BACKGROUND:Percutaneous mesh-container-plasty (PMCP), a modified traditional percutaneous kyphoplasty (PKP) technique, is increasingly being used to treat osteoporotic vertebral compression fractures with up-endplate injury. This retrospective study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of this disease. METHODS:We retrospectively analyzed the medical records of patients with osteoporotic compression fractures and upper endplate injuries treated at our hospital between January 2019 and December 2021. A total of 192 patients who met the inclusion and exclusion criteria were enrolled. Of these, 103 underwent PKP and 89 underwent PMCP. Key outcome measures included surgical safety, clinical efficacy, and radiological results. RESULTS:Both the PKP and PMCP groups showed significant improvements in visual analog scale and Oswestry Disability Index scores postoperatively. Additionally, anterior vertebral body height ratio and Cobb's angle improved in both groups, though no statistically significant difference was observed between them. The hospital stay duration was similar between the 2 cohorts. Notably, the PMCP group required a larger volume of bone cement injection yet exhibited a significantly lower incidence of cement leakage and adjacent vertebral fractures (9/89 and 2/89, respectively) compared to the PKP group (24/103 and 11/103, respectively) (P < 0.05). Moreover, the PMCP group had shorter operation times (34.64 ± 9.88 minutes) and reduced fluoroscopy frequency (35.43 ± 5.46 instances) compared to the PKP group (27.23 ± 8.54 minutes and 23.87 ± 5.59 instances, respectively) (P < 0.05). CONCLUSIONS:PMCP provided superior clinical outcomes for the management of osteoporotic compression fractures with upper endplate injuries. It was associated with reduced operation and fluoroscopy times, as well as lower risks of adjacent vertebral fractures and cement leakage, compared to PKP.

Correction for 'An immunological electrospun scaffold for tumor cell killing and healthy tissue regeneration' by Xingzhi Liu et al., Mater. Horiz., 2018, 5, 1082-1091, https://doi.org/10.1039/C8MH00704G.

OBJECTIVE:The refracture of the previously cemented vertebrae occurs rarely following percutaneous kyphoplasty (PKP). The present study was designed to assess the therapeutic efficacy of repeated PKP for refractures. METHODS:We conducted a retrospective analysis of 36 patients who underwent repeat PKP for refractures in same cemented vertebrae. The study evaluated the cement distribution pattern, restoration of middle vertebral height (MVH), and kyphosis angle (KA). Clinical efficacy was evaluated using visual analog scale (VAS) and the Oswestry Disability Index. A multivariate logistic regression model evaluated age, sex, cement volume, and bone mineral density, with the group's average pain reduction measured at 4.86 points on the VAS. RESULTS:Preoperative VAS scores averaged 7.75 ± 1.23, significantly decreasing to 2.89 ± 0.92 after surgery (P < 0.05). The Oswestry Disability Index significantly improved from 73.83 ± 14.58 preoperatively to 35.97 ± 9.85 postoperatively (P < 0.05). The MVH significantly increased from 12.49 ± 2.95 preoperatively to 16.83 ± 3.49 postoperatively (P < 0.05). The KA significantly increased from 19.22 ± 4.28 preoperatively to 12.01 ± 4.59 postoperatively (P < 0.05). The mean of the correction of KA was 7.17 ± 5.10 and the mean of the restoration rate of MVH was 17.09 ± 9.68. Cement volumes of up to 4.5 ml had about a 40% probability of achieving a minimum 4.86-point VAS reduction, while volumes of at least 4.5 ml showed an 84.6% probability. CONCLUSIONS:Repeated PKP effectively alleviates pain and restores spinal function in patients with refractures. A minimum cement volume of 4.5 ml appears optimal for achieving significant pain relief.

Self-assembling hydrogels have emerged as a promising class of biomaterials for bone regeneration due to their highly tunable properties, stimulus responsiveness, and excellent biocompatibility. While current research predominantly focuses on their applications as structural scaffolds or conventional drug delivery systems, recent advancements highlight their potential for spatiotemporal regulation of bone repair through advanced morphological engineering and multifunctional module integration. This review synthesizes recent progress in self-assembling hydrogel-based strategies aimed at enhancing bone regeneration, emphasizing their dual roles as bioresponsive carriers and architectural regulators. Particular emphasis is placed on their capacity for controlled release of bioactive agents and dynamic adaptation to microenvironmental stimuli, particularly when implementing synergistic design principles combining structural optimization with functional multiplexing. The interplay between these modalities within three-dimensional spatial contexts is systematically analyzed, revealing critical synergies that potentiate osteogenic outcomes. Finally, unresolved challenges related to degradation kinetics, vascularization induction, and precise spatiotemporal control are critically evaluated, along with proposed solutions to advance clinical translation. These collective insights underscore the transformative potential of self-assembling hydrogels in addressing the complexities of critical-sized bone defect regeneration while identifying key directions for future investigative efforts.

Objective To explore the clinical effect of percutaneous kyphoplasty (PKP) via process-rib-pedicle approach for upper and middle thoracic osteoporosis fractures with pedicle stenosis. Methods This study is a retrospective observational study. In this study, we retrospectively analyzed the data of 62 patients with upper thoracic vertebral bone loss compression fracture treated via the process-rib-pedicle pathway PKP at the First Affiliated Hospital of Soochow University from January 2020 to December 2022. The patients were divided into group A (unilateral PKP, 38 cases) and group B (bilateral PKP, 24 cases). The aspects of surgical safety, clinical efficacy, and radiological outcome were investigated. Results All 62 patients successfully completed the surgery without any spinal cord, nerve, or vascular injury, and there were no complications such as infection and vascular embolism. The differences in visual analog scale scores（P < 0.05）, Oswestry disability index functional index（P < 0.05）, and Cobb angle（P < 0.05） were significant when comparing preoperative and postoperative periods, and the differences were not significant when comparing the postoperative periods (P > 0.05). There were no statistically significant differences in days of hospital stay (P = 0.653) and the rate of bone cement leakage (P = 0.537) between the 2 groups. Conclusions For upper middle osteoporotic thoracic vertebral fractures with pedicle stenosis, puncture via the process-rib-pedicle path is a safe and reliable puncture route, and more than 2.5 ml of cement can achieve good clinical outcomes, regardless of bilateral or unilateral PKP.

To compare the safety and efficacy of posterior internal fixation with open vertebroplasty (VP) and posterior internal fixation with open kyphoplasty (KP) in the treatment of metastatic epidural spinal cord compression (MESCC) with posterior wall destruction. This retrospective study, conducted between January 2016 and May 2019, equally divided 60 patients with MESCC and posterior wall destruction into two groups based on the surgical method: open vertebroplasty with pedicle screw fixation (VP group) and open kyphoplasty with pedicle screw fixation (KP group). Visual analogue scale (VAS), SF-36 scores, middle vertebral height (MVH), and posterior vertebral height (PVH) were evaluated for the two groups preoperatively, postoperatively, and 1 year after surgery. Spinal Instability Neoplastic Score, Frankel grades and complications were recorded and evaluated. Five patients were excluded from the analysis, and our study cohort consisted of 55 adult patients who met the inclusion criteria. The VAS and SF-36 scores of these two groups of patients significantly improved, when compared with those before the surgery ( P < 0.05). There were significant differences in total cost (8835 ± 1468 vs 9540 ± 053 USD) and cement volume (4.51 ± 0.96 ml vs 6.35 ± 1.09 ml) between two groups ( P < 0.05). The MVH and PVH of these two groups of patients significantly improved, when compared with those before the surgery ( P < 0.05). The MVH was significantly larger in the KP group than in the VP group postoperatively (20.15 ± 4.86 vs 17.70 ± 3.78, P < 0.05) and at the final follow-up (20.42 ± 5.59 vs 17.28 ± 3.23, P < 0.05). However, the PVH of the two groups did not significantly differ at the two postoperative follow-ups ( P > 0.05). No significant differences were found in surgery time, time from surgery to discharge, blood loss and complications between both groups postoperatively ( P > 0.05). In the short term, both approaches are effective and safe in patients with MESCC and posterior wall destruction. The posterior internal fixation with open VP may be a good choice of surgical method in patients with MESCC and posterior wall defects.

Inducible costimulator (ICOS) and its ligand (ICOSL) are critical to regulate the immune response in autoimmune diseases. The participation of B lymphocytes exhibits pathogenic potential in the disease process of rheumatoid arthritis (RA). However, the precise role of ICOSL in RA remains unclear. In this study, we aimed to explore the regulatory effects of CD19+ICOSL+ B cells in the pathogenesis of RA. We demonstrated the increased expression of ICOS and ICOSL in patients with RA and collagen-induced arthritis (CIA) mice. The population of CD19+ICOSL+ B-cell subset was significantly correlated with clinicopathological characteristics of RA patients and CIA mice. Adoptive transfer of CD19+ICOSL+ B cells aggravated arthritic progression in CIA mice. Moreover, microarray analysis revealed that CD19+ICOSL+ cells could exert pivotal effect in pathological process of RA. Further blocking of ICOSL significantly inhibited proinflammatory responses and ameliorated arthritic progression. Therefore, CD19+ICOSL+ B-cell subset could be defined as a specific pathogenic cell subpopulation involved in immunopathological damage of RA. Blockade of ICOSL is promising to be a potential new approach for RA therapy.

To compare the efficacy and safety of kyphoplasty (KP) in the treatment of occult metastatic vertebral tumors (OMVT) and non-occult metastatic vertebral tumors (MVT). From January 2013 to December 2017, 65 cases of occult metastatic vertebral tumors and 82 cases of metastatic vertebral tumors were selected and divided into 2 groups. After KP, they were followed up by a year of outpatient visits and telephone calls. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores, the amount of bone cement injected, the change of vertebral height and the incidence of complications were recorded, compared and analyzed by SPSS software. t test was used to compare the differences between the same group of patients at different times and between the 2 groups of patients. In the OMVT group, the operation time was 24.52 ± 4.24 minutes, the fluoroscopy time was 10.18 ± 1.53 minutes and the volume of bone cement was 3.62 ± 0.93 ml. The VAS score decreased from 7.26 ± 01.08 preoperatively to 2.77 ± 0.93 postoperatively (P < .01). The ODI score decreased from 64.89 ± 9.05 preoperatively to 25.82 ± 4.63 postoperatively (P < .01). In the MVT group, the operation time was 26.63 ± 4.61 minutes, the fluoroscopy time was 11.04 ± 2.15 minutes and the volume of bone cement was 4.09 ± 1.10 ml. The VAS score decreased from 7.73 ± 0.94 preoperatively to 3.22 ± 0.80 postoperatively (P < .01). The ODI score decreased from 69.20 ± 7.14 preoperatively to 28.02 ± 4.40 postoperatively (P < .01). The vertebral height of MVT patients was significantly improved after operation (P < .01), but there was no difference in OMVT patients (P > .05). Occult metastatic vertebral tumors can be detected by Magnetic Resonance Imaging (MRI), and KP may be more effective and safer in the treatment of OMVT.

Objective To evaluate the safety and efficacy of O‐arm‐guided minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for metastatic spinal tumors with posterior wall destruction. Methods Patients who underwent minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for pathological vertebral fractures with posterior wall defects from January 2015 to December 2017 were followed up for 1 year. Visual analogue scale (VAS), SF‐36 scores, middle vertebral height, posterior vertebral height, and the accuracy of pedicle screws were assessed preoperatively, postoperatively, and 1 year after surgery. The operation time, time from operation to discharge, blood loss, volume of bone cement, and leakage of bone cement were recorded. Results Twenty‐three patients (13 females and 10 males) who met our criteria were followed up for 1 year. The operation time of these patients was 162.61 ± 33.47 min, the amount of bleeding was 230.87 ± 93.76 mL, the time from operation to discharge was 4.35 ± 2.42 days, and the volume of bone cement was 3.67 ± 0.63 mL. The VAS score decreased from 7.04 ± 1.07 to 2.65 ± 0.93 before surgery ( P = 0.000) and remained at 2.57 ± 0.79 1 year after surgery. Compared with the preoperative SF‐36 scores for physical pain, physiological function, energy, and social function, the postoperative scores were significantly improved ( P = 0.000). The height of the middle vertebral body increased from 14.47 ± 2.96 mm before surgery to 20.18 ± 2.94 mm ( P = 0.000), and remained at 20.44 to 3.01 mm 1 year after surgery. The height of the posterior vertebral body increased from 16.56 ± 3.07 mm before operation to 22.79 ± 4.00 mm ( P = 0.000), and 22.45 ± 3.88 mm 1 year after surgery. The 23 patients had a total of 92 pedicle screws; 85 screws were Grade A and 7 screws were Grade B. There was no leakage of bone cement after surgery. Conclusion In the short term, O‐arm‐guided minimally invasive pedicle screw fixation combined with kyphoplasty is safe and effective in the treatment of metastatic spinal tumors with posterior wall destruction.

Polyurethane (PU) and polyurea (PUA) materials have shown significant potential for application in tissue repair. Herein, we design a glycerol ethoxylate (PEG)-based poly(urethane-urea) for bone tissue repair. The polymer precursor was prepared from the reaction of PEG and isophorone diisocyanate (IPDI). The cystine dimethyl ester was used as a cross-linker for the preparation of poly(urethane-urea) elastomers. The material was further strengthened by physical blending of nano-hydroxyapatite (nHA). The physical and biological properties of final material were evaluated by mechanical testing, scanning electron microscopy characterization, degradation tests, cell proliferation and cell differentiation assays. The obtained scaffolds showed good mechanical strength, excellent biocompatibility and osteogenic capability. All the evidences demonstrated that this type of materials has good prospects for bone tissue repair application.

Background: Kyphoplasty (KP) is a palliative treatment for patients with metastatic vertebral tumors. The distribution pattern of cement affects safety and efficacy. The distribution pattern of cement has not been previously reported for patients with metastatic vertebral tumors. Material/Methods: From January 2013 to December 2017, patients with metastatic vertebral tumors who met our criteria were divided into cement fusion (n=91) and separation (n=97) groups. Visual analogue scale (VAS) and middle vertebral height (MVH) were evaluated preoperatively, postoperatively, and 1 year after surgery. Spinal Instability Neoplastic Score, fluoroscopy time, operation time, cement volume, cement leakage, and vertebral fractures were recorded and evaluated. Results: Compared with the fusion group, the separation group had significantly different (P<0.001) operation time, fluoroscopy time, and cement volume. Compared with preoperative status, VAS and MVH were significantly improved 3 days postoperatively and 1 year postoperatively in both groups (P<0.001). The difference in cement leakage between the 2 groups (P<0.05) and in the number of adjacent vertebral fractures between the 2 groups (P<0.05) were significant. Conclusions: The distribution patterns of the bone cement had a good analgesic effect and preventive effect on vertebral collapse. However, the separation of bone cement may be safer.

Background L3 vertebral fractures with posterior dislocation are rare and usually secondary to high-energy trauma. To assess the outcome of a valuable distraction technique, using long-tail multiaxial pedicle screw which we have employed in reduction of L3 vertebral fracture with posterior dislocation, and emphasize the importance of preoperative blood vessel evaluation. Case presentation A 47-year-old patient fell from a height of 4 m and was paralyzed. Computed tomography scan revealed a three-column ligamentous injury with posterior fracture-dislocation of the L3 vertebral body. Computed tomography angiography showed that the third lumbar artery was ruptured without active bleeding. The patient underwent posterior approach with reduction, transpedicular fixation, and posterolateral fusion with autologous bone graft. Finally, Vertebral reduction and sagittal balance were achieved and patients recovered well after operation. Conclusion Preoperative blood vessel evaluation is very important to avoid massive bleeding during the surgery, and the standard technique which can achieve good reduction is easy to understand, perform, and is reproducible.

Objective To compare the safety and efficacy of kyphoplasty in the treatment of occult and non-occult osteoporotic vertebral compression fractures (OOVF). Material and Methods From 2015 to 2017, 82 OOVF and 105 non-occult osteoporotic vertebral compression fractures (N-OOVF) were evaluated with the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and vertebral height preoperatively, immediately postoperatively, and one year postoperatively. Operative time, fluoroscopy time, and cement injection volume were recorded. Results Compared with the preoperative VAS and ODI scores, the scores of both groups were significantly improved after surgery. Preoperative ODI and VAS scores of the OOVF were lower than those of the N-OOVF. The operative time, fluoroscopy time, and bone cement injection volume of the OOVF were significantly lower than those of the N-OOVF. Vertebral height of the N-OOVF improved significantly after surgery. There were differences in cement leakage and adjacent vertebral fractures between the two groups. Conclusion Compared with N-OOVF, OOVF are safer with kyphoplasty, and it is necessary to diagnose OOVF in a timely manner.

Osteoporosis greatly impairs in vivo implant osseointegration because of poor osteogenesis in osteoporotic conditions and the low bioactivity of implants, such as titanium-based biomaterials. Various surface engineering strategies, including unstable physical absorption or complex chemical conjugations, have been developed to biofunctionalize titanium implants and improve interfacial osseointegration. However, very few of them took into consideration the clinically challenging osteoporotic condition, as well as dual-functionalization of the implants for improvement of both osteoblast adhesion and osteogenesis. In this work, we combined two mussel-inspired bioactive peptides (i.e., with cell adhesive or osteogenic sequences) for one-step dual-functionalization of Ti screws via a facile self-organized multivalent coordinative interaction. In vitro study indicated that the biomimetic dual-functional coating could efficiently improve the osteogenesis of osteoporosis-derived mesenchymal stem cells despite of their impaired bone metabolism. Moreover, under osteoporotic in vivo condition, the dual-functional peptide coating on Ti screws could also give rise to significant enhancement of interfacial osteogenesis, newly formed bone condition, osseointegration, as well as implant mechanical stability. This is probably due to the integrin-targeted cell adhesive and osteogenic motifs on the modified Ti screws, which recovered the regular bone metabolism equilibrium between osteogenesis and osteoclastogenesis in an osteoporotic condition. We anticipate that the highly biomimetic peptides and one-step dual-functionalized strategy would provide a facile and effective means for improving the clinical outcome of Ti-based implants in patients with a disturbed bone metabolism.

An immunological tissue engineering scaffold is fabricated using anti-CD40 antibody grafted in electrospun fibers for inducing cancer cell apoptosis, activating immune response and promoting healthy tissue regeneration.

Calcium phosphate cement (CPC) is one of the most promising bone-filling materials and drug carriers, but its clinical applications are often limited by its poor mechanical properties and lacking osteoinduction. This paper aimed to improve the preformation of CPCs by adding silk fibroin (SF) and chitosan (CS)-N-acetylcysteine (NAC) nanoparticles (CSNACSF cements), to the best of our knowledge we are the first ones to do so. As a result, the incorporation of SF and CS-NAC nanoparticles successfully increased the compressive strength of CPCs. In addition, CPCs containing SF and CS-NAC nanoparticles exhibited a higher potential in enhancing the expression of osteogenic gene makers and promoting :osteogenic differentiation, as compared with the blank ones. Thus, these CSNAC-SF cements could be useful tools in clinical applications.

Periosteum plays the pivotal role in neomineralization, vascularization and protection during bone tissue regeneration. However, many artificial periosteum focused only on protection and lacked of the osteogenesis and angiogenesis functional capacity. In this study, we developed a novelty inorganic strengthened gelatin hydrogel membrane via inorganic and organic co-cross-linked double network as artificial periosteum for enhancing the durable angiogenesis and osteogenesis in bone reconstruction. Mesoporous bioactive glass nanoparticles (MBGNs) chemically modified with photo-cross-linkable gelatin derivative (GelMA) were further incorporated into GelMA to fabricate an organic/inorganic co-cross-linked hydrogel membrane (GelMA-G-MBGNs). The GelMA-G-MBGNs hydrogel membrane displayed better mechanical property, durable degradation time, pH stable, biomineralization and long-term ion release. In vitro study demonstrated that, when compared with GelMA or GelMA/MBGNs, the GelMA-G-MBGN membrane significantly promoted osteogenic differentiation while maintaining stable local pH, which is conducive to cell adhesion and proliferation. Finally, the GelMA-G-MBGN membrane shows a superior artificial periosteum with superior capacity in angiogenesis and osteogenesis for accelerating new and mature lamellar bone formation in rat calvarial critical size defect. This co-cross-linked hydrogel membrane implied a promising strategy for the development of advanced periosteum biomaterials with excellent handle and bone repairing properties.

Objective: To assess the effects of axial vibrations on gene expression and lumbar intervertebral disc degeneration in vivo. Methods: A modified bipedal rat model was established using a brachial plexus rhiZotomy approach to imitate human upright posture. The experimental animals were randomly divided into three groups: control, vertical vibration, and whole-body vibration. Gene expression in degeneration of the intervertebral discs was assessed by reverse transcription-quantitative polymerase chain reaction. Results: The expression of aggrecan, Col1 alpha 1, Col2 alpha l, and decorin were shown to be up-regulated in 14-week-old rats in the vertical vibration and whole-body vibration groups, whereas biglycan and versican expression was down-regulated in 14-week-old rats of the two experimental groups. Furthermore, biglycan and versican expression levels were shown to be lower in the whole-body vibration group than in the vertical vibration group (P<0.05). Conclusions: This in-viva study demonstrated that vibrations can influence the expression of anabolic genes. Furthermore, whole-body vibrations seem to have a greater effect in this regard than vertical vibrations. A new method is expected to relieve the low back pain of the patients through our research.

We thank Sun et al for their interest in our study on percutaneous vertebroplasty (PVP) in painful Schmorl’s nodes (SNs) (1). In response to their concerns and opinions, we would like to clarify the following points: There is obvious oedematous rim around SNs in T2 weighted Magnetic Resonance Imaging (MRI) presented in our article, which is regarded as the evidence diagnosing symptomatic SNs (2). Moreover, there is still no evidence to identify that the more significant oedematous rim, the higher degree of pain caused by SNs. So, it is possible that the SNs are symptomatic even the oedematous rim in MRI is not so significant. In our article, we stated that “The symptoms associated with some SNs may be due to inflammatory changes around the herniated nucleus pulposus of the diseased vertebra” (1). But we didn’t describe the specific mechanism about it. Micromovements, inflammation and pressure on nociceptors within the oedematous area probably induce back pain, as Sun et al concluded (3,4). Sun et al reported their study about the effectiveness and safety of percutaneous kyphoplasty (PKP) to symptomatic SNs. Their thoughtful research identified that PKP could be regarded as an effective and safe approach to symptomatic SNs refractory to conservative therapy. They propose the use of PKP over PVP as a therapeutic strategy in patients with symptomatic SNs with the reason that PKP can reduce the probability of cement leakage when comparing with PVP (5). However, there is still no evidence showing that PKP is superior to PVP in treating vertebral compression fractures (VCFs) (6). As Sun et al said, there is clear evidence that cement extravasation is less frequent for PKP than for PVP due to lower cement injection pressure following balloon cavity creation, which is the most important advantage of PKP over PVP (7,8). Also, PKP resulted in greater kyphosis correction (9). However, several studies demonstrated that there is no difference between PKP and PVP when regarding the pain reduction (7,10-12). A large retrospective review comparing conservative therapy, PVP and PKP using Medicare date, found that both PVP Reply to: Percutaneous Vertebral Augmentation for the Treatment of Symptomatic Schmorl’s Nodes: Our Viewpoint and Experience