibility of damage, and limited treatment options. Recent studies have shown that microRNAs (miRNAs) transported by exosomes play a crucial role in the occurrence, progression, and outcomes of SCI. This article systematically reviews the functional mechanisms of exosomal miRNAs in SCI, with a particular focus on elucidating the unique advantages and molecular mechanisms by which Traditional Chinese Medicine (TCM) intervenes in SCI through an integrated "multi-component, multi-target, multi-pathway" approach that modulates miRNA networks. The content encompasses the biogenesis of exosomal miRNAs and their regulatory roles in various pathological processes post-SCI, including the inflammatory microenvironment, axonal regeneration, cell apoptosis, and vascular injury. It provides a detailed summary of how active TCM components and compound formulas target specific miRNAs to regulate corresponding signaling pathways, thereby exerting synergistic and integrated effects across multiple aspects such as inhibiting inflammatory responses, reducing apoptosis, and promoting axonal regeneration and revascularization. Despite some progress in SCI research, numerous challenges persist, including the complexity of regulatory mechanisms, difficulties in clinical translation, and shortcomings in delivery technologies. Building on this, the article points out future directions for the integrated treatment of SCI combining traditional Chinese and Western medicine, explores the application prospects of nano-drug delivery systems in enhancing the delivery efficiency and therapeutic specificity of TCM, and provides a theoretical basis and conceptual reference for in-depth exploration of miRNA-targeted therapy and the modernization of TCM research. In conclusion, with the continuous advancement of integrated Chinese and Western medicine research, more effective treatment options for SCI patients are anticipated, ultimately improving their quality of life and prognosis.
Femoral shaft fracture (FSF) is a common fracture in orthopedic practice. Closed reduction and intramedullary nailing, due to their minimally invasive nature and ability to promote fracture healing, have become the mainstream treatment for FSF. However, accurately assessing and correcting rotational deformities during surgery remains a major challenge for this technique. This article reviews the research progress on the assessment and correction of rotational deformities in closed reduction and intramedullary nailing of FSF. Current assessment methods involve the wire-drawing method, femoral neck anteversion angle method, lesser trochanter-femoral shaft tangent method, cortical "step-sign" method, lesser trochanter morphology comparison method, greater trochanter inclination index quantification method, and computer-assisted navigation for reduction. These methods all have their own advantages and disadvantages, and the choice depends on fracture type, hospital resources, and surgical skill. Methods for correcting rotational deformities are mainly divided into two types:closed reduction under traction and percutaneous device-assisted reduction. Closed reduction under traction is easy to perform and suitable for patients with mild shortening deformities. However, it's less effective for patients with extensive shortening, and may cause iatrogenic fractures and nerve injuries. Percutaneous device-assisted reduction can effectively reduce surgical time, blood loss, and radiation exposure. However, it still has limitations when dealing with complex fractures. In recent years, the application of computer-assisted navigation for reduction has offered new possibilities for the precise correction of rotational deformities. However, it's operationally complex and demands high technical skills from surgeons. This article, through a review of existing methods, aims to provide clinicians with more references. It is expected to achieve more accurate rotational deformity correction in the treatment of FSF, thereby improving patients' prognosis.
OBJECTIVE:To analyze the learning curve associated with ultrasound measurement of the change rate of lumbar spinous process distance in patients with lumbar disc herniation. METHODS:A retrospective analysis was conducted on 90 patients with lumbar disc herniation who underwent ultrasound measurement of the change rate of lumbar spinous process distance from October 2018 to October 2020. Patients were sequentially numbered from 1 to 90 according to their visit order. All ultrasound measurements were performed by the same physician. Examination time was recorded for each patient. The cumulative sum analysis (CUSUM) method was used to plot the learning curve scatter diagram, which was then fitted with a polynomial function to calculate the inflection point (turning point) of the curve. Based on this turning point, patients were divided into a learning exploration group and a learning stability group. Intergroup comparisons of various indicators were performed to verify the existence of the learning curve. RESULTS:(1)The best-fit simulation function for the learning curve was Y=8.75+1.86X-0.05X2+0.000 3X3(R2=0.951, P<0.05), with the turning point identified at the 27th case. (2)There were no statistically significant differences between the learning exploration group and the learning stability group regarding age, sex, body mass index (BMI), disease duration, Oswestry disability index(ODI) scores, or the change rate of lumbar spinous process distance(P>0.05). However, the mean examination time was significantly longer in the learning exploration group(3.88±1.30) min compared to the learning stability group(2.21±0.32) min(P<0.05). CONCLUSION:Ultrasound measurement of the change rate of lumbar spinous process distance exhibits a distinct learning curve. The turning point occurs at the 27th case. Once the stable phase is reached, the average examination time stabilizes at approximately (2.21±0.32) min.
The treatment of spinal metastases is highly dependent on multidisciplinary collaboration. This study systematically reviews the evolution of clinical decision-making systems for spinal metastases, from traditional frameworks to the era of precision medicine. The neurologic, oncologic, mechanical, systemic(NOMS) framework, introduced in 2006, focused on surgical and radiotherapeutic interventions;however, it had notable deficiencies in its neurologic assessment grading and, in terms of oncologic management, largely overlooked the role of systemic therapy in achieving local control of bony metastatic lesions. The LMNOP (location, mechanical, neurologic, oncologic, patient) framework, proposed in 2011, attempted to explore individualized surgical approaches, but its accuracy in determining optimal strategies remained suboptimal, and it still fell short in adequately incorporating systemic therapeutic factors. In 2017, the International Spinal Oncology Consortium introduced the MNOP(mechanical, neurologic, oncologic, patient) system, which placed greater emphasis on patient survival assessment. In 2018, the Dutch guidelines standardized surgical timing and radiotherapy strategies, and in the same year, the MOSS (medical/mental, oncological, stenosis, stability) framework achieved innovations in systematic evaluation, non-surgical interventions, and the integration of psychological status. In 2021, the Department of Orthopedics at the Chinese PLA General Hospital proposed the SENO framework for spinal metastases, which encompasses four major elements:systemic conditions, effectiveness of systemic treatment of tumors, neurology, and oncology. Built upon the foundation of the ESCC Twelve-Point Grading System developed by the Chinese PLA General Hospital, the SENO framework has successfully established a novel precision comprehensive treatment model characterized by "minimally invasive intervention first, followed by systemic therapy". Clinical practice has demonstrated that the SENO framework offers significant advantages in therapeutic outcomes compared with traditional decision-making approaches. The continuous evolution of clinical decision-making systems for spinal metastases profoundly reflects the broader transformation of oncology from experience-based medicine to evidence-based medicine. Looking ahead, with the deep integration of artificial intelligence and multi-omics technologies, decision-making systems for spinal metastases are poised to advance toward a comprehensive, intelligent "prevention-intervention-rehabilitation" continuum, bringing new promise for improving patient prognosis.
OBJECTIVE:To investigate the biological mechanisms underlying the therapeutic effect of modified Shaoyao Gancao decoction () in alleviating muscle spasms following spinal cord injury. METHODS:①Extract and modify the active components from the original Shaoyao Gancao decoction (), determined their concentrations using chromatography-mass spectrometry (HPLC-MS), and compared the differences between the two formulations.②Forty SD rats were randomly divided into four groups: normal control group, model group, treatment group, and positive control group, with 10 rats in each group. With the exception of the normal control group, all other rats were subjected to a spinal cord injury model via semi-transverse sectioning of the T9-T10 segments. Three days post-surgery, the normal control group and the model group received oral administration of deionized water;the drug-treated group received oral administration of modified Shaoyao Gancao decoction (), Shaoyao∶Gancao=3∶1, 3.3 g of crude drugs per kg body weight;the positive control group received oral administration of Standard Shaoyao Gancao Decoction(Shaoyao∶Gancao=1∶1, 3.3 g of crude drugs per kg body weight). The total treatment duration was 2 weeks.The drug efficacy was evaluated using the BBB scale(Basso, Beattie & Bresnahanlocomotor rating scale, BBB scale), and 5-hydroxytryptamine(5-HT) levels in spinal cord tissue were measured. The expression of long noncoding RNA H19 (lncRNA H19, hereinafter referred to as H19) and microRNA 185-5p (miR-185-5p) in spinal cord tissues was examined using polymerase chain reaction (RT-qPCR) in both the model group and the treatment group. Furthermore, a dual-fluorescein enzyme reporter assay was employed to verify that H19 regulates the expression of miR-185-5p and that miR-185-5p, in turn, regulates the expression of tryptophan hydroxylase 1 (Tph1).③In vitro culture of spinal cord nerve cells was conducted, where modified Shaoyao Gancao decoction (), H19 inhibitor, and miR-185-5p inhibitor were administered to investigate the effects of these agents as well as H19 and miR-185-5p on Tph1 expression.④Twelve SD rats were randomly divided into four groups:the model group, the drug administration group, the H19 inhibitor group, and the positive control group, with three rats in each group. Rats in the H19 inhibitor group received intravenous injection of H19 inhibitor at a dose of 50 mg·kg-1 via the tail vein, while all other groups were treated as described in step ①. The expression levels of 5-HT were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS:①The overall ion current profile showed no significant differences;however, in the modified Shaoyao Gancao decoction (), compounds related to Paeonia exhibited higher responses, while those related to Glycyrrhiza demonstrated reduced responses. ②At 2 weeks post-administration, the BBB score was 10.000±1.291 in the drug-treated group and 9.667±1.633 in the positive control group, both significantly higher than those in the model group 3.286±0.756(P<0.01). Additionally, 5-HT expression levels were elevated in the drug-treated group (7.097±1.414) pg·mL-1 compared to the model group (5.144±0.904) pg·mL-1(P<0.01). RT-qPCR and Western blot results demonstrated increased expression of H19 and Tph1 in spinal cord tissue following administration, while miR-185-5p expression was downregulated. Dual-fluorescein reporter gene experiments further confirmed that H19 regulates miR-185-5p expression, which in turn modulates Tph1 expression. ③In the cultured model group, Tph1 expression in spinal cord cells was lower than that in the normal control group, whereas it increased in the drug-treated group. In the H19 inhibitor group, Tph1 expression was reduced compared to both the normal control group and the drug-treated group;however, it was elevated in the miR-185-5p inhibitor group compared to both the model group and the H19 inhibitor group.④Further experiments demonstrated that 5-HT exhibited high expression levels in the spinal cord tissues of rats in the drug-treated group, and the H19 inhibitor could reverse this phenomenon. CONCLUSION:Shaoyao Gancao decoction () exerts a positive effect on spinal cord repair in rats with spinal cord injury by modulating the H19/miR-185-5p/Tph1 axis, thereby promoting the synthesis of the neurotransmitter 5-HT.
OBJECTIVE:To evaluate the efficacy and safety of unilateral transtransverse process superior border pedicle external approach vertebral body reconstruction for lumbar fractures associated with osteoporosis in small pedicles. METHODS:A retrospective analysis was conducted on 13 patients with vertebral fractures accompanied by osteoporotic microarches who underwent unilateral transluminal pedicle approach vertebral body reconstruction between October 2021 and March 2024, including 5 males and 8 females, with an average age of (72.92±5.95) ranging from 65 to 85 years old. The cases included 9 L1 fractures and 4 L2 fractures, all with a history of low-energy trauma characterized by lower back pain exacerbated upon sitting up and radiating to both costal regions in 4 cases. The disease duration ranged from 1 to 5 days with a mean of (2.92±1.19) days. Preoperative visual analogue scale (VAS) ranged from 5 to 7 with a mean of (6.31±0.75). MRI findings indicated fresh fractures with bone mineral density T-values <-2.5;axial CT measurements revealed pedicle diameters at their narrowest point ranging from 4.2 to 4.7 mm with a mean of (4.42±0.17) mm, all <5 mm. Individualized puncture planning was performed preoperatively, including measurement of skin-puncture distance on CT cross-sections and head-side deviation distance on lateral X-rays for precise intraoperative positioning. Surgical parameters including operative time, number of fluoroscopic procedures, bone cement volume injected, cement dispersion, and complications were recorded. Efficacy was assessed using VAS and the Oswestry disability index (ODI) at preoperative, postoperative day 1, and postoperative 3-month follow-up. RESULTS:All patients underwent the surgery successfully and received follow-up examinations ranging from 3 months to 1 year. The operative duration ranged from 35 to 46 with a mean of (40.15±3.34) minutes. The number of fluoroscopic procedures was 11 to 17 with a mean of (13.77±2.05). The bone cement volume injected ranged from 4 to 6 with a mean of (4.73±0.70) mL, achieving uniform bilateral distribution throughout the bone cement. One case exhibited asymptomatic intervertebral space cement leakage, with no complications such as nerve injury or hematoma observed. Both VAS and ODI at 1 day and 3 months postoperatively were significantly lower than preoperative levels (P<0.05), with better outcomes at 3 months compared to 1 day (P<0.05). CONCLUSION:For osteoporotic lumbar fractures with narrow pedicles, unilateral percutaneous vertebral body formation via an extra-pedicular approach via the superior border of the transverse process is a technically feasible and highly effective treatment modality, offering advantages including shorter operative time, enhanced safety, reduced fluoroscopic requirements, and minimal invasiveness.
OBJECTIVE:To analyze the effect of wearing a lumbar corset after internal fixation surgery for lumbar degenerative diseases on patients' vertebral bone mineral density (BMD) and screw stability. METHODS:A total of 123 patients with lumbar degenerative diseases who underwent posterior lumbar decompression, bone grafting, fusion, and internal fixation from January 1, 2021 to December 31, 2023 were prospectively enrolled. Using a random number table method, patients were divided into two groups according to the postoperative lumbar corset wearing time:70 cases in the 1-month wearing group 70 cases, including 20 males and 50 females, aged (63.4±7.9) years;and 50 cases in the 3-month wearing group, including 18 males and 35 females, aged (64.3±7.5) years. To deeply analyze the impact of osteoporosis status on outcomes, all patients were further divided into an osteoporosis subgroup (54 cases) and a non-osteoporosis subgroup (69 cases) based on preoperative bone mineral density results following the initial randomization. All patients underwent plain lumbar CT scans preoperatively and at 1, 3, and 6 months postoperatively. Bone's FRAX V1.0 software was used to quantitatively measure vertebral bone mineral density and assess screw stability, aiming to compare the temporal changes under different wearing durations and different bone mineral density states. Preoperatively and at the final follow-up, the visual analogue scale (VAS) was used for pain scoring, and the Oswestry disability index (ODI) was used for dysfunction evaluation. RESULTS:All patients were followed up for 6 months. Regardless of whether they were osteoporotic or non-osteoporotic, the vertebral BMD of patients in the 1-month group was significantly higher than that of patients in the 3-month group at the 3rd and 6th months postoperatively (P<0.05);the BMD loss in the 3-month group was greater than that in the 1-month group at 3 and 6 months postoperatively (P<0.05). In addition, although the imaging-observed screw loosening rates were relatively high in both the 1-month and 3-month groups, no clinical symptoms occurred. Whether in osteoporotic or non-osteoporotic patients, there was no statistically significant difference in screw loosening rates between the 1-month and 3-month groups (P>0.05). At the final follow-up, the VAS for low back pain in the 1-month group decreased from (7.05±1.08) preoperatively to (2.90±1.02), while that in the 3-month group decreased from (7.19±0.91) preoperatively to (2.83±0.95), with no statistically significant difference between the two groups at the final follow-up (P=0.699). At the final follow-up, the ODI in the 1-month group decreased from (39.69±15.12) preoperatively to (13.08±8.06), while that in the 3-month group decreased from (37.78±14.62) preoperatively to (12.79±8.02), with no statistically significant difference between the two groups at the final follow-up(P=0.520). CONCLUSION:Patients with lumbar degenerative diseases lose more and faster vertebral BMD when wearing a lumbar corset for 3 months postoperatively compared to wearing it for only 1 month. However, different corset wearing durations and different osteoporosis statuses have no significant impact on postoperative screw stability.
OBJECTIVE:Based on real-world clinical data, aimed to systematically characterize the key factors, decision-making pathways, and structural relationships influencing pain, and to investigate the differences and associated structural effects of changes across two pain dimensions in patients with knee osteoarthritis(KOA). METHODS:Using the visual analog scale (VAS) and Traditional Chinese Medicine(TCM) pain symptom score as bimodal pain dimensions, XGBoost models were constructed under a unified feature system. Multi-layer interpretability analysis was conducted through SHAP, rule extraction, and Bayesian networks to examine the observational data from 187 cases of KOA. RESULTS:The model identified age, disease duration, body mass index (BMI), administration time and local joint symptoms as key factors influencing changes in the TCM pain symptom score, while baseline VAS and medication use were key factors for changes in the VAS. Decision path analysis revealed that the primary pathway for changes in TCM pain symptoms was "age<69 years, BMI≥23.94 kg·m-2, and joint swelling score<4, " while the main pathway for VAS changes was "baseline VAS≥6 and concurrent use of analgesics." Furthermore, the structural relationships between variables and the two pain dimensions were revealed. For example, under the condition of "age <69 years, BMI≥23.94 kg·m-2, and joint swelling score<4", the conditional probability of a "significant change" in the TCM pain symptom score was higher than that in the VAS. CONCLUSION:Under a unified model framework, an analytical approach for examining differential changes in related indicators was explored. Through multi-layered interpretability analysis encompassing "feature importance assessment-decision rule extraction-Bayesian network inference, " it was found that the dual pain dimensions share common influencing factors in reflecting pain changes in knee osteoarthritis, yet also exhibit structural association differences. These findings provide a reference basis for identifying pain change characteristics and selecting pain assessment tools in KOA patients, and offer a replicable methodological paradigm for similar analyses.
OBJECTIVE:To investigate the safety of manual lumbar pedicle screw placement based on the position of the cat's eye (pedicle projection) on X-ray films. METHODS:A total of 150 patients with lumbar spine disorders from December 2022 to June 2024 were enrolled and classified into three types according to the cat's eye position on AP X-rays:type A (the lateral edge of the cat's eye extends beyond the lateral edge of the vertebral body); type B (the lateral edge of the cat's eye largely coincides with the lateral edge of the vertebral body);and type C (the lateral shadow of the pedicle is located at the medial edge of the pedicle). Patients were divided into two groups:the imaging-guided simulation group (90 patients, 30 each in types A, B, and C) and the imaging review group (60 patients, 20 each in types A, B, and C). All patients underwent screw insertion at the intersection of the inferior third of the transverse process and the lateral edge of the articular process. In the imaging-guided simulation group, the lumbar spine was divided into three regions from medial to lateral on AP X-rays;the screw direction was adjusted so that the tip of the screw tract corresponded to these three regions on the virtual projection, and CT analysis was performed to evaluate accuracy and determine whether the medial wall of the pedicle or the lateral edge of the vertebral body was penetrated. The imaging review group included 60 patients with lumbar pedicle screw placements;their AP and lateral X-ray images as well as postoperative CT data were analyzed to quantify the number of screws at corresponding positions and assess effectiveness via postoperative CT evaluation. RESULTS:In the imaging-guided simulation study, the rate of successful screw placement in zone 3 for type A patients was 96.67% (29/30), significantly higher than that in zone 1 50%(15/30) and zone 2 86.67%(26/30), with a statistically significant difference(P<0.05);In type B cat's eyes, the placement rates of screws in zone 1 and zone 2 were 90.00% (27/30) and 93.33% (28/30), respectively, significantly higher than those in zone 3 70% (21/30), with a statistically significant difference (P<0.05);In type C cat's eyes, the placement rate in zone 1 was 90.00% (27/30), superior to that in zone 2 63.33%(19/30) and zone 3 40%(12/30), also showing a statistically significant difference(P<0.05). Imaging analysis revealed that among patients with type A cats eyes, screw placements were in zone 1(3 cases), zone 2 (10 cases), and zone 3 (7 cases);the placement rates in zones 2 and 3 were 90% (9/10) and 100% (7/7), respectively, significantly higher than that in zone 1 33.3%(1/3), with a statistically significant difference (P<0.05). For patients with type B cat's eyes, the placement rates in zones 1 and 2 were both 100% (5/5) and 100% (12/12), significantly higher than that in zone 3 33.3%(1/3), with a statistically significant difference (P<0.05). In patients with type C cat's eyes, the placement rate in zone 1 was 100%(10/10), significantly higher than that in zones 2 and 3 87.5%(7/8) and 0%(0/2), respectively, with a statistically significant difference (P<0.05). CONCLUSION:By analyzing the relative positions of the cat's eye and vertebral body on anteroposterior X-rays, this study establishes a quantitative correlation between cat's eye zones and screw placement areas for the first time, effectively preventing spinal cord injury and reducing surgical risks.
OBJECTIVE:To explore the technique and early clinical efficacy of unilateral biportal endoscopy (UBE) with the Corner approach in the treatment of low lumbar disc herniation (LDH). METHODS:A retrospective analysis was conducted on the clinical data of 22 patients with low LDH who underwent treatment via the Corner approach of UBE from June 2022 to June 2023. Among these patients, there were 10 males and 12 females;their ages ranged from 37 to 82 years old, with an average of (56.8±13.8) years old;the disease duration varied from 3 to 32 months, with an average of (16.5±9.0) months. The intraoperative endoscopic operation time, postoperative drainage volume, postoperative hospital stay, and related complications were recorded and analyzed. The clinical efficacy was evaluated based on the Oswestry disability index(ODI), visual analogue scale (VAS) for low back pain and lower limb pain, and modified Macnab criteria measured preoperatively, at 1, 4, and 8 weeks postoperatively, and at the final follow-up. RESULTS:All patients were followed up for 6 to 12 months, with an average of(9.27±2.05) months. All patients successfully completed the operation under endoscopy. The intraoperative endoscopic operation time was(16.50±8.40) minutes for single-level cases and (32.00±10.56) minutes for double-level cases; the postoperative drainage volume was (20.00±13.50) ml for single-level cases and (38.00±21.82) ml for double-level cases. The postoperative hospital stay was (5.58±4.62) days. Compared with the preoperative data, the ODI and VAS for low back pain and lower limb pain of the patients at all postoperative time points showed statistically significant differences(P<0.05). At the final follow-up, according to the modified MacNab criteria, 17 cases were rated as excellent, 4 cases as good, and 1 case as fair. CONCLUSION:The Corner approach of UBE for the treatment of low LDH has reliable clinical efficacy, with advantages including minimal bony resection, shoter operative time, and clear visual field.
OBJECTIVE:To analyze the risk factors for postoperative complications in elderly patients with fragile hip fractures and their impact on postoperative mobility, and to construct a risk prediction model. METHODS:A retrospective analysis was performed on the postoperative clinical data of 278 elderly patients diagnosed with fragility hip fractures, who received treatment between January 2019 and December 2024. Of these patients, 120 were male and 158 were female, aged from 63 to 82 with a mean age of (74.91±4.87) years old and an average bone mineral density (BMD) T uale was raging from -3.63 to -2.15 with an aberage of (-2.89±0.74) g·cm-2. The patients were categorized into two groups based on the presence or absence of postoperative complications:the complication group(78 patients) and the non-complication group (200 patients). Furthermore, according to the postoperative functional mobility status of elderly patients with fragile hip fractures, those in the complication group were further classified into a good activity ability group(37 patients) and a limited activity ability group (41patients). Clinical data were collected from patients, including gender, Charlson comorbidity index (CCI), mini-mental state examination(MMSE) scores, age, type of surgical procedure, and time to ambulation. The study further analyzed potential risk factors for postoperative complications and their impact on patients' postoperative functional mobility. RESULTS:There were statistically significant differences between the complication group and the non-complication group with respect to age, MMSE score, CCI score, type of surgery, operation time, intraoperative blood loss, anesthesia method, and preoperative nutritional status(P<0.05). Logistic regression analysis demonstrated that age[OR=1.167, 95% CI(1.103, 1.234), P=0.001], MMSE score [OR=0.847, 95% CI(0.775, 0.927), P=0.001], CCI score[OR=1.374, 95% CI(1.099, 1.718), P=0.005], type of surgery [OR=2.976, 95% CI(1.700, 5.208), P=0.001], operation time [OR=2.065, 95% CI(1.209, 3.528), P=0.008], intraoperative blood loss[OR=1.024, 95% CI(1.004, 1.044), P=0.020], anesthesia method [OR=2.165, 95% CI(1.267, 3.698), P=0.005], and preoperative nutritional status[OR=0.500, 95% CI(0.348, 0.719), P=0.001], were significant independent risk factors associated with the development of postoperative complications in elderly patients with brittle hip fractures. There were statistically significant differences in activity levels among patients with different types of complications (P<0.05). Additionally, statistically significant differences were observed in the incidence of complications including pulmonary infection, deep vein thrombosis, pressure ulcers, surgical site infection, and cardiovascular and cerebrovascular diseases between the group with good activity ability and the group with limited activity ability (P<0.05). The receiver operating characteristic(ROC) curve of the nomogram prediction model, constructed based on independent risk factors, demonstrates that the mean area under the curve (AUC)>0.800 for each influencing factor. CONCLUSION:The risk prediction model developed through multifactorial analysis facilitates the early identification of postoperative complications and functional limitations in elderly patients with fragility hip fractures, thereby supporting the clinical formulation of individualized intervention strategies and improving patient outcomes.
OBJECTIVE:To investigate the effects of acupotomy on the paraspinal muscle status via MRI and spinal pelvic parameters, as well as lumbar activity in patients with lumbar disc herniation (LDH) post-surgery, aiming to elucidate the relative correlation and the traditional Chinese medicine (TCM) theory "regulating tendons to treat bones". METHODS:Between December 2019 and December 2021, a total of 104 patients with LDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) were enrolled via a prospective case-control study. They were randomly assigned to the acupotomy group (52 cases, 3 cases lost to follow-up) and the control group (52 cases, 4 cases lost to follow-up). There were 49 patients in the acupotomy group, including 38 males and 11 females, aged from 30 to 70 years with a mean age of (57.21±11.19) years and disease course ranged from 1 to 12 month with a mean of (4.83±1.31) months. The affected segments were L3,4 in 3 cases, L4,5 in 35 cases and L5S1 in 11 cases. Patients in the acupotomy group received one acupotomy intervention within 24 hours after PTED, and additional interventions were performed on postoperative day 7 and day 14 respectively. A total of 48 patients were enrolled in the control group, including 32 males and 16 females, aged from 30 to 69 years with an average age of (53.03±12.37) years old and disease course ranged from 1 to 12 month with a mean disease course of (5.14±1.43) months. The lesioned segments involved L3,4 in 1 case, L4,5 in 37 cases and L5S1 in 10 cases. All patients underwent PTED following the identical surgical procedures without acupotomy intervention, and the remaining rehabilitation and nursing protocols were consistent with those in the acupotomy group. Relevant evaluations were performed on patients before surgery as well as at 6 and 12 months postoperatively. The spinal pelvic parameters included lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). Indicators of lumbar mobility include the Oswestry Disability Index (ODI) and the Japanese Orthopedic Association Scores (JOA). Pearson correlation analysis was used to study the relationship between spinal muscle structure parameters, spinal pelvic parameters and lumbar mobility function for the patients with LDH after acupotomy, and generalized linear regression analysis was used to study the effects of spinal paravertebral muscle structure on the spinal joint force lines for the patients with LDH after acupotomy. RESULTS:All patients completed 12-month follow-up. At 6 and 12 months after surgery, the multifidus muscle IF values at L4,5 segment in the acupotomy group were (28.50±6.20)% and (26.43±8.80)%, which were significantly lower than the preoperative level of (45.16±10.45)% with statistically significant differences (P<0.01). Meanwhile, these values were obviously lower than those in the control group (40.14±15.16)% and (38.41±14.92)%, and the differences were statistically significant (P<0.01). At 12 months postoperatively, the LL of (47.48±6.49)° and SS of (35.10±7.01)° in the acupotomy group were higher than (43.06±4.22)° and (31.12±10.25)° in the control group respectively, with statistically significant differences (P<0.01). The PT of (13.73±4.66)° was lower than that of the control group (18.01±6.56)°, showing a statistically significant difference (P<0.05). There was no significant difference in PI between the two groups during the study period (all P>0.05). At 12 months postoperatively, IF was correlated with JOA and ODI (P<0.01), and PS was positively correlated with JOA (P<0.01). PT was correlated with JOA and ODI (both P<0.05), LL was positively correlated with JOA (P<0.01), SS was positively correlated with JOA (P<0.01), and SS was strongly positively correlated with JOA (r=0.91). IF was significantly correlated with LL, PT and SS (all P<0.01), PS was also significantly correlated with LL, PT and SS (all P<0.01), and PS was strongly positively correlated with LL (r=0.75). Regression studies showed that the degree of IF at L4,5 segments had statistically significant effects on PT, and SS had statistically significant effects on JOA. CONCLUSION:Acupotomy based on the theory of "regulating tendons to treat bones" can alleviate intramuscular fat infiltration of lumbar multifidus in post-PTED patients, thereby triggering favorable shifts in spinal-pelvic alignment and promoting lumbar functional recovery. Among them, the decrease in fat infiltration rate of multifidus(decreased by approximately 41% at the L4,5 level at 12 months postoperatively) and the increase in SS (increased by approximately 21% at 12 months postoperatively) were the most prominent factors for the changes of spinal paravertebral muscle structure and spinal-pelvic alignment. The relationship between "regulating tendons first" and "treating bones later" in the TCM theory of "regulating tendons to treat bones" can also be explained from an anatomical perspective.
OBJECTIVE:To investigate a novel regulatory pathway mediated by exosomal non-coding RNA in rats with spinal cord injury (SCI). METHODS:(1) A rat model of spinal cord injury (SCI) was established via T9-T10 spinal cord hemisection method. The success of model establishment was evaluated using the Basso-Beattie-Bresnahan(BBB) scoring scale. Spinal cord tissues were collected from successfully modeled rats and normal control rats, respectively. The levels of inflammatory factors-interleukin-6 (IL-6), interleukin-16 (IL-16), tumor necrosis factor-α (TNF-α), and nuclear transcription factor-κB (NF-κB)-were measured by enzyme-linked immunosorbent assay (ELISA). (2) miRNAs capable of regulating inflammatory factors were identified through literature review and bioinformatics analysis. The regulatory relationship between miR-125b-5p and IL-6/IL-16 was verified using a dual-luciferase reporter gene assay. (3) Spinal cord neuronal cells were cultured in vitro and identified by immunofluorescence. The effects of exosomal miR-125b-5p on the expression of IL-6 and IL-16 in both SCI rat neuronal cells and spinal cord tissues were comparatively analyzed. RESULTS:Compared with normal control group[(29.81±7.29), (35.88±5.73), (71.67±8.75), and (1 285.01±86.40) pg·mL-1, respectively], the levels of IL-6, IL-16, TNF-α and NF-κB in spinal cord tissue of model group(38.36±5.73), (46.82±7.20), (198.33±20.32), (1 907.47±120.95) pg·mL-1, respectively] increased significantly (all P<0.05). Bioinformatics search results showed that miR-125b-5p could regulate IL-6 and IL-16 simultaneously, and the results of dual luciferase reporter gene experiments confirmed this regulatory relationship directly. Cell and animal experiments have confirmed that exosomal miR-125b-5p could down regulate expression of IL-6 and IL-16. CONCLUSION:The regulatory pathway regulating IL-6/IL-16 in spinal cord tissue through exosomal miR-125b-5p was identified in SCI rats.
OBJECTIVE:To investigate the clinical feasibility of a paper-cutting method to simulate posterior cervical single open-door laminoplasty for predicting postoperative increases in central sagittal canal diameter and cross-sectional area of the spinal canal. METHODS:Between January 2021 and February 2022, 21 patients underwent posterior cervical single open-door laminoplasty, including 12 males and 9 females, aged from 42 to 73 years with a mean of (59.7±9.9) years. There were 18 cases of ossification of the posterior longitudinal ligament, 3 cases of ligamentum flavum hypertrophy, 11 cases of multilevel cervical disc herniation, and 2 cases of developmental spinal stenosis. Cervical CT data were imported into Mimics software to measure preoperative and postoperative spinal canal parameters. Preoperative C3-C7 vertebrae were 3D-printed to simulate open-door laminoplasty, and corresponding spinal canal parameters were recorded. The increase in cross-sectional area of the spinal canal was calculated using the sector area formula ( S=nπr2/360). Comparative statistical analysis was performed among preoperative measurements, postoperative outcomes, simulated open-door parameters, and to verify the clinical feasibility of the paper-cutting method and the formula for calculating the increase in spinal canal cross-sectional area. RESULTS:Imaging data were obtained in all 21 patients. Preoperative VAS and JOA scores in the 21 patients were (6.80±1.93) and(10.52±3.80), respectively, which significantly improved to (2.42±1.20) and (12.90±4.18) at 12 months postoperatively (P<0.05). Additionally, significant differences were observed in the C3-C7 spinal canal parameters between pre-and post-operation(P<0.05). At 3 days postoperatively, the C3 opening angle (22.94±5.00)° was significantly smaller than those at the C4 (28.67±5.99)°, C5 (30.78±5.94)°, C6(29.18±6.55)°, and C7(27.32±6.18)° segments (P<0.05). Furthermore, the opening width at C3(7.09±0.28) mm and C7(7.47±0.36) mm, as well as the increase in spinal canal cross-sectional area at C3(68.54±17.39) mm2 and C7(63.64±15.82) mm2, were significantly smaller than those at C4(9.17±0.32) mm and (86.84±18.12) mm2, C5(9.31±0.34) mm and (92.80±18.94) mm2, and C6(8.60±0.35) mm and (79.53±17.06) mm2, respectively(P<0.05). There were no statistically significant differences among the spinal canal parameters measured by the paper-cutting method, the increment of spinal canal cross-sectional area calculated by the formula, and the actual postoperative CT measurements(P>0.05). CONCLUSION:The extent of laminar opening varies among different cervical levels in posterior cervical single-open door laminoplasty. In clinical practice, the paper-cutting method can be used to plan relevant surgical parameters and may help reduce the incidence of intraoperative and postoperative complications.
In recent years, the etiological mechanisms of Adolescent Idiopathic Scoliosis (AIS) have gradually become a focal point of academic research. Previous studies have shown that poor sitting posture can induce morphological changes in the coccyx, while recent research indicated a significant difference in coccygeal morphology between AIS patients and individuals without scoliosis. This suggests that coccygeal morphological features may serve as a crucial link in explaining the correlation between sitting posture and AIS. This review recent advances regarding the reciprocal interactions among AIS, sitting posture, and coccygeal morphology, pointing out that postural-induced changes in coccygeal morphology may be one of the mechanisms through which sitting posture influences the onset and development of AIS. Future research could leverage high-precision 3D imaging and biomechanical modeling to quantitatively analyze the association between coccygeal morphological features in the sitting position and the pathogenesis of AIS, thereby providing a theoretical basis for ergonomic seat design and AIS prevention strategies based on postural intervention.
