Ossification of posterior longitudinal ligament (OPLL) is a complex multifactorial spinal disorder characterized by ectopic bone formation within the ligament, leading to progressive spinal canal stenosis and neurological deficits. While its epidemiological and clinical profiles are well-established, the precise molecular pathogenesis remains incompletely understood. This review systematically synthesizes recent advances in understanding the mechanistic underpinnings of OPLL, highlighting the interplay of genetic predisposition, epigenetic regulation, metabolic disorders, and biomechanical stress. Pathological manifestations, anatomical features, and the dual-origin hypothesis of OPLL are elaborated, alongside its phenotypic overlaps with ankylosing spondylitis and the contribution of inflammatory signaling cascades. Susceptibility loci identified via genome-wide association studies and their functional relevance to key regulatory pathways are summarized. Epigenetic regulation, encompassing pre and posttranscriptional modifications, is highlighted with particular attention to the roles of long noncoding RNAs (lncRNAs) and microRNAs (miRNAs). Metabolic mechanisms implicated in OPLL, including diabetes, lipoprotein receptor-related protein 5 signaling, and lipid metabolism dysregulation, are discussed, as is the critical role of biomechanical stress in disease progression. By integrating insights across multiple disciplines, this review establishes a comprehensive pathophysiological framework for OPLL, with the goal of bridging basic science and clinical practice and identifying promising avenues for the development of targeted therapeutic strategies.

Study DesignRetrospective Cohort Study.ObjectiveTo propose a new technique named "lateral mass gutter" and investigate its role in augmenting spinal canal cross-sectional area (SCA) during laminoplasty.MethodsThis study included 105 patients who received cervical laminoplasty from February 2021 to February 2024. Patients were allocated to the conventional (CON) group or the lateral mass (LM) group according to the guttering technique used intraoperatively. Propensity score matching with a caliper of 0.2 was utilized to reduce selection bias. Intergroup comparisons encompassed clinical outcomes (Visual Analog Scale (VAS) of neck pain, Japanese Orthopaedic Association (JOA) score), radiographic measurements (SCA, laminoplasty opening angle (LOA), hinge fractures, hinge fusion, C2-7 Cobb angle) and postoperative complications (cerebrospinal fluid leakage, incisional fat liquefaction, C5 nerve root palsy, axial neck pain, cervical spine instability).ResultsFollowing propensity score matching, baseline parameters were comparable between the CON and LM groups (37 patients per group, P > 0.05). Compared to the CON group, the LM group exhibited a significantly smaller LOA, a lower incidence of hinge fractures, a higher rate of hinge fusion, greater improvement in JOA and a larger expansion in the SCA (P < 0.05). No statistically significant differences were observed between the two groups regarding VAS of neck pain or postoperative complications (P > 0.05).ConclusionCompared to conventional guttering technique, lateral mass gutter significantly reduces hinge fracture, promotes hinge fusion, enhances spinal canal expansion and optimizes postoperative neurological recovery in posterior cervical laminoplasty.

Bone, characterized by its extensive vascularization, relies on angiogenesis as a fundamental prerequisite for successful regeneration. However, conventional bone implant materials often exhibit limitations such as insufficient vascularization, leading to cellular necrosis and delayed host tissue infiltration. To address these challenges, this study integrates 3D printing and photo-crosslinking technologies to develop a pre-vascularized bioactive scaffold driven by endothelial cells (ECs)/ bone marrow mesenchymal stem cells (BMSCs) bidirectional cellular communication, aiming to facilitate the rapid reconstruction of vascular and bone networks. The results demonstrate that the scaffold not only enhances the vascularization of ECs, but also activates BMP-2 and TGF-β signaling of BMSCs through EC-secreted growth factors, thus synergistically enhancing the osteogenic differentiation of BMSCs. In a rat femoral defect model, this bioactive pre-vascularized scaffold exhibited robust matrix deposition and osteoinductive capacity, offering a promising strategy to enhance bone regeneration and address bone defects.

Intervertebral disc degeneration (IDD) is a major cause of chronic low back pain, the mechanism of which is still unclear. Inflammation-induced extracellular matrix metabolism (ECM) dysregulation in the nucleus pulposus (NP) and NP cell senescence are known to be the key causes of IDD. However, few drugs can reliably alleviate ECM dysregulation and NP cell senescence. Muscone, as the key natural component of musk, is a widely applied antiapoptotic and anti-inflammatory drug. We found Muscone exerts protective effects by inhibiting the expression of ECM catabolism-related genes, cell apoptosis, the cell senescence and senescence-associated secretory phenotype (SASP) in NP cells, which is the key cellular phenotype associated with IDD. We have also shown that muscone can increase the expression of ECM anabolism-related genes and the proliferation of NP cells during inflammation. High-throughput RNA sequencing indicated that muscone protects NP cells mainly by altering the phosphorylation and expression of p53. Further validation confirmed both in vivo and in vitro that muscone could regulate ECM-related genes, cell apoptosis, cell senescence and the SASP by inhibiting p53. In summary, our findings show that muscone protects against the degeneration of nucleus pulposus cells by inhibiting p53 signaling and thus may have therapeutic value for IDD.

Mitochondrial respiratory chain dysfunction-induced chondrocyte senescence is a key contributor to the progression of osteoarthritis (OA), yet effective strategies for restoring mitochondrial respiratory homeostasis remain elusive. Herein, we develop a charge-guided micro/nano interpenetrating network hydrogel that targets cartilage and delivers a mitochondria-directed MnO2-based nanoparticles, in which the nanozyme catalyzes intracellular hydrogen peroxide to generate oxygen while releasing nicotinamide adenine dinucleotide (NAD+) precursor via particle degradation, thereby enabling synchronized electron donor and acceptor supply to fully reactivate the mitochondrial respiratory chain and alleviate chondrocyte senescence. Comprehensive evaluations reveal that this system enhances the activity of key antioxidant enzymes including superoxide dismutase, catalase, and glutathione peroxidase, elevates the intracellular nicotinamide adenine dinucleotide/nicotinamide adenine dinucleotide hydrogen (NAD+/NADH) ratio, and suppresses the secretion of senescence-associated secretory phenotype factors, thereby preserving cartilage matrix integrity. Collectively, these findings underscore the therapeutic potential of this dual-delivery platform to achieve full-length mitochondrial respiratory chain activation, offering a compelling strategy to mitigate chondrocyte senescence and impede OA progression.

Study DesignRetrospective Cohort Study.ObjectiveThe aim of this study was to evaluate the efficacy of our proposed surgical procedure named unilateral exposure channel-assisted (UCA) laminoplasty in treating degenerative cervical myelopathy (DCM), and the postoperative volume changes of cervical paraspinal muscles.MethodsFrom January 2020 to January 2022, 104 patients with DCM underwent unilateral open-door laminoplasty, among which, 63 patients underwent UCA laminoplasty (UCA group) and 41 patients underwent traditional laminoplasty (LP group). The radiological and clinical parameters as well as postoperative complications were recorded and analyzed before operation and during the follow-up.ResultsThe operation was completed successfully for all patients from both groups, who showed significant but comparable improvement in clinical outcome indicators including mJOA score, Neck pain VAS score, NDI score and radiological indicators including spinal canal diameter and area at the final follow-up compared to pre-operation. When conducting the intra-group comparison, less intraoperative time consumption and blood loss, less postoperative drainage and lower incidence of axial symptoms were observed in patients from UCA group than LP group. Furthermore, we found better preservation of C2-7 cobb angle, cervical curvature index (CCI) and cervical paraspinal muscle on the hinge side in patients underwent UCA laminoplasty than traditional laminoplasty.ConclusionThe UCA laminoplasty showed similar efficacy on alleviating clinical symptoms, and priority on maintaining cervical sagittal balance, minimizing intraoperative invasion, speeding up postoperative rehabilitation, reducing paraspinal muscle atrophy and postoperative axial symptoms when compared with traditional unilateral open-door laminoplasty.

BACKGROUND:There is currently no established index for evaluating the adequacy of the surgical area during laminoplasty. This study aims to propose a novel concept of the drifting angle of the spinal cord (DA-SC) at the cephalic and caudal junction of surgical and nonsurgical laminae during laminoplasty, and to assess its clinical relevance. METHODS:A retrospective review of clinical and radiological data was conducted on 296 patients who underwent laminoplasty. Patients were classified into four groups based on preoperative DA-SC of cephalic and caudal junction of surgical and nonsurgical laminae: Group DA-SC SS (both cephalic and caudal DA-SC were small); DA-SC LL (both cephalic and caudal DA-SC were large); DA-SC LS (cephalic DA-SC was large whereas caudal DA-SC was small); and DA-SC SL (cephalic DA-SC was small whereas caudal DA-SC was large). Clinical outcomes were recorded and analyzed before surgery, 2 months postoperatively, and at the last follow-up. RESULTS:Both cephalic and caudal DA-SC increased significantly following laminoplasty, patients in group DA-SC SS demonstrated superior clinical recovery rate than that of other three groups, indicating that small DA-SC is positively related with great clinical outcomes. CONCLUSIONS:The concept of DA-SC is valuable in assisting making decisions regarding the extent of laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Reducing the DA-SC by extending the surgical area is necessary when DA-SC is large.

Hematoma is a life-threatening complication of anterior surgery in cervical spondylosis patients. Herein, we report a cervical spondylosis patient complicated with Huntington’s disease, who developed unexpected neck hematoma after anterior cervical discectomy and fusion (ACDF) surgical treatment. During the debridement, we found no noticeable vessel lesions and concluded that the occurrence of postoperative hematoma might be due to the drainage displacement caused by excessive uncontrolled movements of the neck after the operation. The patient recovered well, and further literature review suggests that chorea secondary to Huntington’s disease likely increases mechanical stress on the cervical spine, indicating an internal relationship between degenerative cervical spondylosis and Huntington’s disease. Cervical spondylotic patients complicated with Huntington’s disease can be treated with surgical intervention but need to be immobilized and under close observation.

Introduction:Low back pain following transforaminal endoscopic lumbar discectomy (TELD) is prevalent (15-25% incidence). Modifying TELD techniques to avoid excessive disc removal has been suggested to reduce such pain. Facet injury, re-herniation, and disc space collapse might contribute. This retrospective study aimed to explore factors linked to post-TELD low back pain.Methods:A total of 351 patients with L3/4, L4/5, and L5/S1 intervertebral lumbar disc herniations, who underwent TELD at two spine centers, were included. Patients were followed for one year. Low back and leg pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Pfirrmann grade, and disc height were measured at 3 months and 1 year. Correlation analyses examined links between postoperative low back pain VAS scores, age, sex, disc/vertebrae height ratio (D/V H ratio), Pfirrmann grade, cannula position grade, re-herniation grade, high-intensity zone (HIZ), disc calcification, surgical grade, and other factors. Significant variables were identified using partial least square tests, with variable importance in projection (VIP) values quantifying their impact on low back pain.Results:Univariate analysis indicated that surgical grade correlated with long-term postoperative low back pain (P = 0.023), while re-herniation (P = 0.008, P = 0.000), disc height (P = 0.001, P = 0.034), and sex (P = 0.025, P = 0.003) correlated with both short- and long-term postoperative low back pain. Trephine/cannula position is correlated with short-term low back pain (P = 0.036). Worsening low back pain was associated with female sex, improper trephine/cannula position, re-herniation, and post-surgical disc space collapse. Intradiscal irrigation was linked to decreased low back pain.Discussion:This study highlights factors influencing low back pain after TELD. Loss of disc height, extent of re-herniation, quality of trephine/cannula position, and sex were associated with low back pain at both 3 months and 1-year post-TELD. Proper techniques, like minimizing disc height loss and re-herniation, may help mitigate postoperative low back pain.

腰椎间盘突出症指因纤维环破裂、髓核突出而压迫神经导致腰腿痛的一种综合病症,在中医属于痹症、腰腿痛范畴.一旦患有腰椎间盘突出症,在积极治疗的同时,还需转变生活方式.

目的 探讨椎管扩大椎板成形术联合MRI T2加权像髓内高信号（ISI）节段单侧侧块螺钉内固定治疗多节段脊髓型颈椎病（MCSM）的临床疗效。方法 2015年1月—2019年1月收治伴MRI T2加权像髓内ISI的MCSM患者59例，其中26例采用椎管扩大椎板成形术联合MRI T2加权像髓内ISI节段单侧侧块螺钉内固定治疗（A组），33例采用单纯椎管扩大椎板成形术治疗（B组）。记录2组手术时间、术中出血量及并发症发生情况。采用日本骨科学会（JOA）评分及其改善率评价神经功能状态。在颈椎X线片上测量C 2～7 Cobb角，计算颈椎整体活动度（ROM）。测量髓内信号改变比值（SCR=ISI区域光密度值/C 7 ～T 1 正常区域光密度值），定量评估髓内ISI程度，并进一步分析SCR变化值对JOA评分及其改善率的影响。结果 所有手术顺利完成。2组手术时间、术中出血量差异无统计学意义（P＞0.05）。A组术后JOA评分及其改善率、术后SCR及其变化值明显高于B组，差异均有统计学意义（P＜0.05）。2组术后C 2～7 Cobb角、颈椎整体ROM及其保留率差异无统计学意义（P＞0.05）。2组并发症发生率差异无统计学意义（P＞0.05）。SCR变化值显著改变组的JOA评分改善率最高，中度改变组次之，轻度改变组最低，3组间两两相比，JOA评分改善率差异均有统计学意义（P＜0.05）。结论 对于伴MRI T2加权像髓内ISI的MCSM患者，椎管扩大椎板成形术联合MRI T2加权像髓内ISI节段单侧侧块螺钉内固定具有较好的临床和影像学结果，尤其在术后髓内ISI的改善方面具有一定优势。

目的:评价颈后路单侧显露选择性通道辅助下椎管扩大椎板成形术(selective channel-assisted lamino-plasty,SCA-LP)治疗多节段颈椎行性疾病的安全性与有效性,并对比3种颈椎后路单开门椎管扩大椎板成形术(laminoplasty,LP)的临床疗效.方法:回顾性分析2020年3月～2021年7月共114例行颈后路LP的患者资料,其中男62例、女52例,年龄58.27±7.36岁.其中多节段脊髓型颈椎病52例、颈椎管狭窄症25例、颈椎后纵韧带骨化症37例.39例患者接受了颈后路单侧显露SCA-LP,33例患者接受了颈后路单侧显露完全保留对侧椎旁肌的椎管扩大椎板成形术(muscle-preserved laminoplasty,MP-LP),42例患者接受了常规的颈后路单开门LP.随访12～28个月(18.46±5.75个月).比较三组患者的年龄、性别、体重指数(body mass index,BMI).记录并比较三组的手术时间、术中出血量、术后引流量及平均住院日.于术前、术后即刻、术后2个月、术后12个月及末次随访时采用疼痛视觉模拟量表(visual analog scale,VAS)评分评估颈部和上肢疼痛程度,颈椎功能障碍指数(neck disability index,NDI)评价患者颈椎功能,日本骨科学会(Japanese Orthopedic Association,JOA)评分评估神经功能状况.在术前、术后即刻、术后2个月、术后12个月及末次随访时的颈椎侧位X线片上测量C2-C7 Cobb角、CT横断面上测量骨性椎管面积,比较三种手术方法对C2-C7 Cobb角的影响及椎管面积的增加程度(比较每个节段的增加程度及每例患者的平均增加程度).结果:三组患者的年龄、性别、BMI差异无统计学意义(P＞0.05).所有患者均顺利完成手术,术后均未发生神经损伤、感染等并发症.手术时间及平均住院日MP-LP组均最短、SCA-LP组次之、LP组最长,术中出血量及术后引流量MP-LP组均最少、SCA-LP组次之、LP组最多,三组间的差异均有统计学意义(P＜0.05).三组患者术后各时间点NDI及JOA评分均较术前有明显改善(P＜0.05),术前、术后即刻、术后2个月、术后12个月及末次随访时的NDI及JOA评分三组间均无统计学差异(P＞0.05).LP组中,术后即刻的颈痛VAS评分要高于术前,术后12个月及末次随访时低于术前,差异均有统计学意义(P＜0.05);术后2个月的颈痛VAS评分与术前比较无统计学差异(P＞0.05).SCA-LP组、MP-LP组术后即刻的颈痛VAS评分与术前的差异均无统计学意义(P＞0.05),术后2个月、12个月及末次随访均显著低于术前(P＜0.05).术后即刻及术后2个月随访,SCA-LP组、MP-LP组的颈痛VAS评分均显著低于LP组(P＜0.05);术后12个月及末次随访三组的颈痛VAS评分差异无统计学意义(P＞0.05).三组术后即刻的C2-C7 Cobb角均较术前无统计学差异(P＞0.05),LP组术后2个月、12个月及末次随访的C2-C7 Cobb角均显著小于术前(P＜0.05),SCA-LP组、MP-LP组术后2个月的C2-C7 Cobb角均与术前无统计学差异(P＞0.05),SCA-LP组、MP-LP组术后12个月及末次随访的C2-C7 Cobb角均显著小于术前(P＜0.05).三组间术前及术后即刻C2-C7 Cobb角差异无统计学意义(P＞0.05),术后2个月、12个月及末次随访的C2-C7 Cobb角SCA-LP组、MP-LP组均大于LP组(P＜0.05).三组间术后即刻、2个月、12个月及末次随访的平均椎管面积增加百分比差异无统计学意义(P＞0.05).SCA-LP组中所有患者的C7(100％)、12例患者的C6(30.77％)、6例患者的C3(15.38％)需要通道下制作铰链.术后即刻、2个月、12个月及末次随访SCA-LP组和LP组患者C7的椎管面积增加程度均优于MP-LP组(P＜0.05);三组间C3～C6椎管面积增加程度的差异无统计学意义(P＞0.05).结论:与常规的颈后路单开门LP相比,两种改良术式均能有效减少铰链侧肌肉韧带的损伤,术后加速康复,减少术后早期轴性颈痛的发生率.与MP-LP相比,SCA-LP能更有效地增加手术节段的椎管面积.

Objective:Osteogenesis imperfecta (OI) is a congenital disorder characterized by muscle defect and skeletal fragility, and no cure is yet available. Crosstalk between bone and muscle has become a new coming focus of therapeutic strategy in OI. Irisin, a secreted myokine, was found to be involved in regulating bone metabolism, and may be beneficial for the treatment of OI. However, its effects in OI have yet to be determined. This study sought to determine whether Irisin therapy is capable of reducing fracture risk in OI and to investigate the potential mechanisms of action.Methods:Fibronectin type III domain containing 5 (FNDC5)/Irisin expression was assessed by enzyme-linked immunosorbent assay (ELISA) and immunohistochemical staining. In vivo, X-ray was used for fracture counting and micro-CT, dynamic histomorphometry analysis, immunohistochemistry, histomorphometry, and biomechanical test were used to evaluate the effects of Irisin on fracture frequency and bone quality in OI mouse model, oim/oim mouse. In vitro, osteogenesis-related gene expressions were determined by quantitative real-time PCR (qRT-PCR), western blot, and osteoblastogenesis assay were assessed by alkaline phosphatase (ALP) staining and alizarin red S (ARS) staining. Mechanistically, cell immunofluorescence staining, co-immunoprecipitation (co-IP) (Co-IP), molecular docking, western blot, luciferase reporter assay, and chromatin immunoprecipitation (ChIP) assay were used for elucidating the mechanisms of how Irisin antagonized transforming growth factor-β (TGF-β)/Smad signaling in oim/oim osteoblasts and further attenuated the inhibitory effect of TGF-β1 on osteogenic differentiation.Results:Musculoskeletal system-related FNDC5/Irisin was decreased in the serum, muscle, and bone in oim/oim mice. Irisin administration reduced bone fracture and attenuated bone abnormalities by improving bone mass and strength and facilitating the expression of osteogenic differentiation markers. In vivo study and in vitro experiments showed that Irisin antagonized TGF-β/Smad signaling by interfering with TGF-β1-TGF-β receptor II (TβRII) binding. In oim/oim osteoblasts, Irisin alleviated TGF-β1-induced suppression of osteogenic differentiation through both integrin-dependent and integrin-independent mechanisms. Independent of integrin receptors, Irisin affected osteogenesis by activating ERK/p38 signaling and counteracting TGF-β/Smad2/3 signaling. In particular, Irisin alleviated TGF-β1-induced inhibition of Runx2 function at the osteocalcin promoter through decreasing Smad2/3 signaling and inducing HADC4/5 degeneration.Conclusions:Collectively, Irisin could effectively reduce bone fracture in oim/oim mice through promoting osteogenesis and counteracting TGF-β/Smad signaling.Translational potential statement:Findings from this study provided evidence for using Irisin as a potential therapeutic reagent to prevent the progression of OI.

[目的]分析严重椎间隙狭窄颈椎病的影像学特征.[方法]将C2/3或C3/4椎间隙称之为参考椎间隙,将椎间隙狭窄最严重的间隙称之为目标椎间隙,如果目标椎间隙高度小于或等于参考椎间隙高度的50％定义为严重椎间隙狭窄.回顾性分析2019年1月-2022年2月132例严重椎间隙狭窄颈椎病患者的影像指标测量结果,分析不同节段间测量指标的变化,探讨它们之间的相关性.[结果]132例患者中,严重椎间隙狭窄累及1～4个椎间隙,共累及225个椎间隙.不同节段发生严重椎间隙狭窄的概率依次为:C5/6为79.6％,C6/7为56.1％,C4/5为28.0％;C3/4为6.8％.各节段之间椎间隙高度、颈椎整体曲度C2-7Cobb角、局部Cobb角、中立位各节段棘突间距、动力位下各节段棘突间距,以及椎间孔高度、宽度及面积的差异均有统计学意义(P＜0.05).相关性分析方面,椎管面积与椎间隙高度、局部Cobb角、动力位棘突间距变化呈正相关(P＜0.05),但与C2～C7Cobb角、中立位棘突间距没有相关性(P＞0.05).椎间孔面积与椎间隙高度、局部Cobb角、动力位棘突间距变化有呈显著正相关(P＜0.001),与C2～C7 Cobb角、中立位棘突间距没有相关性(P＞0.05).[结论]严重椎间隙狭窄最常见于C5/6椎间隙,其次是C6/7椎间隙.椎间孔面积与椎间隙高度、局部Cobb角、动力位棘突间距变化有显著相关性.

Background The present study aimed to assess the efficacy of a new haplo-paraspinal-muscle-preserving (HMP) laminoplasty technique in the treatment of cervical myelopathy. Methods The medical records of 68 patients diagnosed with multisegmental cervical myelopathy were retrospectively reviewed. Of these, 22 patients who underwent HMP laminoplasty were defined as the muscle-preserved group (MP), and 46 patients who underwent traditional open-door laminoplasty were enrolled and defined as the traditional open-door laminoplasty group (LP). Patient demographic data and surgical parameters like clinical and radiological parameters, operation duration, blood loss, and spinal canal expansion distance were compared. Results Average surgical time and blood loss were significantly reduced in the MP group when compared with the LP group (P < 0.05). Both groups demonstrated significant improvements in neurological function and spinal canal expansion (P > 0.05). However, the visual analog scale score in the MP group was significantly lower compared with the LP group at the 6-month follow-up (P < 0.05), but no differences were found at the 1-year follow-up. The loss of lordosis was more prominent in the LP group when compared with the MP group at 1-year follow-up (P < 0.05). Lower events of persistent axial pain were found in the MP group but with no statistical significance. More hinge side laminae fractures could be found in the MP group, but more hinge side displacements were found in the LP group. Conclusions The HMP laminoplasty technique is relatively safe, effective, easier to perform, and better for lordosis maintenance and complication control compared with the traditional open-door technique. Clinical Relevance Although traditional open-door laminoplasty is an efficient approach in treating multisegmental cervical myelopathy, the complications could significantly affect the clinical outcome. Our new HMP laminoplasty technique has a lower complication rate and a better lordosis maintenance ability; therefore, it could be a better choice in treating multisegmental cervical myelopathy. Level of Evidence 3.

Four-level cervical spondylotic myelopathy (CSM) is a common disease affecting a large number of people, with the optimal surgical strategy remaining controversial. This study compared the clinical outcomes, radiological parameters, and postoperative complications of primarily performed surgical procedures such as anterior cervical discectomy and fusion (ACDF), open-door laminoplasty (LAMP), and laminectomy with fusion (LF) in treating four-level CSM. A total of 116 patients who received ACDF (38 cases), LAMP (45 cases), and LF (33 cases) were followed up for a minimum of 24 months were enrolled in this study and retrospectively analyzed. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system, the Neck Disability Index (NDI), and the Visual Analogue Scale (VAS). Changes in the curvature of the cervical spine were determined using the cervical curvature index (CCI) and the C2–C7 Cobb angle. Cervical mobility was evaluated using the C2–C7 range of motion (ROM) and active cervical ROM (aROM). Complications were recorded and compared among the three groups. All patients achieved significant improvement in JOA, NDI, and VAS scores at the final follow-up (P < 0.05), whereas no remarkable difference was found among the groups (P > 0.05). In addition, both C2–7 ROM and aROM were significantly reduced in the three groups and LAMP showed the least reduction relatively. As for complications, LAMP showed the lowest overall incidence of postoperative complications, and patients in the ACDF group were more susceptible to dysphagia, pseudoarthrosis than LAMP and LF. Considering improvements in clinical symptoms and neurological function, no remarkable difference was found among the groups. Nevertheless, LAMP had advantages over the other two surgical procedures in terms of preserving cervical mobility and reducing postoperative complications.

Study Design A retrospective observational study. Objective To describe a novel outcome indication system, the posterior compression score (PCS), and investigate its clinical value in cervical ossification of the posterior longitudinal ligament (OPLL) patients treated with laminoplasty. Methods A total of 282 OPLL patients who underwent laminoplasty from January 2013 to December 2018 were reviewed. The patients were divided into high-score (HS) or low-score (LS) groups based on whether the PCS was over 8. Propensity score matching analysis with a caliper of .1 was used to attenuate the potential selection bias. Clinical measurements, including the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS), neck disability index (NDI), and radiological measurements, including C2–C7 lordotic angle and range of motion (ROM), were compared between the groups. Results The mean follow-up period was 29.87 ± 9.17 months. There were no significant differences between the two groups regarding patients’ baseline demographical and clinical characteristics after propensity score matching. No significant differences were found in the operative time, blood loss, postoperative VAS score for neck and arm pain, postoperative C2–C7 lordotic angle, or postoperative ROM ( P > .05). However, the postoperative JOA score and recovery rate were significantly higher in the HS group than in the LS group, while the postoperative NDI was significantly lower in the HS group ( P < .05). Conclusion OPLL patients with higher PCS scores displayed better clinical outcomes. The novel PCS system is suggested to be a reliable scoring system for surgical outcome evaluation in patients with cervical OPLL.

Objectives: Intervertebral disc (IVD) degeneration is an important disease with no efficient biological therapy identified. Autophagy, a wildly known therapeutic target for human disease, has been demonstrated to be activated under hypoxia, with underlying mechanism remains elusive. Thus, this study aims to specify the role of autophagy in IVD degeneration, the regulating mechanism of hypoxia-inducing autophagy, and the therapeutic value of autophagy for IVD degeneration. Methods: RNA-seq was used to screen the primary pathway affected in NP cells under hypoxia, the specific link between hypoxia and autophagy were investigated using ChIP-seq and dual luciferase reporter assay. Conditional ATG7 knockout mice (ATG7(-/-)) were constructed for assessing the effect of autophagy on IVD degeneration, and puncture induced mice model of IVD degeneration were used for intradiscal injection to evaluate the therapeutic value of autophagy. Results: We demonstrated that hypoxia induces autophagy by transcriptional activation of autophagic gene LC3B and ATG7, which is controlled by PERK signaling. Then, we observed that inhibiting autophagy or PERK signaling leads to impaired NP cell viability and function, furthermore, using ATG7 knockout (ATG7(-/-)) mice, we identified the protective role of autophagy in IVD. Furthermore, we found that intradiscal injection of PERK signaling agonist, CCT020312, significantly restores the degeneration level of needle punctured mice IVD. Conclusion: We showed that the activation of PERK signaling upon hypoxia serves as a vital mechanism to induce autophagy and identified the therapeutic value of PERK signaling agonist for IVD degeneration treatment. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International.