Study DesignRetrospective cohort study.ObjectiveTo evaluate the therapeutic effects of postoperative repetitive transcranial magnetic stimulation (rTMS) on neuropathic pain (NP) and neurological recovery in patients with degenerative cervical myelopathy (DCM).MethodsFifty-nine DCM patients who underwent cervical decompression between 2017 and 2024. Twenty-seven received postoperative rTMS (20 Hz, 20 trains of 40 pulses at 90% resting motor threshold over the biceps brachii for 5 consecutive days) in addition to routine care, while 32 received routine care only. Pain intensity at the neck, upper limbs, and below-neck regions was assessed using the 10-cm Visual Analog Scale (VAS). NP was identified by a Douleur Neuropathique 4 (DN-4) score ≥4. Hand dexterity, myelopathy severity, and conduction function were evaluated by the 10-second grip-and-release test, modified Japanese Orthopedic Association (mJOA) scale, and somatosensory/motor evoked potentials (SSEP/MEP) respectively.ResultsAmong patients with NP (n = 25), rTMS significantly reduced VAS pain scores in the upper limbs and below-neck regions (P < 0.05), but not in the neck. No effect was observed in non-NP patients (n = 34). rTMS also improved hand dexterity, mJOA scores, and recovery rates compared with controls, particularly in patients with preoperative mJOA ≤14 (P < 0.05). These benefits persisted for 6 months. However, SSEP and MEP results were comparable between groups, suggesting that rTMS did not alter cervical conduction.ConclusionFive-day postoperative rTMS was associated with NP and functional recovery in DCM, especially in severe cases, possibly by modulating higher central pathways.

Recurrent lumbar disc herniation (RLDH) after endoscopic lumbar discectomy (ELD) remains challenging, with recurrence rates of 2.8–15

STUDY DESIGN:A multicenter retrospective study. OBJECTIVE:Several classifications of cervical spinal cord injury without fracture-dislocation (CSCIWOFD) have been reported during past decades, but no classification propose suggestions for surgical approach decision. In this study, we aimed to establish a new classification of CSCIWOFD based on imaging features of patients, and to determine the surgical outcomes of the different types of CSCIWOFD after different surgical approaches. SETTING:Affiliated hospital of University in Nanchang, the Second Hospital of Shanxi Medical University in Taiyuan, Guangdong Provincial People's Hospital in Guangdong and Renji Hospital in Shanghai, China. METHODS:The clinical data of patients with CSCIWOFD who received conservative or surgical treatment at participating centers between January 2018 and December 2022 were retrospectively reviewed. Patients were classified into four types based on preoperative cervical spine X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) characteristics. The reliability and reproducibility of the new classification was evaluated by six observers from different centers at an interval of 4 weeks. All patients were followed up at least 2 years, and the surgical outcomes of the different types were analyzed. RESULTS:A total of 300 patients with CSCIWOFD were included. Among these patients, 15 received conservative treatment, 169 underwent anterior cervical surgery, 105 underwent posterior cervical surgery, and 11 underwent posterior combined with anterior surgery. The mean Kappa value for inter-observer reproducibility was 0.811, and for intra-observer reliability was 0.893. For Type II patients, the improvement rate of ASIA grade in anterior surgery was significantly higher than that in posterior surgery (P = 0.009). However, for Type III patients, the improvement rate following posterior surgery was higher than that of those undergoing anterior surgery, though no statistically significant difference was observed. In Type IV patients, the combined anterior and posterior approach resulted in a higher improvement rate compared to either the anterior or posterior surgery alone (63.64% vs. 33.33% vs. 16.67%), but again, no statistically significant difference was found. CONCLUSIONS:For patients with CSCIWOFD, a novel classification was developed based on preoperative imaging features, which was proven to be reliable. Type I patients can be treated with conservative treatment or anterior surgery; patients with Type II CSCIWOFD have good neurological outcomes after anterior surgery. For Type III patients, the posterior approach may offer better outcomes, while for Type IV patients, the combined anterior and posterior approach may be more effective.

BACKGROUND:Intervertebral disc degeneration (IVDD) is a leading cause of low back pain and disability. Ferroptosis, an iron-dependent form of regulated cell death driven by oxidative stress, plays a critical role in IVDD pathogenesis. Melatonin, a neurohormone with antioxidative properties, has shown potential protective effects, but its precise mechanism of action remains unclear. METHODS:This study integrated multi-omics analyses, human NP specimens, cultured human NP cells, and a rat IVDD model induced by tert-butyl hydroperoxide (TBHP). Ferroptosis, oxidative stress, mitochondrial injury, and ECM metabolism were evaluated using histological staining, flow cytometry, ELISA, immunofluorescence, and western blotting. The involvement of melatonin receptors and PI3K/AKT-mTOR signaling was examined using pharmacological activation/blockade. Computational structural modeling was additionally employed to assess interactions between mTOR and ferroptosis-related proteins. RESULTS:Melatonin significantly inhibited TBHP-induced ferroptosis in NP cells by restoring GSH levels, reducing Fe2⁺ accumulation and ROS generation, preserving mitochondrial morphology, and upregulating SLC7A11 and GPX4. Melatonin also ameliorated ECM metabolic imbalance by increasing collagen II, aggrecan, and osteonectin, while suppressing MMP-9 and ADAMTS5. These protective effects were abolished by MT1/MT2 receptor antagonism or AKT phosphorylation inhibition, indicating pathway dependence. In vivo, melatonin attenuated disc degeneration, reduced apoptosis, restored ECM components, and normalized ferroptosis-related markers. Multi-omics datasets and structural modeling further supported that melatonin regulates ferroptosis through MT1/2-mediated activation of the PI3K/AKT-mTOR axis. CONCLUSIONS:Melatonin mitigates IVDD by suppressing ferroptosis and preserving ECM homeostasis through melatonergic receptor (MT1/MT2)-dependent activation of the PI3K/AKT-mTOR pathway. Notably, clinical and protein-level evidence suggests that MT1 may represent the predominant therapeutic target, supporting melatonin as a promising, low-toxicity candidate for delaying IVDD progression.

STUDY DESIGN:Retrospective study. PURPOSE:To compare postoperative paravertebral muscle atrophy, fat infiltration, and clinical efficacy between unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and Wiltse approach transforaminal lumbar interbody fusion (W-TLIF). OVERVIEW OF LITERATURE:The long-term effects of UBE-TLIF and W-TLIF techniques on paravertebral muscle integrity and clinical outcomes have not been directly compared. METHODS:Fifty patients who underwent UBE-TLIF and 50 patients who underwent W-TLIF, each with >2 years of follow-up, were retrospectively analyzed. Outcomes included operative parameters, time to postoperative mobilization, paravertebral muscle atrophy and fat infiltration rates, clinical scores (Visual Analog Scale [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association [JOA]), modified Macnab criteria, fusion rates, and complications. RESULTS:Compared with W-TLIF, the UBE-TLIF group had significantly less intraoperative blood loss, shorter operative times, and lower postoperative drainage volumes (p <0.05). The UBE-TLIF group showed faster postoperative recovery and shorter hospital stays. At 6 months, 1 year, and 2 years, W-TLIF patients had higher multifidus and erector spinae atrophy, and greater paravertebral muscle fat infiltration (p <0.05). The UBE-TLIF group also had lower VAS and ODI scores at 1 year and 2 years (p <0.05) and fewer surgical complications (6% vs. 10%). Fusion rates (94% vs. 92%) and modified Macnab outcomes (88% vs. 86%) were comparable (p >0.05). CONCLUSIONS:UBE-TLIF is associated with reduced intraoperative trauma, quicker recovery, and fewer complications. In the long-term, it better preserves paravertebral muscle integrity and provides superior pain and functional outcomes.

A retrospective study. This study aims to investigate the relationship between the resection of ossification of the nuchal ligament (ONL), its morphological features, and cervical stability following modified laminoplasty. We retrospectively reviewed the data of patients diagnosed as degenerative cervical myelopathy (DCM) who underwent modified laminoplasty with muscle-ligament complex (MLC) reconstruction in our hospital between July 2018 and October 2022. Demographic information (e.g., age, gender), cervical sagittal parameters, cervical angular displacement (AD), cervical horizontal displacement (HD), range of motion and patient-reported outcomes were compared between patients with and without ONL. The cervical AD at C4-C5, C5-C6 and cervical HD at C5-6 were significantly higher in ONL (+) group than ONL (-) group before surgery and at the 24-month follow-up time (p < 0.05, all). The AD and HD at C4-C5 and C5-C6 were higher in ONL (+) segments before surgery and at the 24-month follow-up (p < 0.05, all). But the values of AD or HD were lower in ONL (+) segments at 3- or 6-month follow-up (p < 0.05, all). ONL (+) group with two or more consecutive segments demonstrate significantly increased cervical AD and HD at the C4-C5 level after a 24-month follow-up period (p < 0.01, both). Resection of the ONL, particularly involving ≥ 2 cervical segments, is moderately associated with an increased likelihood of cervical instability and abnormal sagittal alignment in long-term follow-up after laminoplasty. Reconstruction of the MLC during laminoplasty may enhance cervical stability in the early follow-up period. For DCM patients with long segmental ONL, more attention should be paid to protecting the MLC structure during posterior cervical surgery. Not applicable.

Background:The supplemental harvesting of in-situ bone obtained from cervical vertebrae as cage-filling material in anterior cervical discectomy and fusion (ACDF) results in a good fusion outcome. This study aimed to further quantitatively evaluate the obtainable bone volume and clinical outcomes of cervical in-situ autogenous bone grafting based on a three-dimensional (3D) preoperative simulation. Methods:This study included 78 patients who underwent single-level ACDF. Prior to the surgical procedure, a 3D simulated surgery was performed by constructing several cutting planes in the cervical vertebrae based on Mimics software. The volumes of the harvested in-situ bone graft, including the anterior lip, posterior osteophytes, and Luschka's joint volumes, were measured during the simulated surgery. Immediate postoperative computed tomography (CT) scans were performed to evaluate the efficacy of the preoperative planning. During the postoperative follow-up period, the neurological function and cervical fusion state were also evaluated. Results:The average volume of the cage's bone graft groove was 373.1±74.4 mm3, which was lower than that calculated in the preoperative planning (501.6±179.6 mm3, P<0.001). In 88.5% (69/78) of the simulated surgery cases, the harvested bone met the volume of the cage's bone graft groove, aligning with the intraoperative scenario. Male patients, elderly patients, patients with lower surgical segments, and patients with higher-grade facet joint degeneration had a more sufficient availability of in-situ autologous bone. The mean follow-up time was 18.02±4.9 months. At the final follow-up, the pain and functional status scores of the patients had improved significantly following surgery (P<0.05). Conclusions:Preoperative planning for ACDF using Mimics software was shown to be both feasible and accurate. The 3D simulated surgery revealed that the majority of patients could supply a sufficient volume of cervical autologous bone for intraoperative grafting. The comprehensive analysis of the in-situ bone harvesting in ACDF provided precise reference data for the clinical implementation.

To evaluate the impact of frailty, as measured by the 5-item modified frailty index (mFI-5), on short- and long-term postoperative outcomes in patients undergoing cervical posterior laminoplasty for ossification of the posterior longitudinal ligament (OPLL). A retrospective cohort study. 198 patients who underwent cervical posterior laminoplasty were divided into three groups based on mFI-5 scores: Group A (0 point), Group B (1 point), and Group C (2 or more points). Preoperative and postoperative mJOA, NDI, and VAS scores were assessed at short-term follow-ups (1 and 6 months) and long-term follow-ups (12 and 24 months). The incidence of complications, including superficial surgical site infections (SSI) and deep vein thrombosis (DVT), was recorded. Statistical analyses included ANOVA and Spearman correlation to evaluate the association between mFI-5 scores and clinical outcomes. In the short-term (1 and 6 months), there were no significant differences in mJOA, NDI, and VAS scores among the three groups. However, in the long-term (12 and 24 months), Group C (mFI-5 ≥ 2) exhibited significantly worse mJOA and NDI scores compared to Groups A and B. Additionally, Group C had a higher incidence of complications, such as superficial SSI and DVT. Frailty, as measured by mFI-5, is a significant predictor of long-term postoperative outcomes in patients undergoing cervical posterior laminoplasty for OPLL. Patients with higher mFI-5 scores experienced poorer long-term functional recovery and a higher incidence of complications. These findings emphasize the importance of assessing frailty in preoperative risk stratification and surgical planning.

Bi-allelic loss-of-function (LoF) variants in SLC10A7 cause short stature, amelogenesis imperfecta, and skeletal dysplasia with scoliosis (SSASKS). Here, we report findings from an individual of Chinese ancestry with SSASKS carrying compound heterozygous splice-altering SLC10A7 variants: a previously reported pathogenic variant (NM_001029998.6:c.722-16A>G, paternal) and a de novo splice site variant (NM_001029998.6:c.472-1G>T, maternal). In silico predictions, minigene assays, and analyses of RNA and protein from the affected individual revealed that c.472-1G>T causes in-frame exon 7 skipping and c.722-16A>G induces out-of-frame exon 9 skipping. RNA sequencing of blood-derived cells showed that ∼32% residual SLC10A7 function in the affected individual, consistent with the 43% protein accumulation observed by western blot analysis of muscle tissue. These findings indicate that a previously presumed complete LoF allele instead results in partial LoF, prompting a refinement of the genotype-phenotype framework for SLC10A7-related SSASKS. This study highlights the challenges of predicting partial LoF effects, the value of RNA and protein analyses from affected individual-derived tissues, and the importance of distinguishing partial from complete LoF variants in the diagnosis and counseling of recessive disorders.

OBJECTIVE:We aim to investigate the spatiotemporal dynamics of intervertebral disc (IVD) cell subpopulations in IVD degeneration (IVDD). METHODS:To gain combined spatial and transcriptomic insights into IVDD, we employed both spatial transcriptomic sequencing (stRNA-seq) and single nucleus RNA sequencing (snRNA-seq) in a rat puncture-induced IVDD model. The findings were verified in rat and human IVD by immunostaining and qRT-PCR. Tamoxifen-administered PdgfraCreERT2;R26tdTomato mice were adopted to track platelet-derived growth factor receptor alpha (Pdgfra) positive cells. RESULTS:Puncture response regions were revealed on day 1 post-puncture, for which oxidative stress emerged as a prominent pathway in a Stress Zone consisting of lipocalin-2 (Lcn2)+ annulus fibrosus (AF) cells (AFC), which propagated and migrated into nucleus pulposus (NP), playing a key role in delivering injury signals and triggering pathological processes, including ferroptosis, fibrosis, and immune reactions. In the NP, Collagen 3-high (Col3hi) NP cells (NPC) were another induced population demonstrating a fibrochondrocyte-like phenotype and high epithelial-mesenchymal transition activation, an important pathway involved in tissue fibrosis. Crucially, lineage tracing experiments in PdgfraCreERT2;R26tdTomat mice revealed the significant migration and proliferation of Pdgfra+ AFCs from the AF into the NP following puncture. These findings provide direct evidence that both Pdgfra+ AFCs and Col3hi NP cells may contribute to NP fibrosis. CONCLUSION:Puncture-induced oxidative stress in a stress zone is the primary reaction playing an important role in initiating IVDD. Several puncture-induced cell subpopulations were identified, including Lcn2+ AFC, Col3hi NPC, and Pdgfra+ AFC. Lcn2+ AFC plays a pivotal role in connecting oxidative stress with other pathological processes. Our results clarified the dual origin of Pdgfra+ cells, highlighting the contribution of AF-derived cells to the NP during degeneration and emphasizing the complexity of cellular changes underlying NP fibrosis. Further investigation into the specific contributions of Pdgfra+ cells from different origins to fibrosis is warranted. KEY POINTS:Puncture induced oxidative stress in a Stress Zone is the primary reaction in initiating IVDD. Puncture induced several IVD cell subpopulations, including Lcn2+ AFC, Col3hi NPC and Pdgfra+ AFC. Lcn2+ AFC plays a pivotal role in connecting oxidative stress with other pathological processes. Pdgfra+ cells in the NP derived from both Pdgfra+ AFC and Col3hi NPC, highlighting dual origin of NP fibrosis.

Background:Anterior cervical discectomy and fusion (ACDF) is a standard surgical procedure for treating degenerative cervical disc diseases. However, the differences between autograft and allografts in terms of early-stage fusion and bone morphology remain largely unclear. This study aimed to provide a comprehensive analysis of the fusion process via quantitative computed tomography (CT)-based three-dimensional (3D) reconstruction, focusing on the differences between autografts and allografts and their impact on clinical outcomes. Methods:A retrospective analysis was conducted on 134 patients who underwent single- or two-level ACDF with polyetheretherketone (PEEK) cages filled with either autografts (n=80) or allografts (n=54). Fusion volume and osteogenic morphology were assessed at 3, 6, 12, and 24 months postoperatively via CT-based 3D reconstruction. Fusion morphology was classified into stalactite, hourglass, and columnar patterns. Clinical outcomes were evaluated with the neck pain visual analog scale (VAS) and modified Japanese Orthopaedic Association (mJOA) scores, while radiographic parameters included cervical sagittal vertical axis (cSVA), C2-7 lordosis, segmental height, and subsidence. Results:At 3 and 6 months, the autograft group, as compared to the allograft group, exhibited significantly higher fusion volumes (3 months: the autograft group 185.04±92.67 mm3 vs. the allograft group 143.54±60.41 mm3; 6 months: the autograft group 270.03±96.15 mm3 vs. the allograft group 213.42±114.08 mm3) and fusion rates (3 months: the autograft group 11.2% vs. the allograft group 0%; 6 months: the autograft group 46.9% vs. the allograft group 23.8%), and superior osteogenic morphology (P<0.05). By 12 and 24 months, the fusion rates were similar between groups, but the autograft group demonstrated a more structured fusion morphology, with a higher prevalence of columnar fusion patterns. Larger early fusion volumes were associated with better intervertebral height maintenance, reduced subsidence, and greater pain relief. The absence of postoperative cervical collar use did not negatively impact fusion progression, likely due to the stability provided by advanced implant designs. Conclusions:Quantitative CT-based 3D reconstruction offers a highly precise and dynamic approach for assessing bone fusion in ACDF, enabling detailed visualization of fusion morphology and volume over time. These findings indicate that autografts promote earlier and more robust osteogenesis, leading to superior early clinical outcomes. These results emphasize the importance of graft selection and suggest that advanced 3D imaging techniques should be integrated into clinical practice to enhance fusion evaluation and optimize patient recovery.

Objective The mechanisms of intervertebral disc degeneration (IVDD) in low back pain (LBP) patients are multiples. In this study, we attempt to investigate whether melatonergic system plays a potential role in IVDD patients with LBP by analyzing their clinical specimens. The fucus will be given to the correlation between the melatonin receptor expression and intervertebral disc tissue apoptosis. Methods In this clinical study, 107 lumbar intervertebral disc nucleus pulposus (NP) specimens from patients with LBP were collected with patients’ consents. The disc height (DH) discrepancy ratio, range of motion and sagittal parameters of the pathological plane were measured and Pfirrmann grade was used to classified the grades of IVDD level. Discs at grades 1–3 were served as normal control and grades 4–5 were considered as IVDD. The expression levels of melatonin receptor 1A (MT1) and 1B (MT2) were measured by immunohistochemistry. The apoptosis of NP was assessed using TUNEL staining. Their potential associations among MT1/2, DH, apoptosis, sagittal parameters with IVDD and LBP were evaluated with statistical analysis. Results The incidence of IVDD was positively associated with age and negatively related to VAS scores for LBP (p < 0.001). Patients with higher degree of IVDD also have higher DH discrepancy ratio (p < 0.001), higher prevalence of lumbar instability (p = 0.003) and higher cell apoptosis compared to the control. Nevertheless, no statistically significant correlation was identified between Pfirrmann grade and lumbar sagittal parameters. MT1 and MT2 both were highly expressed in the NP tissues. Importantly, MT1 expression but not MT2 was significantly increased in the intervertebral disc tissue of patients with IVDD and its level correlated well with cell apoptosis level and the severity of IVDD as well as lower VAS scores for LBP. Conclusion The highly elevated MT1 expression was found in NP tissues of patients with IVDD and LBP compared to the control. This phenomenon probably reflects the compensating response of the body to the pathological alteration of the IVDD and LBP. Therefore, these findings provide the novel information to use selective agonists of MT1 to target IVDD and LBP clinically.

Study design. Diagnostic accuracy study with prospectively collected data. Objective. This study aimed to establish optimal cutoff values for the 10-second grip and release (10s-G&R) Test to distinguish between mild, moderate, and severe levels of hand dexterity impairment in patients with degenerative cervical myelopathy (DCM). Background. The 10s-G&R test is widely utilized to assess hand function in DCM patients. However, whether this test can effectively distinguish between varying severities of hand dexterity impairment, along with the relevant cutoff values, remains unknown. Materials and Methods. The authors analyzed hand motion data from 551 consecutively enrolled DCM patients using an artificial intelligent system. In addition, the authors conducted evaluations of functional status, quality of life, and outcome measures. Receiver operating curve analysis was performed to determine cutoff values that differentiate mild, moderate, and severe hand dexterity impairments based on the ability to fasten buttons, as assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire Q2-1. The validity of these cutoffs was assessed by comparing G&R parameters, upper limb disability, overall disease severity, and quality of life among patients in different severity groups. Results. The authors identified 16 G&R cycles as the cutoff for moderate hand dexterity impairment and 13 G&R cycles as the cutoff for severe impairment. Patients with severe impairment exhibited significantly worse G&R parameters, more severe upper limb symptoms, greater overall disease severity, and reduced quality of life. Patients completing fewer than 13 G&R cycles within 10 seconds were more likely to have moderate-to-severe DCM, indicating the need for potential surgical intervention. Conclusion. The authors propose classifying mild hand dexterity impairment as 17 to 20 cycles on the 10s-G&R test, moderate as 14 to 16 cycles, and severe as 13 cycles or less. Our study underscores that the 10s-G&R test can serve as an effective supplementary tool within the context of other currently available measurement tools.

Background: Cellular senescence, a novel hallmark of cancer, is associated with patient outcomes and tumor immunotherapy. However, at present, there is no systematic study on the use of cellular senescence- related long non-coding RNAs (CSR-lncRNAs) to predict survival in patients with osteosarcoma. In this study, we aimed to identify a CSR-lncRNAs signature and to evaluate its potential use as a survival prognostic marker and predictive tool for immune response of osteosarcoma. Methods: We downloaded a cohort of patients with osteosarcoma from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. We performed differential expression and co-expression analyses to identify CSR-lncRNAs. We performed univariate and multivariate Cox regression analyses along with the random forest algorithm to identify lncRNAs significantly correlated with senescence. Subsequently, we assessed the predictive models using survival curves, receiver operating characteristic curves, nomograms, C-index, and decision curve analysis. Based on this model, patients with osteosarcoma were divided into two groups according to their risk scores. Then, using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses, we compared their clinical characteristics to uncover functional differences. We further conducted immune infiltration analyses using estimation of stromal and immune cells in malignant tumor tissues using expression data (ESTIMATE), cell-type identification by estimating relative subsets of rna transcripts (CIBERSORT), and single-sample gene set enrichment analysis for the two groups. We also evaluated the expression of the target genes of immune checkpoint inhibitors (ICIs). Results: We identified six lncRNAs that were significantly correlated with senescence and accordingly established a novel cellular senescence-related lncRNA prognostic signature incorporating these lncRNAs. The nomogram indicated that the risk model was an independent prognostic factor that could predict the survival of patients with osteosarcoma. This model demonstrated high accuracy upon validation. Further analysis revealed that patients with osteosarcoma in the low-risk group exhibited better clinical outcomes and enhanced immune infiltration. Conclusions: The six-CSR-lncRNA prognostic signature effectively predicted survival outcomes and patients in the low-risk group might have improved immune infiltration.

Objective Hand clumsiness and reduced hand dexterity can signal early signs of degenerative cervical myelopathy (DCM). While the 10-second grip and release (10-s G&R) test is a common clinical tool for evaluating hand function, a more accessible method is warranted. This study explores the use of deep learning-enhanced hand grip and release test (DL-HGRT) for predicting DCM and evaluates its capability to reduce the duration of the 10-s G&R test. Methods The retrospective study included 508 DCM patients and 1,194 control subjects. Propensity score matching (PSM) was utilized to minimize the confounding effects related to age and sex. Videos of the 10-s G&R test were captured using a smartphone application. The 3D-MobileNetV2 was utilized for analysis, generating a series of parameters. Additionally, receiver operating characteristic curves were employed to assess the performance of the 10-s G&R test in predicting DCM and to evaluate the effectiveness of a shortened testing duration. Results Patients with DCM exhibited impairments in most 10-s G&R test parameters. Before PSM, the number of cycles achieved the best diagnostic performance (area under the curve [AUC], 0.85; sensitivity, 80.12%; specificity, 74.29% at 20 cycles), followed by average grip time. Following PSM for age and gender, the AUC remained above 0.80. The average grip time achieved the highest AUC of 0.83 after 6 seconds, plateauing with no significant improvement in extending the duration to 10 seconds, indicating that 6 seconds is an adequate timeframe to efficiently evaluate hand motor dysfunction in DCM based on DL-HGRT. Conclusion DL-HGRT demonstrates potential as a promising supplementary tool for predicting DCM. Notably, a testing duration of 6 seconds appears to be sufficient for accurate assessment, enhancing the test more feasible and practical without compromising diagnostic performance.

Background It is widely believed that the Percutaneous endoscopic lumbar discectomy (PELD) is associated with minimal blood loss. However, significant perioperative hidden blood loss (HBL) is frequently unaccounted for. This study aimed to investigate HBL and peri-operative factors contributing to HBL in a series of individuals undergoing PELD. Method ology: A total of 156 consecutive patients with a mean age of 43.6 years (ranging from 18 to 80 years) who underwent PELD at our department from May 2019 to November 2020, were included in the study. Factors including gender, age, body mass index, symptom duration, operation approach/technique, operation duration, the presence of associated chronic diseases, and improvements in the Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score and the Oswestry Disability Index (ODI) were analyzed, and Gross's formula was applied to calculate blood loss, which was used to determine HBL. Results The average total blood loss (TBL) was 221.0 ± 126.2 mL, while the average HBL was 181.7 ± 119.0 mL (82.2 % of TBL). There was no statistically significant difference in HBL between the transverse surgical approach and the interlayer approach. Additionally, no significant differences were observed in improvements in VAS, JOA, and ODI scores between the two surgical approaches. However, the multivariate linear regression analysis revealed that longer surgical time and foraminal decompression were factors contributing to the increase in HBL, which subsequently led to the occurrence of post-operative anemia. Conclusion HBL is significant in PELD cases with long surgical time and lumbar foraminal decompression.

Background: Intervertebral disc degeneration (IDD) is the leading cause of low back pain (LBP). The mechanism of IDD development and progression is not fully understood. Peripheral biomarkers are increasingly vital non-radioactive methods in early detection and diagnosis for IDD. Nevertheless, less attention has been paid to the role of mitophagy genes in the progress of IDD. This study aimed to identify the mitophagy disease-causing genes in the process of IDD and mitophagy diagnostic biomarkers for IDD. Methods: Mitophagy-related differentially expressed genes (MRDEGs) related to IDD were investigated by analyzing the microarray datasets of IDD cases from GEO, PathCards and Molecular Signatures Databases. We used R software, WGCNA, PPI, mRNAmiRNA, mRNA-TF, GO, KEGG, GSEA, GSVA and Cytoscape to analyze and visualize the data. We further used ssGSEA for immunoinfiltration analysis to obtain different immune cell infiltration. LASSO model was developed to screen for genes that met the diagnostic gene model requirements. Finally, qRT-PCR, Western blotting and HE were used to verify hub genes and their expression from clinical IDD samples. Results: We identified 14 MRDEGs and 12 hub genes. GO, KEGG, GSEA and GSVA analyses demonstrated that hub genes were critical for the development of IDD. LASSO diagnostic model consisted of six hub genes, among which SQSTM1, ATG7 and OPTN were significantly different between the two IDD disease subtypes. At the same time, SQSTM1 also had a high correlation with immune characteristic subtypes. The results of qRT-PCR and Western blotting also indicated that these genes were significantly differentially expressed in nucleus pulposus cells (NPCs) of the IDD group. Conclusion: We explored an association between MRDEGs-associated signature in IDD and validated that hub genes like SQSTM1 might serve as biomarkers for diagnostic and therapeutic targets for IDD. Meanwhile, this study can provide new insights into the functional characteristics and mechanism of mitophagy in the development of IDD.

BACKGROUND CONTEXT For cervical spine surgeries that involve precise procedures and high surgical risks, 3D CT reconstruction greatly improves the accuracy and safety of the surgery. However, a dearth of literature reports the utilization of 3D preoperative planning for calculating and designing bone harvest in ACDF. PURPOSE To investigate the morphological characteristics of cervical vertebrae in three dimensions, quantify the volume of bone obtained during in-situ harvesting, and evaluate the clinical outcomes of grafting in anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING N/A PATIENT SAMPLE N/A OUTCOME MEASURES N/A METHODS Sixty-one patients undergoing single-level ACDF were included in this study. Before surgery, a 3D surgical planning simulation was conducted, and constructed a simulated cutting plane in ACDF. Harvested in-situ bone graft volumes were measured during simulated surgery, including anterior lip, posterior osteophytes, and Luschka joints. Postoperative CT scans were performed to evaluate the efficacy of preoperative planning. Subsequently, the radiological fusion rate and clinical outcomes were monitored during the follow-up period. RESULTS The mean duration of follow-up was 18.02 ± 4.9 months. Upon final follow-up, it was observed that the mJOA, VAS, and NDI scores exhibited significant improvement following surgery (P < 0.05). Five cases experienced subsidence. The average graft groove volume of the cage measured 373.2 ± 74.4 mm3, which was found to be lower than the surgical plan (494.4 ± 209.5 mm3, P <0.001). In 88.5% (54/61) of the cases involving simulated operation, it was observed that the volume of the cage's bone graft groove met the stipulated requirements, aligning with the intraoperative scenario. Male, elderly patients, lower surgical segments, and higher-grade facet joint degeneration exhibited a greater availability of in-situ autologous bone. CONCLUSIONS The comprehensive analysis of the in-situ bone harvest in ACDF, offers valuable guidance for the decision-making process regarding bone grafting and potential cost reduction through eliminating allografts. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.

Congenital vertebral malformations (CVMs) and neural tube defects (NTDs) are common birth defects affecting the spine and nervous system, respectively, due to defects in somitogenesis and neurulation. Somitogenesis and neurulation rely on factors secreted from neighbouring tissues and the integrity of the axial structure. Crucial signalling pathways like Wnt, Notch and planar cell polarity regulate somitogenesis and neurulation with significant crosstalk. While previous studies suggest an association between CVMs and NTDs, the exact mechanism underlying this relationship remains unclear. In this review, we explore embryonic development, signalling pathways and clinical phenotypes involved in the association between CVMs and NTDs. Moreover, we provide a summary of syndromes that exhibit occurrences of both CVMs and NTDs. We aim to provide insights into the potential mechanisms underlying the association between CVMs and NTDs, thereby facilitating clinical diagnosis and management of these anomalies.

To assess the impact of diabetes mellitus (DM) on the postoperative motor and somatosensory functional recoveries of degenerative cervical myelopathy (DCM) patients. Motor and somatosensory evoked potentials (MEP and SSEPs) and modified Japanese Orthopedic Association (mJOA) scores were recorded in 27 diabetic (DCM-DM group) and 38 non-diabetic DCM patients (DCM group) before and 1 year after surgery. The central motor (CMCT) and somatosensory (CSCT) conduction time were recorded to evaluate the conductive functions of the spinal cord. The mJOA scores, CMCT and CSCT improved (t test, p < 0.05) in both of the DCM-DM and DCM groups 1 year after surgery. The mJOA recovery rate (RR) and CSCT recovery ratio were significantly worse (t test, p < 0.05) in the DCM-DM group compared to the DCM group. DM proved to be a significant independent risk factor for poor CSCT recovery (OR = 4.52, 95