Background context Inadequate osteogenesis is a crucial connection between vertebral bone destruction and osteoporosis in patients with spinal tuberculosis (STB). Bone marrow mesenchymal stem cells (BMSCs) play a vital role in osteogenesis. Nevertheless, the specific contribution of BMSCs to osteopenia in STB patients remains unclear. Study design A single-center retrospective study. Purpose To explore the role of BMSCs in osteopenia in spinal tuberculosis (STB) patients. Methods Bone mineral density (BMD) was measured in 53 STB patients and 55 controls. The migration and osteogenesis of BMSCs were assessed by wound healing assays and alizarin red staining, and osteoclast marker expression was measured. All quantitative comparisons were analyzed using independent samples t - tests (two-tailed) unless explicitly stated otherwise. To mitigate potential confounding effects, our analytical models incorporated age and gender as covariates through multivariate adjustment procedures. RNA-seq was performed on BMSCs, and the enriched signaling pathways were verified. Results The BMD of STB patients was significantly decreased, and BMSC migration and osteogenesis were significantly reduced. After verification, we found that the B-cell receptor signaling pathway, tuberculosis, osteoclast differentiation, Th17-cell differentiation, the Ras signaling pathway and the PI3K-Akt signaling pathway were affected. Of these pathways, B-cell receptor signaling, Th17-cell differentiation, the Ras signaling pathway and the PI3K-Akt signaling pathway were not previously known to be involved in osteopenia. MAPK signaling pathway activity and ECM-receptor interactions were correlated with STB prognosis. Conclusion Our study indicates that diminished migration and osteogenesis of BMSCs play pivotal roles in the development of osteopenia in STB patients, highlighting BMSCs as potential therapeutic targets. Clinical significance BMSCs may represent a novel therapeutic target for the clinical treatment of osteopenia in patients with spinal tuberculosis, and this study provides evidence for the refinement of treatment strategies for spinal tuberculosis.

BACKGROUND:Previous studies have reported an association between the IL-17 A rs2275913 polymorphism and tuberculosis (TB) susceptibility in Egyptians and Argentines, but there have been few reports in Chinese people, especially among spinal tuberculosis (STB) patients. To investigate the association between the polymorphism of IL-17 A rs2275913 and different types of TB susceptibility in a southern Han Chinese population, we conducted a case-control study. METHODS:This study collected peripheral blood samples from 296 TB patients (154 STB patients and 142 pulmonary tuberculosis (PTB) patients) and 182 healthy controls. The SNPscan™ kit was used to genotype the polymorphism of IL-17 A rs2275913. RESULTS:There were significant differences in the distribution of the AA genotype at this locus between the STB group and control group (p = 0.002) and between the STB group and PTB group (p = 0.003). However, there were no significant differences were observed in the genotype distribution between the TB group and control group or between the PTB group and control group. The proportion of the A allele in the STB group was significantly lower than that in the control group (p = 0.007) and PTB group (p = 0.008). CONCLUSION:In the Han population of southern China, the IL-17 A rs2275913 was first identified as associated with susceptibility to STB, but not with susceptibility to PTB. This locus maybe a relatively specific genetic locus for STB. The A allele at this locus is a protective factor against STB and maybe one of the genetic factors determining which subtype of tuberculosis progresses.

BACKGROUND:Implantation of titanium alloys (Ti-6Al-4V) or cobalt-chromium-molybdenum alloys (Co-Cr-Mo) for long-segment spinal fixation is the standard surgical treatment for adolescent idiopathic scoliosis (AIS), but long-term presence of the implants in the body may lead to the release of metal nanoparticles. Unlike orthopaedic internal fixation surgeries, spinal implants generally remain in the human body for a lifetime. The release of metal nanoparticles remains a potential clinical issue, but currently there is a lack of strong data on the topic. This study aimed to fill this crucial knowledge gap by providing longitudinal evidence on the dynamics of metal ion release. This is the first step in determining safety characteristics and clinical thresholds. QUESTIONS/PURPOSES:(1) Are serum Ti, Co, and Cr concentrations in patients with AIS after implantation elevated compared with in patients without implantation over a 4-year period? (2) Does surgical removal of implants lead to a reduction in systemic metal nanoparticle load? (3) Is there a correlation between metal ion levels and implant burden? (4) Does implant type (Ti-6Al-4V versus Co-Cr-Mo) influence serum metal concentrations? METHODS:This was a single-center retrospective cohort study performed at an urban tertiary referral hospital from January 2018 to December 2020. A total of 336 patients with AIS were included, including 60% (201 of 336) who underwent surgical treatment and 40% (135 of 336) who received nonsurgical treatment. Among the 201 patients who underwent AIS operations, 6% (13 of 201) were excluded because of the presence of metal implants in other parts (ulna and radius [n = 5], around the elbow joint [n = 4], femoral shaft [n = 4]), and 15% (31 of 201) were excluded because they were lost to follow-up, resulting in incomplete clinical data. Forty-eight percent (96 of 201) of the patients only received spinal implant treatment without revision surgery (implant group), 23% (46 of 201) of the patients received spinal implant treatment and underwent revision surgery but did not have the implants removed (revision group), and 7% (15 of 201) of the patients received spinal implant treatment, underwent revision surgery, and had the implants removed (removal group). Among the 135 patients with AIS who did not undergo surgery, 6% (8 of 135) were excluded because of the presence of metal implants in other parts (ulna and radius [n = 3], around the elbow joint [n = 3], femoral shaft [n = 2]), and 16% (22 of 135) were excluded because they were lost to follow-up, resulting in incomplete clinical data. Seventy-eight percent (105 of 135) of the patients who did not undergo surgery who met the inclusion criteria were ultimately included in the control group. Since 2015, according to a standardized protocol, serum samples from patients undergoing surgery for AIS and from the nonsurgical control group have been collected. This is part of a broader and ongoing research project for patients with AIS. Between February and April 2025, we determined the metal ion concentrations in the collected blood samples. Serum Ti, Co, and Cr levels were measured via inductively coupled plasma mass spectrometry at multiple postoperative time points. The correlation between metal ion levels and rod length as well as the number of screws were evaluated using correlation analysis. Linear regression analysis was employed to assess the relationship between implant types (Ti-6Al-4V and Co-Cr-Mo), rod diameter, and serum metal concentrations. The extracted implants were subjected to scanning electron microscopy (SEM) combined with energy-dispersive x-ray spectroscopy analysis to examine the surface morphology and elemental composition of the implants. RESULTS:Serum concentrations of Ti, Co, and Cr were higher in patients with spinal implants than in nonsurgical controls at all postoperative time points. At 48 months, the mean ± SD serum Ti was 1.1 ± 0.3 μg/L in the implant group versus 0.2 ± 0.1 μg/L in controls (mean difference 0.9 μg/L [95% confidence interval (95% CI) 0.8 to 1.0]; p < 0.001), for Co it was 0.3 ± 0.2 μg/L versus 0.2 ± 0.1 μg/L (mean difference 0.1 μg/L [95% CI 0.1 to 0.2]; p < 0.001), and for Cr it was 1.0 ± 0.5 μg/L versus 0.1 ± 0.1 μg/L (mean difference 0.9 μg/L [95% CI 0.6 to 0.7]; p < 0.001). Metal levels peaked at 12 months postoperatively and remained elevated for 48 months. Implant removal was associated with a reduction in serum metal concentrations. At 6 months after removal, Ti levels decreased by 1.8 μg/L (95% CI -2.1 to -1.6; p < 0.001), Co levels by 0.4 μg/L (95% CI -0.5 to -0.3; p < 0.001), and Cr levels by 1.2 μg/L (95% CI -1.4 to -1.0; p < 0.001) compared with the removal group. At 12 months after removal surgery, there was no difference in Ti ion concentration between the removal group and the control group (0.2 ± 0.2 versus 0.2 ± 0.1, mean difference 0.0 [95% CI -0.2 to 0.1]; p = 0.38). Similarly, no difference was observed in Co ion concentration (0.2 ± 0.1 versus 0.2 ± 0.1, mean difference 0.0 [95% CI -0.1 to 0.1]; p = 0.62). Additionally, Cr ion concentration did not differ between groups (0.2 ± 0.1 versus 0.1 ± 0.1, mean difference 0.1 [95% CI -0.2 to 0.1]; p = 0.45). Serum metal concentrations correlated positively with implant load (rod length r = 0.85 to 0.87, number of screws r = 0.87 to 0.88; all p < 0.001) and rod diameter (β = 0.54 to 0.58; all p < 0.001).The serum Co concentration had a substantial positive correlation with the use of Co-Cr-Mo implants (β = 0.54; p < 0.001). Similarly, the serum Cr concentration had a substantial positive correlation with the use of Co-Cr-Mo implants (β = 0.58; p < 0.001). SEM analysis confirmed implant surface corrosion and nanoscale defects consistent with metal release. CONCLUSION:Serum levels of Ti, Co, and Cr increase after posterior spinal fusion in patients with AIS, reaching a peak at 12 months after operation, and remaining elevated for at least 4 years, which suggests continuous release of metal ions from the implants. Removal of the implants was associated with a reduction in serum metal ion levels, confirming that the implants are the main source of metal nanoparticle release. The concentration of metal ions is related to the burden of the implant (such as the length of the rod and the number of screws) and the type of implant. However, the clinical importance of elevated metal ions needs further confirmation. Our findings are preliminary and do not support routine metal ion tests or imaging examinations in patients with AIS treated surgically or recommendations regarding implant removal; however, future research may attempt to correlate ion levels with symptoms or imaging results in the study environment. LEVEL OF EVIDENCE:Level III, therapeutic study.

PURPOSE:The purpose of this study was to evaluate the efficacy of multirod constructs in the treatment of young patients (<20 years) with scoliosis accompanied by lumbosacral deformity and to compare the corrective outcomes and postoperative quality of life between 3-rod and 4-rod techniques. METHODS:Thirty-nine adolescent patients with lumbosacral anomalies underwent surgical treatment at our institution. Following application of the inclusion/exclusion criteria, 17 young patients with severe scoliosis and concomitant lumbosacral deformities were enrolled in this study. Preoperative, 1-week postoperative, and final follow-up standing whole-spine anterior-posterior/lateral radiographs were retrospectively analyzed. The following parameters were assessed: major curve Cobb angle, lumbosacral curve Cobb angle, trunk shift, thoracic kyphosis angle, lumbar lordosis angle, and sagittal vertical axis (SVA), In addition, Scoliosis Research Society-22 (SRS-22) questionnaire scores were collected and analyzed preoperatively and at the final follow-up. RESULTS:The lumbosacral Cobb angle improved from 33.6° ± 4.5° to 7.7° ± 2.8° postoperatively ( P < 0.05), maintained at 8.6° ± 2.6° during follow-up. The major curve decreased from 62.1° ± 8.3° to 19.6° ± 6.5° ( P < 0.05), with slight correction loss to 23.3° ± 6.1° at follow-up. Trunk shift reduced from 3.0 ± 1.5 cm to 1.1 ± 0.7 cm ( P < 0.05), stabilizing at 1.4 ± 0.6 cm. Sagittal measurements showed TK improved from 29.8° ± 6.0° to 33.3° ± 5.0° postoperatively ( P > 0.05), whereas lumbar lordosis increased from 34.2° ± 19.4° to 43.0° ± 7.3° ( P > 0.05). SVA changes were notable ( P < 0.05). SRS-22 self-image scores improved from 2.21 ± 0.64 to 3.79 ± 0.50 ( P < 0.001), with pain scores also enhanced from 4.02 ± 0.58 to 4.71 ± 0.17 ( P < 0.001). No statistically significant differences were observed in correction rates or final follow-up SRS-22 scores between 3-rod and 4-rod constructs ( P > 0.05). CONCLUSION:The multiple-rod technique effectively addresses severe scoliosis with lumbosacral deformities in young patients, providing sustained radiographic correction, reduced implant failure risk, and improved clinical outcomes. In long-segment lumbosacral fixation constructs, bilateral supplementary rod configuration may reduce rod fracture risk compared with unilateral reinforcement.

Selective posterior thoracic fusion (sPTF) for Lenke 1/2 adolescent idiopathic scoliosis (AIS) aims to reconcile multi-planar correction with motion preservation. Nevertheless, postoperative coronal imbalance (CIB) frequently compromises these objectives. This study developed an interpretable machine learning architecture to stratify CIB risk and identify key predictors. Data from 282 patients were analyzed. Following dual-stage dimensionality reduction (Boruta and LASSO) on 24 candidate predictors, ten machine learning architectures were trained and evaluated using split-sample internal validation. Model efficacy was evaluated via area under the curve (AUC), Brier score, and decision curve analysis, using SHapley Additive exPlanations (SHAP) framework for algorithmic transparency. The LightGBM model demonstrated favorable performance, achieving peak AUC of 0.885 (training) and 0.824 (internal validation). SHAP identified three key predictors: the spatial relationship between the lowest instrumented vertebra and the last substantially touching vertebra (LIV-LSTV), regional lumbar adaptability (Lumbar Modifier), and skeletal maturity (Risser grade). Lower LIV-LSTV values, Lumbar Modifiers C, and lower Risser grades were associated with a higher predicted risk of CIB. This framework incorporates information on distal instrumentation selection, lumbar curve morphology, and skeletal maturity. The model may provide a preliminary basis for future preoperative CIB risk estimation and support a more informed assessment of the trade-off between deformity correction and preservation of lumbar motion segments. Independent external validation is required before the model can be used to guide surgical decision-making.

This study aimed to evaluate the clinical efficacy and safety of the dual growing rods (DGR) technique combined with preoperative halo-femoral traction (HFT) in treating early onset scoliosis (EOS), with a focus on spinal deformity correction, preservation of spinal growth, and complication management. The integral role of preoperative HFT in enabling DGR implantation for severe rigid curves was a primary focus of the analysis. A retrospective study was conducted on 42 EOS patients treated with the DGR technique, with a mean follow-up of 38.10 ± 12.95 months. Radiographic parameters—including Cobb angle, T1–S1 distance, apical vertebral translation (AVT), and sagittal alignment—were measured preoperatively, postoperatively, and at final follow-up. Complications were recorded and analyzed. Subgroup analysis compared patients with and without preoperative HFT. At final follow-up, the main Cobb angle correction rate was 64.30

This study aimed to investigate the risk factors associated with postoperative shoulder imbalance (PSI) and to construct predictive models for Lenke 1 A/B and 2 A/B adolescent idiopathic scoliosis (AIS) patients. Preoperative and first erect (FE) radiographic parameters were measured in 147 Lenke 1 A/B and 2 A/B AIS patients. Univariate analysis and multivariate logistic regression analysis were employed to compare clinical data between the PSI and non-PSI groups, leading to the establishment of a corresponding predictive model. At the last follow-up, 32 (21.8

BACKGROUND:Direct vertebral rotation (DVR) effectiveness in improving scoliosis correction outcomes remains unclear and requires further investigation. PURPOSE:This study aimed to evaluate the effectiveness of short and extended fusion techniques using en-bloc DVR in correcting adolescent idiopathic scoliosis (AIS) classified as Lenke 5 curve (5C). MATERIALS AND METHODS:This retrospective study included 90 randomly selected AIS patients with Lenke 5C who underwent posterior spinal instrumentation surgery using en-bloc DVR between 2014 and 2021. Patients were divided into 2 groups: (1) extended fusion, Group A (n = 40): upper instrumented vertebra = upper-end vertebra +1 or +2 or (2) short fusion, Group B (n = 50): upper instrumented vertebra = upper-end vertebra. Radiographic parameters were compared preoperatively and at postoperative follow-ups of 6 months, 3 years, and more. RESULTS:The mean follow-up duration was 37.5 ± 6 months for Group A and 40.0 ± 8 months for Group B (P = 0.596). The coronal balance correction rate was comparable between the 2 groups, with no significant differences observed at the final follow-up. Significant differences were noted in the fused segment, with Group A having an average fusion rate of 6.8 ± 0 compared with 6.3 ± 0 in Group B (P = 0.001). TK and lumbar lordosis measurements at the final follow-up did not show significant differences between the groups. However, substantial differences were observed in rib hump correction, with Group A demonstrating a better correction rate than Group B at both 6 months and the last follow-up (P = 0.001 for both time points). CONCLUSION:Selective DVR spinal instrumentation effectively corrects AIS Lenke 5C. However, extended fusion demonstrates more efficient correction and greater improvement in the patient's cosmetic appearance, including better thoracic curve correction, rib hump correction, and shoulder balance, compared with short-level fusion.

Rapid etiological identification of Staphylococcus aureus in spinal infections can be challenging, often delaying targeted therapy. We developed a machine learning model leveraging XGBoost to predict S. aureus etiology in spinal infections directly from routine laboratory indicators. The XGBoost model demonstrated superior predictive performance (AUC 0.812; 95% CI: 0.728-0.896) among four algorithms, with SHAP analysis identifying D-dimer, Monocyte Percentage, Albumin, and Alanine Aminotransferase as crucial predictors.

This study aimed to evaluate the efficacy of selecting the lowest instrumented vertebra (LIV) with extended upper instrumented vertebra (UIV) using the direct vertebral rotation (DVR) technique in patients with adolescent idiopathic scoliosis (AIS) Lenke type 5 C. A total of 120 patients with AIS Lenke 5 C with a lower-end vertebra (LEV) at L4 were prospectively enrolled and randomized into two groups based on the planned LIV: L3 (n = 44) or L4 (n = 50). All patients underwent posterior instrumentation with the DVR technique, with the upper instrumented vertebra (UIV) positioned at the upper end vertebra (UEV) + 1 or + 2. The final LIV was determined intraoperatively based on fluoroscopic assessment of disc alignment after DVR correction. Clinical and radiographic outcomes, including coronal balance, sagittal alignment, and complications, were evaluated preoperatively, at six months post-surgery, and at a minimum three-year follow-up. The mean follow-up duration was 39.8 ± 3 months for both groups, with no significant difference between them (P = 0.782). Coronal balance correction rates were comparable between the L3 and L4 groups, showing no significant differences at the final follow-up (P > 0.05). However, the number of fused segments differed significantly, with an average of 7.8 levels in the L3 group and 8.7 levels in the L4 group (P = 0.001). The distance between the central sacral vertical line (CSVL) and the L3 inner pedicle on convex side-bending films was the primary parameter for selecting L3 as the lowest instrumented vertebra (LIV). Notably, no complications such as adding-on or distal junctional kyphosis were observed in both groups. Selecting the LIV at L3, when feasible based on intraoperative disc alignment, can preserve spinal mobility and reduce the number of fused segments without compromising correction outcomes. The CSVL-L3 inner pedicle distance on preoperative convex side-bending films is a useful predictor for the selection of appropriate LIV level for AIS Lenke 5 C with DVR. These findings highlight the importance of individualized LIV selection and intraoperative assessment in optimizing outcomes for patients with AIS Lenke 5 C. Additionally, raising the upper instrumented vertebra (UIV) enhances the correction of the thoracic curve, levels the rib hump, and improves shoulder balance in patients with AIS Lenke 5 C.

OBJECTIVES:The early imaging features of spinal tumors and spinal infections are similar, and the lack of specific early diagnostic indicators can lead to misdiagnosis or missed diagnosis. Although serum tumor markers have been widely used in early cancer screening, spinal tumors are mostly metastatic, lacking specific markers, and some patients with spinal tumors may even test negative for tumor markers. Therefore, the role of tumor markers in the early differential diagnosis of spinal tumors remains unclear. This study aims to investigate the value of tumor markers in the early differential diagnosis of spinal tumors and spinal infection. METHODS:We retrospectively analyzed the clinical data of 221 patients with spinal bone destruction admitted to Xiangya Hospital of Central South University between April 2017 and October 2022. Peripheral blood levels of 10 tumor markers were measured upon admission, including carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), neuron-specific enolase (NSE), cytokeratin 19 fragment antigen 21-1 (cyfra21-1), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), carbohydrate antigen 72-4 (CA72-4), pepsinogen I (PGI), pepsinogen II (PGII), and the PGI/PGII ratio (PGR). Univariate Logistic analysis was used to screen relevant variables, and the correlation between tumor markers was analyzed. Multivariate Logistic regression was then employed to identify risk and protective factors. The optimal cut-off values were calculated using the receiver operating characteristic (ROC) curve and Youden index, and a differential diagnosis model for early spinal tumors and spinal infections was constructed based on the selected indicators. Diagnostic performance was then evaluated. RESULTS:According to the pathological diagnosis, 91 patients had spinal tumors, and 130 patients had spinal infections. The levels of CEA, AFP, NSE, cyfra21-1, CA199, and CA72-4 were higher in the spinal tumor group than those in the spinal infection group, while PGR was lower, with statistically significant differences (all P<0.05). Univariate Logistic analysis showed significant differences in CEA, AFP, NSE, cyfra21-1, CA199, CA125, CA72-4, and PGR (all P<0.05). Correlation analysis indicated a strong positive correlation between CEA and cyfra21-1, CA199, and CA125, as well as a strong negative correlation of PGII with PGI and PGR. Multivariate Logistic analysis identified AFP and cyfra21-1 as risk factors (P<0.01) and PGR as a protective factor (P<0.05). When the standard cut-off values (AFP<20 ng/mL, cyfra21-1< 3.3 ng/mL, and PGR>3) were applied, AFP had a sensitivity of 3.3% and accuracy of 60.2%, cyfra21-1 had a sensitivity of 20.9% and accuracy of 66.1%, and PGR had a sensitivity of 2.2% and accuracy of 59.3%. The AUC of the early spinal tumor diagnosis model was 0.623. Using the optimal cut-off values (AFP<1.625 ng/mL, cyfra21-1<1.175 ng/mL, and PGR>11.05) from the ROC curve, AFP had a sensitivity of 69.2% and accuracy of 64.7%, cyfra21-1 had a sensitivity of 68.1% and accuracy of 70.1%, and PGR had a sensitivity of 62.6% and accuracy of 57.5%, with the model's AUC at 0.772. CONCLUSIONS:A comparative analysis of 10 serum tumor markers reveals that AFP, cyfra21-1, and PGR are significantly associated with spinal tumors. The diagnostic model constructed based on these 3 markers shows promising predictive performance and may be helpful to the differentiation for the early clinical diagnosis of spinal tumors and spinal infection.

During the development and treatment of adolescent idiopathic scoliosis (AIS), obvious soft tissue injury around the vertebrae and back pain are always present.1, 2 Abnormal paraspinal muscle development can affect the progression and rehabilitation of scoliosis.3 However, there is insufficient attention to the pathogenesis and personalised treatment for addressing the abnormal changes in the paraspinal muscles in patients with AIS. Our study found that the activation of the NLRP3/GSDMD pathway, a key factor in paraspinal muscle injury of patients with AIS, and a nano-drug delivery system we designed can effectively inhibit this damage. In this study, we enrolled a total of 30 patients with AIS and 15 age- and gender-matched patients with non-AIS (Table S1). Clinical imaging analysis revealed high levels of fat infiltration in AIS paraspinal muscle, but no significant differences were observed between concave and convex sides (Figure S1A,B). Next, we investigated anomalous changes in the paravertebral muscle tissues of patients with AIS, including increased muscle cell pyroptosis and apoptosis, increased inflammatory infiltration and decreased proliferation ability of primary paravertebral muscle cells (Figures 1A–C and S1). Subsequently, RNA sequencing was performed on paravertebral muscle tissues to identify essential genes associated with AIS paraspinal muscle injury. Through various bioinformatic analyses and qPCR validation, we identified NLRP3, an important regulator in pyroptosis pathway,4 as a key candidate gene (Figures 1D–G and S2A,B). The sequences of all qPCR primers are listed in Table S2. Subsequently, various validation confirmed that the pyroptosis and apoptosis pathway proteins in paravertebral muscle of AIS were significantly higher than those in non-AIS (Figures 1H–K and S2C–E). Then, we overexpressed NLRP3 in C2C12 cells using lentiviral transfection and found that not only the NLRP3/GSDMD/IL-1β signalling pathway was activated (Figures 2A–F and S3A–C), but also the apoptosis pathway was upregulated (Figures 2E–H and S3D–F). Meanwhile, knocking down NLRP3 expression in primary paravertebral muscle cells of AIS using siRNA transfection significantly inhibited cell pyroptosis and apoptosis (Figure S4). The sequences of all interfering RNAs are presented in Tables S3 and S4. Some studies have reported that the N-terminal peptides of GSDM protein families, such as GSDMD/GSDME, can activate apoptotic pathway through entering the mitochondrial.5 Therefore, we further explored the mechanism by which NLRP3 simultaneously activates pyroptosis and apoptosis in AIS paraspinal muscle cells. Using Crispr-Cas9 technology to knockout GSDMD expression in C2C12 cells, we found that both the activation of pyroptotic and apoptotic pathway caused by OE-NLRP3 were inhibited (Figures S5 and S6). Moreover, JC1 staining suggested that GSDMD-N activated the cell apoptosis by affecting the mitochondrial membrane potential and increasing the expression of CYTC (Figure 3D–G). In addition, novel material-based drugs have been demonstrated to have promising applications in many diseases, such as aneurysm.6, 7 Here, we designed a nanoparticle (NP) drug containing disulphiram (DSF), a recognised inhibitor of GSDMD.8 The NP we constructed contains thioketal bonds, which would break and release DSF under oxidative stress stimulation.9 Through multiple analyses, we examined a variety of physicochemical properties of NP (Figure S7). In vitro experiments showed that it could be effectively taken up by muscle cells (Figure 3A,B), and could effectively inhibit the pyroptosis and apoptosis of AIS primary paravertebral muscle cells at appropriate doses (Figure 3C–K). In vivo study, OE-NLRP3 and OE-NLRP3 + NP groups were established via paraspinal muscle injection adenovirus or NP. The results suggested that at the appropriate concentration, NP could effectively inhibited the activation of the pyroptosis pathway and the necrosis of paraspinal muscle fibres caused by OE-NLRP3 (Figure 3L–T). Figure 4 is the schematic diagram of the critical role of NLRP3 in causing paravertebral muscle Injury in patients with AIS. In conclusion, we first demonstrated that the high level of NLRP3 in AIS mediates severe inflammatory events, further inducing pyroptosis and apoptosis through the activation of GSDMD, which is an important pathogenic factor in paraspinal muscle injury in AIS. Moreover, the use of NP can effectively alleviate the paraspinal muscle injury caused by OE-NLRP3, offering potential targets for effective and personalised clinical treatment of AIS and providing new insights for the development of novel drugs. Conceived and completed the experiment: Zhuo-Tao Liang, Hao Tang and Meng-Jun Li. Data analysis and interpretation: Jia-Ke Li. Assembly and collection of data: Jiong Li and Zhuo-Tao Liang. Administrative and financial support: Hong-Qi Zhang and Chao-Feng Guo. Manuscript writing: Zhuo-Tao Liang. Guidance for writing and submission: Hong-Qi Zhang and Chao-Feng Guo. The authors would like to express their gratitude to Rong Rong (Hunan Key Laboratory of Ophthalmology, Changsha, Hunan 410008, P. R. China) for the guidance of nanoparticle design and other technical support. The authors would also like to thank EditSprings (https://www.editsprings.com/) for the expert linguistic services provided. This study was supported by the National Natural Science Foundation of China (81772298, 82072390 and 82270937) and the National Natural Science Foundation of China (82170901). The authors declare they have no conflicts of interest. The human sample study and animal study were reviewed and approved by the Ethics Committee approval of Xiangya Hospital. Informed written consent was given by all the participants and their legal guardians before study. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

As there are no substantial selection criteria for determining the lowest instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) Lenke 5C/6C, thus, many surgeons base their selection on experience. The study aims to compare the selection of the lowest instrumented vertebrae (LIV) lumbar vertebra three (L3) with the use of direct vertebrae rotation (DVR) to the lowest instrumented vertebrae (LIV) lumbar vertebra four (L4) with the use of non-DVR for the correction of adolescent idiopathic scoliosis (AIS) Lenke 5C/6C when the lower end vertebrae (LEV) is at lumbar vertebrae four (L4). This prospective study involved 101 patients who were divided into two groups based on different techniques. The patients were prospectively followed up for at least four years. All patients included in the study had a lower end vertebra (LEV) at L4, while patients older than 18 years and patients with prior surgical procedures were excluded. The DVR group consisted of 49 patients, and the non-DVR group included 51 patients. The preoperative mean LIV disc angle was 3.1 ± 3 and 3.1 ± 1, P = 0.097, which corrected to 1.2 ± 0 and 1.1 ± 0 in both groups at 4-year follow-up without statistical significance. The LIVDA and LIVT were statistically insignificant at the preoperative, and there were no significant differences at the follow-up visitation. The DVR group achieved a satisfactory coronal and Cobb’s angle correction compared to the NDVR group; however, there were no statistical differences at the follow-up visitations. Both groups achieve a satisfactory correction rate without substantial significance in clinical and radiological outcomes. Furthermore, no post-surgical complications were recorded in either group. DVR is suitable for selecting L3 as the LIV in AIS Lenke 5C/6C compared to L4 in non-DVR. DVR preserved more segments without substantial complications during the follow-up visitations. Nevertheless, both groups will continue to be followed up to prevent adding-on post-surgical complications.

BACKGROUND AND OBJECTIVES:The surgical intervention for hemivertebra removal is complex, leading to a lack of a definitive solution. We aim to compare the clinical efficacy of less invasive, partial hemivertebra resection vs total hemivertebra resection in children. METHODS:Between 2011 and 2016, a retrospective study was conducted on a cohort of 43 patients diagnosed with congenital scoliosis coexisting with hemivertebrae. This study evaluated the outcomes of a posterior-only surgical approach, dividing the cohort into 2 groups based on the surgical technique applied: 23 patients underwent total hemivertebrae resection (TR), whereas 20 patients received partial hemivertebrae resection (PR), accompanied by short-segment fusion. RESULTS:There were 43 patients with congenital scoliosis associated with hemivertebrae in both the PR and TR groups. The average age at the time of surgery was 6.3 ± 2.0 years for the PR group and 6.0 ± 1.9 years for the TR group. The PR group exhibited a comparable correction rate of the Cobb angle at postoperation (4.3 ± 4.9 and 2.2 ± 3.2, P = .174) and the last follow-up (7.8 ± 1.3 and 5.5 ± 2.3, P = .113) compared with the TR group. CONCLUSION:Partial hemivertebra resection is efficient and secure. A less invasive technique obtained an equivalent, well-maintained correction rate to the total hemivertebra resection. However, this is the initial result, and the patients continue to be followed; we will await the results of the outcome at full-growth sprouts.

PURPOSE:The aim of this study was to identify associated risk factors of distal adding-on phenomenon in Lenke 1A/B and 2A/B adolescent idiopathic scoliosis (AIS) patients and establish the corresponding prediction model. METHODS:The clinical data of 119 Lenke 1A/B and 2A/B AIS patients were retrospectively analyzed. Preoperative, first erect (FE) radiographic parameters and radiographic parameters at the last follow-up were measured. Patients were divided into the adding-on group and the no adding-on group according to whether the adding-on phenomenon was observed at the last follow-up. Univariate analysis and multivariate logistic regression analysis were used to establish the corresponding prediction model. RESULTS:Adding-on affected 39 (32.8%) patients at the last follow-up. Risser sign and 19 radiographic parameters showed significant differences between the two groups by univariate analysis. Stepwise logistic regression analysis found that the Risser sign and so on five predictor variable, and the nomogram was drawn. The calibration curve showed that the model fitted well. The area under the receiver operating characteristic (ROC) curve is 0.949. And the decision curve analysis curve model within the threshold range for interventions to improve clinical outcomes. There was no significant difference in SRS-22 scores between the two groups. CONCLUSIONS:This study established a prediction model with adding-on in Lenke 1A/B and 2A/B AIS patients. The nomogram contains five predictive variables, which can effectively predict the probability of adding-on phenomenon during follow-up, and may have greater clinical value for the treatment and prevention of adding-on phenomenon.

BACKGROUND:Complete fractures and dislocations of the lower cervical spine are usually associated with severe spinal cord injury. However, a very small number of patients do not have severe spinal cord injury symptoms, patients with normal muscle strength or only partial nerve root symptoms, known as "lucky fracture dislocation". The diagnosis and treatment of such patients is very difficult. Recently, we successfully treated one such patient.CASE PRESENTATION:A 73-year-old male patient had multiple neck and body aches after trauma, but there was sensory movement in his limbs. However, preoperative cervical radiographs showed no significant abnormalities, and computed tomography (CT) and magnetic resonance imaging (MRI) confirmed complete fracture and dislocation of C7. Before operation, the halo frame was fixed traction, but the reduction was not successful. Finally, the fracture reduction and internal fixation were successfully performed by surgery. The postoperative pain of the patient was significantly relieved, and the sensory movement of the limbs was the same as before. Two years after surgery, the patient's left little finger and ulnar forearm shallow sensation recovered, and the right flexion muscle strength basically returned to normal.CONCLUSION:This case suggests that when patients with trauma are encountered in the clinic, they should be carefully examined, and the presence of cervical fracture and dislocation should not be ignored because of the absence of neurological symptoms or mild symptoms. In addition, positioning during handling and surgery should be particularly avoided to increase the risk of paralysis.

ObjectiveTo investigate the differences in postoperative deep venous thrombosis (DVT) between patients with spinal infection and those with non-infected spinal disease; to construct a clinical prediction model using patients' preoperative clinical information and routine laboratory indicators to predict the likelihood of DVT after surgery. MethodAccording to the inclusion criteria, 314 cases of spinal infection (SINF) and 314 cases of non-infected spinal disease (NSINF) were collected from January 1, 2016 to December 31, 2021 at Xiangya Hospital, Central South University, and the differences between the two groups in terms of postoperative DVT were analyzed by chi-square test. The spinal infection cases were divided into a thrombotic group (DVT) and a non-thrombotic group (NDVT) according to whether they developed DVT after surgery. Pre-operative clinical information and routine laboratory indicators of patients in the DVT and NDVT groups were used to compare the differences between groups for each variable, and variables with predictive significance were screened out by least absolute shrinkage and operator selection (LASSO) regression analysis, and a predictive model and nomogram of postoperative DVT was established using multi-factor logistic regression, with a Hosmer- Lemeshow goodness-of-fit test was used to plot the calibration curve of the model, and the predictive effect of the model was evaluated by the area under the ROC curve (AUC). ResultThe incidence of postoperative DVT in patients with spinal infection was 28%, significantly higher than 16% in the NSINF group, and statistically different from the NSINF group (P < 0.000). Five predictor variables for postoperative DVT in patients with spinal infection were screened by LASSO regression, and plotted as a nomogram. Calibration curves showed that the model was a good fit. The AUC of the predicted model was 0.8457 in the training cohort and 0.7917 in the validation cohort. ConclusionIn this study, a nomogram prediction model was developed for predicting postoperative DVT in patients with spinal infection. The nomogram included five preoperative predictor variables, which would effectively predict the likelihood of DVT after spinal infection and may have greater clinical value for the treatment and prevention of postoperative DVT.