BACKGROUND:Secondary spinal cord injury (SCI) involves intense neuroinflammation driven by pyroptosis and damage-associated molecular patterns (DAMPs). Targeting NINJ1, an executioner protein for plasma membrane rupture, may break this cycle. METHODS:A mouse contusion SCI model was used, with groups including Sham, Vehicle, Methylprednisolone, and low/high-dose NINJ1 monoclonal antibody (mAb). Functional recovery was assessed by BMS scoring and gait analysis. Histopathology and molecular changes (neuronal survival, pyroptosis proteins GSDMD/NLRP3/Caspase-1, microglial polarization markers, and related pathways) were analyzed at 14 dpi. HMGB1 release was quantified. An in vitro co-culture model of glutamate-injured HT22 neurons and BV2 microglia validated the effects. RESULTS:NINJ1 mAb treatment significantly improved motor function and reduced pathology versus controls. It enhanced neuronal survival, suppressed pyroptosis executers (GSDMD, while NINJ1 mRNA expression remained unchanged), and decreased HMGB1 release. The treatment shifted microglial polarization from pro-inflammatory M1 to anti-inflammatory M2, correlating with reduced nuclear p-NF-κB p65 and increased p-STAT3. In vitro, NINJ1 mAb directly protected neurons and suppressed microglial M1 polarization and pro-inflammatory cytokine release. CONCLUSION:The NINJ1 monoclonal antibody promotes recovery after SCI by inhibiting pyroptotic membrane rupture, reducing DAMP release, and modulating microglia toward an anti-inflammatory phenotype, presenting a novel therapeutic strategy.

Nucleus pulposus cell (NPC) senescence is a core driver of intervertebral disc degeneration (IVDD), but the metabolic mechanisms underlying this process remain poorly understood. We integrated transcriptomics, untargeted metabolomics, and single-cell RNA sequencing to characterize metabolic reprogramming in TBHP-induced senescent rat NPCs, followed by validation in a human disc degeneration dataset. The functional relevance of the identified metabolic nodes was evaluated through exogenous glutamate supplementation in primary rat NPCs and an in vivo rat tail puncture model. Multi-omics integration revealed a critical metabolic bottleneck characterized by glutamate depletion, which impaired antioxidant defense despite transcriptional upregulation of synthesis enzymes. Single-cell analysis confirmed this vulnerability in senescent subpopulations. Functional rescue experiments showed that exogenous glutamate supplementation reduced ROS accumulation and partially alleviated senescence-associated changes in vitro. Furthermore, in vivo administration of glutamate in a rat tail puncture model partially alleviated histological degeneration and reduced senescence-associated markers. These findings suggest that substrate-driven metabolic alterations play a significant role in NPC senescence within our experimental models. Restoring metabolic homeostasis may offer a potential strategy for future therapeutic investigation in IVDD.

Introduction:Unilateral biportal endoscopic unilateral laminotomy for bilateral decompression (UBE-ULBD) is a minimally-invasive yet technically demanding procedure for lumbar spinal stenosis. Aim:This study aimed to compare the learning curves of 2 generations of surgeons performing UBE-ULBD under a structured mentorship model. Materials and methods:We retrospectively analyzed 200 consecutive surgeries performed between January 2020 and June 2024. The first-generation surgeon (FGS) performed all procedures independently. The second-generation surgeon (SGS) assisted in 30 surgeries and then received on-site supervision for the first 15 independent cases. Data on operative time, blood loss, complications, and clinical outcomes, including the Visual Analog Scale and Oswestry Disability Index, were collected. Operative time-based cumulative sum analysis was used to evaluate the learning curves. Results:The FGS achieved proficiency after 37 and the SGS after 29 procedures. The SGS had significantly shorter mean (SD) operative time of 127.6 (13.2) vs 137.1 (19.3) minutes and lower blood mean (SD) loss of 49 (13.6) vs 57.7 (20.6) milliliters, as compared with his first-generation counterpart. Complications and clinical outcomes were comparable. After achieving proficiency, both surgeons showed improved efficiency without differences in safety or outcomes. Conclusions:Under the guidance of the FGS, the SGS achieved proficiency in UBE-ULBD more rapidly, as reflected in the shorter operative time. Moreover, once proficiency was reached, no notable differences were observed between the 2 surgeons in terms of postoperative complications or clinical outcomes.

ABSTRACT Objective The clinical application of the Nine‐grid Area Division Method for pedicle puncture in L‐OVCF is limited by high technical thresholds and low efficiency. This study aimed to develop an AI‐integrated automated system for L‐OVCF diagnosis and pedicle puncture planning by combining the nine‐grid method with deep learning, and to validate its diagnostic accuracy, planning consistency, and clinical application efficiency. Methods A multicenter CT dataset of L‐OVCF patients was collected from three hospitals affiliated with Capital Medical University (January 2020–December 2022). A two‐stage improved U‐Net architecture was constructed for automated lumbar vertebral segmentation, and a 3D ResNet50 network was used for L‐OVCF identification. A geometric algorithm was developed to realize automated puncture path planning based on the Nine‐grid Area Division Method. The performance of the segmentation and diagnosis modules was evaluated with DSC, AUC, and Hausdorff Distance. 20 cases were randomly selected to compare the consistency of puncture planning between the AI system and senior surgeons' manual planning, and the planning efficiency and resource consumption of the two methods were analyzed. Results The proposed two‐stage U‐Net achieved an overall DSC of 0.934 for vertebral segmentation, significantly outperforming the single‐stage nnU‐Net model. The L‐OVCF identification model yielded a high degree of accuracy with AUC of 0.918 (95% CI: 0.885–0.925). The automated planning results showed extremely high consistency with manual planning (DSC = 0.958, IoU = 0.921, HD = 486.7 μm), and the planning efficiency was significantly improved with memory consumption within the capacity of standard clinical workstations. Conclusions The developed AI‐integrated system accurately reproduces the preoperative planning logic of senior surgeons, with high diagnostic accuracy and puncture planning consistency, while markedly improving planning efficiency and reducing the technical threshold of the nine‐grid method. It has good clinical translational potential and can provide a reliable auxiliary tool for the precise and minimally invasive treatment of L‐OVCF.

INTRODUCTION:Lumbar degenerative disease (LDD) is increasingly common, and causes back and leg pain that impairs quality of life. Lumbar interbody fusion (LIF) is effective for patients with neural compression and segmental instability. Unilateral biportal endoscopic LIF (UBE-LIF) allows for minimally-invasive decompression and fixation, while navigation- and robot-assisted systems improve pedicle screw accuracy and intraoperative guidance. AIM:This study compared perioperative outcomes and clinical efficacy of navigation-assisted vs robot-assisted single-level UBE-LIF. MATERIALS AND METHODS:Patients with single-level LDD who underwent navigation-assisted (Na group; n = 23) or robot-assisted (Ra group; n = 29) UBE-LIF between January 2020 and December 2024 were retrospectively enrolled. Clinical outcomes were assessed using the Numeric Rating Scale, Oswestry Disability Index, and modified MacNab criteria. Pedicle screw placement and radiological parameters, including disc height, lumbar lordosis, and segmental lumbar lordosis, were evaluated, and IF was assessed at 12 months postoperatively. RESULTS:Endoscopic operative time was shorter in the Na group than in the Ra group (116.74 vs 127.86 min; P = 0.03), whereas screw insertion time and pedicle screw placement were superior in the Ra group (39.55 vs 46.52 min; P = 0.001 and 98.5% vs 92.4%; P = 0.04, respectively). Both groups showed comparable improvements in clinical outcomes, radiological parameters, and fusion rates, with similarly low complication rates. CONCLUSIONS:Navigation- and robot-assisted UBE-LIF are safe and effective procedures. Robot-assisted surgery offers higher screw accuracy and faster insertion, while the navigation-assisted approach reduces endoscopic operating time. Clinical outcomes and fusion rates between the 2 techniques are similar.

Background:Degenerative lumbar spinal stenosis (DLSS) is a leading cause of low back and leg pain in the elderly. While conventional posterior lumbar interbody fusion (PLIF) is effective, it remains associated with significant tissue trauma and a relatively high incidence of chronic postoperative low back pain, even when empowered by current robotic-assisted technologies. Existing evidence suggests that robotic-assisted midline lumbar interbody fusion with cortical bone trajectory (RA-MIDLIF-CBT) may offer advantages in terms of minimal invasiveness. However, there is a lack of high-quality evidence regarding its non-inferiority in efficacy compared to the equally robotic-assisted PLIF technique, as well as its potential for enhancing accelerated recovery after surgery. Methods:A single-center, prospective, randomized controlled, non-inferiority trial will be conducted. Seventy-four patients aged 60-80 years with single-level DLSS refractory to conservative treatment and meeting definitive criteria for lumbar interbody fusion will be enrolled and randomly assigned (1:1 ratio) to either Group A (control): Robot-assisted PLIF with pedicle screw fixation, or Group B (experimental): Robot-assisted MIDLIF-CBT. The primary outcome measure is the Oswestry Disability Index (ODI). Secondary outcomes include Visual Analog Scale (VAS) scores for low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, operative time, intraoperative blood loss, radiation exposure, screw placement accuracy, compliance with enhanced recovery after surgery (ERAS) protocols, and health economic parameters. Patients will be followed up for 12 months postoperatively. Discussion:This study will be the first to provide high-level evidence on the non-inferiority of RA-MIDLIF-CBT compared to robot-assisted PLIF for treating DLSS. Leveraging the foundational platform of robotic assistance, the findings have the potential to establish RA-MIDLIF-CBT as a novel fusion technique that balances minimal invasiveness, safety, and cost-effectiveness. Additionally, the results will contribute evidence-based support for optimizing ERAS pathways in geriatric spine surgery. Trial Registration:The trial protocol was registered at Chinese Clinical Trial Registry (www.chictr.org.cn, Registration Number: ChiCTR2500095896).

Introduction:Chronic discogenic low back pain (DLBP) with active discopathy (Modic type 1 changes) is a specific and debilitating phenotype. Transforaminal epidural steroid injection (TESI) and transforaminal intradiscal steroid injection (TISI) are commonly used treatments, yet their comparative efficacy remains uncertain due to a lack of high-quality, direct comparative studies. Objectives:To compare the clinical efficacy and safety of TISI versus TESI and to investigate whether the anatomical target of corticosteroid delivery (intradiscal vs. epidural) influences clinical and radiological outcomes in patients with chronic DLBP with active discopathy. Trial design:This is a single-center, prospective, parallel-group, assessor- and patient-blinded, randomized, controlled trial. Methods:A total of 118 eligible participants will be randomly allocated in a 1:1 ratio to receive either TISI or TESI. The primary outcome is the change in low back pain intensity from baseline to 1-month post-intervention, measured by the Numerical Rating Scale (NRS). Secondary outcomes, assessed at multiple time points up to 12 months, include longitudinal pain intensity (NRS), functional status (Oswestry Disability Index, Japanese Orthopaedic Association score), health-related quality of life (12-item Short Form Health Survey), psychological status (Hospital Anxiety and Depression Scale), radiological changes (Modic classification, intervertebral disc heigh and Pfirrmann grade), and the incidence of procedure-related adverse events. The primary analysis will follow the modified intention-to-treat principle, with longitudinal data analyzed using a linear mixed model. Discussion:This trial addresses a critical evidence gap by conducting a direct head-to-head comparison of two mechanistically distinct injection therapies. The findings are anticipated to significantly inform clinical practice and guide the development of evidence-based treatment algorithms for managing chronic low back pain with active discopathy. Ethics and dissemination:The study protocol has been approved by the Ethics Committee of Beijing Shijitan Hospital, Capital Medical University (IIT2024-032-003). Written informed consent will be obtained from all participants. The results of this trial will be submitted for publication in peer-reviewed journals and presented at scientific conferences, regardless of the outcome. Clinical trial registration:ChiCTR2500096006, https://www.chictr.org.cn/showproj.html?proj=249912.

Purpose: The aging population has led to a rise in the incidence of lumbar degenerative diseases, especially lumbar spinal stenosis (LSS). When conservative treatment fails, surgical intervention has become the preferred approach. The emerging cortical bone trajectory (CBT) screw technique and the traditional pedicle screw technique remain subjects of debate. A retrospective cohort study was conducted to compare the early efficacy of robot-assisted CBT and traditional pedicle screw (TPS) in the treatment of LSS in patients with Osteoporosis. Methods: A total of 110 patients underwent robot-assisted posterior lumbar interbody fusion (PLIF) between September 2018 to June 2021. They were divided into two groups, the CBT group (N = 55) and the TPS group (N = 55). The general information, surgical related data, postoperative related indicators and functional scores for the two groups were analyzed to evaluate the differences between the two screw placement methods. Results: The CBT group demonstrated significantly lower the intraoperative blood loss, length of surgical incision and visual analogue scale (VAS) scores at 6 months after operation compared with TPS group (P < 0.05). The difference of blood glucose at 1 week after operation was statistically significant (P < 0.05). The rate of screw loosening, adjacent facet joint invasion and the degree of paraspinal muscle fat infiltration in the CBT group were significantly lower than those in the TPS group as at the last follow-up (P < 0.05). Conclusions: Compared to TPS instrumentation, PLIF with robot-assisted CBT screw provides better short-term symptom relief, a lower rate of screw loosening, and reduced adjacent facet joint invasion and paraspinal muscle fat infiltration.

Magnesium phosphate cement (MPC) continues to gain attention in the field of biomedicine. However, its suboptimal mechanical strength and weak biological activity hinder its wider clinical application. Given the excellent biological characteristics of bioglass fiber (BGF), In this study, magnesium phosphate bone cement (BMPC) containing MPC and BGF with different concentrations (0%, 10%, 20%) are fabricated. Called (MPC, 10BMPC, 20BMPC) respectively. BGF-induced mechanical strengthening is verified through physical and chemical performance tests. In vitro experiments showed that BMPC have better osteogenic properties than MPC and can enhance the proliferation and adhesion capacity of human umbilical vein endothelial cells. In vivo experiment, 20BMPC can significantly promote bone regeneration and vascular network formation, and histological analysis further confirmed the osteogenic capacity of 20BMPC. Transcriptomic analyses confirmed that the activities of the Notch pathway and Hif1 pathway are upregulated in the 20BMPC group, reflecting the strong interconnection between osteogenesis and angiogenesis. 20BMPC, which have the highest BGF content, showed the best performance among all the tested materials. This study showed that BGF improved the mechanical strength of bone cement and enhanced its osteogenic and angiogenic abilities. Therefore, 20BMPC can be used as a new bone repair material.

STUDY DESIGN:Retrospective cohort study. OBJECTIVES:The goal of this study was to identify the clinical and radiological characteristics of patients with osteoporosis and to develop a practical clinical prediction model for patients for accurately predicting the risk of osteoporosis. METHODS:This study included 954 patients from September 2020 to September 2024 at our hospital. Independent risk factors were selected by the least absolute shrinkage and selection operator method (LASSO) regression. Then, a prediction model (nomogram) was established. Randomly split internal validation cohorts were used to test the nomogram model's calibration, discrimination, and clinical utility. RESULTS:Six independent prediction factors, age, female, glucocorticoid use, chronic obstructive pulmonary disease (COPD), cut-off values for Hounsfield unit (HU) and vertebral quality (VBQ) scores, were identified, and based on this a nomogram model was developed for predicting patient prognosis. The C-index of the prediction nomogram was 0.86 in training set. The area under the receiver operating characteristic curve (AUC) was 0.87 in both the training and validation sets. The model has good practicability for clinics according to the decision curve analysis (DCA) and clinical impact curve (CIC). CONCLUSIONS:The nomogram model has good predictive performance and clinical practicability, which could provide a certain basis for simplifying osteoporosis diagnosis.

STUDY DESIGN/SETTING:A retrospective cohort study. OBJECTIVE:To compare long-term outcomes and complications of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) with cage-plate constructs (CPC) and stand-alone (SA) cages in treating degenerative cervical spondylosis. SUMMARY OF BACKGROUND DATA:ACDF is commonly used for cervical radiculopathy but may increase adjacent segment degeneration (ASD). CDR has gained popularity by preserving motion and potentially reducing ASD, whereas SA cages offer a simpler alternative to CPC. Despite widespread adoption, further research is needed to clarify the long-term outcomes and associated complications. METHODS:A retrospective analysis was conducted on 1146 patients who underwent cervical surgery between 2009 and 2012 at three Chinese hospitals, grouped into CDR (n=220), CPC-ACDF (n=540), and SA-ACDF (n=386). Primary outcomes included overall success rate and complications. Secondary measures were JOA, VAS, SF-36 scores, and imaging parameters. RESULTS:The CDR group exhibited a significantly higher overall success rate compared with CPC-ACDF and SA-ACDF groups. Dysphagia incidence immediately post-surgery was significantly lower in the CDR and SA-ACDF groups compared with CPC-ACDF. At the final follow-up, implant subsidence was lowest in the CDR group. Radiographic-ASD incidence was significantly lower in the CDR and SA-ACDF groups compared with CPC-ACDF, with SA-ACDF having the lowest rate of symptomatic-ASD. The reoperation occurred in 38 (7.0%) CPC-ACDF, 18 (4.7%) SA-ACDF, and 8 (3.6%) CDR patients. Despite a 65.5% incidence of heterotopic ossification (HO), CDR partially preserved the angular range of motion. Multivariate logistic regression analysis suggested that SA-ACDF and CDR were protective factors against postoperative radiographic-ASD. Conditional nomograms demonstrated good predictive performance for symptomatic-ASD, supported by receiver operating characteristics and calibration curves. CONCLUSION:This study suggests that CDR provides similar clinical outcomes with fewer complications compared with ACDF. However, further research is needed to confirm these findings, particularly considering the variability between different CDR devices and the potential for selection bias.

BACKGROUND:Lumbar spinal stenosis (LSS) is a common degenerative disorder characterized by neural compression, leading to radicular pain, neurogenic claudication, and lower limb dysfunction. Unilateral biportal endoscopic unilateral laminotomy for bilateral decompression (UBE-ULBD) has emerged as an effective minimally invasive surgical technique, but it requires advanced surgical skills and has a steep learning curve. The use of computer-assisted navigation has been increasingly adopted to improve surgical efficiency and safety; however, its clinical effectiveness and safety in UBE-ULBD for single-level LSS remain insufficiently investigated. METHODS:A total of 119 patients undergoing UBE-ULBD were included and divided into Group A (navigation-assisted, n = 57) and Group B (fluoroscopy-guided, n = 62), with a minimum follow-up of 12 months. Perioperative outcomes and clinical efficacy were evaluated using operative time, fluoroscopy frequency, estimated blood loss, postoperative hospital stay, complication rates, as well as visual analogue scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria. RESULTS:No statistically significant differences were observed in baseline characteristics between the two groups. Group A had a significantly shorter operative time, fewer intraoperative fluoroscopies, and lower estimated blood loss compared with Group B (all P < 0.001), while postoperative hospital stay and overall complication rates did not differ significantly (P > 0.05). No surgical site infections or permanent nerve injuries occurred in either group. Both groups showed significant postoperative improvements in VAS and ODI scores relative to preoperative values; however, no intergroup differences were found at any follow-up point (P > 0.05). At the final follow-up, the excellent/good rate based on the modified MacNab criteria was 93.0% in Group A and 87.1% in Group B, with no significant difference (P > 0.05). CONCLUSION:Navigation-assisted UBE-ULBD can significantly improve surgical efficiency and markedly reduce intraoperative radiation exposure for surgeons, while demonstrating comparable safety and clinical efficacy to conventional fluoroscopy-guided procedures. These advantages highlight its potential clinical value as a safer and more efficient alternative for minimally invasive decompression in lumbar spinal stenosis.

>骨质疏松性脊柱骨折（osteoporotic vertebral fracture,OVF）是骨质疏松症最常见的并发症之一，尤其好发于老年人群，且随着年龄增长，发病率显著上升。此类骨折不仅导致剧烈疼痛、脊柱畸形，还可能引发神经功能障碍，严重影响患者生活质量，甚至增加死亡率。手术治疗在缓解疼痛、恢复脊柱稳定性及预防再骨折方面具有显著优势，已成为临床治疗的重要选择。

Background As the world's population ages, osteoporotic fractures have become a growing medical, social and economic problem. Objective Vertebral fractures (VFs) are the most common osteoporotic fractures and are a strong risk factor for subsequent VFs, leading to VF cascade (VFC). This study aimed to identify potential causes of and risk factors for VFC. At the same time, the factors influencing the time between fractures in patients with osteoporotic VFC were examined. Methods We retrospectively analysed the clinical data of 889 patients diagnosed with osteoporotic vertebral fracture at Beijing Shijitan Hospital affiliated to Capital Medical University from January 1, 2015, to December 31, 2022. Results The study included 193 patients with VFC. The multifactorial risk analysis showed that the independent risk factors for VFC included a history of diabetes mellitus (hazard ratio, 1.635; p value = 0.016), a history of oral corticosteroid therapy (hazard ratio, 1.798; p value = 0.001), chronic obstruction pulmonary disease (COPD, hazard ratio 1.666, p value = 0.036), thoracolumbar fracture (hazard ratio, 2.664, p value <0.001), and a body mass index (BMI) >= 28 (hazard ratio 1.421; p value = 0.045). Further study showed that glycated haemoglobin was also an important factor affecting the interval between fractures in patients with VFC. Conclusion Independent risk factors for VFC include a history of diabetes, prior oral corticosteroid therapy, COPD, thoracolumbar fracture, and BMI >= 28. The occurrence of fractures in the thoracolumbar segment is the most important risk factor. Additional research has shown that after the first vertebral fracture, the poorer the patient's blood sugar control, the faster the refracture rate.

IntroductionLow back pain (LBP), primarily driven by intervertebral disc degeneration (IDD), imposes a significant global health burden. While type 2 diabetes mellitus (T2DM) is a recognized risk factor for IDD, the shared molecular mechanisms remain incompletely characterized.MethodsThis study employed integrated bioinformatics (WGCNA, machine learning - LASSO, RF, ANN) on human T2DM and IDD transcriptomic datasets, alongside scRNA-seq analysis of diabetic mouse nucleus pulposus (NP) tissue, to identify key drivers of diabetes-associated IDD.ResultsBioinformatics analysis of human data identified three diagnostic biomarkers (S100A12, IL1R1, FCGR2B) and constructed a robust ANN diagnostic model (AUCs: 0.744-0.868). IL1R1 emerged as the most significant risk factor. scRNA-seq revealed altered cellular composition in diabetic discs, notably increased proportion of granulocytes (predominantly neutrophils) and decreased proportion of nucleus pulposus (NP) cells. IL1R1 was highly expressed in specific diabetes-associated NP subpopulations and showed significant positive correlation with neutrophil infiltration. Functional enrichment linked IL1R1 to inflammation, DNA repair, and immune pathways. Furthermore, we constructed a regulatory network (STAT1/STAT6-IL1R1-miRNAs-lncRNAs) and identified icariin as a potential therapeutic candidate via molecular docking.DiscussionThese findings establish IL1R1 as a pivotal molecular bridge connecting T2DM and IDD, driven by neutrophil-mediated inflammation and NP cell dysfunction, offering novel diagnostic and therapeutic avenues.

Study Design/Setting. A retrospective cohort study. Objective. To compare long-term outcomes and complications of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) with cage-plate constructs (CPC) and stand-alone (SA) cages in treating degenerative cervical spondylosis. Summary of Background Data. ACDF is commonly used for cervical radiculopathy but may increase adjacent segment degeneration (ASD). CDR has gained popularity by preserving motion and potentially reducing ASD, while SA cages offer a simpler alternative to CPC. Despite widespread adoption, further research is needed to clarify the long-term outcomes and associated complications. Methods. A retrospective analysis was conducted on 1,146 patients who underwent cervical surgery between 2009 and 2012 at three Chinese hospitals, grouped into CDR (n=220), CPC-ACDF (n=540), and SA-ACDF (n=386). Primary outcomes included overall success rate and complications. Secondary measures were JOA, VAS, SF-36 scores, and imaging parameters. Results. The CDR group exhibited a significantly higher overall success rate compared to CPC-ACDF and SA-ACDF groups. Dysphagia incidence immediately post-surgery was significantly lower in the CDR and SA-ACDF groups compared to CPC-ACDF. At the final follow-up, implant subsidence was lowest in the CDR group. Radiographic-ASD incidence was significantly lower in the CDR and SA-ACDF groups compared to CPC-ACDF, with SA-ACDF having the lowest rate of symptomatic-ASD. The reoperation occurred in 38 (7.0%) CPC-ACDF, 18 (4.7%) SA-ACDF, and 8 (3.6%) CDR patients. Despite a 65.5% incidence of heterotopic ossification (HO), CDR partially preserved angular range of motion. Multivariate logistic regression analysis suggested that SA-ACDF and CDR were protective factors against postoperative radiographic-ASD. Conditional nomograms demonstrated good predictive performance for symptomatic-ASD, supported by receiver operating characteristic and calibration curves. Conclusion. This study suggests that CDR provides similar clinical outcomes with fewer complications compared to ACDF. However, further research is needed to confirm these findings, particularly considering the variability between different CDR devices and potential for selection bias.

Abstract Background Radiculopathy of the lower limb after acute osteoporotic vertebral fractures (OVFs) in the lower lumbar spine is uncommon in geriatric patients. Moreover, surgical intervention is generally recommended in patients who are irresponsive to conservative treatment. Determining an optimum surgical strategy is challenging considering the poor general condition of this population. Thus, herein, we established an algorithm for surgically managing this clinical scenario, hoping to provide a reference for making a surgical decision. Methods We retrospectively studied patients who suffered from new-onset radiculopathy of the lower limb after acute single-level OVFs in the lower lumbar spine and eventually underwent surgical intervention at our department. Information on the demographics, bone quality, AO spine classification of the vertebral fracture, pre-existing degenerative changes, including foraminal stenosis and lumbar disc herniation, and surgical intervention type was collected. Additionally, clinical outcomes, including preoperative and postoperative visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), and MacNab criterion for response to surgery, were evaluated. Results From September 2019 to December 2021, a total of 22 patients with a mean age of 68.59 ± 9.74 years were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Among the 22 patients, 15 (68.2%) were diagnosed with the A1 type fracture of AO classification, and among them, 11 (73.3%) were characterized by the collapse of the inferior end plate (IEP). Three patients (13.6%) suffered from A2-type fractures, whereas four patients (18.2%) suffered from A3-type fractures. Pre-existing degenerative changes were observed in 12 patients (54.5%) of the patients. A total of 16 patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Additionally, three patients underwent posterior instrumentation and fusion, two patients underwent a secondary endoscopic foraminoplasty, and one patient underwent a secondary radiofrequency ablation. The mean follow-up period was 17.42 ± 9.62 months. The mean VAS scores for leg and back pain and ODI decreased significantly after the surgery (P < 0.05). The total satisfaction rate at the last follow-up was 90.9% per the Macnab criterion. Conclusion Patients with OVFs in the IEP are predisposed to suffer from radiculopathy of the lower limb. PKP alone or in combination with other minimally invasive surgical strategies is safe and effective in treating stable fractures. Additionally, aggressive surgical intervention should be considered in patients with unstable fractures or severe foraminal encroachment.

Background The prevalence of chronic non-specific neck pain (CNNP) is on the rise among the young adult population. We herein aimed to compare the effects of long-term specific cervical extensor training and stretching exercises on improving this chronic disorder in young adults. Methods In this prospective, randomized, controlled study, 70 participants aged 18–35 years with CNNP and cervical lordosis loss were included. The participants were assigned to undergo either specific cervical extensor training (observation group) or perform usual stretching exercises (control group). The exercise duration was set at 12 months, with 9 months at the clinic and 3 months at home. The outcome assessments included changes in the neck disability index, visual analog scale from baseline, cervical range of motion (CROM), cross-sectional areas (CSAs) of cervical extensors, and cervical curvature from baseline. The outcome measures were compared between groups at 3, 6, and 12 months of follow-up. Results All 70 participants underwent randomization, and no significant differences in demographics and baseline data were found between the two groups. The observation group showed a greater improvement in neck disability index and visual analog scale scores at the 12-month follow-up than the control group. Additionally, a more substantial increase in CROM and CSAs of cervical extensors was observed in the observation group at the 6-month and 12-month follow-ups ( P < 0.05). Although more participants in the observation group achieved cervical lordosis at the 12-month follow-up, the difference was marginally nonsignificant (9% in the control group vs. 28% in the observation group, P = 0.075). Conclusions In young adults with CNNP, long-term specific cervical extensor training was associated with a more significant clinically meaningful improvement in disability, pain, and CROM than stretching exercises. The increased CSAs of cervical extensors may potentially contribute to the restoration of cervical lordosis. Trial registration The study is registered at the Chinese domestic clinical trial (ChiCTR2000040009) at Chictr.org. The date of registration: November 18, 2020.