PURPOSE:Discitis is a severe suppurative infection of the intervertebral disc (IVD) posing significant clinical challenges. This study evaluated the therapeutic efficacy of ozonated water (OW) in a rat model of Staphylococcus aureus-induced discitis and elucidated its underlying mechanisms, focusing on NF-κB signaling, extracellular matrix homeostasis, and nucleus pulposus (NP) cell apoptosis. METHODS:A rat tail coccygeal IVD discitis model was established by injecting S. aureus (102 cfu) into the disc space. From day 3 post-infection, animals received transdiscal lavage with normal saline, levofloxacin (5 mg/mL), or OW (30 μg/mL) three times daily until day 9. In vitro, NP cells were stimulated with S. aureus Protein A (SpA, 1 μg/mL). Antibacterial activity, extracellular matrix metabolism, inflammatory cytokine expression, NF-κB p65 signaling, and apoptosis were evaluated by bacterial culture, Western blotting, immunohistochemistry, TUNEL assay, and flow cytometry. RESULTS:OW significantly alleviated tail swelling and IVD structural damage. OW demonstrated potent antibacterial activity against S. aureus, disrupting bacterial membrane integrity. OW attenuated extracellular matrix degradation by upregulating collagen II and aggrecan while downregulating MMP3 and MMP9, and suppressed inflammatory responses (IL-1β, IL-6, TNF-α, Cox2) by inhibiting NF-κB p65 phosphorylation and nuclear translocation. OW also reduced NP cell apoptosis, evidenced by decreased TUNEL-positive rate, elevated Bcl-2/Bax ratio, and reduced Cleaved caspase-3. CONCLUSIONS:OW attenuates S. aureus-induced discitis through direct antibacterial action, suppression of NF-κB-mediated inflammation, protection against NP cell apoptosis, and preservation of extracellular matrix integrity, highlighting its promise as a novel lavage strategy for discitis management.

Secondary spinal cord injury (SCI) involves neuroinflammatory mechanisms such as microglial pyroptosis, which aggravates neural impairment via NLRP3 inflammasome activation. Although liraglutide (Lr) is commonly used for managing blood glucose, it also exhibits anti-inflammatory effects. Previous studies from our group have shown that glucagon-like peptide-1 receptor (GLP-1R) activation in microglia attenuates neuroinflammation and promotes functional recovery after SCI, the precise mechanism linking GLP-1R to the inhibition of pyroptosis remained unclear. Here, we report that high-dose Lr (independent of its metabolic effects) significantly improves functional and histological outcomes in a murine SCI model, and these benefits are abolished in GLP-1R-/- mice. In vitro, RNA sequencing, combined with pharmacological and genetic approaches, revealed that Lr, via the PI3K/Akt/transcription factor EB (TFEB) axis, by upregulates Fanconi anemia complementation group C (FANCC) to suppress pyroptosis. Crucially, FANCC knockdown both elevated p38 phosphorylation and blocked the anti-pyroptotic effect of Lr, thereby establishing FANCC as an essential downstream mediator. This signaling cascade culminates in the inhibition of p38-dependent NLRP3 inflammasome activation. Collectively, our work defines a novel GLP-1R/PI3K/Akt/TFEB/FANCC/p38 pathway through which Lr alleviates secondary SCI, identifying FANCC as a pivotal neuroprotective node and supporting the translational potential of GLP-1R modulation in SCI.

BACKGROUND:Lumbar disc herniation (LDH) is a common cause of back and leg pain. Diagnosis relies on clinical history, physical exam, and imaging, with magnetic resonance imaging (MRI) being an important reference standard. While artificial intelligence (AI) has been explored for MRI image recognition in LDH, existing methods often focus solely on disc herniation presence. METHODS:We retrospectively analyzed MRI images from patients assessed for surgery by specialists. We then trained deep learning convolutional neural networks to detect LDH on MRI images. This study compared pure AI, pure human, and AI-assisted approaches for diagnosis accuracy and decision time. Statistical analysis evaluated each method's effectiveness. RESULTS:Our approach demonstrated the potential of deep learning to aid LDH diagnosis and treatment. The AI-assisted group achieved the highest accuracy (94.7%), outperforming both pure AI and pure human approaches. AI integration reduced decision time without compromising accuracy. CONCLUSIONS:Convolutional neural networks effectively assist specialists in initial LDH diagnosis and treatment decisions based on MRI images. This synergy between AI and human expertise improves diagnostic accuracy and efficiency, highlighting the value of AI-assisted diagnosis in clinical practice.

Study Design Retrospective cohort study. Objectives To investigate the incidence of neurological deficits associated with percutaneous vertebral augmentation (PVA) surgery and to identify related risk factors. Methods We performed a retrospective analysis of the clinical data of patients who underwent PVA surgery at our institution between 2017 and 2022. A range of clinical parameters, including age, sex, fracture cause, fracture segment, number of vertebrae treated, surgical approach and surgical method, were collected. Results This study included a total of 1847 patients, including 422 (22.8%) men and 1425 (77.2%) women, with a total of 2319 diseased vertebrae. The mean age of the patients was 70.71 ± 8.80 years, with 211 (11.4%) patients aged under 60 years and 1636 (88.6%) patients aged over 60 years. Forty-six (2.5%) patients, accounting for 67 diseased vertebrae, were treated for tumors, whereas the remaining 1801 (97.5%) patients underwent surgery for fractures. Four hundred seventy-eight (20.6%) vertebrae underwent unilateral puncture, and the remaining 1841 (79.4%) vertebrae underwent bilateral puncture. Percutaneous vertebroplasty was performed on 1781 (76.8%) vertebrae, whereas percutaneous kyphoplasty was chosen for the remaining 538 (23.2%) vertebrae. Postoperative X-ray evaluations were conducted on the treated vertebrae, revealing that 403 (17.4%) vertebrae experienced polymethylmethacrylate (PMMA) leakage. Among the 1847 patients, 6 (7 diseased vertebrae) experienced nerve injuries postoperatively, and the incidence of neurological deficits after PVA surgery was 0.32%. Four of the 6 patients had nerve injuries due to PMMA leakage, and the other 2 patients had failed punctures. There was no statistically significant difference in terms of neurological complication rates according to patient age, sex, fracture segment, number of vertebrae treated, surgical approach or surgical method. However, the incidence of neurological complications was greater for patients with neoplastic fractures who underwent PVA surgery than for those with osteoporotic fractures. Conclusions PVA is an effective minimally invasive procedure for treating osteoporotic and neoplastic vertebral fractures. However, PVA can lead to serious neurological deficits. The incidence of neurological deficits associated with PVA surgery is 0.32%. Compared with patients with osteoporotic fractures, patients with neoplastic vertebral fractures who undergo PVA have a greater risk of neurological complications.

This study aimed to compare the predictive performance of CT-derived Hounsfield units (HU) and MRI-based vertebral bone quality (VBQ) scores for pedicle screw loosening (PSL) following single-level lumbar spinal fusion in patients with various types of degenerative lumbar disorders. A retrospective analysis was conducted on patients who underwent transforaminal lumbar interbody fusion (TLIF) at our institution between April 2021 and December 2023. PSL was identified on lumbar X-ray obtained at 12-month follow-up, defined as a radiolucent zone of ≥ 1 mm around the pedicle screw. VBQ score and HU value were measured using preoperative MRI and CT, respectively. Receiver operating characteristic (ROC) curve analysis was performed to evaluate and compare the predictive capabilities of HU and VBQ for PSL. Across all patients (n = 154), the area under the curve (AUC) of the VBQ score (AUC = 0.807; 95

The effective osteointegration of orthopedic implants is a key factor for the success of orthopedic surgery. However, local metabolic imbalance around implants under osteoporosis condition could jeopardize the fixation effect. Inspired by the bone structure and the composition around implants under osteoporosis condition, alendronate (A) was grafted onto methacryloyl hyaluronic acid (H) by activating the carboxyl group of methacryloyl hyaluronic acid to be bonded to inorganic calcium phosphate on trabecular bone, which is then integrated with aminated bioactive glass (AB) modified by oxidized dextran (O) for further adhesion to organic collagen on the trabecular bone. The hybrid hydrogel could be solidified on cancellous bone in situ under UV irradiation and exhibits dual adhesion to organic collagen and inorganic apatite, promoting osteointegration of orthopedic implants, resulting in firm stabilization of the implants in cancellous bone areas. In vitro, the hydrogel was evidenced to promote osteogenic differentiation of embryonic mouse osteoblast precursor cells (MC3T3-E1) as well as inhibit the receptor activator of nuclear factor-κ B ligand (RANKL)-induced osteoclast differentiation of macrophages, leading to the upregulation of osteogenic-related gene and protein expression. In a rat osteoporosis model, the bone-implant contact (BIC) of the hybrid hydrogel group increased by 2.77, which is directly linked to improved mechanical stability of the orthopedic implants. Overall, this organic-inorganic, dual-adhesive hydrogel could be a promising candidate for enhancing the stability of orthopedic implants under osteoporotic conditions.

Background: The aim of this study was to explore the significance of three-dimensional double-echo steady-state (3D-DESS) sequence and multidetector computed tomography (CT) plain scan in the diagnosis of lumbar disc herniation (LDH) remaining controversial in conventional magnetic resonance imaging (MRI), and to compare the efficiency between 3D-DESS and CT in diagnosing controversial patients by conventional MRI. Methods: A total of 61 patients with controversial LDH diagnosed by conventional MRI were collected. Before operation, the disease of these patients was further confirmed by 3D-DESS sequences and continuous CT plain scan from L3 to S1. Finally, for patients whose postoperative curative effect was marked and symptoms were obviously alleviated, the sensitivity, specificity and accuracy. Results: Among, 59 patients with remarkably relieved symptoms after operation were included, and 2 patients with varying degrees of non-remission of pain and partial dysfunction after operation were excluded. The sensitivity, specificity and accuracy of 3D-DESS were 94.6, 100 and 94.9%, respectively, and those of CT were 75.0, 33.3 and 72.9%, respectively. Conclusion: 3D-DESS is a very useful diagnostic method for patients with some special types of LDH that remain controversial in conventional imaging diagnostic methods. Through 3D-DESS, the morphology of lumbosacral nerve roots can be directly observed, which is conducive to the improvement of the sensitivity, specificity and accuracy, thus further reducing the misdiagnosis rate. Moreover, 3D-DESS plays a guiding role in the formulation of operative methods.

Background:A prospective controlled study was conducted to compare the short-term clinical results and postoperative complications of minimally invasive transforaminal lumbar decompression and fusion (minimally invasive surgery transforaminal lumbar interbody fusion, MIS-TLIF) and percutaneous endoscope-assisted transforaminal lumbar interbody fusion (endoscopic lumbar interbody fusion, Endo-LIF) in the treatment of single-segment degenerative lumbar diseases, to provide some scientific guidance for clinicians to select surgical treatment for patients with lumbar degeneration.Methods:From October 2020 to October 2021, a total of 62 patients were enrolled, with 31 patients in the MIS-TLIF group and 31 patients in the Endo-LIF group. All patients were followed up for 6 months. The following information from the two groups of patients was recorded: (1) operation time, radiation exposure time, intraoperative blood loss, bed rest time, and hospital stay; (2) ODI score (The Oswestry Disability Index), low back pain VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores) 1 day before the operation; 1, 3, 6 days after operation; and 1, 3 and 6 months after operation. (3) X-ray evaluations of lumbar fusion at the last follow-up.Results:There were significant differences in operation time, intraoperative fluoroscopy time, and hospitalization cost between the two groups. The MIS-TLIF group was significantly better than the Endo-LIF group, and the intraoperative bleeding volume of the Endo-LIF group was significantly better than that of the MIS-TLIF group, but there was no significant difference in postoperative bed rest time and postoperative hospital stay. There was no significant difference in the scores of ODI, VAS, and JOA between the two groups before and after the operation. At the last follow-up, the fusion rate was 100% in the MIS-TLIF group and 100% in the Endo-LIF group.Conclusions:There was no significant difference in short-term clinical efficacy and safety between Endo-LIF and MIS-TLIF in the treatment of single-segment degenerative lumbar diseases, but MIS-TLIF was significantly better than Endo-LIF in terms of the operation time, hospitalization cost, and fluoroscopy time, and Endo-LIF was significantly better than MIS-TLIF in terms of intraoperative blood loss.

Fully simulating the components and microstructures of soft tissue is a challenge for its functional regeneration. A new aligned hydrogel microfiber scaffold for spinal cord regeneration is constructed with photocrosslinked gelatin methacryloyl (GelMA) and electrospinning technology. The directional porous hydrogel fibrous scaffold consistent with nerve axons is vital to guide cell migration and axon extension. The GelMA hydrogel electrospun fibers soak up water more than six times their weight, with a lower Young's modulus, providing a favorable survival and metabolic environment for neuronal cells. GelMA fibers further demonstrate higher antinestin, anti‐Tuj‐1, antisynaptophysin, and anti‐CD31 gene expression in neural stem cells, neuronal cells, synapses, and vascular endothelial cells, respectively. In contrast, anti‐GFAP and anti‐CS56 labeled astrocytes and glial scars of GelMA fibers are shown to be present in a lesser extent compared with gelatin fibers. The soft bionic scaffold constructed with electrospun GelMA hydrogel fibers not only facilitates the migration of neural stem cells and induces their differentiation into neuronal cells, but also inhibits the glial scar formation and promotes angiogenesis. Moreover, the scaffold with a high degree of elasticity can resist deformation without the protection of a bony spinal canal. The bioinspired aligned hydrogel microfiber proves to be efficient and versatile in triggering functional regeneration of the spinal cord.

Objective: The aim of the present study was to compare the clinical outcomes of hybrid fixation using elastic stable intramedullary nailing (ESIN) for the ulna and plate screw fixation for the radius (Hybrid group) with dual plating fixation for both-bone forearm fractures in children between 10 and 16 years of age. Methods: Twenty-six patients were treated using a hybrid fixation struct and 30 patients were treated with dual plating fixation. The two groups were compared prospectively according to perioperative data and patient outcome measures. Result: The hybrid fixation construct group had 26 patients, with a mean age of 13.27 years (range, 10-16 years) and the dual plate group had 30 patients, with a mean age of 13.33 years (range, 10-16 years). The groups were similar for sex, arm injured, fracture location. Incision length of ulna, duration of surgery and hospital costs were significantly different between the two groups (P < 0.05). There was no significant difference in either time to union or Price scores for function evaluation between the 2 groups (P < 0.05). Complication rates were also similar between the groups. Conclusion: Hybrid fixation, using open reduction and internal fixation with a plate-and-screw construct on the radius and closed reduction and elastic intramedullary fixation of the ulna, is an acceptable method for treating both-bone diaphyseal forearm fractures in skeletally immature patients 10-16 years old. The small incision and less cost are the characteristics of this hybrid fixation.

In article number 1806899, Bruno Sarmento, Wenguo Cui, Liang Chen, and co-workers construct a new aligned hydrogel microfiber scaffold, which is inspired by the intricate physiological anatomy and unique physical properties of the spinal cord, using hydrogel and electrospinning for treating spinal cord injuries.

Background: Hyperglycemia in the Diabetes mellitus (DM) patients is a potential etiology of disc degeneration. 17 beta-estradiol (17 beta-E-2) supplementation plays an anti-diabetic role in DM patients. Objective: This study was aimed to investigate the role and mechanism of 17 beta-E-2 in regulating nucleus pulposus (NP) cell apoptosis and NP matrix production under a high glucose condition. Methods: Rat NP cells were cultured in medium with a high glucose concentration (0.2 M). 17 beta-E-2 was added into the culture medium to investigate its protective effects. The ER beta inhibitor PHTPP and ER beta activator ERB041 were used to investigate the effects of ER beta. NP cell apoptosis was analyzed by flow cytometry and expression of apoptosis-related molecules. NP matrix production was evaluated by expression of matrix macromolecules. Additionally, intracellular reactive oxygen species (ROS) content was also detected. Results: Compared with the control NP cells, 17 beta-E-2 decreased NP cell apoptosis ratio, down-regulated gene expression of Bax and caspase-3, up-regulated gene expression of Bcl-2, increased protein expression of cleaved PARP and cleaved caspase-3, and increased expression of matrix molecules (aggrecan and collagen II). Moreover, 17 beta-E-2 decreased ROS content. Further analysis showed that ER beta inhibition partly reversed these effects of 17 beta-E-2 whereas ER beta activation further promoted its effects. Conclusion: 17 beta-E-2/ER beta interaction attenuates apoptosis and promotes matrix biosynthesis of NP cells through alleviating oxidative damage under a high glucose condition. This study provides new knowledge on strategies for retarding disc degeneration.

STUDY DESIGN:This was a prospective study of patients who underwent vertebroplasty (VP) at a single institute.OBJECTIVE:The aim of this study was to assess and compare the clinical outcomes and complications of unilateral and bilateral VP in treating severe vertebral compression fractures.SUMMARY OF BACKGROUND DATA:Typically, VP involves cement injection by bilateral transpedicular or extrapedicular approach. Recently, several articles reported that unilateral VP can achieve comparable outcomes in most cases. However, few prospective randomized studies compared the clinical outcomes and complications in treating severe vertebral compression fractures.METHODS:Thirty-nine patients with 44 severe osteoporotic vertebral compression fractures (OVCFs) were randomly allocated into 2 groups adopting unilateral or bilateral VP. Preoperative and postoperative pain scores, back disability, and cement leakage were recorded and compared.RESULTS:Significant improvement on the visual analog scale and Oswestry disability index scores were noted in each group, and there were no significant differences between the 2 groups. Cement leakage was seen more in bilateral VP.CONCLUSIONS:Severe OVCFs should be candidates for VP. The unilateral VP can get the same clinical results with fewer complications compared with the bilateral VP.

目的 探讨和分析不稳定性Hangman骨折的手术治疗方式及临床疗效.方法 对不稳定性Hangman骨折21例采用颈前路手术治疗12例,颈后路手术治疗6例,颈前后联合入路手术治疗3例.结果 本组获得随访7～40个月,骨折端复位满意、愈合好,植骨融合率为100％,未出现钛板松动等现象.结论 颈椎前路及后路手术均n可使不稳定性Hangman骨折获得良好的治疗效果,严重骨折脱位的Hangman骨折采用前后路联合入路的手术方式更为可靠.

BACKGROUND: During posterior screw-rod internal fixation of upper cervical spine, placement of atlas lateral mass screw is the key technology. OBJECTIVE: To summarize entrance point for screw insertion of posterior screw-rod internal fixation system in instable axis fractures. METHODS: From January 2007 to December 2010, nineteen patients with instable axis fractures, including 12 males and 7 females, with an average age of 49.5 years (range, 21-75 years), were treated with Vertex posterior screw-rod internal fixation. Atlas lateral masses screw and axis pedicle screw were performed in 6 cases for internal fixation. Atlas lateral masses screw, single axis pedicle screw and neck 3 lateral masses screw were performed in 3 cases for internal fixation. Atlas lateral masses screw, double axis pedicle screws and neck 3 lateral masses screw were performed in 1 case for internal fixation. Axis pedicle screw and neck 3 lateral masses screw were performed in 9 cases for internal fixation. Fusion technique was performed in all cases. RESULTS AND CONCLUSION: Nineteen patients were followed up from 7 to 43 months. All cases had satisfactory reduction and healing in the positions of axis fractures, fusion rate in the positions of bone grafts was 100%. There were no screw and rod breakage, and no iatrogenic injury of spinal cord and vertebral artery happened. The method for the treatment of instable axis fractures is little trauma and reliable fixation. The authors according to clinical experiences, entrance point for screw insertion are summarized as follows: ①The entrance point of atlas lateral masses screw is slightly outer side in the lateral mass midpoint, at the bottom 1/3 of vertebral arch. Direction of needle is inward and upward slightly tilted about 10° and 5°. ②The entrance point of axis pedicle screw is between the upper and lower articular surface of axial, the midpoint of the middle vertical line of subtalar joint. Direction of needle is inward and upward slightly tilted about 15°-20° and 25°. ③The entrance point of neck 3 lateral masses screw is 2 mm inside of lateral mass center. Direction of needle is inward and upward slightly tilted about 20°-25°.

Objective To patients suffering from malignant spinal primitive neuroectodermal tumor in patients with clinical manifestations and therapeutic effect analysis.Methods For extracting over a period of time in our hospital,8 patients suffering from malignant spinal primitive neuroectodermal tumor clinical diagnosed patients case,which can be divided into A,B two group,average each of 4 cases.The A group were treated by operation treatment method treatment;group B patients in A the basis of further chemotherapy treatment.Two groups of patients with an average survival rate,average discharge time of comparative analysis,and summarize its clinical manifestations.Results We found in the B group,the mean survival time,signi?cantly higher than that of A group patients,and the statistical difference is obvious(P<0.05);the group of patients with the average hospitalization time,significantly shorter than in the A group,and the difference is obvious(P<0.05).Conclusion To fully understand the suffering from malignant spinal primitive neuroectodermal tumor of the clinical manifestations of patients,can guarantee the clinical of the patients were more accurate diagnosis,effective treatment for further more time,the clinical operation plus chemotherapy on the patients treatment effect is very obvious,although occurs in patients with bone marrow transplantation common complications of radiotherapy and chemotherapy,but can make the survival time of patients,survival of patients with better security,can do for future clinical of the patients preferred method.