Objective: Posterior lumbar interbody fusion (PLIF), posterolateral fusion (PLF), and Hybrid fusion are widely used fusion procedures for lumbar degenerative diseases (LDDs). Postoperative complications dominated by cage migration (CM) and adjacent segment degeneration (ASD) remain major challenges. This study aimed to identify and compare the independent risk factors for CM and ASD in PLIF, PLF, and Hybrid fusion, so as to provide evidence-based references for preoperative evaluation, surgical selection, and complication prevention in clinical practice. Methods: A retrospective cohort study was conducted in patients who underwent PLIF, PLF, or Hybrid fusion for LDDs at our institution. Demographic data (age, gender, and body mass index [BMI]), lifestyle factors (smoking and insobriety), comorbidities (hypertension, diabetes, hyperuricemia, osteoporosis, and hypoalbuminemia), surgical parameters (operative time, intraoperative blood loss, fusion segments, and lumbar lordosis angle), radiological indices (Pfirrmann grading of intervertebral disc degeneration and relative disc height), and biological markers (C-reactive protein/lymphocyte ratio [CLR], procalcitonin [PCT], and serum amyloid A [SAA]) were collected. Patients were stratified into complication and non-complication groups based on the occurrence of CM or ASD. Univariate and binary logistic regression analyses were performed to determine independent risk factors for postoperative complications. Results: A total of 203 patients were enrolled, including 80 cases with complications in the PLIF group, 64 in the Hybrid group, and 59 in the PLF group. No significant differences were noted in the distribution of complication types among the three groups (p = 0.179). Univariate analysis revealed that BMI, osteoporosis, the Pfirrmann grading of superior adjacent disc degeneration, lumbar lordosis angle, operative time, and intraoperative blood loss were significantly associated with postoperative complications across all three surgical groups (p < 0.05). Binary logistic regression analysis confirmed that elevated BMI (PLIF: OR = 1.18, 95%CI: 1.05-4.38; PLF: OR = 1.19, 95%CI: 0.76-2.18; Hybrid: OR = 1.14, 95%CI: 1.07-2.54), osteoporosis (PLIF: OR = 6.86; PLF: OR = 7.62; Hybrid: OR = 5.62), advanced superior adjacent disc degeneration (PLIF: OR = 8.04; PLF: OR = 4.49; Hybrid: OR = 2.87), prolonged operative time, and increased intraoperative blood loss were independent risk factors for postoperative complications. In contrast, age, gender, smoking, insobriety, hypertension, diabetes, CLR, PCT, and SAA were not identified as risk factors (p* > 0.05). Conclusions: Elevated BMI, osteoporosis, pre-existing superior adjacent disc degeneration, prolonged operative time, and increased intraoperative blood loss are shared independent risk factors for CM and ASD following PLIF, PLF, and Hybrid fusion for LDDs. Targeted interventions addressing these factors may reduce postoperative complication rates and improve patient outcomes.

Purpose:Despite the lack of evidence, the current standard of care following posterior pedicle screw-rod stabilization for spinal trauma includes instrumentation removal. This retrospective cohort study aimed to assess the necessity of implant removal in patients aged ≥65 years who underwent minimally invasive pedicle screw-rod fixation for AO type A and B thoracolumbar fractures. Methods:We evaluated the clinical and radiological outcomes of 57 patients aged ≥65 years with mono-segmental AO type A and B thoracolumbar fractures treated with percutaneous short-segment pedicle screw fixation, and compared the two groups with and without hardware removal. Clinical outcomes included the visual analog scale score for back pain (VAS), Oswestry Disability Index (ODI), residual chronic back pain (RCBP) and implant-related complications. Radiological parameters, such as the vertebral wedge angle (VWA), segmental kyphosis Cobb angle (SKCA), anterior edge height ratio (AEHR) and adjacent intervertebral height index (IHI), were measured. Results:No significant differences were observed between the two groups in the mean VAS and ODI values at 12 months and final follow-up. The incidence of RCBP in the implant retention group (25.9%) was slightly higher than that in the implant removal group (20%). However, there were no significant differences between the two groups. Both groups showed correction loss over time. An increase in the segmental kyphosis Cobb angle only differed by 2.02° with no significant difference between the two groups at final follow-up (implant removal group A 4.15°, implant removal group 2.13°). However, whether the implant was removed or not, no statistically significant differences were found in the correction loss of SKCA, VWA, IHI, or AEHR between the two groups within the 12-month follow-up period. Conclusion:Our results suggest that percutaneous short-segment pedicle screw fixation showed similar radiological and functional outcomes in patients aged ≥65 years, regardless of whether the implants were removed after fracture healing.

Background: Numerous studies have confirmed that both posterior lumbar interbody fusion (PLIF) and posterior lumbar fusion (PLF), have their advantages and disadvantages. However, the inconsistent results of these studies make it difficult to reach a consensus on which fusion method is superior. Objective: To compare the clinical outcomes of PLIF, PLF, and hybrid surgery combining PLIF and PLF in the treatment of lumbar degenerative disease. Methods: A retrospective review was conducted, collecting clinical records and radiological data of patients with lumbar degenerative disease from 2014 to 2022. Patients were divided into 3 groups based on surgical strategy: PLIF group, PLF group, and hybrid group. Clinical data included patient- reported outcomes such as the Japanese Orthopedic Association score, Oswestry Disability Index score, visual analog scale score, 36- item Short Form Health Survey score, and the occurrence of complications. Radiological data included Cobb angle, fusion rate, adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), and cage subsidence. Results: A total of 378 patients were divided into 3 groups: PLIF group (n = 122), PLF group (n = 126), and hybrid group (n = 130). The baseline characteristics were balanced among the 3 groups. As the follow- up time increased, visual analog scale scores showed varying degrees of improvement (all P measuretime < 0.001), but there were no significant differences observed between the groups (all P measuretime * group > 0.05). Oswestry Disability Index scores improved over time ( F measuretime = 939, P measure time < 0.001), with the hybrid group showing more significant improvement ( F measure time * group = 2.826, P measure time * group = 0.006). The 36- item Short Form Health Survey scores and Cobb angles also improved significantly during the follow- up period, with no significant differences observed among the groups. The overall fusion rates for the hybrid group and PLIF group were 93% and 91%, significantly higher than the fusion rate of the PLF group (84%; P = 0.031). The postoperative complication rate was significantly higher in the PLIF group (24.4%) compared with the PLF group (16.4%) and the hybrid group (12.5%; P = 0.022). There was no significant difference in the overall 5- year ASDeg occurrence rate (38% vs 36%) and ASDis occurrence rate (11.3% vs 8.3%) between the PLIF group and PLF group for single- level fusion (P > 0.05). The occurrence rate of ASDeg for multilevel fusion in the hybrid group was 29%, significantly lower than that in the PLIF group (42%) and PLF group (37%; P = 0.044). The overall 5- year ASDis occurrence rates for multilevel fusion were 12.3%, 9.9%, and 7.6% for the PLIF group, PLF group, and hybrid group, respectively, with no significant statistical difference (P = 0.338). Conclusion: All 3 surgical techniques might improve the clinical symptoms of patients with degenerative lumbar disease effectively. The hybrid technique demonstrated comparable efficacy to PLIF and PLF in increasing fusion rate, reducing complications, and decreasing the occurrence of ASDeg in multilevel fusion cases significantly. Clinical Relevance: This study holds significant clinical relevance as it directly addresses the treatment outcomes of common surgical interventions for lumbar degenerative disease, a condition that significantly impacts patient quality of life and functionality. This study is also crucial for clinicians when selecting the most appropriate treatment strategy for patients with lumbar degenerative disease.

目的 探讨应用自主研发的腰椎复合运动机对直立体位犬腰椎施加累积性轴向载荷和六位相复合运动构建犬腰椎间盘退变模型的可行性.方法 成年雌性草犬20只,体重(10.0±0.5)kg,随机分为两组,每组10只.模型组:将实验动物以垂直坐位固定于运动机上,在持续轴向载荷下(245 N)进行一定周期的腰椎六位相(前屈后伸、左右侧屈、左右旋转各45°)复合运动;对照组:将实验动物以垂直坐位固定于运动机上,不予任何干预.模型组动物在进行复合运动前、运动2、5、10及15万次时行腰椎影像学检查,侧位X线片测定椎间盘高度指数(disc height index,DHI),MRIT2-mapping成像定量分析椎间盘退变程度,当MRI T2WI显示椎间盘出现明显退变(改良pfirrmann分级系统＞Ⅴ级)时停止复合运动.取两组动物腰椎各节段椎间盘标本,通过Micro-CT定量分析上、下终板骨密度(bone mineral density,BMD)及骨小梁结构,组织学染色(HE染色、番红"O"染色、天狼猩红染色)验证及评价椎间盘退变程度.结果 模型组动物5万次复合运动后L6-7、L7S1椎间盘MRIT2WI呈轻度退变,随着运动负荷累积其退变程度逐渐加重;至复合运动10万次时达到中度退变,表现为DHI开始降低,同时K5-6椎间盘也出现轻度退变;当复合运动量15万次时,L5-6、L6-7、L7S1椎间盘高度进一步降低,椎间盘呈严重退变(改良pfirrmann分级系统Ⅳ～Ⅵ级),而上位L4-5椎间盘也级联出现轻度退变.L5-6椎间盘组织学评分为(8.2± 0.8)分、L6-7为(9.5±0.7)分、L7S1为(10.3±0.5)分.退变程度表现为L5-6＜L6-7＜L7S1.HE及番红"O"染色证实L5-6、L6-7、L7S1椎间盘高度塌陷,髓核组织严重皱缩,内部结构松散、紊乱,几乎未见空泡样髓核细胞;天狼猩红染色示椎间盘前后环纤维均存在明显褶皱、排列紊乱、明显多处断裂,椎间盘后环明显重于前环,且骨性终板厚度及骨小梁密度变得更为菲薄和稀疏.Micro-CT定量分析进一步证实模型组L5.6、L6.7、L7S1节段上、下终板BMD及骨小梁数目明显低于模型组其他节段和对照组,骨小梁分离度明显大于模型组其他节段和对照组.结论 应用"腰椎复合运动机"可模拟人类腰椎间盘生物力学及运动学特点,对直立体位犬腰椎累积性施加轴向载荷和六位相复合运动能诱发犬腰椎椎间盘发生与运动负荷量相关的不同程度慢性退变,尤以L5-6、6-7、L,S1椎间盘退变最为明显.

Intervertebral disc (IVD) degeneration (IDD) is a primary cause of low-back pain in people, which is associated with nucleus pulposus-derived mesenchymal stem cells (NPMSCs). In this study, the involvement of lipopolysaccharide (LPS) in the pyroptosis of NPMSCs was investigated. The effect of RADKPS on the pyroptosis of NPMSCs and the underlying mechanism behind the impact of RADKPS on the proliferative capacity of NPMSCs were also studied. Pyroptosis of NPMSCs was induced with 10 & mu;g/mL LPS and its effects on the downstream signaling pathways were explored. The protective effect of RADKPS on NPMSCs under the action of LPS and its possible mechanism were explored, using different techniques such as immunohistochemical analysis, cell proliferation assay, quantitative real-time polymerase chain reaction (qPCR), and Western blot analysis. Accordingly, caspase1/p20/p10, a protein associated with pyroptosis, was found to be overexpressed in LPS-challenged NPMSCs, Furthermore, the qPCR results demonstrated that LPS promoted the expression of pyroptosis-related gene IL-1 & beta; (p < 0.0001), while downregulating the expression of Sox-9 (p < 0.001), which was a gene associated with the extracellular matrix. The immunohistochemical results identified lowered extracellular signal-regulated kinase 1/2 (ERK1/2) expression and phosphorylated (p-)ERK1/2 in the degenerated IVD tissues. In this study, the influence of RADKPS on the proliferative ability of NPMSCs was evaluated using two-dimensional (2D) and three-dimensional (3D) cultures. It was noted that RADKPS promoted the proliferation of NPMSCs in 2D and 3D cultures. The findings of the Western blot experiments revealed that RADKPS inhibited the expression of pyroptosis-related proteins, while it upregulated the p-ERK1/2 (p < 0.001), RhoA (p < 0.01), collagen II (p < 0.01), and Sox-9 (p < 0.01), whereas ERK inhibitor PD98059 and RhoA signaling pathway inhibitor CCG-1423 inhibited their expression. These findings reveal to us that RADKPS hydrogel may protect NPMSCs from pyroptosis. It was also noted that cell proliferation-related signaling pathways may promote the proliferation of NPMSCs. The results revealed that RADKPS hydrogel could be used as a potential therapeutic approach for IDD. Impact StatementRADKPS inhibits the pyroptosis of NPMSCs and promotes the production of extracellular matrix, which has the potential of intervertebral disc biotherapy.

BackgroundDegenerative disc disease(DDD)is one of the most important causes of low back pain (LBP). Programmed death of human nucleus pulposus mesenchymal stem cells (NPMSCs) plays an important role in the progression of DDD. Growth differentiation factor-5 (GDF-5) is a protein that promotes chondrogenic differentiation, and has been reported to slow the expression of inflammatory factors in nucleus pulposus cells. Compared with those in normal rats, MRI T2-weighted images show hypointense in the central nucleus pulposus region of the intervertebral disc in GDF-5 knockout rats.Methods and resultsWe aimed to evaluate the role of GDF-5 and Ras homolog family member A (RhoA) in NPMSCs. We used lipopolysaccharide (LPS) to simulate the inflammatory environment in degenerative disc disease, and performed related experiments on the effects of GDF-5 on NPMSCs, including the effects of pyroptosis, RhoA protein, and the expression of extracellular matrix components, and the effects of GDF-5, on NPMSCs. In addition, the effect of GDF-5 on chondroid differentiation of NPMSCs was included. The results showed that the addition of GDF-5 inhibited the LPS-induced pyroptosis of NPMSCs, and further analysis of its mechanism showed that this was achieved by activating the RhoA signaling pathway.ConclusionThese findings suggest that GDF-5 plays an important role in inhibiting the pyroptosis of NPMSCs and GDF-5 may have potential for degenerative disc disease gene-targeted therapy in the future.

BackgroundExcessive oxidative stress has been accepted as one of the critical factors for intervertebral disc degeneration (IDD), which is associated with low back pain (LBP). Fisetin (Fis) is a bioactive flavonoid that possesses strong bioactive activity. In present study, we aimed to illuminate the role of Fis on nucleus pulposus mesenchymal stem cells (NPMSCs). MethodsNPMSCs were isolated and cultured from rat NP tissues and identified by flow cytometry and multilinear differentiation. The cytotoxicity of Fis, EX-527, and hydrogen peroxide (H2O2) on NPMSCs was validated using Cell Counting Kit-8 tests. Cell apoptosis was tested by flow cytometry and TUNEL assay. Inflammatory mediators were assessed by Elisa tests, RT-PCR. Extracellular matrix (ECM) metabolism was measured by Western blot analysis and RT-qPCR. The expression of the SIRT1 was evaluated by Western blot analysis. ResultsNPMSCs were successfully isolated and cultured from rat NP tissues, and it has been identified by flow cytometry and multilinear differentiation. The results showed that Fis attenuated H2O2-induced apoptosis, inflammation, and ECM degradation of NPMSCs. Moreover, the above protective effects of Fis can be inhibited by EX-527, a unique SIRT1 inhibitor, indicating that SIRT1 may involve in the mechanism of Fis in protecting NPMSCs from oxidative stress. ConclusionsAs a natural compound with little cytotoxicity on NPMSCs, Fis alleviate H2O2-induced apoptosis, inflammation, and ECM degradation by suppressing oxidative stress, this finding may add the theoretical basis for research on new treatment of IDD based on NPMSCs.

Purpose Adjacent segment degeneration (ASDeg) after anterior cervical discectomy and fusion (ACDF) seriously affects the long-term efficacy of the operation. Therefore, our team has done a lot of research on allograft intervertebral disc transplantation (AIDT) to prove its feasibility and safety. This study will compare the efficacy between AIDT and ACDF in the treatment of cervical spondylosis. Methods All patients who received ACDF or AIDT in our hospital from 2000 to 2016 and followed up for at least 5 years were recruited and divided into ACDF and AIDT groups. The clinical outcomes including functional scores and radiological data of both groups were collected and compared preoperatively and postoperatively at 1 week, 3 months, 6 months, 12 months, 24 months, 60 months and last follow-up. Functional scores included Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), Visual Analog Scale of Neck (N-VAS) and Arms (A-VAS) pain, the Short Form Health Survey-36 (SF-36) and imaging dates including digital radiographs in the lateral, hyperextension and flexion positions to assess the stability, sagittal balance and mobility of the cervical spine and magnetic resonance imaging (MRI) scans to assess the degeneration of adjacent segment. Results There were 68 patients with 25 in AIDT group and 43 in ACDF group. Satisfactory clinical results were obtained in both groups, but the long-term NDI score and N-VAS score in the AIDT group were better. The AIDT obtained the same stability and sagittal balance of the cervical spine as fusion surgery. The range of motion of adjacent segments can be restored to the preoperative level after transplantation, but this increases significantly after ACDF. There were significant differences in the superior adjacent segment range of motion (SROM) between two groups at 12 months ( P = 0.039), 24 months ( P = 0.035), 60 months ( P = 0.039) and the last follow-up ( P = 0.011). The inferior adjacent segment range of motion (IROM) and SROM had a similar trend in the two groups. The ratio value of the greyscale (RVG) of adjacent segments showed a downward trend. At the last follow-up, the RVG decreased more significantly in the ACDF group. At the last follow-up, there was a significant difference in the incidence of ASDeg between the two groups ( P = 0.000). And the incidence of adjacent segment disease (ASDis) is 22.86% in the ACDF group. Conclusion The allograft intervertebral disc transplantation may be as an alternative technique to traditional anterior cervical discectomy and fusion for the management of cervical degenerative diseases. For the more, the results showed it would improve cervical kinematics and reduce the incidence of adjacent segment degeneration.

目的 利用自研定制的腰椎复合运动机使犬腰椎模拟人类脊柱生物力学及运动学特点,通过累积性施加腰椎运动负荷,无创性构建腰椎椎间盘退行性变动物模型.方法 将20只成年雌性草犬随机分为实验组和对照组,每组10只.实验组犬麻醉后以垂直坐位固定于运动机上,在持续轴向载荷下(245 N)进行一定周期数的腰椎六位相(前屈、后伸、左右侧曲、左右旋转各45°)复合运动,每天运动6 h;对照组犬麻醉后以垂直坐位固定于运动机上,不予任何干预.实验组犬在进行复合运动前及运动2万、5万、10万、15万次时进行腰椎影像学检查,采用侧位X线片测定椎间隙高度指数(DHI)下降情况,MRI及T2-mapping成像定量分析评定椎间盘退行性变程度,采用改良Pfirrmann分级系统进行退行性变程度分级,当椎间盘在MRI T2加权像上出现明显退行性变(改良Pfirrmann分级>5级)时即认定为造模成功,停止复合运动,观察是否存在逆转现象.结果 实验组犬下腰椎3个节段DHI值随着复合运动量的累积而缓慢下降,当复合运动10万次时,L6/L7、L7/S1的DHI值较5万次时明显下降,差异有统计学意义(P<0.05);至15万次时,DHI值进一步下降,L5/L6、L6/L7、L7/S1 DHI值较10万次时明显降低,差异有统计学意义(P<0.05).实验组犬MRI及T2-mapping值变化类似于DHI值,随着复合运动量的累积,下腰椎L5/L6、L6/L7、L7/S13个节段退行性变呈逐渐加重趋势;当复合运动5万次时,L6/L7、L7/S1椎间盘在MRI T2加权像上出现轻度退行性变现象(改良Pfirrmann分级2级),其T2-mapping值<2万次时,差异有统计学意义(P<0.05);复合运动10万次时,L6/L7、L7/S1椎间盘退行性变进展为中度(改良Pfirrmann分级3级),且L5/L6椎间盘也出现轻度退行性变,其T2-mapping值<5万次时,差异有统计学意义(P<0.05);当复合运动量累积到15万次时,L5/L6、L6/L7、L7/S13个椎间盘进展为更为严重的退行性变(改良Pfirrmann分级4～6级),而上位节段L4/L5椎间盘也相继出现轻中度退行性变(改良Pfirrmann分级2～3级),其T2-mapping值降低程度为L4/L5

OBJECTIVE:To explore the technical aspects of the accuracy of cervical pedicle screw placement with O-arm guidance.METHODS:The clinical data of 21 patients who underwent cervical pedicle screw fixation by O-arm real-time guidance from December 2015 to January 2020 were analyzed retrospectively. There were 15 males and 6 females, aged from 29 to 76 years old with an average of (45.3±11.5) years. The postoperative CT scan was utilized to evaluate the placement of the pedicle screw and classified according to the Gertzbein and Robbins classification.RESULTS:A total of 132 pedicle screws were implanted in 21 patients, 116 at C3-C6 and 16 at C1 and C2. According to Gertzbein & Robbins classification, the overall breach rates were found to be 11.36% (15/132) with 73.33% (11 screws) Grade B, 26.67% (4 screws) Grade C, and no Grade D or E screw breaches. There were no pedicle screw placement related complications at final follow-up.CONCLUSION:The application of O-arm real-time guidance technology can make cervical pedicle screw placement reliable. High accuracy and better intra-operative control can increase surgeon's confidence in using cervical pedicle instrumentation. Considering the high-risk nature of anatomical area around cervical pedicle and the possibility of catastrophic complications, the spine surgeon should have sufficient surgical skills, experience, ensures stringent verification of the system, and never relies solely on the navigation system.

Six-screw short-segment posterior fixation for thoracolumbar fractures, which involves intermediate screws at the fractured vertebrae has been proposed to reduce the rates of kyphosis recurrence and implant failure. Yet, little is known about the mechanisms and biomechanical responses by which intermediate screws at the fracture vertebrae enhance fixation strength. The objective of this study was to investigate the biomechanical properties that are associated with the augmentation of intermediate screws in relation to the severity of type A thoracolumbar fracture using finite element analysis. Short-segment stabilization models with or without augmentation screws at fractured vertebrae were established based on finite element model of moderate compressive fractures, severe compressive fractures and burst fractures. The spinal stiffness, stresses at the implanted hardware, and axial displacement of the bony defect were measured and compared under mechanical loading conditions. All six-screw stabilization showed a decreased range of motion in extension, lateral bending, and axial rotation compared to the traditional four-screw fixation models. Burst thoracolumbar fracture benefited more from augmentation of intermediate screws at the fracture vertebrae. The stress of the rod in six-screw models increased while decreased that of pedicle screws. Our results suggested that patients with more unstable fractures might achieve greater benefits from augmentation of intermediate screws at the fracture vertebrae. Augmentation of intermediate screws at the fracture vertebrae is recommended for patients with higher wedge-shaped or burst fractures to reduce the risk of hardware failure and postoperative re-collapse of injured vertebrae.

椎间盘源性腰痛是慢性腰痛的常见类型,是导致残疾的首要原因之一,给社会带来了巨大的经济负担.由于椎间盘解剖结构的特殊性,目前关于椎间盘源性腰痛的具体机制尚不清楚,其诊断及治疗尚未达成统一共识.国内外对于椎间盘源性腰痛的治疗主要包括保守治疗及外科手术治疗,治疗的目的是缓解临床症状,而不是从根本上逆转椎间盘退变.近年来生物治疗开始兴起,为椎间盘源性腰痛的治疗提供了新的方向,但国内关于生物治疗的相关研究报道较少.本文就椎间盘源性腰痛的诊断及治疗进展作一综述,以期为临床提供相关参考.

The treatment of intervertebral disc degeneration (IVDD) is still a huge challenge for clinical updated surgical techniques and basic strategies of intervertebral disc regeneration. Few studies have ever tried to combine surgery and cell therapy to bridge the gap between clinical and basic research. A prospective clinical study with a 72-month follow-up was conducted to assess the safety and feasibility of autologous discogenic cells transplantation combined with discectomy in the treatment of lumbar disc herniation (LDH) and to evaluate the regenerative ability of discogenic cells in IVDD. Forty patients with LDH who were scheduled to have discectomy enrolled in our study and were divided into the observed group (transplantation of autologous discogenic cells after discectomy) and control group (only-discectomy). Serial MRI and X-ray were used to evaluate the degenerative extent of index discs, and clinical scores were used to determine the symptomatic improvement. No adverse events were observed in the observed group, and seven patients in the control group underwent revisions. Both groups had significant improvement of all functional scores post-operatively, with the observed group improving more considerably at 36-month and 72-month follow-up. The height and water content of discs in both groups decreased significantly since 36 months post-op with the control group decreased more obviously. Discectomy combined with autologous discogenic cells transplantation is safe and feasible in the treatment of LDH. Radiological analysis demonstrated that discogenic cells transplantation could slow down the further degeneration of index discs and decrease the complications of discectomy.

Intervertebral disc degeneration (IDD) creates a hostile environment with high osmotic pressure, high mechanical stress, hypoxia and a low pH, where cytokines such as TNF‑α and IL‑1β are highly expressed. The degenerating intervertebral disc has high local expression of monocyte chemoattractant protein‑1 (MCP‑1), which is associated with the degree of degeneration. However, there are a few reports on the influence of MCP‑1 on nucleus pulposus‑derived stem cells (NPSCs). In the present study, a significant upregulation of MCP‑1 was observed in NPSCs cultured in vitro with pro‑inflammatory cytokines. MCP‑1 significantly inhibited the migration and proliferation of NPSCs in a dose‑dependent manner as detected via Cell Counting Kit‑8, wound healing and Transwell assays. Western blotting and histological analysis demonstrated that MCP‑1 significantly reduced chondrogenic NPSC differentiation. Reverse transcription‑quantitative PCR and western blotting revealed that C‑C chemokine receptor type 2 (CCR2) mRNA and protein expression levels were significantly enhanced by MCP‑1. Furthermore, MCP‑1 significantly inhibited the migration, differentiation and proliferation of NPSCs, which was effectively reversed by blocking CCR2 with the inhibitor RS504393. Overall, these results demonstrated that MCP‑1 may contribute to the inhibition of chondrogenic NPSC differentiation via MCP‑1/CCR2 chemotaxis signals, providing a potential therapeutic target for IDD.

Low back pain (LBP) is a common problem that causes enormous socioeconomic burden worldwide. Intervertebral disc degeneration (IDD) is considered to be a major cause of LBP. The specific mechanism of IDD is not fully understood; however, the decrease in the number of nucleus pulposus (NP) cells and loss of function are thought to be the main reasons for IDD. Therefore, the study of NP cell apoptosis plays an important role in the study of IDD. Autophagy, as a major intracellular lysosome-dependent degradation process, plays a key role in maintaining intracellular homeostasis and resisting environmental pressure, which may be a potential therapeutic target for IDD. Ferroptosis is a type of iron-dependent regulated cell death caused by disruption that occurs when oxidative stress and antioxidant defenses interact, and is subsequently driven by lipid peroxidation and plasma membrane ruptures. However, the potential links between autophagy and ferroptosis in IDD are unknown. Herein we postulate that SIRT1-autophagy axis can inhibit oxidative stress-induced NP cell ferroptosis. These findings may aid the development of novel therapeutic approaches for IDD treatment.

Objective: the aim of this study was to investigate whether the functionalized self-assembling peptide hydrogel RADKPS is safe and effective for regenerative repair of degenerative intervertebral discs. Methods: an in vitro degenerative model of human nucleus pulposus cells was constructed by serum starvation culture, and their proliferation, apoptosis and viability were examined after three-dimensional culture with the RADKPS hydrogel. An in vivo degenerative model of the rabbit intervertebral disc was constructed by annulus fibrosus puncture, and the degeneration of the intervertebral disc was evaluated by imaging, histology, immunohistochemistry, and biomechanics after RADKPS hydrogel intervention. Results: through in vitro cell experiments it is shown that human degenerated nucleus pulposus cells after three-dimensional culture with the RADKPS hydrogel still exhibited better proliferation, viability, and low apoptosis rate. Through in vivo animal experiments we found that rabbit degenerated intervertebral discs intervened with the RADKPS hydrogel had higher water content, better histological morphology, more extracellular matrix synthesis, and better biomechanical properties. It is demonstrated that the RADKPS hydrogel may initiate the endogenous repair process through the sustained recruitment and enrichment of nucleus pulposus progenitor cells. Conclusion: it is verified from both in vitro cellular experiments and in vivo animal experiments that the regenerative repair effect of RADKPS, a functionalized self-assembling peptide hydrogel, on degenerated intervertebral discs is safe and effective. It is shown that it would be a new therapeutic approach for the regenerative repair action of intervertebral discs.

颈肩腰腿痛是一种常见的肌肉骨骼症状,是目前导致残疾和工作时间减少的主要原因之一.导致颈肩腰腿痛的原因很多,具体的机制目前还没有被阐明,但影像学和病理学证据提示大多数的颈肩腰腿痛和椎间盘退变(intervertebral disc degeneration,IDD)有关[1,2].现有的药物治疗和手术治疗大多只是针对临床症状的缓解和治疗,并不能完全延缓和逆转IDD的进程.基于间充质干细胞(mesenchymal stem cells,MSCs)的细胞疗法旨在通过各种方式和因子诱导外源性和内源性MSCs向髓核(nucleus pulposus,NP)细胞表型分化,调节椎间盘内环境并再生椎间盘组织中的蛋白聚糖和胶原蛋白来解决IDD的根本原因,不同来源的MSCs在治疗IDD的领域已经进行了初步的体外和体内实验[3,4].因此本综述重点阐述MSCs在IDD领域的研究进展.

随着融合器(Cage)在腰椎后路融合术中得到广泛应用,临床上因Cage脱出而导致的严重并发症越来越多.Cage脱出的危险因素有患者、Cage、手术技术、其他等因素,本文针对Cage脱出危险因素的相关研究进展进行综述.

Anterior cervical discectomy and fusion (ACDF) has achieved good clinical results since it was used in clinic, and is considered as the gold standard for the treatment of cervical spondylosis. However, more and more attention has been paid to adjacent segment degeneration(ASDeg) after fusion, and the debate about its pathogenesis is mainly focused on the bio-machanical stress changes of adjacent segments caused by fusion and the result of the natural aging process. The occurrence of ASDeg after fusion seriously affect the med-and long-term outcome of surgery, and some patients even need secondary surgery. In order to reduce or even avoid the occurrence of ASDeg, many new techniques have emerged in clinic, such as artificial disc replacement with preservation of motor segments, emerging cell transplantation technology and so on, but the clinical effect still needs to be confirmed by a large number of studies. Therefore, finding the risk factors of ASDeg after fusion is of great significance for fusion surgery on the clinical work. At present, there is still no unified overview of the research on the risk factors of ASDeg. This article will review the research progress and corresponding countermeasures of the risk factors of ASDeg after ACDF, in order to guide the clinical application.

椎间盘退变 ( intervertebral disc degeneration,IVDD ) 是临床腰痛 ( low back pain ) 的主要原因之一,其机制涉及多个信号通路.因此,对 IVDD 信号通路机制的研究一直是脊柱外科基础研究领域的热点,具有重要意义.