Previously reported cases of cauda equina herniation primarily involve compression of the spinal cord caused by fracture fragments intruding into the spinal canal following traumatic spinal burst fractures or by dural tears occurring during spinal endoscopic surgery. Such cases can often be evaluated preoperatively or intraoperatively to facilitate the selection of an appropriate treatment plan. However, cauda equina herniation resulting from the use of a drainage tube following spinal endoscopic surgery has not yet been reported. In this article, we present a case of a 76-year-old male patient who experienced a dural tear resulting in cauda equina herniation due to the positioning of the drainage tube following an L4/5 lumbar unilateral biportal endoscopy procedure. This case highlights the importance of timely surgery following cauda equina herniation and provides guidance for intraoperative procedures and perioperative management of patients undergoing spinal endoscopic surgery.

Background and objectives: Few studies have investigated the interaction between pelvic obliquity (PO) and coronal balance in degenerative lumbar scoliosis (DLS). This study investigated whether PO compensates for global coronal balance or regional scoliosis in DLS and compared radiographic and clinical outcomes between different PO orientations. Methods: This study included 166 DLS patients. Coronal parameters included coronal balance distance (CBD), main Cobb angle (MC), fractional Cobb angle (FC), and PO. Patients were categorized as Type 1 (PO tilting toward the main curve) or Type 2 (PO tilting opposite the main curve). Based on CBD, patients were further classified as coronal balanced (Type A), coronal imbalance shifted toward the concavity (Type B), or coronal imbalance shifted toward the convexity (Type C). Evaluation of the PSM on magnetic resonance imaging were conducted preoperatively.Clinical included visual analogue scale (VAS), Oswestry Disability Index (ODI), and Scoliosis Research Society-22R (SRS-22R). Results: The patients were divided into 67 with A1, 18 with A2, 28 with B1, 6 with B2, 24 with C1, and 11 with C2. Patients in Type 2 exhibited greater FC, vertebral rotation, and lateral listhesis at L4-5 and L5-S1, as well as more severe degeneration and asymmetrical degeneration of lumbosacral PSM. Additionally, type C2 exhibited the poorest VAS-back, SRS-pain and activity domains. In type 1, PO was significantly correlated with MC and MC-FC. In type 2, PO was significantly correlated with FC. No significant correlation was found between PO and CBD in either type. Conclusion: In DLS patients, PO participates in compensating for local scoliotic curve rather than global coronal balance. Patients with PO oriented opposite the main curve demonstrated more severe three-dimensional deformity of the lower lumbar region and inferior pain and activity related outcomes, which may be associated with more severe and asymmetric degeneration of paraspinal muscles.

Purpose In recent years, cervical spine surgeries performed in the elderly population have led to some postoperative complications after cervical spine procedures, particularly infections. While current research focuses predominantly on surgical site infections (SSIs), other types, including respiratory tract infections (RTIs) and urinary tract infections (UTIs), remain understudied. Additionally, comprehensive multiclass machine learning models for predicting diverse postoperative infections are lacking. This study aims to develop an optimal ML-based predictive model for identifying multiple infection risks in elderly patients undergoing cervical spine procedures. Methods This retrospective study included patients aged 60 years and older who underwent open cervical spine surgery at our institution between March 2011 and January 2024. We developed six ML algorithms [logistic regression, Gaussian naive Bayes, decision tree, random forest, K-nearest neighbors, and Light Gradient Boosting Machine (LightGBM)]. These algorithms were comprehensively evaluated in terms of accuracy, precision, recall, F1-score, and AUC. Results This study included a total of 1,151 patients, among whom 40 were diagnosed with postoperative SSIs, 30 with RTIs, and 35 with UTIs. In developing the ML models, we incorporated 54 variables, and among the various algorithms evaluated, LightGBM demonstrated the best performance in terms of accuracy, precision, recall, F1-score, and AUC for predicting different classes of outcomes. SHAP analysis highlighted the significant factors that were utilized to predict various types of infections, including actual days of hospitalization, absolute monocyte count, total cholesterol level, glucose level, APTT ratio, albumin concentration, AST, and so forth. Conclusions ML algorithms demonstrated exceptional performance in predicting different infections that may arise following cervical spine surgery in elderly patients. These algorithms successfully identified the key predictors of postoperative infections, enabling clinicians to effectively identify patients who are at heightened risk of developing infections after surgery in clinical practice.

PURPOSE:To compare clinical outcomes and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), unilateral biportal endoscopic lumbar interbody fusion (ULIF), and modified MIS-TLIF via unilateral biportal endoscopic assistance (UBE-MIS-TLIF) for single-segment Schizas C/D LSS. METHODS:A retrospective analysis of 205 patients (UBE-MIS-TLIF: 37, MIS-TLIF: 93, ULIF: 75) evaluated clinical outcomes using visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, modified MacNab criteria, fusion rates, and complications over 12 months. Surgical parameters and deep ligamentum flavum (LF) preservation were also analyzed. RESULTS:All groups demonstrated significant postoperative improvements in VAS [low back pain (LBP)/leg pain], ODI, and JOA scores. MIS-TLIF demonstrated higher VAS scores for incision pain compared to the other two groups. UBE-MIS-TLIF and ULIF exhibited lower LBP VAS and ODI within one week postoperatively. At final follow-up, no significant differences were observed in VAS, ODI, JOA, modified MacNab criteria, complications, intervertebral height index, or fusion rates among these groups. UBE-MIS-TLIF demonstrated significant improvements in intraoperative blood loss, wound drainage volume, CRP level, and postoperative hospital stay compared to MIS-TLIF, while showing no statistically significant differences from ULIF. However, UBE-MIS-TLIF required longer operative time and more fluoroscopy than MIS-TLIF. UBE-MIS-TLIF showed superior performance in preserving the deep LF. CONCLUSION:UBE-MIS-TLIF, MIS-TLIF, and ULIF demonstrated comparable long-term efficacy for single-segment Schizas C/D LSS. As a modified approach, UBE-MIS-TLIF reduced invasiveness versus MIS-TLIF, achieved shorter operative time compared to ULIF, and could preserve the deep LF, offering a viable alternative for severe LSS management.

STUDY DESIGN:Retrospective cohort study. OBJECTIVE:To evaluate whether C7 laminoplasty and decompression construct length were associated with postoperative axial symptoms after expansive unilateral open-door laminoplasty (ELAP) for cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA:Postoperative axial symptoms remain a common source of dissatisfaction after cervical laminoplasty. Although prior studies have examined patient-related risk factors, the association between observed operative patterns and postoperative pain burden remains clinically relevant. METHODS:Adults undergoing ELAP for CSM between April 2016 and April 2024 were retrospectively reviewed. Patients with preoperative axial symptoms, cervical deformity, trauma-related cervical spinal cord injury, neurologic disorders affecting outcome assessment, incomplete data, or follow-up shorter than 1 year were excluded. The primary outcome was new-onset postoperative axial symptoms at 12 months. The main operative variables were C7 laminoplasty versus C7 preservation and longer- versus shorter-segment ELAP. Multivariable logistic regression, descriptive joint operative-pattern analyses, longitudinal mixed-effects models, and sensitivity analyses were performed. RESULTS:Among 865 patients, crude axial symptom rates differed across the four joint operative-pattern groups: 1.4%, 27.6%, 22.7%, and 69.4%. Exploratory logistic-regression, Firth-penalized, and propensity score analyses were directionally consistent with these absolute event-rate patterns, but the OR magnitudes should be interpreted cautiously because of nonrandom operative selection, clinical coupling between operative variables, residual confounding, and sparse reference-group events. VAS trajectories differed across groups, whereas JOA trajectories and complication rates were broadly similar. CONCLUSION:C7 laminoplasty and longer-segment ELAP were associated with greater postoperative axial symptom burden, and the C7-preserving/shorter-segment group had the lowest observed pain burden. These findings should be considered hypothesis-generating and should not be interpreted as evidence of operative superiority or causal surgical effects because of the observational design, nonrandom operative selection, clinical coupling between operative variables, and residual confounding.

The mechanisms underlying the activation of endogenous stem cells following spinal cord injury (SCI) remain a fundamental challenge in neural regeneration. Ependymal cells, which constitute a resident stem/progenitor population, possess latent regenerative potential, yet the metabolic cues governing their activation remain poorly understood. In this study, by integrating single-cell RNA sequencing with computational metabolic profiling, we systematically characterized the temporal transcriptional and metabolic reprogramming of injury-responsive ependymal cells after SCI. We found that SCI induces a metabolic switch characterized by marked upregulation of polyamine metabolism, which critically drives the transition of ependymal cells from quiescence to proliferation. Trajectory inference and metabolic analyses identified ornithine decarboxylase 1 (ODC1), a pyridoxal 5′-phosphate (PLP)-dependent rate-limiting enzyme in polyamine biosynthesis, as a key regulator of this fate transition. Mechanistically, molecular docking and molecular dynamics simulations revealed that PLP forms a stable covalent Schiff base with ODC1, thereby enhancing polyamine flux, remodeling the intracellular milieu and extracellular matrix, and ultimately establishing a regenerative niche. In a murine model of SCI, systemic PLP administration enhanced polyamine metabolism, promoted ependymal cell proliferation and tissue repair, and led to significant improvements in locomotor function. Collectively, this study identifies PLP-dependent ODC1-mediated polyamine metabolism as a mechanistically grounded and translationally actionable target for enhancing endogenous spinal cord regeneration.

OBJECTIVES:Ependymal cell-derived perilesional glial borders may play a beneficial role in neural regeneration after spinal cord injury (SCI). Yes-associated protein (YAP), a key transcriptional cofactor, is involved in the control of body organ size by regulating cell differentiation, proliferation, growth, and apoptosis; however, it remains unclear whether the roles and underlying mechanisms of YAP signaling regulate the ependymal cell-derived perilesional glial borders after SCI. METHODS:We established a dorsal cord incision injury mouse model. The YAPf/f; FoxJ1-CreERT2 (YAPFoxJ1-ERT2-CKO) mice and YAPf/f; FoxJ1-CreERT2; Rosa26tdTomato mice were generated to examine the roles of ependymal YAP signaling in SCI. The RNA-seq, western blot, immunostaining, and cell-fate tracing tools were used to investigate the underlying mechanisms of YAP signaling in the regulation of ependymal cell-derived perilesional glial borders after SCI. RESULTS:YAP was activated in ependymal cells after SCI. Interestingly, YAP deletion in ependymal cells (YAPFoxJ1-ERT2-CKO mice) aggravated the neuronal loss and impaired the formation of perilesional glial borders and then inhibited the functional recovery after SCI. Furthermore, YAP deletion inhibited the proliferation and differentiation of ependymal cells to astrocytes and oligodendrocytes and reduced the secretion of neurotrophic factors after SCI. Mechanically, RNA-seq revealed that the expression of Colorectal Neoplasia Differentially Expressed (CRNDE) was downregulated in YAPFoxJ1-ERT2-CKO mice. Furthermore, we found downregulation of P300 and β-catenin and upregulation of GSK-3β in YAP-/- ependymal cells after SCI. CONCLUSION:Ependymal YAP signaling promotes the formation of ependymal cell-derived perilesional glial borders in mice through the P300-CRNDE-Wnt/β-catenin pathway after SCI, which provides a novel target for SCI.

To investigate the asymmetrical sacroiliac joint degeneration (SIJD) in degenerative lumbar scoliosis (DLS), and to evaluate the correlation between SIJ degeneration, spinopelvic parameters and clinical outcomes. We retrospectively reviewed 183 DLS patients. Preoperative measurements were measured on full-length plain radiographs. Backlund’s protocol was used to assess SIJD on CT scans. Patient-reported outcome measures (PROMs) including the Visual analogue scale for back pain (VAS-BP) and leg pain (VAS-LP), Oswestry Disability Index (ODI), and Scoliosis Research Society-22r (SRS-22r) were recorded at baseline. Correlation analyses were performed to investigate the relationship between the SIJD and spinopelvic parameters and between the SIJD and PROMs. SIJ degeneration was more severe on the convex side than on the concave side (p = 0.013). The asymmetry degree of SIJD between the concave side and the convex side was significantly associated with Cobb angle (r = 0.251, p = 0.012) and lumbosacral coronal angle (r = 0.426, p = 0.001). Multivariate regression analysis showed that factors associated with SIJ degeneration were the PIA (coefficient B = 0.153), and LSLA (coefficient B=-0.118). SIJ degeneration was significantly correlated with preoperative VAS-BP, SRS-22 pain, SRS-22 activity and SF-36 PCS (all p < 0.05). SIJ degeneration was more severe on the convex side compared to the concave side in DLS, and the asymmetry degree increased with both the Cobb angle and the lumbosacral coronal angle. PIA and LSLA were significantly associated with SIJ degeneration score. These findings highlight the importance of considering the SIJ during preoperative assessment and surgical planning for DLS, particularly in patients with severe SIJ degeneration, which may contribute to low back pain and functional limitation.

Spinal cord injury (SCI), a serious neurological condition caused by trauma, inflammation, infection, or vascular diseases, potentially causing partial or complete loss of sensory and motor function, and in severe cases, may lead to paralysis. The global incidence of SCI is rising annually, with a significant increase observed in China. The ependymal region of the spinal cord, containing endogenous neural stem cells (ENSCs), is recognized for its potential in neural regeneration and functional recovery after SCI. Cells lining the central canal of the spinal cord can develop into neurons, astrocytes, and oligodendrocytes, which are essential for repairing SCI. The present manuscript delves into the cellular origins, distribution, heterogeneity, and the potential therapeutic applications of ENSCs, offering insights into novel clinical interventions for SCI based on endogenous regenerative capabilities.

STUDY DESIGN:Retrospective study. SUMMARY OF BACKGROUND DATA:A considerable proportion of patients with degenerative lumbar scoliosis (DLS) have concomitant hip osteoarthritis (OA). However, the effect of hip OA on DLS patients remains unclarified. PURPOSE:To investigate the impact of concomitant hip OA on patient-reported outcome measures (PROMs) and global spinopelvic alignment in DLS. METHODS:Patients were divided into severe and low OA groups based on the Kellgren-Lawrence (KL) classification, with grades 0 to 2 classified as low OA and grades 3 or 4 classified as severe OA. Radiographic parameters and PROMs including the Visual Analog Scale (VAS), Scoliosis Research Society-22 (SRS-22), and Oswestry Disability Index (ODI) were compared among 3 groups: Bilateral severe, Unilateral severe, or Bilateral low. Multivariable regression analysis was performed to assess the effect of hip OA on pelvic decompensation and PROMs. RESULTS:A total of 134 patients were enrolled: 61 Bilateral severe, 25 Unilateral severe, and 48 Bilateral low. Bilateral severe hip OA was independently associated with pelvic decompensation (OR 1.37, 95% CI: 1.09-1.54, P=.016). At 2-year postoperatively, severe OA patients exhibited worse global sagittal malalignment and inferior clinical outcomes. Multivariate analysis showed that bilateral severe OA was significantly associated with worse baseline ODI (B=0.352, 95% CI: 0.082 to 0.622) and SRS-function (B=-0.405, 95% CI: -0.749 to -0.062), and 2-year VAS-back pain (B=0.223, 95% CI: 0.021 to 0.425), VAS-leg pain (B=0.365, 95% CI: 0.057 to 0.673), SRS-pain (B=-0.326,95% CI: -0.619 to -0.020 ), SRS-function (B=-0.337, 95% CI: -0.734 to -0.090) and ODI (B=0.323, 95% CI: 0.039 to 0.607). CONCLUSIONS:Severe hip OA was associated with pelvic decompensation and reduced hip extension. Patients with severe hip OA had worse baseline sagittal malalignment and inferior PROMs that persisted 2 year following surgery. These findings underscore the importance of evaluating hip OA during preoperative planning for DLS.

Spinal cord injury (SCI), a complex and serious neurological disease may induce severe cellular stress. In response to stress signals, cells form stress granules (SGs) as protective measures, and T-cell intracellular antigen 1 (TIA1) is a vital component of SGs. However, the roles and mechanism of TIA1-mediated SGs in SCI remain unknown. In this study, we found that TIA1 was upregulated in the cytoplasm of neurons and co-localized with the cytoplasmic G3BP1+ SGs. Furthermore, Tia1 knockout in the CNS (Tia1Nestin-CKO mice) did not affect the development of the spinal cords and locomotion function, but impeded the neural regeneration, and then inhibited the functional recovery after SCI, whereas, Tia1 knockout in the astrocytes (Tia1GFAP-CKO mice) did not affect development of the spinal cords and the locomotion functional recovery after SCI. Mechanistically, we found that Tia1 deletion decreased the formation of SGs, and increased the lipocalin 2 (LCN2, a secreted protein) expression in neurons through decreasing the sequestration of their mRNA into SGs after SCI, which further induced the neuroinflammation by activating astrocytes and microglia through cGAS-STING signaling pathway. Finally, treatment with deferoxamine (DFO), an inhibitor of LCN2, inhibited the neuroinflammation and partially restored the deficits in neural degeneration and functional recovery after SCI in Tia1Nestin-CKO mice. Together, these results suggest neuronal TIA1-mediated SGs encapsulates lcn2 mRNA, halting its translation and thereby attenuating the neuroinflammation and promoted the functional recovery after SCI, and TIA1-mediated SGs serves as a novel strategy for SCI treatment by regulating neuroinflammation.

After spinal cord injury (SCI), the blood-spinal cord barrier (BSCB) is disrupted, and endothelial cells, a critical component of BSCB, undergo proliferation and remodeling to maintain barrier integrity. However, the molecular mechanisms underlying BSCB remodeling remain unclear after SCI. Here, we reveal that Yes-associated protein (YAP), a principal downstream effector of the Hippo signaling pathway, promotes endothelial proliferation and BSCB repair in mice after SCI. First, we found that YAP expression was significantly upregulated and activated in endothelial cells after SCI. Endothelial YAP knockout (YAPTEK-cre/ERT2-CKO mice) impaired endothelial proliferation, endothelial-astrocyte end-feet reorganization, and tight junction (TJ) integrity, thereby aggravating BSCB disruption and impairing BSCB remodeling and motor functional recovery after SCI. Mechanistically, endothelial YAP-dependent BSCB repair was associated with angiopoietin-1 (ANGPT1) expression and PI3K/AKT pathway activation after SCI. Exogenous ANGPT1 treatment mitigated YAP deficiency-induced inhibition of endothelial proliferation and endothelial barrier disruption via PI3K/AKT signaling in vitro. Finally, activation of YAP signaling partially mitigated SCI-induced BSCB disruption, ultimately improving motor function recovery. Together, these results identify endothelial YAP signaling as a critical regulator of BSCB remodeling associated with ANGPT1/PI3K/AKT pathway and provide a potential therapeutic target for SCI.

Study Design Retrospective study. Objectives To investigate the correlation between lumbar anatomical parameters and spinal epidural lipomatosis (SEL) in patients with lumbar spinal stenosis (LSS). Methods A total of 397 patients with LSS who underwent surgical treatment were enrolled and divided into SEL and No-SEL groups. Clinical and radiological data were collected for all participants. Correlation analysis was performed to evaluate the relationships between various parameters and epidural fat thickness. Variance inflation factor (VIF) was calculated to assess multicollinearity among the covariates. Univariate and multivariate analyses were employed to investigate factors associated with SEL in patients with LSS. Furthermore, to eliminate the confounding effect of segmental differences on other risk factors, separate univariate and multivariate analyses were conducted specifically for the L3/4 and L4/5 levels. Results Correlation analysis showed facet angle (FA), intervertebral angle (IA), the ratio of bony spinal canal / intervertebral space spinal canal (BSC/ISSC), BMI, and endocrine disorders all showed weak to moderate correlations with fat thickness. Univariate analysis showed significant differences in FA, IA, endocrine disorders, BSC/ISSC and segment between SEL group and NO SEL group. Binary logistic regression analysis showed lesser BSC/ISSC and segment (upper lumbar spine) were independent factor associated with the imaging presence of SEL. The Youden index shows the cut-off value of BSC/ISSC is 0.735.The univariate and multivariate analyses showed that, for the data obtained from L3/4 and L4/5, there was a statistically significant difference in BSC/ISSC, whereas no such difference was observed for FA or IA. Conclusions Lesser BSC/ISSC and upper lumbar spine were independent anatomical factor associated with the imaging presence of SEL. Spinal stenosis leads to compression of the dorsal epidural adipose tissue, and the change in its distribution pattern may uncover the key mechanism underlying the development of SEL in LSS patients.

Axial pain is a common complication following expansive unilateral open-door laminoplasty (ELAP); however, traditional statistical methods are unable to effectively predict this complication. This study developed machine learning (ML) models to predict post-ELAP axial pain and identify key predictors. This retrospective study enrolled 851 cervical spondylotic myelopathy (CSM) patients undergoing ELAP, split into training (n = 714) and temporal validation sets (n = 137). Demographic, imaging, clinical, and surgical data were collected. Predictive features were selected by the least absolute shrinkage and selection operator (Lasso) regression, followed by ML model development with grid search optimizing hyperparameters. The top-performing model underwent temporal validation, and SHapley Additive exPlanations (SHAP) analyzed predictor contributions. The training set included 218 axial pain cases; the test set had 47. Key predictors (C7 laminoplasty, cervical kyphosis, etc.) were identified to develop ML model. Post-optimization, extreme gradient boosting (XGBoost) achieved superior performance (internal validation area under the receiver [AUC] = 0.948; 95

Study Design Retrospective Cohort Study. Objective This study examines the consistency of Vertebral Bone Quality (VBQ) and Computed Tomography Hounsfield Units (CT HUs) with Dual-energy X-ray absorptiometry (DXA) as a reference standard, evaluating the diagnostic performance of these 2 imaging techniques across different age groups and genders. Particular attention is given to the applicability of VBQ in different age and gender cohorts. Methods We included 972 eligible patients, from which 569 patients were randomly selected and included in the analysis according to the inclusion criteria. These patients underwent lumbar Magnetic Resonance Imaging (MRI), lumbar CT, and DXA within 3 months of hospital admission. The study assessed the correlation and diagnostic efficacy of these techniques in measuring lumbar and femoral neck bone mineral density (BMD). Results It showed good correlation between VBQ and CT HUs with DXA in individuals under 70 years of age. However, in the population over 70 years, the correlation of VBQ with DXA significantly decreased (lumbar BMD pr = −.145 P > .05; femoral neck BMD r = −.097 P > .05), whereas CT HUs maintained high diagnostic performance. The ROC curve analysis indicated that the AUC for differentiating osteoporosis (based on lumbar spine BMD) by VBQ was .545 in males over 70 and .487 in females over 70. However, CT HUs demonstrated diagnostic performance across all groups. Conclusion VBQ is effective in assessing osteoporosis in patients under 70 but shows decreased efficacy in those over 70. When using VBQ to predict osteoporosis in patients on opportunistic grounds, it is still necessary to incorporate additional reference indicators, such as CT HUs.

To evaluate a novel measurement method based on X-ray images for accurately determining the relationship between pedicle screws and the medial wall of the pedicle in thoracic and lumbar spine surgery. A total of 650 pedicle screws from 126 patients who underwent thoracic or lumbar internal fixation surgery were included. Postoperative X-ray images were used to calculate the distance between the medial edge of the screw threads and the medial wall of the pedicle (“b-x”) based on our measurement method. This distance was also measured using postoperative CT (“Y”). The agreement of “b-x” and “Y” was assessed using Spearman’s correlation analysis, intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. The cutoff value of “b-x” and its accuracy in predicting “Y” value was evaluated using the receiver operating characteristic (ROC) curve. Of the 650 screws, 59 (9.08

Bone infections in diabetic patients often result in devastating outcomes, highlighting the need for effective treatment strategies. Our study aims to explore how Staphylococcus aureus adapts to the diabetic microenvironment. This study found increased bacterial resistance to reactive oxygen species (ROS) and a higher expression of the crtOPQMN operon among strains isolated from diabetic patients. Mechanistically, S. aureus was found to increase its staphyloxanthin (STX) level through genomic changes in the locus of rsbU, rsbW, and sigB. Both in vitro and in vivo experiments demonstrated that genomic changes were due to bacterial adaptation to the ROS pressure. Moreover, by adopting simvastatin, a representative STX synthesis inhibitor, we found that statins can inhibit the frequency of S. aureus genomic changes under the pressure of ROS. A mouse infection model demonstrated that simvastatin can reduce bacterial loads, alleviate bone infection outcomes, and increase the cure rate of vancomycin in treating bone infections. These findings suggest that by inhibiting bacterial adaptation toward ROS pressure, simvastatins could be a promising adjunctive therapy for bone infection treatment, especially among diabetic patients.

Spinal cord injury (SCI) causes devastating neurological deficits, and cellular senescence critically contributes to the pathogenesis of various diseases. Notably, endothelial cells (ECs) senescence exerts a pivotal effect on the pathogenesis following SCI. In this study, we found that the number of senescent ECs increased by 18.87% ± 5.91%, and the disruption of the blood-spinal cord barrier (BSCB) was aggravated with an 18% increase in Evans Blue dye extravasation in diabetic mice with spinal cord injury (DM-SCI). To address this pathological process, a bioinspired nanotherapeutic platform utilizing milk-derived small extracellular vesicles with platelet membrane fusion (PM-sEVs) was developed for the targeted delivery of curcumin (Cur). In vitro, PM-sEVs-Cur effectively mitigated HG/IL-1β-induced HUVECs senescence by 54.19% ± 5.39% and increased expression of the tight junction protein ZO-1 by 4.33-fold. Mechanistically, Cur attenuated HUVECs senescence by activating the NRF2/HO-1 pathway. In vivo, platelet membrane modification enhanced the lesion targeting of sEVs. Treatment with PM-sEVs-Cur attenuated ECs senescence by 34.96% ± 6.59%, preserved BSCB integrity with a 17% reduction in Evans Blue dye extravasation, promoted axonal regeneration with a 6.36-fold increase in neurofilament expression, and improved motor function recovery with an increase of 2.4 ± 0.55 points in Basso Mouse Scale score in DM-SCI. This study highlights PM-sEVs-Cur as a promising therapeutic delivery platform for DM-SCI treatment.

To identify risk factors associated with cage subsidence (CS) following single segment transforaminal lumbar interbody fusion (TLIF) and unilateral biportal endoscopic lumbar interbody fusion (ULIF) and to compare the predictive performance of various bone quality assessment methods using MRI and CT images. A total of 226 patients from 2021 to 2023 who underwent ULIF/TLIF because of lumbar disc herniation and lumbar spinal stenosis were enrolled. The subsidence of the cage into the vertebral body exceeding 2 mm was defined as CS and diagnosed using CT scans. Immediate endplate destruction (IED) was defined by CT and VBQ was measured through T1-weighted lumbar MRI. The independent sample t-test was employed to examine the risk factors associated with CS. Additionally, risk factors associated with CS were identified using logistic regression analysis. Lastly, the comparative predictive values were assessed through ROC curve analysis. Logistic regression analysis revealed that increased postoperative posterior disc height (PPDH), higher segmental VBQ scores, higher mean VBQ (M-VBQ) scores, decreased segmental HU values, decreased mean HU (M-HU) values and immediate endplate destruction (IED) were associated with the occurrence of CS. The area under the curve (AUC) of the VBQ score was higher than that of the HU value, both in segment and in average. The incidence of CS was lower in ULIF compared to TLIF. High VBQ scores, low HU values, high PPDH and the presence of IED were associated with an increased risk of CS. Notably, the predictive value of both VBQ scores and HU values were high for CS, with the former potentially outperforming the latter.

ObjectivesLower back pain (LBP) is a prevalent health issue that has substantial effects on individuals and society. However, the association between bone mineral density (BMD) and LBP remains controversial. In this study we aimed to ascertain whether a relationship exists between BMD and LBP in the United States population.MethodsData from the National Health and Nutrition Examination Survey (NHANES) spanning 1999–2004 were analyzed using a cross-sectional approach. BMD and LBP were assessed using multivariate logistic regression, smoothing curves, and generalized additive models. Subgroup analyses were also performed to ensure data stability and mitigate confounding factors.ResultsIn this population-based study, the data of 107,570 adults were analyzed (mean age: 47.13 ± 18.38 years) and 36.74% of them had LBP. After controlling for all covariates, a positive correlation was established between BMD and LBP [odds ratio (OR) = 1.87, 95% confidence interval (CI) = (1.00, 3.50)]. The two-segment linear regression model revealed a U-shaped relationship between BMD and LBP with a 1.14 g/cm2 inflection point. BMD values <1.14 g/cm2 were linked to a lower likelihood of experiencing LBP [OR = 0.55, 95% CI = (0.45, 0.68)]. However, a BMD >1.14 g/cm2 increased the risk of LBP [OR = 6.15, 95% CI = (4.51, 8.39)].ConclusionsBMP was significantly and positively correlated with LBP. A U-shaped relationship was observed between BMD and LBP, indicating that both insufficient and excessive BMD may increase the risk of LBP.