Intervertebral disc degeneration (IDD) is the main cause of low back pain (LBP), and it is caused by the deterioration of the physiological function and structure of the nucleus pulposus. Previous research has separately studied the effects of adipose-derived mesenchymal stem cells (ADSCs) and periodic mechanical stress (PMS) in IDD. However, the synergistic effect of these two on the repair of IDD remains unclear. Therefore, we simulated the effects of periodic mechanical stress co-culture (PMSC) on nucleus pulposus cells (NPCs) by using Transwell chambers and periodic compression device. We found that PMSC can promote the proliferation of NPCs and activate autophagy by activating Integrin alpha1(ITGA1), and rescue the apoptosis of NPCs under inflammatory conditions. To elucidate the mechanism underlying the effects of PMSC, the expression of ITGA1 was inhibited. It was found that PMSC regulates the Src/GIT1/ERK11/2 axis through ITGA1, thus promoting proliferation and inducing autophagy in NPCs.

Osteoarthritis (OA) is a progressive whole-joint disease driven by a persistent inflammatory–oxidative microenvironment that fuels cartilage destruction and osteochondral remodeling, while effective disease-modifying interventions remain scarce. Here, an injectable microsphere platform (HM@BPZn) is engineered by incorporating electronically coupled BPNS–ZnO hybrid nanosheets into a dual-polysaccharide network of methacrylated hyaluronic acid and gallic acid-grafted chondroitin sulfate. Interfacial electronic redistribution within the BPNS–ZnO hybrids enables active modulation of the pathological joint microenvironment. HM@BPZn suppresses reactive oxygen species accumulation and NF-κB signaling in macrophages, reducing inflammatory mediator production and promoting pro-resolving polarization. In inflamed chondrocytes, HM@BPZn activates the Keap1–Nrf2 pathway, upregulates antioxidant effectors including HO-1 and NQO1, and restores matrix homeostasis by suppressing catabolic markers while enhancing anabolic and lubrication-associated phenotypes. Transcriptomic profiling further verifies coordinated rewiring of inflammatory and antioxidant signaling networks. In an ACLT-induced OA model, intra-articular delivery of HM@BPZn markedly mitigates synovitis, preserves proteoglycan-rich cartilage, and attenuates pathological subchondral bone remodeling and osteophyte formation. These findings establish HM@BPZn as an injectable microenvironment-regulating platform for disease-modifying OA treatment.

ETHNOPHARMACOLOGICAL RELEVANCE:Nodakenin, a coumarin compound derived from Radix Angelicae Biseratae, has been traditionally recognized for its anti-inflammatory and antioxidant properties, which are relevant to the pathophysiology of intervertebral disc degeneration (IVDD) involving oxidative stress and inflammatory responses. AIM OF THE STUDY:This study aimed to investigate the role and underlying mechanism of Nodakenin in IVDD, with a focus on its effects on ferroptosis and the Notch signaling pathway. MATERIALS AND METHODS:A rat model of IVDD was established to evaluate the therapeutic effects of Nodakenin. In vitro experiments were conducted to assess lipid peroxidation-dependent ferroptosis. Transcription factor target gene prediction tools and experimental validations, including promoter binding assays, were employed to examine the relationship between c-Myc and SLC7A11. The involvement of the Notch pathway was further analyzed. RESULTS:Nodakenin significantly delayed IVDD progression in vivo and alleviated ferroptosis in vitro. Mechanistically, Nodakenin activated the Notch pathway, leading to c-Myc-mediated upregulation of SLC7A11 expression. c-Myc was confirmed to directly bind to the SLC7A11 promoter. Activation of this pathway reversed ferroptosis phenotypes and mitigated disc degeneration. CONCLUSION:Nodakenin modulates ferroptosis through the Notch-c-Myc-SLC7A11 axis, thereby attenuating IVDD. These findings identify a potential therapeutic target for IVDD treatment and highlight the clinical relevance of Nodakenin.

OBJECTIVE:To assess if pre-emptive bilateral approach decompression (BAD) lowers early neural events and enhances very-early recovery versus unilateral approach decompression (UAD) in single-level transforaminal lumbar interbody fusion for Meyerding grade I degenerative spondylolisthesis. METHODS:Single-center retrospective study (2015-2022) with ≥24-month follow-up. Allocation by practice evolution: UAD (2015-2018) and BAD (2019-2022), limited to uniform mild-to-moderate contralateral risks. PRIMARY ENDPOINTS:very-early recovery (visual analog scale/Oswestry Disability Index/Japanese Orthopaedic Association at postoperative day [POD] 1/POD7) and neural complications. RESULTS:Analyzed 208 patients (UAD n = 102; BAD n = 106). BAD had longer operative time (114 ± 10 vs. 75 ± 9 minutes; P < 0.001). BAD improved very-early recovery: visual analog scale POD7 4.2 ± 0.6 versus 5.0 ± 0.7 (P < 0.001). Neural events were lower in BAD: early postoperative radicular pain 1.9% versus 9.8% (P = 0.017) and contralateral aggravation 0% versus 4.9% (P = 0.027). Two-year Japanese Orthopaedic Association recovery was similar (73% vs. 73%). CONCLUSIONS:In grade I spondylolisthesis transforaminal lumbar interbody fusion, BAD reduces early neural events and boosts very-early recovery without added blood loss or fusion compromise.

PurposeThe clinical results of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic discectomy (UBED) for the treatment of L4/L5 disc herniation were compared.MethodsPatients with L4/L5 disc herniation who had either Percutaneous Transforaminal Endoscopic Discectomy (PTED; n = 53) or Unilateral Biportal Endoscopic Discectomy (UBED; n = 69) at our facility during the same time period were the subject of a retrospective evaluation. Clinical outcomes, radiological information, and complications were collected and evaluated for each group.ResultsA retrospective analysis of 122 patients with L4/L5 disc herniation revealed that 69 of them received unilateral biportal endoscopic discectomy (UBED) and 53 got percutaneous transforaminal endoscopic discectomy (PTED). Leg pain (P = 0.242) and low back pain (P = 0.645) preoperative, postoperative day 1, and final follow-up VAS scores did not show any significant between-group differences. By the final follow-up, Oswestry Disability Index (ODI) scores were significantly improved for both groups (P < 0.001). The UBED group's patient satisfaction rate was 95.7%, while the PTED group's was 94.0%, according to the modified MacNab criteria. The two groups did not differ statistically significantly (P = 1). Similarly, radiological outcomes did not differ significantly between groups. Compared to the PTED group, patients in the UBED group experienced higher hemoglobin loss and longer hospital stays. On the other hand, intraoperative fluoroscopy exposures were dramatically decreased (P < 0.01) by the UBED method.ConclusionBoth UBED and PTED are effective and safe treatment options for L4/L5 disc herniation. UBED entailed less fluoroscopic exposure, and PTED contributed to less blood loss as well as a shorter hospital stay.

BACKGROUND:The integration of artificial intelligence into image-guided intraoperative interventions holds considerable promise for deriving 3D geometric information from 2D imaging. 2D/3D registration establishes the spatial relationship between preoperative computed tomography (CT) and intraoperative X-rays. However, existing methods are often limited by the image domain gap and imprecise feature extraction, causing coarse registration to provide inadequate initial poses and subsequent fine registration to fall into local optima, thereby reducing accuracy. PURPOSE:We aim to develop a robust single-view lumbar spine 2D/3D registration framework that balances high clinical accuracy with intraoperative efficiency requirements by aligning preoperative CT with intraoperative X-rays. METHODS:We propose utilizing vertebral body edges in X-rays as novel semantic features to guide 2D/3D registration. For robust edge extraction, we develop ESegMamba, an efficient U-shaped Mamba network incorporating Group multi-axis Hadamard Product Attention (GHPA) and Group Aggregation Concatenation (GAC) modules. Experiments for semantic edge extraction were performed on a dataset of 710 images (comprising X-rays and Digitally Reconstructed Radiographs) derived from 10 patients. The dataset was partitioned using a 4:1 patient-specific split, resulting in 568 training and 142 test images. The training set was further utilized via 5-fold cross-validation for network fine-tuning. ESegMamba was benchmarked against SegMamba, SwinUNETR, and UNETR using Dice and mIoU metrics. For 2D/3D registration, experiments were conducted separately on 300 simulated samples and 90 real clinical samples, following the same patient-specific split. The proposed framework was compared with landmark-based, intensity-based, and learning-based methods using mean Target Registration Error (mTRE). Statistical significance was assessed using the Wilcoxon signed-rank test with a significance level of 0.05, applying Bonferroni correction for multiple comparisons. RESULTS:ESegMamba outperforms representative networks with fewer parameters (99.18 M), achieving 90.36% Dice and 85.49% mIoU on the test set. Compared to the strong baseline SegMamba, ESegMamba demonstrated a large effect size in Dice improvement (Cohen's d = 2.05 $d = 2.05$ , p < 0.00067 $p < 0.00067$ ). For 2D/3D registration, the proposed method demonstrated superior performance over representative benchmarks. Specifically, compared to Xreg and PSSS, our method achieved large practical improvements in mTRE ( d = 1.04 $d = 1.04$ and d = 2.12 $d = 2.12$ , respectively; p < 0.0011 $p < 0.0011$ ). On real clinical data, the method achieved a mean in-plane translation error of approximately 1.5 mm and an average registration time of approximately 10 s. CONCLUSIONS:The proposed method, empowered by ESegMamba, yields statistically significant improvements over intensity-based benchmarks ( p < 0.0011 $p < 0.0011$ ). The achieved sub-2mm accuracy and 10 s processing time on clinical data confirm its efficacy for intraoperative spinal navigation. The code for the proposed method is available at github.com/shenao1995/lineReg.

Bone regeneration requires coordinated regulation of osteogenesis, immunity, and angiogenesis, which remains challenging for traditional strategies. In this study, britanin-loaded mesoporous silica nanoparticles (britanin@MSNs) are synthesized via surface conjugation and drug encapsulation. Their effects and mechanisms are evaluated using bone marrow mesenchymal stem cells (BMSCs), macrophages, and human umbilical vein endothelial cells, and further validated in a rat femoral defect model. Low-dose britanin significantly enhances BMSCs proliferation and osteogenic differentiation, increasing ALP activity, mineralization, and the expression of RUNX2, OPN, and OCN. Mechanistically, britanin activates NPY1R, upregulates the PI3K/AKT/mTOR pathway, and promotes S6K1 phosphorylation, thereby enhancing autophagy and osteogenic protein synthesis. Britanin@MSNs provide efficient delivery and sustained release, maintaining cell viability and promoting osteogenesis and migration. In macrophages, britanin@MSNs improve mitochondrial function, reduce ROS, increase ATP levels, and promote M2 polarization by activating the TGF-β1/SMAD3 pathway. Moreover, britanin@MSNs upregulate angiogenic markers such as CD31 and VEGF, facilitating tube formation by endothelial cells. In vivo studies demonstrate that britanin@MSNs significantly promote new bone formation, increase bone mineral density, and enhance collagen deposition and tissue remodeling, while supporting angiogenesis and osteogenic signaling. This multifunctional platform offers a promising translational strategy for bone tissue engineering by integrating osteoinductive capability and microenvironment modulation

Purpose To investigate the cell viability, proliferation of nucleus pulposus mesenchymal stem cells(NPMSCs) in different types of collagen scaffolds, and to construct a double-layer collagen scaffold to provide a method for the treatment of intervertebral disc degeneration. Methods Type I collagen extracted from porcine tendon.Type II collagen extracted from porcine articular cartilage.Giving appropriate pressure to collagen with a cover slip and then freeze-drying it in a vacuum.It is a collogen membrane with double layers: porous upper layer and compact lower layer. We take EDC/NHS as a compound crosslinking agent to make collagen structure more stable. The pores of the scaffolds before and after cross-linking were observed by scanning electron microscope (SEM), and the anti-degradation performance of the scaffolds before and after cross-linking was evaluated. The influence of the scaffold on nucleus pulposus mesenchymal stem cells(NPMSCs) proliferation was assessed by the CCK-8.The three-dimensional structure of the scaffolds co-cultured with NPMSCs was observed by a JSM-5600LV SEM. Results Scanning electron microscopy showed that collagenⅠhad a dense network structure and collagen Ⅱhad a loose and porous structure. The results of CCK-8 showed that both collagen scaffolds could promote the proliferation of NPMSCs(p < 0.05). The proliferative effect of collagenⅡwas more significant than that of collagenⅠ. (p < 0.05). The degradation rate of the cross-linked scaffolds was significantly slowed down, and the cross-linked scaffolds had more pores and more uniform sizes. Scanning electron microscopy showed NPMSCs can adhere and grow on scaffolds. Conclusion Type Ⅱ collagen is more suitable as a scaffold for tissue engineering nucleus pulposus.

ObjectiveTo study the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (ULIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases, and to compare perioperative indicators, radiological outcomes, and paraspinal muscle –atrophy resulting from these two different surgical methods.BackgroundTransforaminal lumbar interbody fusion (TLIF) is widely acknowledged as an efficacious surgical modality for alleviating low back pain. In recent years, unilateral biportal endoscopic lumbar interbody fusion (ULIF) has gained increasing application.MethodsWe recorded the basic information of patients who underwent single-segment ULIF or TLIF for the first time in our hospital from May 2021 to November 2022, including age, gender, BMI, diagnosis, and surgical segment. Perioperative indicators such as estimated blood loss, operation time, postoperative hospital stay, and complications were observed in both groups. Clinical efficacy was assessed preoperatively and at 1 month, 3 months, and 12 months postoperatively using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the modified Macnab criteria. The displacement of the fusion device was also assessed. x-rays were taken preoperatively, at 3 months postoperatively, and at 12 months postoperatively to observe fusion device displacement and measure the intervertebral disc height of the upper and lower segments. The Cobb angle was used to measure lumbar lordosis and segmental lumbar lordosis. CT scans at 3 months postoperatively were used to observe intervertebral fusion, including bridging trabeculae, endplate cysts, and screw loosening. MRI at 1 year postoperatively was used to manually trace the cross-sectional area of the paraspinal muscles to compare muscle atrophy.ResultsA total of 150 patients were included in the study, with 71 patients in the ULIF group and 79 patients in the TLIF group. No statistically significant disparities were observed between the two groups with respect to age, gender, BMI, diagnosis, and surgical segment. The estimated blood loss in the ULIF group was 108.78 ± 58.3 ml, which was significantly less than that in the TLIF group at 199.44 ± 84.91 ml (p < 0.001). The postoperative hospital stay was shorter in the ULIF group (p = 0.020), although the operation time was longer for ULIF. There were no significant differences in complications between the two groups. Patients in the ULIF group experienced quicker relief from back pain postoperatively, but there were no significant differences between the ULIF and TLIF groups in the VAS, ODI, and satisfaction rates at the final follow-up. At 3 months postoperatively, the ULIF group demonstrated a higher incidence of bridging trabeculae, a lower incidence of endplate cysts, and less fusion device displacement. There were no significant differences between the two groups in the correction of segmental lumbar lordosis (SL) and overall lumbar lordosis (LL). Additionally, the ULIF group showed less muscle damage.ConclusionULIF has the advantages of reducing pain in the short term, less blood loss, and shorter hospital stays. Its more precise handling of the intervertebral space reduces the occurrence of endplate cysts and fusion device displacement, which has certain significance in preventing delayed fusion and nonunion. However, ULIF requires a longer operation time, which increases potential risks for elderly patients or those with poor nutritional status. Although ULIF causes less damage to the bony structure, it has not shown a significant advantage in improving adjacent segment degeneration.

OBJECTIVE:The purpose of this study was to explore the optimal needle-tip depth through conventional percutaneous vertebroplasty (PVP) and further analyze the correlation between needle-tip depth and anterior cement leakage in osteoporotic vertebral compression fractures. METHODS:A total of 560 patients with PVP were retrospectively analyzed, and they were stratified into a shallow (needle-tip at 2/3-3/4 depth, n = 291) and deep placement group (3/4-7/8 depth, n = 269). The clinical outcomes and anterior leakage rates were compared. Biomechanical parameters, including symmetric cement diffusion, flow velocity, anterior wall arrival time, and contact pressure, were derived from finite element analysis. RESULTS:Anterior leakage risk was significantly higher with deep placement (P = 0.005). Finite element analysis demonstrated increased distal diffusion asymmetry fraction, decreased anterior wall arrival time, increased cement flow velocity, and increased contact pressure for the deep insertion (all P < 0.0001). Risk of leakage was particularly elevated in the type 4 German Society for Orthopaedics and Trauma Surgery Osteoporotic Fracture Classification fracture group when placed deep (72.92% vs. 29.17%, P < 0.001). CONCLUSIONS:Greater amount of cement septum extension during PVP increases anterior cement leakage risk, especially in osteoporotic fracture type 4 fractures, suggestive that practitioners should be cautious about controlling needle-depth in order to effectively minimize complications.

Purpose To compare the clinical outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous interlaminar endoscopic discectomy (PIED) for treating L5/S1 disc herniation. Methods Patients with L5/S1 disc herniation treated with UBED (n = 46) and PIED (n = 50) in our hospital during the same period were retrospectively reviewed. Clinical outcome, radiographic parameters, and complications of each group were collected and evaluated. Results The mean follow-up period was 14.11 ± 3.47 months in the UBED group and 14.52 ± 5.37 months in the PIED group. There was no significant difference in visual analog scale score for the leg (P = 0.836) or lumbar scores (P = 0.335) between PIED and UBED group at preoperative, 1-day postoperative, and last follow-up point. Within the same group, there were significant differences in visual analog scale score for the leg (P < 0.001) and lumbar scores (P < 0.001) compared pairwise at 3 time points. Oswestry Disability Index scores of both groups showed significant improvement at the last follow-up (P < 0.001, P < 0.001), and there was no significant difference in patient satisfaction rates (97.8% vs. 96%) between the 2 groups on the basis of the MacNab criteria. The percentage of facet joint preservation was 96.74 ± 9.10% in the UBED group and 99.22 ± 1.52% in the PIED group. The total blood loss and hospitalization cost was greater in the UBED group. One patient in both groups showed postoperative hematoma. A dural tear occurred in UBED group and a never root injury occurred in the PIED group. Conclusions UBED indicates similar short-term efficacy compared with PIED for treating L5/S1 disc herniation. No difference was found in facet joint preservation between the 2 groups. We believe the increased cost of UBED as the result of surgical consumables will decrease in the future.

Objectives: This study’s purpose is to investigate the lumbar biomechanical effects of unilateral partial facetectomy (UPF) of different facet joint (FJ) portions under percutaneous endoscopy. Methods: Forty fresh calf spine models were used to simulate UPF under a physiological load performed through three commonly used needle insertion points (IPs): (1) The apex of the superior FJ (as the first IP); (2) The midpoint of the ventral side of the superior FJ (as the second IP); (3) The lowest point of the ventral side of the superior FJ (as the third IP). The range of motion (ROM) and the L4/5 intradiscal maximum pressure (IMP) were measured and analyzed under a physiological load in all models during flexion, extension, left–right lateral flexion, and left–right axial rotation. Results: When UPF was performed through the second IP, the ROM of the lumbar spine and the L4/5 IMP in the calf spine models were not statistically different from the intact calf spine model. Conclusions: UPF through the second IP resulted in a minimal impact on the biomechanics of the lumbar spine. Thus, it might be considered the most appropriate IP for UPF.

Currently, intervertebral disc (IVD) degeneration is believed to lead to local accumulation of lactic acid in the IVD, a decrease in pH, activation of the inflammatory pathway, and continued destruction of homeostasis of the IVD. To address these issues, the intelligent and accurate release of drugs is particularly important. In this study, acid-sensitive release methacrylated hyaluronic acid (HAMA) microspheres were constructed by using microfluidic technology, which can be used as a targeted drug delivery system for intervertebral disc degeneration (IVDD) through Schiff base chemical bonding on the surface of the microspheres to achieve intelligent drug release. Interleukin-1 receptor antagonist (IL-1 Ra) is a naturally occurring anti-inflammatory antagonist of the interleukin-1 family of pro-inflammatory cytokines. Despite its outstanding broad-spectrum anti-inflammatory effects, IL-1 Ra has a short biological half-life (4-6 h). The slow-release performance of IL-1 Ra can be greatly improved using bovine serum albumin nanoparticles (BNP). In addition, the modified HAMA microspheres exhibited good injectability and porosity, and efficient and uniform loading of nanoparticles was achieved via the Schiff base bond. The inflammatory microenvironment can be significantly reversed by transporting the modified HAMA microspheres-BNPs (Modified MS) to the degenerative nucleus pulposus.

Background The aim of this study is to evaluate the changes in radiologic parameters and clinical outcomes following unilateral biportal endoscopic unilateral laminotomy and bilateral decompression (UBE ULBD) for treatment of central lumbar spinal stenosis. Methods Forty-one central lumbar spinal stenosis patients who underwent UBE ULBD were enrolled from April 2021 to February 2023. Visual analog scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) score, and the modified MacNab criteria were assessed preoperatively and postoperatively. The preoperative and postoperative cross-sectional area of the spinal canal (CSAC), anteroposterior diameter, horizontal width, and ipsilateral and contralateral lateral recess height were calculated from axial computed tomography (CT) scans. Percentage of facet joint preservation measured on axial CT scans was obtained preoperation and postoperation. Results The VAS for back and leg pain improved from 7.24 +/- 0.80 and 7.59 +/- 0.59 preoperatively to 2.41 +/- 0.55 and 2.37 +/- 0.62 ( p < 0.05) postoperatively and 1.37 +/- 0.54 and 1.51 +/- 0.55 at the last follow-up ( p < 0.05). For ODI, improvement from 60.37 +/- 4.44 preoperatively to 18.90 +/- 4.66 ( p < 0.05) at the last follow-up was observed. CT scans demonstrated that the postoperative CSAC increased significantly from 287.84 +/- 87.81 to 232.97 +/- 88.42 mm ( p < 0.05). The mean postoperative anteroposterior diameter and horizontal width increased significantly from 18.01 +/- 3.13 and 19.57 +/- 3.80 to 22.19 +/- 4.56 and 21.04 +/- 3.72 mm, respectively ( p < 0.05). The ipsilateral lateral recess height and contralateral lateral recess height were 3.39 +/- 1.12 and 3.20 +/- 1.14 mm preoperatively and 4.03 +/- 1.37 and 3.83 +/- 1.32 mm ( p < 0.05) postoperatively, with significant differences. The ipsilateral and contralateral facet joint preservations were 88.17 and 93.18%, respectively. Conclusion The UBE ULBD surgery is a safe and effective treatment for central lumbar spinal stenosis, associated with significant improvement in clinical outcomes and radiologic parameters. Studies with larger samples and longer follow-up periods are needed for further research.

Background In this study, we evaluate the clinical efficacy and safety of full-endoscopic transforaminal lumbar interbody fusion (TLIF) for treatment of single-level lumbar degenerative spondylolisthesis. Methods Fifty-three patients were divided into two groups according to the surgical techniques: Full endoscopic (Endo)-TLIF (n = 25) and TLIF (n = 28). Clinical efficacy was evaluated pre- and postoperatively. The operation time, operative blood loss, postoperative amount of serum creatine phosphokinase (CPK), postoperative drainage volume, postoperative hospital stay time, total cost, and operative complications were also recorded. Results Compared with the TLIF group, the Endo-TLIF group had similar intraoperative blood loss, less postoperative increased CPK, less postoperative drainage volume, and shorter postoperative hospital stay, but longer operative time and higher total cost. The postoperative visual analog scale (VAS) scores of back and leg pain and Oswestry Disability Index (ODI) scores significantly improved compared with the preoperative scores in both two groups; more significant improvement of postoperative VAS scores of back pain and ODI scores were shown in the Endo-TLIF group at the 1-month follow-up (p < 0.05). No difference was found in the intervertebral fusion rate between the two groups. Conclusion The Endo-TLIF has similar clinical effect compared with the TLIF for the treatment of lumbar degenerative spondylolisthesis. It also has many surgical advantages such as less muscle trauma, less postoperative back pain, and fast functional recovery of the patient. However, steep learning curve, longer operative time, and higher total cost may be the disadvantages that limit this technique. Also, the Endo-TLIF treatment of patients with bilateral lateral recess stenosis is considered a relative contraindication.

BackgroundObesity accelerates the development of lumbar disease and increase the risk during surgery. Unilateral biportal endoscopic discectomy (UBE) is a newly developed minimally invasive technique, which refers to the spinal surgery under unilateral double-channel endoscopic surgery. Therefore, the purpose of this study is whether UBE decompression alone can bring good clinical results to young obese patients with lumbar degenerative diseases.MethodsThe patients with lumbar diseases who underwent UBE and open surgery (open discectomy) in our hospital from February 2020 to February 2022 were selected as young (age ≤ 44 years old) and obesity (BMI ≥ 30 kg/m2). The patients were evaluated with VAS, ODI, JOA and modified Macnab score before operation, 1 month, 6 months and 12 months after operation. Nerve root function sensation, muscle strength and tendon reflex were evaluated. The operation time, estimated blood loss, postoperative hospital stay, incidence of postoperative complications and reoperation rate were recorded. MRI quantitative lumbar multifidus muscle (LMM) comparison was performed 12 months after operation.Results77 patients were included, and the scores of VAS, ODI and JOA were similar in the two groups during the last follow-up. There were no difference in nerve root function sensation, muscle strength or tendon reflex. However, one month after operation, the VAS back score and ODI improvement in the UBE group were significantly better than those in the open group, which were 2.44 ± 0.97, 33.10 ± 6.78 and 2.93 ± 0.79 and 36.13 ± 5.84, respectively, with a statistically significant difference (p = 0.020 and 0.038). According to the modified Macnab criteria, UBE group, the excellent and good rate was 97.2%. The excellent and good rate of open group was 97.6%. The estimated blood loss and postoperative hospital stay in UBE group (36.81 ± 17.81, 3.92 ± 1.32) were significantly better than those in open group (104.88 ± 31.41, 6.41 ± 1.94), with a statistically significant difference (p = 0.010). There was no significant difference in operation time between the two groups (p = 0.070). The number of complications in UBE group was 2 (5.6%) and open group was 4 (9.8%). The fat infiltration rate of 19.3%+11.0% in UBE group was significantly lower than that of 27.0%±13.9% in open group (p = 0.010).ConclusionUBE has the advantage of early recovery in the treatment of lumbar degenerative diseases in young obese patients, and reduces the damage to LMM, so it has a good clinical effect.

Background Chordoma is a bone tumor that tends to occur in middle-aged and elderly people. It grows relatively slowly but is aggressive. The prognosis of middle-aged and elderly patients with chordoma is quite different from that of young patients with chordoma. Objectives The purpose of the research was to construct a nomogram to predict the Individualized prognosis of middle-aged and elderly (age greater than or equal to 40 years) patients with chordoma. Methods In this study, we screened 658 patients diagnosed with chordoma from 1983 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. We determined the independently prognostic factors that affect the survival of patients by univariate and multivariate Cox proportional hazards model. Based on the independent prognostic factors, we constructed a nomogram to predict the overall survival (OS) rates of middle-aged and elderly patients with chordoma at 3 and 5 years. The validation of this nomogram was completed by evaluating the calibration curve and the C-index. Results We screened a total of 658 patients and divided them into two cohort. Training cohort had 462 samples and validation cohort had 196 samples. The multivariate Cox proportional hazards model of the training group showed an association of age, tumor size, histology, primary site, surgery, and extent of disease with OS rates. Based on these results, we constructed the corresponding nomogram. The calibration curve and C-index showed the satisfactory ability of the nomogram in terms of predictive ability. Conclusion Nomogram can be an effective prognostic tool to assess the prognosis of middle-aged and elderly patients with chordoma and can help clinicians in medical decision-making and enable patients to receive more accurate and reasonable treatment.

Background:Intervertebral disc degeneration (IDD) can lead to disc herniation and spinal instability, sometimes requiring surgical intervention. Currently, estrogen has a potential protective effect on IDD, and estrogen is associated with an increased risk of some cancers, such as breast and endometrial cancer. Therefore, it is important to identify natural compounds that estrogen analogues treat IDD while reducing the risk of tumor development. Objective:This study aims to explore a natural metabolic treatment strategy by targeting CRISP2 with the natural compound Hesperidin to mimic the protective effects of estrogen on IDD and reduce the risk of tumor development. Methods:Microarray data from healthy volunteers and IDD patients were extracted from the Gene Expression Omnibus (GEO) database, and RNA sequencing and clinical data from various cancer types were analyzed. Differentially expressed genes (DEGs) were identified using the Bioconductor Limma package, followed by principal component analysis, volcano plot, and heatmap visualization. Additionally, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses, CIBERSORT and ssGSEA immune cell infiltration assessments, survival analysis, metabolite enrichment analysis, and molecular docking were performed. Hesperidin's interaction with CRISP2 was further validated through molecular docking and experimental studies. Results:Hesperidin significantly reduced the expression of CRISP2, iNOS, and COX2 in IDD models, decreased reactive oxygen species (ROS) and apoptosis, and diminished inflammatory markers. CIBERSORT and ssGSEA analyses revealed a correlation between CRISP2 and immune cell infiltration. Survival analysis demonstrated that CRISP2 expression levels were associated with patient survival across various cancer types. Hesperidin was found to mimic estrogen's effects on IDD and reduce tumor progression. Cell culture and experimental validation confirmed Hesperidin's protective effects on nucleus pulposus cells (NPCs). Conclusion:Hesperidin, as a potential natural metabolic regulator, not only has therapeutic effects on IDD but may also synergize with estrogen therapy to promote spinal health without increasing cancer risk. This study presents a new clinical approach for IDD treatment and lays the foundation for further drug development and experimental research.

Objective: The objective of this study was to systematically evaluate the safety and efficacy of local anesthesia (LA) and general anesthesia (GA) in percutaneous interlaminar endoscopic discectomy (PIED). Materials and Methods: We searched MEDLINE, EMBASE, EuropePMC, PubMed, Web of Science, Cochrane databases, and CNKI databases for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. Results: A total of 6 articles with 549 study participants were included, with 282 patients in LA group and 267 patients in GA group. The results of the meta-analysis showed that the LA group had significantly better results in hospital stay time (mean difference [MD], −1.68; 95% CI, −3.35 to −0.01) and hospital costs (MD, −0.57, 95% CI, −1.02 to −0.12) compared with the GA group; whereas Oswestry Disability Index (MD, 0.48; 95% CI, −0.07 to 1.04), Visual Analog Scale Scores (MD, −0.05; 95% CI, −0.24 to 0.13), postoperative transient dysesthesia and weakness (odds ratio [OR], 0.83, 95% CI, 0.40 to 1.69), dura and nerve root injury (OR, 0.21, 95% CI, 0.03 to 1.25), operation time (MD, −3.51; 95% CI, −11.5 to 4.48), and willingness rate to receive the same procedure(OR, 0.12, 95% CI, 0.01 to 1.00) showed no significant differences between the 2 groups. Discussion: LA can effectively relieve pain during PIED surgery and ensure the safety of operation without increasing the occurrence of postoperative complications. PIED under LA not only has similar patient satisfaction but also shows obvious advantages in shortening hospital stay and reducing hospital costs compared with GA surgery.

BackgroundThe incidence of chondrosarcoma is increasing every year, and the treatment and prognosis of patients with high-grade chondrosarcoma are becoming more and more important. Nomogram is a tool that can quickly and easily predict the overall survival of tumor patients. Therefore, the development and validation of a nomogram to predict overall survival in patients with high-grade chondrosarcoma was desired.MethodsWe retrospectively collected 396 patients with high-grade chondrosarcoma from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Randomly divided into model and validation groups, the best cut-off values for age and tumor size grouping were derived by using X-tile software. Then, independent prognostic factors for high-grade chondrosarcoma were derived by SPSS.26 univariate and multivariate Cox analyses analysis in the model group, and the model was evaluated by using R software, using C-indix and ROC curves, and finally these independent prognostic factors were included in Nomogram.Results396 patients were randomly assigned to the modelling group (n = 280) or the validation group (n = 116). Age, tissue-type, tumor size, AJCC stage, regional expansion and surgery were identified as independent prognostic factors (p < 0.05) which further combined to construct a nomogram. The C-index of internal validation for overall survival(OS) was 0.757, while the C-index of external validation for overall survival(OS) was 0.832. Both internal and external calibration curves show a good agreement between nomogram prediction and actual survival.ConclusionIn this study, we established age, tumour size, AJCC stage, tissue type, surgery and tumor extension as independent prognostic factors for high-grade chondrosarcoma and constructed a nomogram to predict 3- and 5-year survival rates for high-grade chondrosarcoma.