This study aimed to determine if the characteristics of the facet joints, muscle morphology, and segmental range of motion (ROM) are correlated with the ossification pattern of the posterior longitudinal ligament (OPLL). According to the axial ossified pattern of OPLL, patients were classified into central type group and lateral deviated type group. The sides in the lateral deviated type group were categorized according to their status as the OPLL side or the non-OPLL side. Segmental ROM, muscle degeneration (bilateral deep extensors [DE], deep flexors [DF], superficial flexors [SF]), and facet joint characteristics (facet joint angle [FA] and cervical facet joint degeneration [CFD]) were compared between the central type group and the lateral deviated type group. Furthermore, these parameters were also compared between the bilateral side within each group. A total of 326 consecutive OPLL patients were enrolled in this study, and a final cohort of 208 patients was analyzed. The adjusted functional cross-sectional area (afCSA) of DE was significantly smaller in the central type group compared to the laterally deviated type group. In the lateral deviated type group, the FA, as well as the adjusted cross-sectional area (aCSA), afCSA, and fat infiltration ratio (FI

ObjectiveThe primary objective of this systematic review was to evaluate the effectiveness of the simultaneous combination of neural mobilization and traction therapy (SNMCT) in reducing pain and disability for patients with cervical radiculopathy.MethodsWe conducted a systematic review with meta-analysis using the randomized controlled trials (RCTs) articles published in PubMed, Cochrane Library, CINAHL Complete, EMBASE, CNKI from 01 January 2013 to 05 March 2025. Randomized controlled trials (RCTs) comparing SNMCT with on intervention and other interventions were included. Risk of bias was evaluated using the RoB 2 and the quality of evidence was systematically appraised by the GRADE approach.ResultsThis study included seven RCTs (n = 288). For the primary outcomes of pain and disability, there is moderate-quality of evidence that SNMCT provides statistically significant difference on pain relief (MD: -3.29, 95% CI: -4.08 to -2.49, p < 0.05) and disability (MD: -15.90, 95% CI: -21.34 to -10.45, p < 0.05) than waitlist group. SNMCT provides statistically significant difference than other interventions on pain relief (MD: -0.92, 95% CI: -1.13 to -0.71, p < 0.05) and disability (MD: -3.60, 95% CI: -4.65 to -2.54, p < 0.05) with low-quality of evidence. For the secondary outcomes (hand grip strength and cervical range of motion), SNMCT significantly improved range of motion compared to waitlist controls for both flexion (MD = -5.81, 95% CI: -9.45 to -2.17, p < 0.01) and extension (MD: -7.22, 95%CI: -13.63 to -0.80, p = 0.03), but no difference statistically significant on hand grip strength (MD: 0.39, 95% CI: -3.61 to 4.40, p = 0.85). Based on very low-quality evidence, SNMCT appears to enhance cervical flexion (MD: -4.18, 95%CI: -6.59 to -1.77, p < 0.01; I²=0%) and extension (MD: -4.96, 95%CI: -7.59 to -2.33, p < 0.01; I²=0%), while demonstrating no significant effect on hand grip strength improvement. There were no statistically significant differences were observed between the SNMCT and CNMCT groups regarding pain relief and disability improvement (MD: -0.90, 95%CI: -1.92 to 0.12, p = 0.09; MD: -8.70, 95%CI: -17.62 to -0.22, p = 0.06; respectively) after the treatment. However, the SNMCT group showed significantly better outcomes in cervical range of motion, particularly in flexion (MD: -17.20, 95%CI -24.88 to -9.52, p < 0.01) and extension (MD: -10.60, 95%CI -14.50 to -6.70, p < 0.01). Furthermore, cervical segment traction combined with nerve mobilization is superior to cervical total traction in reducing pain intensity, disability, and cervical range of motion (MD: -1.80, 95% CI: -2.76 to -0.84; MD: -6.07, 95% CI: -9.57 to -2.57; SMD: 3.85, 95% CI: 3.02 to 4.67; respectively).ConclusionThe current findings of this systematic review suggest that SNMCT may be considered an effective intervention for cervical radiculopathy.

Paralysis resulting from spinal cord injury (SCI) arises from the limited regenerative capacity of axons. Mechanical factors have recently emerged as crucial regulators of axon regeneration, complementing or even surpassing chemical cues. In this study, we demonstrated that extracellular matrix stiffness, a key mechanical signal, not only modulated the regenerative capacity of neuronal axons in spinal cord with aging, but significantly fine‐tuned axon pathfinding through negative‐durotaxis pattern. So, it is imperative to develop a scaffold with biomimetic mechanical guidance properties to promote neural axon regeneration after SCI. Strikingly, inspired by the robust adhesive mechanism of mussels, we developed a facile strategy to synthesize catechol‐modified HAMA hydrogel (HAMA@CA) that mimics native spinal cord tissue properties, effectively modulates the biomechanical microenvironment, enhances tissue–implant adhesion, and ultimately promotes spinal cord integration after SCI. Mechanistically, HAMA@CA hydrogel regulates neuronal axon pathfinding following a negative durotaxis pattern, coinciding with changes in mechanosensitive signaling and actomyosin contractility via the Piezo1/RhoA/MLC pathway. RNA‐seq analysis also confirms mechanical‐mediated SCI repairing by HAMA@CA. These results demonstrates that HAMA@CA rationally combined with mechanical and biochemical cues create promising tissue‐engineered strategies to facilitate the repair of SCI. This innovative strategy holds significant promise for future clinical applications in the field.

OBJECTIVES:Accurate placement of the working cannula during foraminoplasty remains a technical challenge in percutaneous transforaminal endoscopic lumbar discectomy (TELD). To address this, we developed a novel centrifuge trephine system designed to improve placement accuracy and provide a self-correcting trajectory. This study aimed to compare its performance with that of conventional trephine systems. METHODS:This investigation comprised a laboratory simulation and a retrospective clinical study. In the laboratory, life-size 3D-printed lumbar models were used to compare operative time, fluoroscopic exposure, and cannula-to-herniation distance between the modified and conventional systems. Clinically, 101 patients with at least one year of follow-up were analyzed. Outcome measures included operative time, fluoroscopy times, cannula-herniation distance, postoperative dysesthesia, visual analog scale (VAS) scores for leg and back pain, Oswestry Disability Index (ODI), re-herniation, and reoperation rates. Statistical analyses were performed using the Mann-Whitney U test for continuous variables and the χ2 test for categorical variables. RESULTS:The modified system significantly reduced operative time and fluoroscopy exposure in both laboratory and clinical settings (P < 0.001). Clinically, it also resulted in a shorter cannula-to-herniation distance (P < 0.05) and lower postoperative back pain VAS scores (P = 0.0004), with no cases of dysesthesia. There were no significant differences in leg pain VAS, ODI, re-herniation, or reoperation rates between groups. CONCLUSIONS:The centrifuge trephine system demonstrated superior accuracy and efficiency compared to the conventional trephine, and was associated with improved clinical outcomes. It may be an alternative to conventional foraminoplasty techniques in TELD procedures.

Studies have demonstrated that the nervous system can perceive and respond to signaling from bone tissue, a process termed interoception, which plays a crucial role in the homeostasis of bone tissue. Sensory nerves extensively innervate bone tissue and transmit interoceptive signals to the central nervous system (CNS). The hypothalamus, located within the CNS, is instrumental in processing these interoceptive signals and regulating bone homeostasis through the autonomic nervous system, the release of neuropeptides, and neuroendocrine mechanisms. Although CNS regulation of bone has been recognized for decades, the specific interoceptive mechanisms governing skeletal homeostasis remain an emerging research focus. This review explores the latest advancements in interoceptive regulation of bone homeostasis, highlighting its role in skeletal diseases such as osteoporosis and osteoarthritis(OA). Furthermore, we discuss potential therapeutic strategies targeting interoceptive pathways, including biomaterials, pharmacological interventions, and non-pharmacological approaches. By elucidating the interplay between the nervous and skeletal systems, this review provides new insights into the regulation of bone health and its implications for future treatments of skeletal disorders.

Epidural fibrosis (EF), associated with various biological factors, is still a major troublesome clinical problem after laminectomy. In the present study, we initially demonstrate that sensory nerves can attenuate fibrogenic progression in EF animal models via the secretion of calcitonin gene-related peptide (CGRP), suggesting a new potential therapeutic target. Further studies showed that CGRP could inhibit the reprograming activation of fibroblasts through PI3K/AKT signal pathway. We subsequently identified metformin (MET), the most widely prescribed medication for obesity-associated type 2 diabetes, as a potent stimulator of sensory neurons to release more CGRP via activating CREB signal way. We copolymerized MET with innovative polycaprolactone (PCL) nanofibers to develop a metformin-grafted PCL nanoscaffold (METG-PCLN), which could ensure stable long-term drug release and serve as favorable physical barriers. In vivo results demonstrated that local implantation of METG-PCLN could penetrate into dorsal root ganglion cells (DRGs) to promote the CGRP synthesis, thus continuously inhibit the fibroblast activation and EF progress for 8 weeks after laminectomy, significantly better than conventional drug loading method. In conclusion, this study reveals the unprecedented potential of sensory neurons to counteract EF through CGRP signaling and introduces a novel strategy employing METG-PCLN to obstruct EF by fine-tuning sensory nerve-regulated fibrogenesis.

随着经济的不断发展以及人们生产和生活方式的改变，腰椎退变性疾病逐渐成为骨科领域中普遍存在的问题，特别是腰椎间盘突出症（lumbar disc herniation,LDH），其发病通常与腰部受到异常应力刺激或不适当姿势有关。LDH好发于20～40岁的人群，且男性多于女性 [1] 。

Spinal cord injury (SCI) represents a profound central nervous system affliction, resulting in irreversibly compromised daily activities and disabilities. SCI involves excessive inflammatory responses, which are characterized by the existence of high levels of proinflammatory M1 macrophages, and neuronal mitochondrial energy deficit, exacerbating secondary damage and impeding axon regeneration. This study delves into the mechanistic intricacies of SCI, offering insights from the perspectives of neuroimmune regulation and mitochondrial function, leading to a pro-fibrotic macrophage phenotype and energy-supplying deficit. To address these challenges, we developed a smart scaffold incorporating enzyme mimicry nanoparticle-ceriumoxide (COPs) into nanofibers (NS@COP), which aims to pioneer a targeted neuroimmune repair strategy, rescuing CGRP receptor on macrophage and concurrently remodeling mitochondrial function. Our findings indicate that the integrated COPs restore the responsiveness of pro-inflammatory macrophages to calcitonin gene-related peptide (CGRP) signal by up-regulating receptor activity modifying protein 1 (RAMP1), a vital component of the CGRP receptor. This promotes macrophage fate commitment to an anti-inflammatory pro-resolution M2 phenotype, then alleviating glial scar formation. In addition, NS@COP implantation also protected neuronal mitochondrial function. Collectively, our results suggest that the strategy of integrating nanozyme COP nanoparticles into a nanofiber scaffold provides a promising therapeutic candidate for spinal cord trauma via rational regulation of neuroimmune communication and mitochondrial function.

Background In the present study, we aimed to investigate the role of baseline (B), interim (I) and end-of-treatment (Eot) 18 F-FDG PET/CT in assessing the prognosis of diffuse large B cell lymphoma (DLBCL), so as to identify patients who need intensive treatment at an early stage. Methods A total of 127 DLBCL patients (62 men; 65 women; median age 62 years) were retrospectively analyzed in this study. Baseline ( n = 127), interim ( n = 127, after 3–4 cycles) and end-of-treatment ( n = 53, after 6–8 cycles) PET/CT images were re-evaluated; semi-quantitative parameters such as maximum standardized uptake value of lesion-to-liver ratio (SUVmax (LLR) ) and lesion-to-mediastinum ratio (SUVmax (LMR) ), total metabolic tumor volume (TMTV) and total metabolic tumor volume (TLG) were recorded. ΔTLG 1 was the change of interim relative to baseline TLG (I to B), ΔTLG 2 (Eot to B). ΔSUVmax and ΔTMTV were the same algorithm. The visual Deauville 5-point scale (D-5PS) has been adopted as the major criterion for PET evaluation. Visual analysis (VA) and semi-quantitative parameters were assessed for the ability to predict progression-free survival (PFS) and overall survival (OS) by using Kaplan–Meier method, cox regression and logistic regression analysis. When visual and semi-quantitative analysis are combined, the result is only positive if both are positive. Results At a median follow-up of 34 months, the median PFS and OS were 20 and 32 months. The survival curve analysis showed that advanced stage and IPI score with poor prognosis, ΔSUVmax (LLR) 1 < 89.2%, ΔTMTV 1 < 91.8% and ΔTLG 1 < 98.8%, ΔSUVmax (LLR) 2 < 86.4% were significantly related to the shortening of PFS in patient ( p < 0.05). ΔSUVmax (LLR) 1 < 83.2% and ΔTLG 1 < 97.6% were significantly correlated with the shortening of OS in patients ( p < 0.05). Visual analysis showed that incomplete metabolic remission at I-PET and Eot-PET increased the risk of progress and death. In terms of predicting recurrence by I-PET, the combination of visual and semi-quantitative parameters showed higher positive predictive value (PPV) and specificity than a single index. Conclusion Three to four cycles of R-CHOP treatment may be a time point for early prediction of early recurrence/refractory (R/R) patients and active preemptive treatment. Combined visual analysis with semi-quantitative parameters of 18 F-FDG PET/CT at interim can improve prognostic accuracy and may allow for more precise screening of patients requiring early intensive therapy.

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.

Intervertebral disc degeneration (IDD) has been identified as one of the predominant factors leading to persistent low back pain and disability in middle-aged and elderly people. Dysregulation of Prostaglandin E2 (PGE2) can cause IDD, while low-dose celecoxib can maintain PGE2 at the physiological level and activate the skeletal interoception. Here, as nano fibers have been extensively used in the treatment of IDD, novel polycaprolactone (PCL) nano fibers loaded with low-dose celecoxib were fabricated for IDD treatment. In vitro studies demonstrated that the nano fibers had the ability of releasing low-dose celecoxib slowly and sustainably and maintain PGE2. Meanwhile, in a puncture-induced rabbit IDD model, the nano fibers reversed IDD. Furthermore, low-dose celecoxib released from the nano fibers was firstly proved to promote CHSY3 expression. In a lumbar spine instability-induced mouse IDD model, low-dose celecoxib inhibited IDD in CHSY3(wt) mice rather than CHSY3(-/-) mice. This model indicated that CHSY3 was indispensable for low-dose celecoxib to alleviate IDD. In conclusion, this study developed a novel low-dose celecoxib-loaded PCL nano fibers to reverse IDD by maintaining PGE2 at the physiological level and promoting CHSY3 expression.

STUDY DESIGN:This is a cross-sectional study. OBJECTIVE:To evaluate the effectiveness of a novel finger Kinematic Parameter-Based Tool in the grip and release (G&R) test for assessing degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA:The development and progression of DCM symptoms are gradual and obscure. Although previous studies have objectively evaluated hand movements specific to myelopathy using the G&R test, virtual reality, or wearable sensors, these methods have limitations, such as limited discrimination or inconvenience for simple screening. Consequently, there is a need to develop effective screening methods. MATERIALS AND METHODS:Totally, 297 asymptomatic volunteers and 258 DCM patients were enrolled. This system comprises a wearable acceleration/gyro sensor. The acceleration/gyro sensor was placed on the little finger of the participants to perform 40 cycles of full-range G&R as quickly as possible. The collected data were then transformed into kinematic parameters using sensor-based software and R studio software (version: RStudio 2022.07.2+576, Boston, USA). Gender, age, and body mass index (BMI) subgroups (classified as BMI<18.5-below normal weight; 18.5≤BMI<25-normal weight group; BMI≥25-overweight group) were matched as predictor variables, and 201 pairs were matched. Nonparametric analysis using the Mann-Whitney U test was used for diagnosing the differences between the two groups, and Kruskal-Wallis's test followed by the Mann-Whitney U test was used for analyzing the differences among three different age groups (<40, 41-60, and >60 yr group). The cut-off value of 10s G&R cycles and a combined parameter were determined using receiver operating characteristics curve analysis, area under the curve, and Youden index. RESULTS:The authors found that little finger kinematic parameters were significantly lower in DCM patients than in asymptomatic participants. The optimal diagnostic indicator appeared to be the average of the top 10 linear accelerations with an area under the curve of 0.923. CONCLUSION:The Finger Kinematic Test System is an objective, practical, and quantitative utility that appears to have the capacity to diagnose and evaluate the severity of DCM. 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.

Abstract Background: To explore the correlation between dopamine transporter (DAT) PET/CT and the clinical characteristics and the scales of Parkinson’s disease (PD) patients, furthermore explore the scientificity and feasibility of incorporating 3D-dopaminergic binding parameters into the clinical scoring system for PD. Methods: A total of 75 patients with PD were retrospectively included. The clinical characteristics (including age, gender, disease duration), modified Hoehn-Yahr (H-Y) grading, UPDRS (the unified Parkinson's disease rating scale) II & III and Mini-Mental State Examination (MMSE) of PD patients in corresponding time periods were obtained. DAT binding parameters and their derived parameters based on plane and 3D images in neostriatum were analyzed for the consistency of plane and 3D parameters, and the correlation between the above parameters and the clinical characteristics of patients. Results: The DAT binding parameters based on 3D images had good consistency with the plane parameters (p<0.05). The asymmetry index (AI) of DAT binding parameters based on 3D and plane images had good consistency in anterior putamen (p<0.05). The plane parameters of anterior and posterior putamen were correlated with the UPDRS II-III score and H-Y score of PD patients (p<0.05), the parameter in caudate nucleus was only correlated with UPDRS II and MMSE. The 3D parameters in neostriatum showed good statistical correlation with the disease duration, UPDRS II-III score, H-Y score, H-Y course of PD patients (p<0.05), and the AI was significantly correlated with MMSE (p<0.05). The 3D parameters in putamen and posterior putamen had good statistical correlation with the UPDRS II-III score, H-Y score and H-Y course of PD patients (p<0.05). The AI in the putamen showed statistical correlation with the UPDRS III score and MMSE. The AI in posterior putamen showed statistical correlation with the UPDRS II score (p<0.05). Conclusions: The quantitative parameters based on plane and 3D images of 11C-CFT PET/CT had good consistency, and 3D parameters in neostriatum had a better correlation with the activities of daily living, UPDRS motor score, the severity and duration of disease and cognition than plane parameters in PD patients.

目的 探讨在颈椎前路椎间盘切除融合（ACDF）术中应用新型低切迹一体化融合器系统（Carmen）治疗单节段脊髓型颈椎病患者的临床效果。方法 对2018年1月至2020年1月于海军军医大学第二附属医院骨科颈椎外科行单节段ACDF治疗的脊髓型颈椎病患者136例的临床资料进行回顾性研究。依据所使用的内固定系统将全部患者分为两组：Carmen组38例，其中男20例，女18例，年龄（47.2±6.7）岁；零切迹内固定系统（Zero-P）组98例，其中男56例，女42例，年龄（48.7±7.3）岁。对两组患者手术时间、术中失血量和术后12个月融合率分别进行比较；对两组患者术前、术后6个月与术后12个月日本骨科协会评分（JOA）、疼痛视觉模拟评分（VAS）、颈椎C2-C7 Cobb角、手术节段局部Cobb角和颈椎活动范围（ROM）分别进行组内和组间比较。采用SPSS 18.0对数据进行统计学处理；P＜0.05为差异有统计学意义。结果 对所有患者完成12个月以上随访。两组患者手术时间、术中失血量和术后12个月融合率差异均无统计学意义（均P＞0.05）;两组患者术后JOA评分、颈部和上肢VAS评分、颈椎ROM较术前均有显著改善（均P＜0.05）,上述指标和手术相关并发症的发生率组间差异均无统计学意义（均P＞0.05）;Carmen组患者术后12个月颈椎C2-C7Cobb角及手术节段局部Cobb角均显著大于Zero-P组患者（均P＜0.05）。结论 在单节段脊髓型颈椎病患者ACDF术中使用Carmen融合器，其临床疗效与传统Zero-P系统相当，在纠正以及维持颈椎曲度方面较Zero-P系统更具优势。

BACKGROUND CONTEXTDecreased cervical range of motion (ROM) is a common symptom of myelopathy patients. Many previous studies have relied on a variety of experimental approaches for quantifying static cervical range of motion. However, the change rules of time-space variation during dynamic cervical spine motion remains unknown.PURPOSETo develop and validate the effectiveness of a novel wearable robot-based sensor system, Analysis of Dynamic Cervical spine Motion (ADCM), in evaluating the dynamic cervical spine motion dysfunction of patients with cervical spondylotic myelopathy (CSM).STUDY DESIGN/SETTINGA cross-sectional study.PATIENT SAMPLEOne hundred forty consecutive healthy individuals (70 men and 70 women) and 120 CSM patients (60 men and 60 women) were enrolled in the present study.OUTCOME MEASURESThe cervical motion process parameters, including the flexion and extension ROM, the flexion and extension time, and the Japanese Orthopedic Association scores (JOA) for cervical spine were measured.METHODSTwo hundred and sixty consecutive participants were asked to wear ADCM system and then fully flex and extend their neck rapidly and evenly at tolerable maximum speed. The cervical motion process was recorded and converted into waveforms. Relevant waveform parameters were measured and analyzed. The number of complete flexion-extension motions in 10 seconds has been defined as 10s F–E cycles. The Japanese Orthopedics Association (JOA) scores of CSM patients were marked.RESULTSCSM patients had a lower number of 10s F–E cycles than healthy subjects. There were significant differences in flexion and extension time and ROM between two groups. The waveforms of myelopathy patients were wider and lower than those in healthy individuals. The average ratio value (defined as F) of wave height to wave width (a+b/c+d) could quantitatively reflect such differences of waveforms. The average F value was correlated with the JOA scores of the cervical motion function (r=0.7538), and F value declined as JOA scores decreased. According to receiver operating characteristic curve analysis, the optimal threshold value of the normal average ratio was more than 34.7.CONCLUSIONSADCM appears to be an objective and quantitative severity assessment tool for confirmed CSM patients by evaluating dynamic cervical spine motion dysfunction.

Sensory nerves are long being recognized as collecting units of various outer stimuli; recent advances indicate that the sensory nerve also plays pivotal roles in maintaining organ homeostasis. Here, this study shows that sensory nerve orchestrates intervertebral disc (IVD) homeostasis by regulating its extracellular matrix (ECM) metabolism. Specifically, genetical sensory denervation of IVD results in loss of IVD water preserve molecule chondroitin sulfate (CS), the reduction of CS bio-synthesis gene chondroitin sulfate synthase 1 (CHSY1) expression, and dysregulated ECM homeostasis of IVD. Particularly, knockdown of sensory neuros calcitonin gene-related peptide (CGRP) expression induces similar ECM metabolic disorder compared to sensory nerve denervation model, and this effect is abolished in CHSY1 knockout mice. Furthermore, in vitro evidence shows that CGRP regulates nucleus pulposus cell CHSY1 expression and CS synthesis via CGRP receptor component receptor activity-modifying protein 1 (RAMP1) and cyclic AMP response element-binding protein (CREB) signaling. Therapeutically, local injection of forskolin significantly attenuates IVD degeneration progression in mouse annulus fibrosus puncture model. Overall, these results indicate that sensory nerve maintains IVD ECM homeostasis via CGRP/CHSY1 axis and promotes IVD repair, and this expands the understanding concerning how IVD links to sensory nerve system, thus shedding light on future development of novel therapeutical strategy to IVD degeneration.

目的 :探讨颈椎后纵韧带骨化（ossification of posterior longitudinal ligament,OPLL）或颈椎间盘突出合并无骨折脱位颈脊髓损伤患者手术治疗的效果及其差异性。方法:回顾性分析2017年1月～2019年12月我科收治的无骨折脱位颈脊髓损伤并经手术治疗患者,选取其中35例3个节段及以上OPLL或者颈椎间盘突出患者纳入本研究。其中男性19例,女性16例。根据术前MRI及CT影像学特点将患者分为OPLL组（A组18例）与颈椎间盘突出组（B组17例）,两组间年龄及性别无统计学差异（P＞0.05）。手术方式均为颈椎后路椎管扩大成形术。记录两组患者术前及术后1周、3个月、6个月的mJOA评分及ASIA分级,计算并比较mJOA评分改善率和ASIA分级改善值。结果:A组手术时间为95±12min,B组为95±15min （P＞0.05）;A组术中出血量为450±55ml,B组为440±60ml（P＞0.05）;A组住院时间为10.5±1.3d,B组为10.2±1.4d（P＞0.05）。随访期间两组患者均未出现严重并发症。A组术前、术后1周、术后3个月、术后6个月mJOA评分分别为5.2±5.6分、7.1±4.3分、8.6±3.7分、12.9±3.8分,B组分别为4.8±3.8分、6.7±4.1分、7.0±3.8分、9.3±3.6分,两组间差异无统计学意义（P＞0.05）。术后1周两组mJOA评分改善率分别为16.2%和14.1%,ASIA分级改善值分别为1.2分和1.0分,两组间无统计学差异（P＞0.05）;术后3个月mJOA评分改善率分别为26.5%和16.5%,ASIA分级改善值分别为2.3分和1.5分,两组间有统计学差异（P＜0.05）;术后6个月mJOA评分改善率分别为62.3%和33.6%,ASIA分级改善值分别为2.6分、1.8分,两组间有统计学差异（P＜0.05）。结论:后路椎管扩大成形术治疗无骨折脱位颈脊髓损伤能够获得满意疗效,其中合并OPLL患者神经功能恢复改善程度在术后3个月及术后6个月时优于合并颈椎间盘突出患者,该差异可能与脊髓致压物的性质有一定关系。

目的 探讨颈前路手术治疗颈椎后凸畸形对脊髓张力的影响。方法 对海军军医大学第二附属医院骨科采用颈前路手术治疗的颈椎后凸畸形患者53例的临床资料进行回顾性分析。男35例，女18例；年龄（54.7±19.1）（12～74）岁。其中退变性颈椎后凸36例，神经纤维瘤病颈椎后凸6例，青少年特发性颈椎后凸3例，颈椎结核颈椎后凸5例，创伤后颈椎后凸3例。根据颈椎后凸程度将患者分为2组：A组32例，颈椎后凸Cobb角＜30°;B组21例，颈椎后凸Cobb角≥30°。采用日本骨科协会（JOA）评分和疼痛视觉模拟评分（VAS）对手术效果进行评价；测量颈椎活动度（ROM）、颈椎矢状面平衡参数[颈椎Cobb角，C2-C7矢状面轴向距离（SVA）,T1倾斜角（T1S）];利用MRI测量术前与术后目标节段脊髓的长度和矢状径，并通过术后脊髓长度的变化和脊髓矢状径的变化间接评估脊髓张力的变化；分别对两组患者术前与术后的脊髓长度和脊髓矢状径的变化进行比较；对术后脊髓长度变化值与颈椎Cobb角变化值进行相关性分析。采用SPSS 19.0软件对数据进行统计学处理；P＜0.05为差异有统计学意义。结果 所有患者术后颈椎后凸Cobb角、C2-C7 SVA和颈椎ROM较术前均显著降低（均P＜0.01）,JOA评分和VAS评分较术前均有显著改善（均P＜0.01）。术后2个月、6个月和末次随访C2-C7脊髓长度与术前差异均无统计学意义（均P＞0.05）,脊髓矢状径均较术前有显著增大（均P＜0.01）。A组术后C2-C7脊髓长度较术前差异无统计学意义（P＞0.05）,脊髓矢状径较术前显著增加（P＜0.01）;B组术后C2-C7脊髓长度较术前显著减小（P＜0.05）,脊髓矢状径较术前显著增加（P＜0.01）。术后脊髓长度变化值与颈椎Cobb角变化值具有显著相关性（r=0.753,P＜0.01）;脊髓长度显著减小（减少值≥5 mm）所对应的Cobb角变化的临界值为26.8°。结论 采用颈前路手术治疗颈椎后凸畸形可以获得较好的效果，同时使脊髓张力得到显著降低。

BACKGROUND Lumbar disc herniation (LDH) is the most common cause of sciatica. Percutaneous endoscopic discectomy (PELD) is indicated when conservative treatments fail, which has been proved effective. During conventional PELD, ruptured discs and loose fragments inside discs are removed as much as possible to guarantee a lower reherniation rate, but it inevitably would lead to deterioration of disc degeneration and loss of disc height after PELD. Ensuring sufficient decompression while alleviating the post-operation disc degeneration process is still a clinical problem. OBJECTIVE To evaluate the imaging and clinical outcomes of bi-needle PELD with intradiscal irrigation technique for the treatment of lumbar disc herniation (LDH). STUDY DESIGN Multicenter retrospective cohort study. SETTING Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China. METHODS A total of 48 patients who underwent bi-needle PELD (B-PELD) or conventional-PELD (C-PELD) for LDH in our 2 spine centers were included in this study. There were 26 cases in the C-PELD group (male 12 cases, female 14 cases) with an average age of 34.6 ± 6.8 years. And there were 22 patients in the B-PELD group (male 10 cases, female 12 cases) with an average age of 35.1 ± 6.4 years. The difference in postoperative disc degeneration (Pfirrmann grades, disc-vertebra height ratios [D-V H ratios]), visual analog scale (VAS) of low back pain, and reoperation rates were compared between the 2 groups. RESULTS There was no significant difference in gender, age, disease duration, and surgical level between the 2 groups (P > 0.05). The postoperative VAS of back pain was 2.31 ± 0.53 for the C-PELD group and 0.63 ± 0.74 for the B-PELD group; the difference was significant (P = 0.013). The difference between the preoperative and postoperative D-V H ratios in the C-PELD group was significant (P < 0.0001), while it was not significant in the B-PELD group (P = 0.6708). The difference between the loss of D-V H ratios after surgery was significant between the 2 groups (P = 0.0003). The loss of D-V H ratios was higher in the C-PELD group. The difference between the preoperative and postoperative Pfirrmann grades in the B-PELD group was not significant (P = 0.7261); however, it was significant in the C-PELD group (P = 0.0012). The reoperation rate in the C-PELD group was 7.7%, and the reoperation rate in the B-PELD group was 4.5%; the difference was not significant (P = 1). LIMITATIONS This study employed a retrospective design, and its inherent selection bias and limited statistical power should be considered. CONCLUSIONS Bi-needle technique with saline irrigation maneuver showed a significant advantage of restoration of disc height and amelioration of disc degeneration compared to conventional PELD surgery.