Spinal fusion is a commonly used technique to treat acute and chronic spinal diseases by fusion of the adjacent vertebrae, aiming at achieving stability and eliminating the mobility of the objective segment. While bone autografts and allografts have been conventionally used for spinal fusion, limitations persist in achieving optimization of both good osteoinductive capacity and mechanical stability. In this study, additively manufactured Zn-Li scaffolds were developed and evaluated for their potential in spinal fusion. First, three scaffold structures (BCC, Diamond, and Gyroid) were designed and verified in vitro. Due to the smooth transition surfaces and uniform degradation behavior, the Gyroid Zn-Li scaffold demonstrated mechanical integrity during degradation and enhanced cellular proliferation compared to the other two scaffolds. Subsequently, Zn-Li scaffolds (Gyroid) were selected for posterolateral lumbar fusion (L4/L5) in rabbits. Following 12 weeks of implantation, the Zn-Li scaffolds demonstrated a moderate biodegradation rate and satisfactory biocompatibility. Compared to bone allografts, the Zn-Li scaffolds significantly improved osseointegration adjacent to the transverse processes, which led to enhanced segmental stability of the fused vertebrae post posterolateral lumbar fusion. Overall, the results show that the biodegradable Zn-Li scaffold holds substantial potential as the next-generation graft for spinal fusion.

Despite the current biomaterials (e.g. titanium mesh and polyether ether ketone) have been applied to clinical skull repair, the limitations on mechanical match, shape adaptability, bioactivity and osteointegration have greatly limited their clinical application. In this work, we constructed a water and inflammatory microenvironment dual-responsive self-adaptive silk fibroin-magnesium oxide-based scaffold with the matrix metalloproteinase-2-responsive gelatin-methacryloyl-interleukin-4 (IL-4) coating, which presented good mechanical compliance, quickly shape matching and intraoperative reprocessability. With the capability of responding to an acute inflammation microenvironment followed by a triggered on-demand release of the IL-4, the combination of immunoactive IL-4 and Mg2+ co-ordinately facilitated metabolic reprogramming by suppressing glycolysis, promoting mitochondrial oxidative phosphorylation and modulating adenosine 5'-monophosphate-activated protein kinase (AMPK) signalling pathways in macrophages, resulting in significantly facilitating M2 macrophage activation. During the stage of tissue remodelling, the sustained release of Mg2+ further promoted macrophage M2 polarization and the expression of anti-inflammatory cytokines, significantly reduced immune response and improved ectopic osteogenesis ability. Meanwhile, the cranial defect models of male rats demonstrated that this scaffold could significantly enhance biomineralized deposition and vascularisation, and achieve good bone regeneration of cranial defects. Overall, the bioactive scaffold provides a promising biomaterial and alternative repair strategy for critical-size skull defect repair.

PurposeFor patients who suffered from L5 spondylolysis and fail to improve using conservative treatment, the best surgical strategy remains controversial. This study compares the efficacy of the treatment of L5 spondylolysis using the smiley face rod (SFR) method versus intervertebral fusion (IF).MethodsWe analyzed 38 patients with L5 spondylolysis who underwent surgery in our department between January 2017 and June 2019. Of these, 32 patients were included in our study: 14 patients in the SFR group and 18 patients in the IF group. The operation time, intraoperative blood loss, postoperative drainage time, length of stay and postoperative complications were compared. The pain visual analog scale (VAS) and Oswestry dysfunction index (ODI) were evaluated before operation and at 3 months, 6 months, and 1 year postoperatively. The changes in range of motion (ROM) in L4/5 and L5/S1 in these two groups before and after surgery were measured through imaging examinations and the bone graft fusion rate was assessed according to the Brown standard.ResultsThe operation time of the SFR group was much shorter than that of the IF group (98.8 ± 8.3 vs. 113.8 ± 8.6 min, P < 0.05), and the blood loss of the SFR group was significantly lower than that of the IF group (90.0 ± 43.9 vs. 175.0 ± 81.2 ml, P < 0.05). Length of stay in the SFR group was less than that of the IF group (9.5 ± 2.5 vs. 12.6 ± 3.2 d, P < 0.05). No difference was found in the VAS and ODI scores between the two groups at 3 months, 6 months, and 1 year after surgery. In the IF group, the ROM in L4/5 showed an obvious increase after surgery compared to that before surgery, and it was much bigger than that of the SFR group (P < 0.05). A notable reduction of ROM was seen in L5/S1 in the IF group compared to the SFR group (P < 0.05). The fusion rate of the isthmus in the SFR group was 79% at 3 months and 86% at 6 months after surgery. In the IF group, one patient suffered from adjacent segment degeneration (ASD), which caused compression symptoms in the lower extremity, and one patient suffered from an internal fixation fracture; these complications were not seen in the SFR group.ConclusionThe SFR and IF both improve the clinical symptoms and quality of life of patients with L5 spondylolysis. However, the SFR technique had the advantages of a shorter operation time and less blood loss than IF; it could also preserve the ROM of the surgical segment and had little influence on adjacent segments in short-term follow-ups.

The regeneration of critical-size bone defects, especially those with irregular shapes, remains a clinical challenge. Various biomaterials have been developed to enhance bone regeneration, but the limitations on the shape-adaptive capacity, the complexity of clinical operation, and the unsatisfied osteogenic bioactivity have greatly restricted their clinical application. In this work, we construct a mechanically robust, tailorable and water-responsive shape-memory silk fibroin/magnesium (SF/MgO) composite scaffold, which is able to quickly match irregular defects by simple trimming, thus leading to good interface integration. We demonstrate that the SF/MgO scaffold exhibits excellent mechanical stability and structure retention during the degradative process with the potential for supporting ability in defective areas. This scaffold further promotes the proliferation, adhesion and migration of osteoblasts and the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in vitro. With suitable MgO content, the scaffold exhibits good histocompatibility, low foreign-body reactions (FBRs), significant ectopic mineralisation and angiogenesis. Skull defect experiments on male rats demonstrate that the cell-free SF/MgO scaffold markedly enhances bone regeneration of cranial defects. Taken together, the mechanically robust, personalised and bioactive scaffold with water-responsive shape-memory may be a promising biomaterial for clinical-size and irregular bone defect regeneration.

Bioinorganic cations, that actively involved in many vital cellular activities, have been highlighted in regeneration and repair of tissues recently. However, researchers are still exploring how the sophisticated regulation of these bioactive factors within the microenvironment contribute to the process. Here, we established magnesium oxide homogeneously- and heterogeneously-embedded biocomposites to investigate the biological impacts that result from the different aggregation structure of the bioinorganic element. On the heterogeneous biocomposite, unbalanced microenvironment with erratic ion niche was provided, while stable ionic microenvironment was shown on the homogeneous biocomposite. Compared with the ionic micro-homeostasis, the heterogeneous micron-cluster-created unbalanced niche compromised cellular adhesion and proliferation by restraining the membrane extensions and downregulating the expression of proliferative genes. This unbalanced niche also motivated nonactivated macrophage polarized towards pro-inflammatory phenotype and induced high ratio of necrotic cell death by increasing the intracellular oxidative stress and decreasing the ATP content. After implantation, the homogeneous scaffold promoted tissue healing, whereas the immune responses were deteriorated and prolonged by heterogeneous scaffold, which leading to impaired bone regeneration. This study demonstrated the importance of biocomposite-established magnesium ionic micro-homeostasis on bone tissue regeneration and may inspires the future development of biomaterials.

The regeneration of critical-sized bone defects, especially for irregular shapes, remain a clinical challenge. Although various biomaterials were developed to enhance bone regeneration, the limitations on the shape-adaptive capacity, the complexity of clinical operation and the unsatisfied osteogenic bioactivity restricted greatly their clinical application. Herein, we construct a mechanically robust, tailorable and blood-responsive shape memory effect silk fibroin/ Magnesium (SF/MgO) composite scaffold, which can quickly match irregular defects by easily trimming and achieve good interface integration. The SF/MgO composite scaffold exhibits excellent mechanical performance and structure retention during the degradation process, which significantly improved the supporting ability in defective site. In addition, the SF/MgO composite scaffolds can achieve shape recovery very quickly either under water or blood conditions. This scaffold promotes cell proliferation, adhesion, migration of osteoblasts, and osteogenic differentiation of BMSCs in vitro. Subcutaneous implantation results confirmed that with suitable content SF/MgO composite scaffold exhibited good histocompatibility, low foreign body reactions, and as well as significant ectopic mineralization and angiogenesis. Meanwhile, the SF/MgO composite scaffold markedly promote in situ robust bone regeneration of cranial defect. This bioactive shape memory porous scaffolds provides a new design idea for minimally invasive clinical-size irregular bone regeneration.

This study compares the accuracy and safety of pedicle screw placement using a 3D navigation template with the free-hand fluoroscopy technique in scoliotic patients. Fifteen scoliotic patients were recruited and divided into a template group (eight cases) and a free-hand group (seven cases). All patients received posterior corrective surgeries, and the pedicle screw was placed using a 3D navigation template or a free-hand technique. After surgery, the positions of the pedicle screws were evaluated using CT. A total of 264 pedicle screws were implanted in 15 patients. Both the two techniques were found to achieve satisfactory safety of screw insertion in scoliotic patients (89.9% vs. 90.5%). In the thoracic region, the 3D navigation template was able to achieve a much higher accuracy of screw than the free-hand technique (75.3% vs. 60.4%). In the two groups, the accuracy rates on the convex side were slightly higher than on the concave side, while no significance was seen. In terms of rotational vertebrae, no significant differences were seen in Grades I or II vertebrae between the two groups. In conclusion, the 3D navigation template technique significantly increased the accuracy of thoracic pedicle screw placement, which held great potential for extensively clinical application.

3D打印技术是一种可塑性和应用性极强的工艺技术,随着技术、材料的发展,3D打印技术在脊柱外科的运用优势越来越显著.3D打印技术在脊柱外科的应用可由繁至简分为四个层次,首先是结合打印材料的特点和脊柱解剖特征制作脊柱植入物,其次是应用 3D打印制备各类辅助手术的工具,以及对目标椎体的 3D建模和实体打印,最后就是个体化定制脊柱矫形康复器械.为了能够更好地了解 3D打印技术在脊柱外科的各方面应用,给广大脊柱外科医师提供更优的临床诊疗思路,本文对 3D打印在脊柱外科应用的最新进展进行综述.

Background:Osteosarcoma (OS) is a malignant bone tumor mainly affecting children and young adolescents. Cisplatin is a first-line chemotherapy drug for OS, however, drug resistance severely limits the survival of OS. Nevertheless, cellular factors in cisplatin resistance for OS remain obscure. In this study, the function and potential mechanism of p53 in cisplatin absorption were explored in OS cells.Methods:The CRISPR-Cas9 gene editing technology was performed to obtain p53 gene knock-out U2OS cells. The p53 over-expression 143B cell line was established by lentivirus-mediated virus infection. Moreover, the functions of p53 and CTR1 in cisplatin absorption were assessed by inductively coupled plasma mass spectrometry (ICP-MS) through CTR1 over-expression and knock-down. Further, the DNA binding activity of SP1 on CTR1 gene promoter was determined by dual-luciferase assay and chromatin immunoprecipitation (ChIP) assay. The functional regulation of p53 on SP1 was studied by nucleocytoplasmic separation assay and electrophoretic mobility shift assay (EMSA). The interaction between p53 and SP1 was verified by Co-Immunoprecipitation assay.Results:Under cisplatin treatment, p53 knock-out promoted CTR1 expression and cisplatin uptake, while p53 overexpression inhibited CTR1 expression and cisplatin uptake. Moreover, p53 regulated CTR1 level not by binding to CTR1 promoter directly but by suppressing the nuclear translocation of transcription factor specificity protein 1 (SP1). It was verified that SP1 is directly bound with CTR1 promoter. SP1 overexpression stimulated CTR1 expression, and SP1 knock-down attenuated CTR1 expression.Conclusion:The p53 might function as a negative regulator in CTR1 mediated cisplatin absorption, and the p53-SP1-CTR1 axis is a target for cisplatin resistance.

2017年上海长征医院史建刚教授团队首次报道颈椎前路椎体-后纵韧带骨化物复合体可控前移融合术(ante-rior controllable antedisplacement and fusion,ACAF)治疗严重颈椎后纵韧带骨化症(ossification of posterior longitu-dinal ligament,OPLL)[1],其可在不切除骨化物的前提下实现脊髓原位减压,已被证明是一种安全有效的治疗严重颈椎OPLL的新型前路减压术式[2-5].然而,目前尚无系统地针对ACAF手术制定的器械,如钛板、螺钉及提拉工具等,尤其是对于提拉工具,仍需要进一步的改进[6].我们团队在早期开展ACAF的过程中,发现使用高速磨钻或超声骨刀开槽后游离椎体-后纵韧带骨化物复合体(vertebrae-OPLL complex,VOC)不彻底,导致不能顺利地完成前移提拉,而在进一步开槽游离椎体的过程中又会增加对神经的干扰,从而导致术后神经根损伤的症状.基于此,我们开发了带线锚钉辅助提拉VOC的方法,在临床应用中取得满意疗效,现对其总结报道.

The Zero-P spacer was primarily developed aiming to reduce the morbidity associated with the traditional anterior cervical plate. During the past decade, many authors have reported the use of Zero-P spacers for anterior cervical discectomy and fusion (ACDF) of one or two segments. Nevertheless, there is still a paucity of knowledge on the safety and feasibility of using Zero-P spacers for 3-level fixation. The objective of this study was to investigate the clinical and radiological outcomes, with a focus on the sagittal alignment reconstruction of 3-level ACDF surgery using Zero-P spacers versus those using a traditional plate and cage system. From Sep 2013 to Aug 2016, a total of 44 patients who received 3-level ACDF surgery due to cervical spondylotic myelopathy were recruited. The Zero-P spacer was used in 23 patients (group ZP) and the traditional plate and cage system in 21 (group PC). Clinical outcomes were analyzed by Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores, and dysphagia was evaluated using the Bazaz score. Radiological outcomes, including fusion rate, adjacent segment degeneration (ASD), and especially changes in cervical sagittal alignment, were analyzed. The NDI and JOA scores did not differ significantly between the two groups postoperatively (p > 0.05); however, there was significantly less dysphagia in patients using Zero-P spacers at the 3- and 6-month follow-up (p < 0.05). At the 24-month follow-up, the fusion rate and ASD were similar between the two groups (p > 0.05). Interestingly, patients using Zero-P spacers had a significantly lower postoperative C2-7 Cobb angle and fused segment Cobb angle, compared to those using a traditional plate and cage system (p < 0.05); meanwhile, the fused segment disc wedge was also found to be significantly smaller in patients using Zero-P spacers after surgery (p < 0.05). Moreover, we further divided patients into subgroups according to their cervical lordosis. In patients with a preoperative C2-7 Cobb angle ≤ 10°, significantly less cervical and local lordosis, as well as disc wedge, were seen in group ZP after surgery (p < 0.05), while in others with a preoperative C2-7 Cobb angle > 10°, no significant difference in postoperative changes of the cervical sagittal alignment was seen between group ZP and group PC (p > 0.05). Zero-P spacers used in 3-level ACDF surgery could provide equivalent clinical outcomes and a lower rate of postoperative dysphagia, compared to the traditional plate and cage system. However, our results showed that it was inferior to the cervical plate in terms of sagittal alignment reconstruction for 3-level fixation. We recommend applying Zero-P spacers for 3-level ACDF in patients with good preoperative cervical lordosis (C2-7 Cobb angle > 10°), in order to restore and maintain physiological curvature of the cervical spine postoperatively.

Abstract Backgrounds Cartilaginous endplate (CEP) plays an essential role in intervertebral disc (IVD) health and disease. The aim was to compare the CEP structure of lumbar IVD and to reveal the detailed pattern of integration between the CEP and bony endplate (BEP) from different species. Methods A total of 34 IVDs (5 human, 5 goat, 8 pig, 8 rabbit, and 8 rat IVDs) were collected, fixed and midsagittally cut; in each IVD, one‐half was used for histological staining to observe the CEP morphology, and the other half was used for scanning electron microscopy (SEM) analysis to measure the diameters and distributions of collagen fibers in the central and peripheral CEP areas and to observe the pattern of CEP‐BEP integration from different species. Results The human, pig, goat, and rabbit IVDs had the typical BEP‐CEP structure, but the rat CEP was directly connected with the growth plate. Human CEP was the thickest (896.95 ± 87.71 μm) among these species, followed by pig, goat, rat, and rabbit CEPs. Additionally, the mean cellular density of the rabbit CEP was the highest, which was 930 ± 202 per mm2, followed by the rat, goat, pig, and human CEPs. In all the species, the collagen fiber diameter in the peripheral area was much bigger than that in the central area. The collagen fiber diameters of CEP from the human, pig, goat, and rat were distributed between 35 nm and 65 nm. The BEP and CEP were connected by the collagen from the CEP, aggregating into bundles or cross links with each other to form a network, and anchored to BEP. Conclusions Significant differences in the thickness, cellular density, and collagen characterization of CEPs from different species were demonstrated; the integration of BEP‐CEP in humans, pigs, goats, and rabbits was mainly achieved by the collagen bundles anchoring system, while the typical BEP‐CEP interface did not exist in rats.

目的 探讨3D打印定位导航模板辅助置钉在脊柱畸形矫形术中应用的可行性,并评估置钉的准确性与安全性.方法 回顾性分析2020年4月—2021年4月北京大学深圳医院收治的因脊柱畸形接受3D定位导航模板辅助置钉矫形术治疗的9例患者临床资料.通过术前规划确定钉道和螺钉尺寸,所有患者术中均使用3D打印定位导航模板辅助置钉,术后复查CT平扫及三维重建,采用Mobbs-Raley分级对螺钉位置进行评估,并分析置钉相关并发症发生情况.结果 所有手术顺利完成.共置入椎弓根螺钉118枚,其中34枚穿破椎弓根皮质,9枚穿破椎体外缘.0级螺钉75枚,1级螺钉24枚,2级螺钉19枚,置钉准确率为63.6％,置钉安全率为83.9％.所有患者均未发生神经、血管损伤等相关并发症,无患者行翻修手术.结论 3D打印定位导航模板辅助置钉在脊柱畸形矫形术中有良好的应用价值,置钉准确性和安全性较高.

目的 探讨沉默信息调节因子(SIRT1)基因对小鼠椎体骨质疏松的影响.方法 将小鼠分为两组:软骨SIRT1基因未敲除小鼠组(A组,n=7);软骨SIRT1基因特异性敲除小鼠组(B组,n=7).利用荧光定量聚合酶链反应及SIRT1免疫组化检测SIRT1基因的表达情况;通过对两组小鼠尾椎行Micro-CT扫描量化骨量体积百分比、骨小梁数量和骨小梁的厚度的改变;再采用HE染色、Masson染色评价椎体骨质结构的改变.结果 B组小鼠SIRT1mRNA表达量为(2.61±1.11),明显低于A组(8.08±1.64)(P＜0.01);B组SIRT1蛋白的免疫组化染色积分为(3.10±2.69),明显低于A组(5.07±2.99)(P＜0.01).Micro-CT结果显示,A组小鼠骨量体积百分比为(37.96±8.54)％,显著高于B组的(28.39±6.27)％,差异有统计学意义(P＜0.05);A组小鼠骨小梁数目(5.76±0.63)显著高于B组(5.15±0.50),差异有统计学意义(P＜0.05);两组小鼠的骨小梁厚度差异无统计学意义(P＞0.05).HE染色和Masson染色结果显示,A组椎体骨质较B组明显密集.结论 SIRT1基因敲除减少了小鼠椎体骨量体积百分比、骨小梁数量,因此SIRT1基因可能对小鼠椎体骨量调节具有积极的作用.

Study Design: A biomechanical study. Objectives: The purpose of this study was to investigate the effects of cruciform and square incisions of annulus fibrosus (AF) on the mechanical stability of bovine intervertebral disc (IVD) in multiple degrees of freedom. Methods: Eight bovine caudal IVD motion segments (bone-disc-bone) were obtained from the local abattoir. Cruciform and square incisions were made at the right side of the specimen’s annulus using a surgical scalpel. Biomechanical testing of three-dimensional 6 degrees of freedom was then performed on the bovine caudal motion segments using the mechanical testing and simulation (MTS) machine. Force, displacement, torque and angle were recorded synchronously by the MTS system. P value <.05 was considered statistically significant. Results: Cruciform and square incisions of the AF reduced both axial compressive and torsional stiffness of the IVD and were significantly lower than those of the intact specimens ( P < .01). Left-side axial torsional stiffness of the cruciform incision was significantly higher than a square incision ( P < .01). Neither incision methods impacted flexional-extensional stiffness or lateral-bending stiffness. Conclusions: The cruciform and square incisions of the AF obviously reduced axial compression and axial rotation, but they did not change the flexion-extension and lateral-bending stiffness of the bovine caudal IVD. This mechanical study will be meaningful for the development of new approaches to AF repair and the rehabilitation of the patients after receiving discectomy.

腰椎峡部裂是指一侧或两侧峡部骨质不连续,在一般人群中发生率为6％,男女比例为2:1[1].腰椎峡部裂是引起青少年腰背痛的常见原因,与腰椎反复过伸及旋转活动密切相关[2-5].有研究[6]表明,青少年腰椎峡部裂有一定遗传倾向.大部分有症状的青少年腰椎峡部裂患者可通过规范的非手术治疗恢复日常生活和运动,尤其对于发现较早的单纯性腰椎峡部裂应首先考虑非手术治疗[7-9].目前腰椎峡部裂非手术治疗包括系统物理治疗、腰背肌锻炼、佩戴支具及封闭治疗等[10].

BACKGROUND CONTEXT: Anterior controllable antedisplacement and fusion (ACAF) is a novel surgical technique for the treatment of ossification of the posterior longitudinal ligament (OPLL). Its prognostic factors for decompression have not been well studied. Additionally, no detailed radiological standard has been set for hoisting the vertebrae-OPLL complex (VOC) in ACAF. PURPOSE: To identify the possible prognostic factors for decompression outcomes after ACAF for cervical OPLL, to determine the critical value of radiological parameters for predicting good outcomes, and to establish a radiological standard for hoisting the VOC in ACAF. STUDY DESIGN: This was a retrospective multicenter study. PATIENT SAMPLE: A total of 121 consecutive patients with OPLL who underwent ACAF at a point between January 2017 and June 2018 at any one of seven facilities and were monitored for at least 1 year afterward were enrolled in a multicenter study. OUTCOME MEASURES: Japanese Orthopedic Association (JOA) scores, recovery rate (RR) of neurologic function, and surgical complications were used to determine the effectiveness of ACAF. METHODS: Patients were divided into two groups according to their RR for neurologic function. Patients with an RR of >= 50% and an RR of <50% were designated as having good and poor decompression outcomes, respectively. The relationship between various possible prognostic factors and decompression outcomes was assessed by univariate and multivariate analysis. The receiver operating characteristic curve was used to determine the optimal cutoff value of the radiological parameters for prediction of good decompression outcomes. Next, the patients were redivided into three groups according to the cutoff value of the selected radiological parameter (postoperative anteroposterior canal diameter [APD] ratio). Patients with postoperative APD ratios of <= 80.7%, 80.7%-100%, and >= 100% were defined as members of the incomplete, optimal, and excessive antedisplacement groups, respectively. Differences in decompression outcomes among the three groups were compared to verify the reliability of the postoperative APD ratio and assess the necessity of excessive antedisplacement. RESULTS: Multivariate logistic regression analysis showed that patients' age at surgery (odds ratio [OR]=1.18; 95% confidence interval [CI]=1.08-1.29; p<.01) and postoperative APD ratio (OR=0.83; 95% CI=0.77 -0.90; p<.01) were independently associated with decompression outcomes. The optimal cutoff point of the postoperative APD ratio was calculated at 80.7%, with 86.2% sensitivity and 73.5% specificity. There were no significant differences in the postoperative JOA scores and RRs between the excessive antedisplacement group and optimal antedisplacement group (p>.05). However, a lower incidence of cerebrospinal fluid leakage and screw slippage was observed in the optimal antedisplacement group (p<.05). CONCLUSIONS: Patients' age at surgery and their postoperative APD ratio are the two prognostic factors of decompression outcomes after ACAF. The postoperative APD ratio is also the most accurate radiological parameter for predicting good outcomes. Our findings suggest that it is essential for neurologic recovery to restore the spinal canal to more than 80.7% of its original size (postoperative APD ratio >80.7%), and restoration to less than its original size (postoperative APD ratio <100%) will help reduce the incidence of surgical complications. This may serve as a valuable reference for establishment of a radiological standard for hoisting the VOC in ACAF. (C) 2020 Elsevier Inc. All rights reserved.

BACKGROUND The correction surgery for severely multidimensional spinal deformity in neurofibromatosis type I is very difficult and it is still a very big challenge for spine surgeons.CASE SUMMARY A 44-year-old woman presented with progressive kyphosis for more than 10 years and low back pain for 2 years. She had been diagnosed with neurofibromatosis at a local hospital many years ago. Conservative treatments had been applied,but the symptoms got worse rather than alleviated. Therefore,surgery was required.CONCLUSION For this patient with severe deformity,the correction treatment of Ponte osteotomy followed by satellite rod technique in the region of the apical vertebra and the technique of pedicle screws and dual iliac screws had been applied,and successful clinical outcomes were achieved.

腰椎术后脑脊液漏是脊柱外科手术的常见并发症,主要原因是术中硬膜破裂导致脑脊液流出[1-2].脑脊液漏可出现典型的头痛、头晕、恶心、呕吐、切口渗液等症状[3-4].脑脊液漏处理不当可引起切口长期不愈合、局部感染,甚至导致脊髓感染、脑膜炎等严重并发症[5];同时,因术后神经系统并发症增加和住院时间延长,患者的经济负担相应加重[6].

Osteosarcoma (OS) is the most common primary bone tumour, with a peak incidence in adolescents, and the five-year survival rate of patients with metastasis or recurrence is much lower than that of patients without metastasis and recurrence. OS is initiated and develops in a complex tumour microenvironment (TME) that contains many different components, such as osteoblasts, osteoclasts, mesenchymal stem cells, fibroblasts, immune cells, extracellular matrix (ECM), extracellular vesicles, and cytokines. The extensive interaction between OS and the TME underlies OS progression. Therefore, rather than targeting OS cells, targeting the key factors in the TME may yield novel therapeutic approaches. MicroRNAs (miRNAs) play multiple roles in the biological behaviours of OS, and recent studies have implied that miRNAs are involved in mediating the communication between OS cells and the surrounding TME. Here, we review the TME landscape and the miRNA dysregulation of OS, describe the role of the altered TME in OS development and highlight the role of miRNA in the crosstalk between OS cells and the TME.