The objective of this study was to develop an automated deep learning-based method for the assessment of shoulder balance in adolescent idiopathic scoliosis (AIS) patients using X-ray images in order to provide a reliable and efficient alternative to manual measurements. A total of 940 AIS radiographs were screened; 937 cases were included in the model-development cohort after quality control and were annotated for precise identification and segmentation of the T1 vertebra, both clavicles, and both coracoids. A deep learning neural network was used to segment these structures. Landmarks were extracted based on morphological image processing, and shoulder balance parameters including the clavicle angle (CA), coracoid height difference (CHD), clavicle tilt angle difference (CTAD), radiological shoulder height (RSH), and T1 tilting angle (T1TA) were calculated. The accuracy of the automated measurements was validated using an external dataset (n = 70) assessed by three senior spinal surgeons. The deep learning neural network achieved reliable segmentation performance for foreground anatomical structures, with macroaverage intersection over union (IoU) values of 0.77 and 0.73 and Dice coefficients of 0.87 and 0.84 in the internal and external validation datasets, respectively. In the external dataset, the automated measurements displayed a high level of agreement with observer-averaged measurements, with intraclass correlation coefficients ranging from 0.964 to 0.994. Bland-Altman analysis revealed small mean biases across the five shoulder balance parameters, and 90.0 to 98.6% of automated measurements were within the range of interobserver variability. The proposed method provides an efficient and reproducible approach for radiographic shoulder balance assessment and may help reduce observer-dependent measurement variability.

Lumbar vertebral substructure segmentation on CT is important for anatomical quantification, surgical planning, and spine imaging biomarker research, but publicly available voxel-level annotations of lumbar subregions remain limited. Here, we present LumbarSeg-6K, a large-scale, multi-source CT dataset comprising 5,952 cropped single-vertebra lumbar volumes derived from VerSe, the CT-COLON subset of CTSpine1K, and LumASe. Each vertebra was annotated for seven anatomical substructures: vertebral body, pedicle, lamina, superior articular process, inferior articular process, transverse process, and spinous process. All data were harmonized under a unified labeling protocol using semi-automated presegmentation, manual refinement, multi-tier expert review, and quality control. Annotation reliability was assessed through an inter-observer consistency analysis, and dataset usability was further evaluated using representative source-stratified segmentation experiments. LumbarSeg-6K is intended to support reproducible research on lumbar vertebral substructure segmentation, anatomical measurement, surgical-planning algorithms, and related CT-based spine applications.

目的 比较颈椎前路椎体可控前移融合术(ACAF)和颈椎后路全椎板切除术治疗颈椎脊髓损伤的疗效.方法 2015年3月—2021年1月,上海第四人民医院、海军军医大学长征医院收治颈椎外伤患者42例,其中20例采用ACAF治疗(ACAF组),22例采用颈椎后路全椎板切除术治疗(LAM组).记录并比较2组术中出血量、手术时间、术后引流量、住院时间及并发症发生情况,采用美国脊髓损伤协会(ASIA)评分评价所有患者术前、术后2周及术后2年的神经功能.结果 所有手术顺利完成,所有患者随访>24个月.2组减压节段数和手术时间差异无统计学意义(P>0.05).LAM组术中出血量、术后引流量和住院时间高于ACAF组,差异均有统计学意义(P<0.05).术后24个月,2组患者神经功能ASIA评分均较术前明显改善,差异有统计学意义(P<0.05);组间差异无统计学意义(P>0.05).ACAF组1例发生术后并发症,LAM组4例发生术后并发症.结论 2种术式均可显著改善患者颈椎脊髓功能,且ACAF可明显减少手术出血量及住院时间,术后并发症较少.

The clinical treatment of bone defects presents ongoing challenges. One promising approach is bone tissue engineering (BTE), wherein hydrogels have garnered significant attention. However, the application of hydrogels in BTE is severely limited due to their poor mechanical properties, as well as their inferior proangiogenic and osteogenic activities. To address these limitations, our develop a dual cross-linked alendronate (ALN)-Ca 2+ /Mg 2+ -doped sulfated hyaluronic acid (SHA@CM) hydrogel, using a one-step mixing injection molding method known as “three-in-one” approach. This approach enabled the simultaneous formation of Schiff-Base crosslinking and electric attraction-based crosslinking within the hydrogel. The Schiff-Base crosslinking contributed to the majority of the hydrogel's mechanical strength, while the electric attraction-based crosslinking served as a release reservoir for Ca 2+ /Mg 2+ and ALN, promoting enhanced osteogenic activities and providing additional mechanical reinforcement to the hydrogel. These experimental data demonstrates several favorable properties of the SHA@CM hydrogel, including satisfactory injectability, rapid gelation, self-healing capacity, and excellent cytocompatibility. Moreover, the presence of sulfated groups and Mg 2+ within the SHA@CM hydrogel exhibited pro-angiogenic effects, while the controlled release of nanoparticles formed by Ca 2+ /Mg 2+ and ALN further enhanced the osteogenesis of the hydrogel. Overall, these results indicate that the SHA@CM hydrogel holds significant potential for the clinical translation of BTE.

背景:血管周围干细胞来源于成体脂肪组织,获取容易且干细胞比较均质,具有较强的增殖和多向分化潜能.目的:通过体外、体内实验探讨人血管周围干细胞的成骨分化能力,以及Wnt/β-catenin信号通路的调控作用.方法:抽脂来源的人脂肪组织,经荧光激活细胞分选法提取血管周围干细胞,第1代血管周围干细胞进行成骨诱导分化,分为空白对照组、成骨诱导组及Wnt信号通路抑制组,成骨诱导第5天行碱性磷酸酶染色,第10天行茜素红染色,第7天通过Western blot检测Runt相关转录因子2蛋白表达.制备血管周围干细胞复合纳米羟基磷灰石/聚乳酸-羟基乙酸共聚物支架材料,通过无胸腺小鼠胫骨单皮质缺损模型,研究血管周围干细胞在体内的骨修复效果.结果 与结论:①每100 mL脂肪中含有基质血管成分细胞为(1.82±0.32)×107,活细胞占(82.72±5.37)％,经荧光激活细胞分选法分选,血管外膜细胞(CD34+、CD45-、CD146-)比例为(17.66±1.05)％、血管外周细胞(CD146+、CD45-、CD34-)比例为(7.18±0.52)％,血管周围干细胞体外扩增迅速,10代之内保持较强的增殖能力;②细胞实验显示血管周围干细胞具有成骨分化能力,抑制Wnt信号通路后Runt相关转录因子2表达明显减少,血管周围干细胞成骨分化受到抑制,动物实验进一步证实血管周围干细胞复合支架材料的成骨效果;③结果 表明:Wnt/β-catenin信号通路在血管周围干细胞成骨分化中发挥重要作用,血管周围干细胞为骨修复提供一种新的治疗选择.

Background: Inferior clinical outcomes have been reported in patients with degenerative lumbar spondylolisthesis (DLS) accompanied by lumbar degenerative scoliosis, but little attention has been paid to its radiologic assessment or preoperative planning. The aim of this study was to analyze the effect of transforaminal lumbar interbody fusion on patients with DLS and lumbar degenerative scoliosis and explore the surgical aspects benefiting the restoration of lumbar degenerative scoliosis. Methods: All patients with DLS and lumbar degenerative scoliosis undergoing single-level unilateral transforaminal lumbar interbody fusion surgery between July 1, 2015, and April 30, 2021, were screened in this retrospective cohort study. Clinical outcomes including visual analog scale (VAS), Oswestry disability index (ODI), and radiographic parameters of sagittal and coronal alignment, cage spatial locations, and angle of pedicle screw (parallel, cranial, and caudad angle) were assessed. Coronal asymmetry was demonstrated by the intervertebral height difference between the medial and lateral margins of indexed intersegmental space. The correlations between.intervertebral height difference (postoperative intervertebral height difference-preoperative intervertebral height difference) and radiographic parameters and clinical outcomes were analyzed by univariable, multivariable, mediation, and correlation analyses. Significance was set at a bilateral P<0.05. Results: A total of 57 included patients were followed up for a minimum of 1 year. Reduction of VAS, ODI, and improvement of radiographic parameters were found after surgery. The cranial angle of the lower pedicle screw positively correlated with.intervertebral height difference restoration ( b=0.54; standard error=0.11; P<0.001). Conclusions: Transforaminal lumbar interbody fusion surgery appears to be an effective approach to improving the radiographic and clinical outcomes of patients with DLS and lumbar degenerative scoliosis. The cranial direction of the lower pedicle screws in single-level unilateral transforaminal lumbar interbody fusion surgery may be associated with a better postoperative restoration of lumbar degenerative scoliosis.

Background: Compared to other risk factors, adjacent facet joint degeneration (AFD) is the main contributor to adjacent segment disease (ASD). The interbody cage may be a potential indirect risk of AFD. This study investigated the correlations among the lumbar sagittal balance parameters, the inter-body cage's intraoperative positioning variables, and adjacent facet joint degeneration following the transforaminal lumbar interbody fusion (TLIF) technique. Methods: Patients who accepted single-level TLIF for symptomatic lumbar degenerative disease and were followed up for at least six months were enrolled in this study. According to the inclusive and exclusive criteria, 93 patients were included (44 males and 49 females). X-ray and computed tomography (CT) images were obtained before and six months after surgery. The vertebral contour and the center of the marker mass in the cage were calculated using a geometric algorithm. Orthopedic surgeons measured the disc height, lordosis angle, and facet joint degeneration. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and the visual analog scale (VAS), were used to assess the clinical outcomes. The Student's t-test, Wilcoxon rank-sum test, and Chi-square test were used for the statistical analyses. Results: The average age was 53.7 years old (range, 27-84 years). The average functional disability outcome assessed by the ODI was 61.2, and the average back and leg pain assessed by the VAS was 6.2 and 6.9, respectively. The patients were categorized into a normal group and an abnormal (AFD) group according to whether the facet joint degeneration was aggravated. The abnormal group had a higher back pain VAS score (P=0.031) and lower sagittal vertical position (P=0.027). The other parameters were similar at baseline (P>0.05). The cage's sagittal vertical position decreased significantly with AFD aggravation (OR, 0.737; 95% CI, 0.561-0.969). Conclusions: In patients with AFD aggravation, the preoperative VAS and postoperative ODI scores were significantly higher. The cage position parameters were related to AFD. A lower cage center was associated with a greater incidence of AFD.

Based on the results of long-term clinical and radiological follow-up studies of decompression and fusion with internal fixation for degenerative lumbar spondylolisthesis (DLS), we recognized that the direction of the pedicle screw affects the stability of the fixation. However, few studies have analyzed the role of pedicle screw insertion trajectory in disc height recovery after fusion. We therefore analyzed patients’ general information, clinical efficacy and sagittal, coronal and implant parameters to determine whether there is a correlation between the insertion trajectory of screws and the recovery of intervertebral space height, with the ultimate aim to provide a basis for improving the clinical efficacy and radiological outcomes of patients with DLS and to identify an optimal technique for spine surgeons that would benefit patients with spondylolisthesis. From May 2015 to October 2019, patients who underwent single-segment decompression and fusion with internal fixation for DLS at our department were screened for enrollment in the study. The clinical history, pre- and post-operative lumbar sagittal parameters, intervertebral height, rate of recovery from spondylolisthesis and pedicle screw angle of inpatients were recorded and followed up for at least 6 months. Clinical assessments included the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for lower back and leg pain. Data on screw angle, fusion segment intervertebral space height and clinical outcome were the primary outputs. Pearson correlation and multivariate regression analyses were performed to investigate the relationship between the pedicle screw angle, the sagittal parameters of the fusion segment and clinical efficacy. A total of 50 patients were initially enrolled, two patients were lost to follow-up after 6 months, 48 patients (17 men, 31 women) were eventually enrolled, and the follow-up rate was 96%. At least 6 months after the operation, vertebral spondylolisthesis improved to varying degrees [> 80% in 17 cases (35.4%) and > 20% in 43 cases (87.5%), respectively]. Changes in disc height (DH) were significantly associated with lower pedicle screw angle, while lumbar lordosis and segment lordosis remained the same. Multivariate regression analysis showed a significant negative correlation between the upper and lower pedicle screw angles and the change in DH (P < 0.05). At 2 weeks post-operation, the VAS score for low back pain and the ODI had improved significantly compared to pre-operation (P < 0.05). These results suggest that the Caudad insertion trajectory technique of pedicle screws may be an ideal alternative for the treatment of DLS. Chinese Clinical Trial Registry (ChiCTR): ChiCTR1800020368.

Background: Controversy remains about the choice of reduction or arthrodesis in situ for surgical management of adolescent spondylolisthesis, while no systematic review and meta-analysis were performed to determine which one is the optimal surgical choice. The study aims to compare outcomes of the two surgical strategies for adolescent spondylolisthesis. Methods: A comprehensive search was performed through Pub/VIed, Web of Science, Cochrane Library, Embase, OVID/MEDLINE, CBM, CNKI, and Wanfang with a cutoff date of May 21(st), 2021. Search terms included "spondylolisthesis", "in situ" and "reduction". Included studies had following characteristics: (I) participants: adolescents with spondylolisthesis. (II) Intervention: reduction following arthrodesis. (III) Control: arthrodesis in situ. (IV) Outcomes: postoperative clinical and/or radiographic results. (V) Study design: randomized controlled trial (RCT), cohort or case-control study. Data were analyzed with Review Manager 5.4, and risk of bias assessment of studies was assessed via Newcastle-Ottawa quality assessment scale (NOS). Results: Six cohort studies were included, with NOS scores of all >= 6. There were no significant differences regarding operative time [mean difference (MD) =152.62; 95% [confidence interval (CI)]: -54.02 to 359.26; I-2 =96%; P=0.15], blood loss (MD =786.61; 95% CI: -646.82 to 2,220.04; I-2 =90%; P=0.28), patient satisfaction (MI) =1.98; 95% CI: 0.72 to 5.43; I-2 =0%; P=0.18), neurological complications (MI) =1.02; 95% Cl: 0.25 to 4.18; I-2 =0%; P=0.98), or total complications (MD =0.59; 95% CI: 0.29 to 1.19; I-2 =0%; P=0.14). However, patients undergoing reduction achieved better radiographic results: fusion rate (MD =3.09; 95% CI: 1.22 to 7.84; I-2 =40%; P=0.02), postoperative pseudarthrosis (MD =0.35; 95% CI: 0.15 to 0.79; I-2 =24%; P=0.01), percentage of slippage (MD =-20.58; 95% CI: -26.32 to -14.84; I-2 =0%; P<0.00001), and slipping angle (MD =-10.05; 95% CI: -14.55 to -5.54; I-2 =0%; P<0.0001). And no overt publication bias was found in the studies. Discussion: Both reduction and arthrodesis in situ in adolescent spondylolisthesis are safe and demonstrate good clinical outcomes. However, reduction showed better radiographic results and was associated with less pseudarthrosis, better relief of disability, and improvements in self-image. In conclusion, reduction may be the optimal choice compared with arthrodesis in situ, but further verification of these findings is recommended using RCTs.

Background Most contemporary studies suggested that intersegmental parameters including disc height and local lordosis contribute to the sagittal balance of fused lumbar. Although similar clinical outcomes following MIS- and Open-TLIF were reported essentially at the early postoperative time, the comparison of local balance variables after these two different techniques was lack. The radiological differences maybe not relevant to the postoperative efficacy at an earlier post-operation stage. But during the long-term follow-up, the complications with regards to the sagittal imbalance might occur due to the distinct biomechanical properties of fusion level after MIS- and Open-TLIF. Methods The patients who underwent a single-level MIS- and Open-TLIF were reviewed retrospectively. The anterior disc height (ADH), posterior disc height (PDH), and segmental lordosis (SL) of the fusion segment were measured using recognition technical fluoroscopy. The mean disc height (MDH) was calculated by (ADH + PDH)/2. The relative DH was normalized by the anterior height of the upper vertebrae. The body mass index (BMI), the pain score of low back and leg visual analogue scale (VAS), Oswestry disability index (ODI), estimated blood loss, and hospital stay length was collected. Results A total of 88 patients undergoing a single-level TLIF (MIS and Open) were included. The pre- and post-operative ADH, PDH, MDH, and SL of MIS-TLIF group were 1.57 ± 0.33 cm, 0.79 ± 0.20 cm, 1.18 ± 0.21 cm, 7.36 ± 3.07 and 1.63 ± 0.30 cm, 1.02 ± 0.28 cm, 1.32 ± 0.24 cm, 10.24 ± 4.79 respectively. Whereas, the pre- and post-operative ADH, PDH, MDH, and SL of Open-TLIF group were 1.61 ± 0.40 cm, 0.77 ± 0.21 cm, 1.19 ± 0.24 cm, 9.05 ± 5.48 and 1.81 ± 0.33 cm, 0.98 ± 0.24 cm, 1.39 ± 0.24 cm, 12.34 ± 4,74 respectively. MIS- and Open-TLIF group showed no significant differences in low back VAS, leg VAS, and ODI both in pre-operation and post-operation ( P > 0.05). The estimated blood loss and hospital stay length in the MIS-TLIF group were significantly lower than those in the Open-TLIF group ( P < 0.05). Conclusion MIS- and Open-TLIF provided similar clinical outcomes as the respect of low back VAS, leg VAS, and ODI. MIS-TLIF significantly reduced the blood loss and length of hospital stay though. The intervertebral parameters of DH and SL were both increased significantly, Open-TLIF group presented better sagittal balance in term of ADH and SL variables. The contrast investigation of intersegmental parameters may help the surgeons to figure out the further advantages of MIS-TLIF technique, and then better manage the rehabilitation and prevent the reoperation.

OBJECTIVE:To analyze the restoration of intervertebral height and lordosis of fusion segment after open-transforaminal lumbar interbody fusion (Open-TLIF) and minimally invasive-TLIF (MIS-TLIF). METHODS:Between January 2013 and February 2016, patients who treated with TLIF due to lumbar degenerative diseases and met the selection criteria were selected as the study objects. Among them, 41 patients were treated with open-TLIF (Open-TLIF group), 34 patients were treated with MIS-TLIF (MIS-TLIF group). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, disease type, disease duration, pathological segment, and other general data. The intraoperative bleeding volume, hospital stay, visual analogue scale (VAS) score of waist and leg, and Oswestry disability index (ODI) were recorded before and after operation. The anterior disc height (ADH), posterior disc height (ADH), and segmental lordosis (SL) of fusion segment were measured by X-ray film before and at 6 months after operation. The differences of ADH, PDH, and SL between pre- and post-operation were calculated. RESULTS:The intraoperative bleeding volume and hospital stay in Open-TLIF group were significantly higher than those in MIS-TLIF group ( t=14.619, P=0.000; t=10.021, P=0.000). All incisions healed by first intention without early complications. All patients were followed up 6-24 months (mean, 12.6 months) in Open-TLIF group and 6-24 months (mean, 11.5 months) in MIS-TLIF group. The preoperative VAS scores of waist and leg and ODI of the two groups significantly improved ( P<0.05). There was no significant difference in VAS scores and ODI between the two groups before operation and at 2 weeks and 6 months after operation ( P>0.05). Imaging examination showed the good intervertebral fusion. There was no significant difference in ADH, PDH, and SL between the two groups before operation and at 6 months after operation ( P>0.05). The differences of ADH, PDH, and SL between the two groups were not significant ( P>0.05). The ADH, PDH, and SL after operation significantly increased in the two groups ( P<0.05). CONCLUSION:Open-TLIF and MIS-TLIF show similar effectiveness and radiological change in the treatment of single lumbar degenerative diseases and the improved intervertebral height and lordosis, but MIS-TLIF can significantly reduce hospital stay and intraoperative blood loss.

Background. Facet joint violation (FV) was reported as variable iatrogenic damage that can be a crucial risk factor leading to the adjacent segment degeneration (ASD). "Blind" screw placement technique in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) contributes to the increasing incidence of FV that can be influenced by several potential factors. Many controversies about these factors and clinical outcomes of different types of FV patients exist, yet they have not been analyzed. Methods. 99 cases undergoing single-segment MIS-TLIF from July 2013 to December 2015 were retrospectively analyzed. Computed tomography (CT) was applied to determine the incidence of FV, and then the correlation between FV and relevant factors, including gender, age, body mass index (BMI), top-screw level, and decompression, was analyzed. A total of 53 cases were followed up after one year, 31 cases in noninjury (A group) and 22 patients in FV injury (B group). Results. The incidence of FV was 39. 39% (39/99) in the patients and 23.23% (46/198) in the screws. Logistic regression analysis showed that screw at L5 in patients with BMI > 30 kg/m(2) was vulnerable to FV (P < 0.05). Moreover, postoperative average intervertebral disc height (AIDH) of fusion segment, visual analog scale (VAS), and Oswestry disability index (ODI) scores improved significantly in group A and B when compared with preoperative data (P < 0.05). Adjacent superior average intervertebral disc height (ASAIDH) presented decrease, but adjacent superior intervertebral disc Cobb angle (ASIDCA) appeared to increase in the two groups at the final follow-up compared with postoperative 3 days (P < 0.05). Low back VAS and ODI scores in group A (31 cases) were lower than those in group B (22 cases) in the final follow-up (P < 0.05). Conclusion. MIS-TLIF is an effective treatment for lumbar degenerative disease, but FV occurred at a higher incidence. Facet joints should be protected in MIS-TLIF to avoid FV.