Organs age at different rates, yet the protective mechanisms contributing to decelerated aging in certain tissues remain unclear. Applying cross-tissue comparisons to molecular readouts of aging, here we report that the intervertebral disc (IVD) ages slowly. We link the rate of aging to the persistently hypoxic environment of the IVD, and its unique ability to degrade hypoxia-inducible factor-1α (HIF-1α) in nucleus pulposus cells through optineurin-mediated selective autophagy, thereby uncoupling hypoxia from HIF-1α accumulation and limiting cellular stress. Further, we developed a small-molecule HIF-1α-targeting autophagy-tethering compound (HATC) to pharmacologically export the protective mechanism to other tissues. In aged mice, systemic weekly administration of HATC reduced HIF-1α levels across multiple organs, ameliorated a range of age-related pathologies and significantly extended both median (~14%) and maximum lifespan (~12%). These findings define a regulatory axis in which HIF-1α degradation under hypoxia contributes to longevity, and support HATC as a geroprotective strategy to improve healthspan.

BACKGROUND:Cervical canal stenosis is one of the important pathogenic factors of cervical spondylosis. The accuracy of the Pavlov ratio measurement is crucial for the diagnosis and treatment of cervical spinal stenosis. Manual measurement is influenced by observer variability, accompanied by its inefficiency, which affects clinical evaluation. PURPOSE:To automatically and accurately measure the Pavlov ratio, we develop a novel deep-learning model by detecting keypoints of cervical spine and measure the Pavlov ratio on plain lateral cervical spine radiographs. METHODS:We developed a two-stage deep-learning model; in the first stage, we employ the YOLOX model as the object detection network to locate the ROIs containing the vertebral bodies and spinous processes; in the second stage, we introduce the high-resolution net (HRNet) as keypoint detection network and a series of deconvolutional networks (DNs) as the heatmap-based regressor. Based on the mentioned combining algorithms, we can rapidly detect the 38 keypoints in plain lateral cervical spine radiographs, and then measure the Pavlov ratio of the cervical spine. Radiographs from Shanghai Changhai Hospital (a total of 874) were split into training and test subsets (787 and 87 radiographs, respectively). One hundred twelve cases from Shanghai Changzheng Hospital and 108 cases from Shanghai Fourth People's Hospital are used as external validation datasets. RESULTS:Our proposed model successfully achieved the objective of automating the recognition of spinal landmarks with the mean absolute error (MAE)ranged from 0.05 to 0.08, and the symmetric mean absolute percentage error (SMAPE) ranged from 4.54% to 6.43%. The achieved accuracy is comparable to that of seasoned medical professionals and notably surpasses the performance of junior physicians (SMAPE ranged from 8.74% to 26.19%). Furthermore, our model demonstrated excellent accuracy in external validation experiments (SMAPE ranged from 4.40% to 5.95%). CONCLUSION:This study presents a novel YOLOX-HRNet-DN model to assist landmarks identification on lateral cervical spine radiographs and demonstrates excellent accuracy in measuring the Pavlov ratio. The proposed method could provide a potential tool for the automatic estimation of the Pavlov ratio to improve the efficiency and accuracy of the treatment workflow.

Intervertebral disc degeneration (IDD) is a major cause of chronic low back pain, the mechanism of which is still unclear. Inflammation-induced extracellular matrix metabolism (ECM) dysregulation in the nucleus pulposus (NP) and NP cell senescence are known to be the key causes of IDD. However, few drugs can reliably alleviate ECM dysregulation and NP cell senescence. Muscone, as the key natural component of musk, is a widely applied antiapoptotic and anti-inflammatory drug. We found Muscone exerts protective effects by inhibiting the expression of ECM catabolism-related genes, cell apoptosis, the cell senescence and senescence-associated secretory phenotype (SASP) in NP cells, which is the key cellular phenotype associated with IDD. We have also shown that muscone can increase the expression of ECM anabolism-related genes and the proliferation of NP cells during inflammation. High-throughput RNA sequencing indicated that muscone protects NP cells mainly by altering the phosphorylation and expression of p53. Further validation confirmed both in vivo and in vitro that muscone could regulate ECM-related genes, cell apoptosis, cell senescence and the SASP by inhibiting p53. In summary, our findings show that muscone protects against the degeneration of nucleus pulposus cells by inhibiting p53 signaling and thus may have therapeutic value for IDD.

To investigate the long-term outcomes of young spondylolysis patients treated with smiley face rod surgery. The study is a retrospective analysis of the clinical data of 45 young lumbar spondylolysis patients from 2008 to 2024. All patients underwent smiley face rod surgery and the follow-up period ranged from 3 months to 17 years. The clinical outcomes (VAS score, ODI index, and Odom score) and radiological evaluations were compared before/after surgery and at the final follow-up. All the participations reported satisfactory short-term outcomes after smiley face rod surgery, with VAS scale and ODI index improved significantly 3 months after surgery. The VAS scale and ODI index both maintained good enough until final follow-up (mean 11.2 years). The successful union rate was only 57.5% at 12 months after surgery and 58.6% at final follow-up, as shown in 3D-CT scan. And the VAS and ODI scales had no statistical difference between the healed and unhealed patients. The smiley face rod technique demonstrated long-term satisfactory outcomes for treating young spondylolysis. Though the healing rate was only 57.5-58.6%, all patients reported excellent clinic outcomes and the healing status had no impact on clinic outcomes.

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

Loss of neurons and disruption of neural circuits are associated with many neurological diseases,including neurodegenerative diseases and mental disorders. The most prevalent pathological feature of neurodegenerative diseases is the aggregate loss of certain neuronal populations.

Cervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis. It is challenging to achieve early diagnosis with current clinical diagnostic tools. In this paper, we propose an end-to-end deep learning approach for early diagnosis of CSM. Electroencephalography (EEG) experiments were conducted with patients having spinal cord cervical spondylosis and age-matched normal subjects. A Convolutional Neural Network with Long Short-Term Memory Networks (CNN-LSTM) model was employed for the classification of patients versus normal individuals. In contrast, a Convolutional Neural Network with Bidirectional Long Short-Term Memory Networks and attention mechanism (CNN-BiLSTM-attention) model was used to classify regular, mild, and severe patients. The models were trained using focal Loss instead of traditional cross-entropy Loss, and cross-validation was performed. Our method achieved a classification accuracy of 92.5 % for the two-class classification among 40 subjects and 72.2 % for the three-class classification among 36 subjects. Furthermore, we observed that the proposed model outperformed traditional EEG decoding models. This paper presents an effective computer-aided diagnosis method that eliminates the need for manual extraction of EEG features and holds potential for future auxiliary diagnosis of spinal cord-type cervical spondylosis.

目的 探讨椎管扩大椎板成形术联合MRI T2加权像髓内高信号（ISI）节段单侧侧块螺钉内固定治疗多节段脊髓型颈椎病（MCSM）的临床疗效。方法 2015年1月—2019年1月收治伴MRI T2加权像髓内ISI的MCSM患者59例，其中26例采用椎管扩大椎板成形术联合MRI T2加权像髓内ISI节段单侧侧块螺钉内固定治疗（A组），33例采用单纯椎管扩大椎板成形术治疗（B组）。记录2组手术时间、术中出血量及并发症发生情况。采用日本骨科学会（JOA）评分及其改善率评价神经功能状态。在颈椎X线片上测量C 2～7 Cobb角，计算颈椎整体活动度（ROM）。测量髓内信号改变比值（SCR=ISI区域光密度值/C 7 ～T 1 正常区域光密度值），定量评估髓内ISI程度，并进一步分析SCR变化值对JOA评分及其改善率的影响。结果 所有手术顺利完成。2组手术时间、术中出血量差异无统计学意义（P＞0.05）。A组术后JOA评分及其改善率、术后SCR及其变化值明显高于B组，差异均有统计学意义（P＜0.05）。2组术后C 2～7 Cobb角、颈椎整体ROM及其保留率差异无统计学意义（P＞0.05）。2组并发症发生率差异无统计学意义（P＞0.05）。SCR变化值显著改变组的JOA评分改善率最高，中度改变组次之，轻度改变组最低，3组间两两相比，JOA评分改善率差异均有统计学意义（P＜0.05）。结论 对于伴MRI T2加权像髓内ISI的MCSM患者，椎管扩大椎板成形术联合MRI T2加权像髓内ISI节段单侧侧块螺钉内固定具有较好的临床和影像学结果，尤其在术后髓内ISI的改善方面具有一定优势。

EEG plays a vital role in early disease diagnosis. In this paper, we conduct brain network analysis using EEG to visualize differences among healthy individuals, mild cervical myelopathy patients, and severe cervical myelopathy patients. We explore specific evaluation indexes and analyze brain functional connectivity based on the phase lag index (PLI). We discover significant differences in functional connectivity among the three categories during imagined fist clenching, imaginary leg flexion and extension, and actual leg flexion and extension using full band EEG. Additionally, we find a significant correlation between brain network properties and JOA clinical scores in patients. Finally, we utilize three machine learning methods to classify the PLI matrix and brain network attribute features, achieving the highest accuracy rate of 79.2%. This classification aids in grading CSM disease.

Study Design A retrospective observational study. Objective To describe a novel outcome indication system, the posterior compression score (PCS), and investigate its clinical value in cervical ossification of the posterior longitudinal ligament (OPLL) patients treated with laminoplasty. Methods A total of 282 OPLL patients who underwent laminoplasty from January 2013 to December 2018 were reviewed. The patients were divided into high-score (HS) or low-score (LS) groups based on whether the PCS was over 8. Propensity score matching analysis with a caliper of .1 was used to attenuate the potential selection bias. Clinical measurements, including the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS), neck disability index (NDI), and radiological measurements, including C2–C7 lordotic angle and range of motion (ROM), were compared between the groups. Results The mean follow-up period was 29.87 ± 9.17 months. There were no significant differences between the two groups regarding patients’ baseline demographical and clinical characteristics after propensity score matching. No significant differences were found in the operative time, blood loss, postoperative VAS score for neck and arm pain, postoperative C2–C7 lordotic angle, or postoperative ROM ( P > .05). However, the postoperative JOA score and recovery rate were significantly higher in the HS group than in the LS group, while the postoperative NDI was significantly lower in the HS group ( P < .05). Conclusion OPLL patients with higher PCS scores displayed better clinical outcomes. The novel PCS system is suggested to be a reliable scoring system for surgical outcome evaluation in patients with cervical OPLL.

Objectives: Intervertebral disc (IVD) degeneration is an important disease with no efficient biological therapy identified. Autophagy, a wildly known therapeutic target for human disease, has been demonstrated to be activated under hypoxia, with underlying mechanism remains elusive. Thus, this study aims to specify the role of autophagy in IVD degeneration, the regulating mechanism of hypoxia-inducing autophagy, and the therapeutic value of autophagy for IVD degeneration. Methods: RNA-seq was used to screen the primary pathway affected in NP cells under hypoxia, the specific link between hypoxia and autophagy were investigated using ChIP-seq and dual luciferase reporter assay. Conditional ATG7 knockout mice (ATG7(-/-)) were constructed for assessing the effect of autophagy on IVD degeneration, and puncture induced mice model of IVD degeneration were used for intradiscal injection to evaluate the therapeutic value of autophagy. Results: We demonstrated that hypoxia induces autophagy by transcriptional activation of autophagic gene LC3B and ATG7, which is controlled by PERK signaling. Then, we observed that inhibiting autophagy or PERK signaling leads to impaired NP cell viability and function, furthermore, using ATG7 knockout (ATG7(-/-)) mice, we identified the protective role of autophagy in IVD. Furthermore, we found that intradiscal injection of PERK signaling agonist, CCT020312, significantly restores the degeneration level of needle punctured mice IVD. Conclusion: We showed that the activation of PERK signaling upon hypoxia serves as a vital mechanism to induce autophagy and identified the therapeutic value of PERK signaling agonist for IVD degeneration treatment. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International.

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

BACKGROUND CONTEXT:The theoretical advantage of cervical disc arthroplasty includes preserved motion at the cervical level, which may reduce degeneration of the adjacent segments. The long-term follow-up results are still controversial. PURPOSE:The present study aimed to retrospectively study the long-term efficacy and complications of cervical disc arthroplasty using a single commercially-available device in a single center. STUDY DESIGN:This was a propensity-score matched cohort study. PATIENT SAMPLE:This study enrolled 148 single-level cervical degenerative disease patients from January 2009 to March 2012. After 1:1 propensity score matching, 39 patients remained in the ACDF or ACDR groups. OUTCOME MEASURES:The outcome measures were neurological functions (Neck Disability Index (NDI) and Japan Orthopedic Association (JOA) scores), radiographic evaluations (cervical curvature, operative segment range of motion, degenerative condition of adjacent segments, heterotopic ossification (HO) of the surgical segment), and complications. METHODS:NDI and JOA scores were used to evaluate patient neurological functions. Cervical curvature (C2-C7 Cobb angle) and operative segment range of motion (ROM) were compared between the two groups. Grading criteria for osteophyte formation were used to evaluate the degenerative condition of adjacent segments. HO after ACDR was graded according to the McAfee grading method. RESULTS:The average follow-up time was 119.3 ±17.2 months. Satisfactory improvements in neurological function were obtained for both the ACDR and ACDF groups. There were no significant differences in VAS or NDI scores between the two groups. In the ACDR group, the ROM of the operative segment increased from 6.7 ±4.3° before the operation to 8.9 ±3.5° on the second day after the operation (p<.001). The ROM of the operative segment was 8.1 ±4.0° at the 1-year follow-up, 7.2 ±3.6° at the 2-year follow-up, 5.7 ±4.5° at the 5-year follow-up and 4.3 ±3.9° at the last follow-up. ASD was more likely to develop in the caudal adjacent segments and progressed with the follow-up time. At the last follow-up, HO was present in 27 patients (69.23%), while high-grade HO (McAfee scores III and IV) was detected in 6 patients (15.38%). CONCLUSIONS:Through nearly 10 years of follow-up, ACDR was as effective as ACDF for treating single-level degenerative cervical disc disease. However, HO and the role of ACDR in the protection of ASD remains to be further observed and followed up.

Recurrent low back pain after spinal surgeries, such as lumbar laminectomy, is a major complication of excessive epidural fibrosis. Although multiple preclinical and clinical methods have been aimed at ameliorating epidural fibrosis, their safety and efficacy remain largely unclear. Single implanted electrospun fibrous membranes provide physical barriers that can decrease tissue fibrosis after surgery; however, they also trigger local inflammation due to the implantation of a foreign body, thus subsequently attenuating their anti-fibrosis properties. Here, we designed a strategy that permits easy incorporation of mefloquine into polylactic acid membranes, and stable long-term mefloquine release, to potentially improve anti-fibrosis effects and relieve or prevent low back pain. The electrospun fibrous membranes grafted with mefloquine showed a well-controlled early temporary peak release, and secondary drug release occurred smoothly over several weeks. Histopathological and histomorphometric results indicated that the drug-loaded membranes had excellent anti-fibrosis effects after laminectomy in rats. Inflammation and neovascularization at the surgical site indicated that the mefloquine-grafted electrospun fibrous membranes provided sustained anti-inflammatory outcomes while effectively alleviating associated neuropathic pain hypersensitivity. In summary, our study indicated that polylactic acid-mefloquine grafted electrospun fibrous membranes may be a potential local agent to mitigate epidural fibrosis and support sensory neurological function after laminectomy, thereby potentially improving patients' postoperative outcomes.

ObjectiveTo evaluate the clinical efficacy and practicality of anterior trans‐intervertebral space decompression and fusion (ATIDF) by comparing radiological and clinical outcomes between ATIDF and traditional anterior cervical corpectomy and fusion (ACCF) in cervical spondylosis patients with severe disc space narrowing.MethodsSeventy‐one cervical spondylosis patients with severe disc space narrowing underwent anterior cervical spine surgery were included in this retrospective study. Thirty‐seven patients underwent ATIDF and 34 patients underwent ACCF. The neck disability index (NDI), Japan Orthopaedic Association (JOA) score and the Hirabayashi improvement rate were used to evaluate patient neurological status. Cervical sagittal alignment (C2–C7 Cobb angle), surgical segment sagittal alignment (Cobb angle of surgical segment) and disc space height were also compared between the two groups.ResultsThere were 39 males and 32 females; mean age was 63.72 ± 6.36 years (range, 39–81 years). Mean follow‐up was 22.4 months (range, 6–45 months). All patients achieved an adequate neurological improvement. There were no significant differences in NDI, JOA scores and Hirabayashi improvement rate between the two groups. The change of C2–7 Cobb angle and surgical segment Cobb angle were both greater in the ATIDF group. The average intervertebral height ratio of the patients in the ATIDF group increased significantly after surgery (0.38 ± 0.17 before surgery to 1.13 ± 0.32 after surgery, P < 0.01). The overall complication rate was lower in the ATIDF group than the ACCF group (35.14% and 44.12%). At 6 months follow‐up, three patients in the ACCF group presented with subsidence of the titanium mesh cage.ConclusionATIDF is an effective technique for treating cervical spondylosis with severe disc space narrowing; it can achieve adequate decompression and improve sagittal alignment while avoiding and reducing the implant‐related complications inherent to traditional ACCF.

Background Although ACDF has been widely used in treating cervical spondylosis and related diseases, the complications along with this anterior surgical technique have hindered its application and affected the postoperative outcome of the patients. Here, we investigated the clinical and radiological outcomes of a new integrated low-profile anterior plate and cage system for anterior cervical discectomy and fusion (ACDF) in treating cervical spondylosis. Methods A total of 96 cervical spondylosis patients who underwent single-level ACDF between 2018 to 2020 in our institute were enrolled. There were 28 patients using the new implants and 68 patients using the zero-profile (Zero-P) implants. The Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) were used to evaluate the clinical outcomes. The cervical and segmental Cobb angle and range of motion (ROM) were used to assessed the radiological outcomes. Incidence of complications were also recorded. All data were recorded at pre-operation, 6-month and 12-month post-operation. Results All patients were followed-up for at least 1-year, the mean follow-up time was over one year. The fusion rate was similar in the two groups. There was no significant difference in the postoperative JOA score recovery rate, postoperative VAS score of neck and arm pain, postoperative ROM, and incidence of complications between two groups ( P > 0.05). However, postoperative cervical and segmental Cobb angle were better maintained in the new low-profile implant group compared to Zero-P group. Conclusions The clinical outcomes of the new low-profile implant were satisfactory and comparable to that of zero-profile system. It may have advantages in improving and maintaining the cervical lordosis, and can be an alternative device for single-level cervical spondylosis treated with ACDF.

OBJECTIVE:To investigate the related problems of three-dimension CT navigation system applied to craniocervical junction malformation diseases surgery. METHODS:The clinical data of 61 patients with craniocervical junction malformation disease who underwent surgical treatment from July 2015 to March 2018 was retrospectively analyzed. There were 39 males and 22 females aged from 25 to 73 years old with a mean of (46.20±12.09) years. According to the different ways of screw placements, these patients were divided into navigation group (30 cases) and non navigation group (31 cases). The screws insertion in the navigation group were guided under three-dimension CT computer-aided navigation system, while the screws insertion were guided by C-arm fluoroscopy and intraoperative anatomical landmarks in non-navigation group. All surgeries were performed by the same group of surgeons. All cases were scanned by CT after operation to assess the accuracy of the screw insertion. RESULTS:A total of 122 screws were inserted in the study, including 60 screws in navigation group and 62 screws in non-navigation group. The screw positions in navigation group were all satisfactory, and there were no screw-related complications. The position of 3 screws (4.83%) in non-navigation group was not satisfactory, and there was no obvious neurological symptoms after operation. The operation time of navigation group was from 87.5 to 112.5 min with a mean of (99.6± 12.0) min;and non-navigation group was from 87.5 to 107.5 min, with a mean of (97.5±10.5) min. There was no statistically significant difference in the operation time between two groups (P>0.05). The screw insertion time in navigation group was from 1.50 to 4.20 min, with a mean of (2.51±1.02) min;and non navigation group was from 1.80 to 5.10 min, with a mean of (3.25±1.05) min. The screw insertion time in navigation group was shorter than that in non-navigation group (P<0.05). The intraoperative blood loss in navigation group was from 122 to 153 ml, with a mean of (137.57±9.48) ml, which in non-navigation group wasfrom 121 to 158 ml, with a mean of (138.75±8.56) ml, there was no statistically significant difference between two groups (P>0.05). CONCLUSION:The three-dimensional CT computer-aided navigation system has the characteristics of clear imaging and accurate positioning, which can help improve the accuracy and safety of the screw insertion in craniocervical junction malformation disease surgery.

Background: The surgical outcomes of individual patient with ossification of the posterior longitudinal ligament (OPLL) can vary depending on various patient-related factors. Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) is a well-developed tool for outcome measurement and considers both disease-specific and general health aspects. This study aimed to investigate the reliability, validity, and responsiveness of the JOACMEQ in patients with OPLL in mainland China and to compare post-operative outcomes of OPLL patients between mainland China and Japan.Methods: This multicenter trial was performed between July 2009 and June 2019. The procedure for the JOACMEQ translation followed Beaton’s guidelines. All patients enrolled were diagnosed with OPLL and had completed the JOACMEQ, the modified Japanese Orthopaedic Association (mJOA) scale, and the 36-Item Short Form Health Survey (SF-36) before and after surgery. The reliability (Cronbach’s α and Pearson’s correlation), construct validity (factor analysis), concurrent validity (Spearman’s correlation with SF-36) and responsiveness (effect sizes) of JOACMEQ were evaluated. A mixed-model analytic approach was used to analyze differences in postoperative outcomes between the 2 countries.Results: Ninety-one patients from mainland China and ninety-one patients from Japan were recruited. JOACMEQ showed satisfactory internal consistency (Cronbach’s α=0.75). In test-retest reliability evaluation, except for the bladder function domain, the JOACMEQ domains had good test-retest reliability (0.89–0.96). In factor analysis, most of the items (19/24) were well clustered. Regarding clinical validity, all 5 domains were found to have moderate correlations with the physical component summary (PCS) of SF-36 (r=0.25–0.50), and the bladder function and quality of life domains also had moderate correlations (r=0.25–0.50) with the mental component summary (MCS) of SF-36. JOACMEQ showed a variable responsiveness in different domains (effect size =0.17–0.84; standardized response means =0.15–0.85). Regarding postoperative improvements in the JOACMEQ score, mixed-model analysis revealed a significant difference in the quality of life domain between Chinese and Japanese patients (16.0±18.7 vs. 7.8±17.7, P<0.05).Conclusions: JOACMEQ generally shows good reliability, good validity and mild responsiveness, and can identify the post-operative improvements in patients with OPLL in mainland China. Chinese OPLL patients showed a significantly larger improvement in postoperative quality of life compared to their Japanese counterparts.

目的 比较颈椎前路椎间盘切除融合术(ACDF)中采用零切迹椎间融合器(Zero-P)与钉板系统(PCC)治疗单节段颈椎椎间盘突出症对术后颈椎曲度的影响.方法 回顾性分析2016年5月—2018年3月在本院接受ACDF治疗的136例单节段颈椎椎间盘突出症患者临床资料,其中71例术中采用Zero-P(Zero-P组),65例采用PCC(PCC组).记录2组手术时间,术中出血量,术前及术后1、6、12和24个月日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分、C2～7颈椎曲度、手术节段Cobb角及邻近椎体高度,术后植骨融合及内固定相关并发症情况.结果 所有手术顺利完成,Zero-P组手术时间明显短于PCC组,差异有统计学意义(P<0.05).2组患者术后JOA评分、VAS评分、C2～7颈椎曲度、手术节段Cobb角及邻近椎体高度均较术前显著改善,差异有统计学意义(P<0.05).术后24个月,Zero-P组C2～7颈椎曲度、手术节段Cobb角和邻近椎体高度较术后1个月降低,与PCC组相比差异亦有统计学意义(P<0.05).结论 ACDF术中采用PCC可获得与Zero-P相同的临床效果,虽然PCC在控制手术时间方面不如Zero-P组,但可更好地维持颈椎曲度.

BACKGROUND CONTEXT:Laminoplasty is a common surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is preferred over traditional laminectomy, the factors affecting the complications and outcomes are unclear. Recently, sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical degenerative diseases, but their relationships with laminoplasty-treated OPLL outcomes remains unknown. PURPOSE:The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcome in laminoplasty treated OPLL patients. STUDY DESIGN:This is a retrospective case study. PATIENT POPULATION:Between January 2015 and January 2017, 181 consecutively included patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=126:75; mean age=60.2 years). Cervical spine lateral radiographs in neutral, flexion, and extension positions were taken before and 2 years after the surgery. OUTCOME MEASURES:The C2-C7 Cobb angle, T1 slope, C1-C7 sagittal vertical axis (SVA), C2-C7 SVA, CGH (center of gravity of the head)-C7 SVA, cervical JOA (Japanese Orthopedic Association) score, and neck VAS (visual analogue scale) score were measured preoperatively and postoperatively at the 2-year follow-up. METHODS:The patients were divided into two groups according to changes in the lordotic angle or the recovery rate of the JOA score. The relationships between the postoperative lordosis loss or the clinical outcome and the preoperative variables, including the patient's age, JOA score, C2-C7 Cobb angle, T1 slope, C1-C7 SVA, C2-C7 SVA, and CGH-C7 SVA, were investigated. RESULTS:The patients were divided into two groups according to the postoperative change in the C2-C7 Cobb angle. There were no differences in the age, preoperative C2-C7 Cobb angle, C1-C7 SVA, or C2-C7 SVA; there was only a difference in the preoperative CGH-C7 SVA and T1 slope level (p=.038, p=.042). The postoperative JOA and JOA recovery rate were related to the postoperative lordosis loss in cervical alignment (p=.048, p=.031). We again divided the patients into two groups according to the JOA recovery rate and found that only the preoperative CGH-C7 SVA and C1-C7 SVA were related to the neurological outcome (p=.011, p=.047). According to the multivariate logistic regression analysis, higher preoperative CGH-C7 SVA levels were significantly associated with decreases in the lordosis angle postoperatively and the clinical outcome (p=.018, OR=1.225; p=.034, OR=1.654). The ROC (receiver operating characteristic) analysis revealed that the proper cutoff value of preoperative CGH-C7 SVA for predicting the postoperative loss of lordosis and clinical outcomes is 3.8 cm. CONCLUSION:Preoperative cervical sagittal balance indexes are related to the outcomes of OPLL patients after laminoplasty. Patients with high preoperative CGH-C7 SVA levels have a high probability of developing sagittal imbalances and neurological symptoms of the cervical spine, and this measurement can be used as a predictor of outcomes in laminoplasty-treated cervical OPLL patients.