Hyperbaric oxygen (HBO) treatment can attenuate the inflammatory response after spinal cord injury (SCI), but the specific molecular mechanisms are unclear. γδT cells have emerged as key immune regulatory cells. This study aims to analyze the mechanism of HBO treatment reducing SCI mainly from the perspective of γδT cells. Contusion SCI models were established in WT, TCRδ−/−, and IL-17−/− mice, and HBO treatment was performed. Hindlimb locomotor function, ChAT-positive motor neuron numbers, γδT cell proportion, and inflammatory cytokines level of different experimental groups were compared after SCI. Furthermore, we measured the protein and gene expression of STAT3 and RORγt in both WT mice and STAT3 overexpression mice following HBO treatment. Our results showed γδT cells, especially IL-17 + γδT cells, were involved in SCI. HBO treatment improved locomotor recovery, reduced the proportion of γδT and IL-17 + γδT cells, and decreased inflammatory cytokines in WT mice after SCI. However, HBO treatment did not affect locomotor recovery or inflammatory cytokines level in TCRδ−/− or IL-17−/− mice after SCI. In addition, HBO treatment significantly inhibited the expression of STAT3 and RORγt in WT mice after SCI. Over-expression of STAT3 weakened the inhibitory effect of HBO on IL-17 + γδT cells and inflammatory cytokines after SCI. These findings indicated that IL-17 + γδT cells may play a key role in HBO treatment alleviating the inflammatory response after SCI. HBO treatment may regulate IL-17 + γδT cells by modulating the pathway of STAT3/RORγt. This study provides the theoretical basis and potential therapeutic target for HBO treatment in SCI.

BACKGROUND:Osteoporotic vertebral compression fractures (OVCFs) are highly prevalent among the elderly. However, spinal metastases can also lead to pathological fractures that are often misdiagnosed as OVCFs. This study aimed to determine the prevalence of unsuspected malignant vertebral compression fractures (VCFs) among patients initially suspected to have OVCFs. METHODS:From October 2020 to December 2023, 141 patients with suspected OVCFs underwent routine vertebral biopsy during percutaneous kyphoplasty (PKP) at our institution. All patients received standardized treatment and prospective clinical data collection. Follow-up questionnaires were completed in person or via telephone. RESULTS:A total of 168 biopsy specimens were obtained from 141 patients, and all samples (100%) were successfully evaluated histopathologically. Unexpected spinal metastases were identified in six patients (4.3%). Of the 19 patients with a known history of malignancy but without characteristic radiographic features of pathological fracture, only two cases (10.5%) were confirmed as metastatic involvement from the primary cancer. Among the remaining 112 patients without a cancer history, four unexpected malignancies were identified (one lymphoma and three lung cancers). The overall prevalence of unsuspected malignant VCFs in this cohort was 4.3%. CONCLUSIONS:Given the observed prevalence of unsuspected malignant VCFs, we recommend that routine vertebral biopsy be performed during every PKP procedure for patients with OVCFs to ensure early detection of occult malignancy.

BackgroundPercutaneous kyphoplasty (PKP) has achieved good clinical efficacy in the treatment of Osteoporotic vertebral compression fractures (OVCFs). However, how to reduce the bone cement leakage rate and improve safety during PKP surgery remains an urgent issue to be addressed in clinical practice. Therefore, the aim of this study was to identify a line, called the “warning line”, to determine whether there is leakage of bone cement during PKP surgery.MethodsFrom February 2018 to September 2022, 88 patients and 106 vertebral bodies with OVCFs treated with PKP by a single surgeon at our center were included in the study. Clinical general data were recorded. Vertebral bodies with bone cement reaching the apex of the posterior margin depression without leakage were designated Group A, whereas those with leakage were designated Group B. The posterior vertebral wall was divided into three equal parts in the postoperative three-dimensional CT scans, and the leakage rates at different positions of the posterior vertebral wall were analysed. In Group A without leakage, line b, called the warning line, was marked as the apex of cement diffusion.ResultsAll 88 patients successfully underwent surgery, with a significant decrease in the postoperative VAS score. No neurological complications occurred. Bone cement leakage rate was 58.5%. There were 44 vertebral bodies in Group A and 62 in Group B. No significant differences were found between the two groups in terms of age, bone density, balloon pressure, contrast dose, or cement volume (P > 0.05). The bone cement leakage rates in the upper third, middle third, and lower third of the posterior vertebral wall were 25%, 61.1%, and 66.7%, respectively, with statistically significant differences (P < 0.05). In Group A without leakage, the warning line was approximately 6.8% of the sagittal diameter from the posterior vertebral margin.ConclusionsPKP is a relatively safe treatment for OVCFs. Most bone cement leakage occurs in the middle and lower thirds of the posterior vertebral wall. When the apex of cement diffusion remains anterior to the warning line in PKP surgery, the posterior vertebral wall cement leakage rate is low.

Posterior lumbar interbody and fusion (PLIF) for lumbar spinal stenosis (LSS) has declined in recent years, with non-fusion techniques such as the interspinous dynamic stabilization system (IDSS) and unilateral biportal endoscopy (UBE) gaining prominence. However, there remains a paucity of comparative studies directly evaluating the therapeutic efficacy between these two distinct non-fusion approaches—IDSS as a motion-preserving stabilization method and UBE as a minimally invasive decompression technique‌. This investigation seeks to systematically assess and contrast both clinical efficacy and radiological findings associated with IDSS and UBE interventions in LSS management. This retrospective cohort study analyzed 209 patients with LSS treated between January 2015 and January 2022, stratified into two cohorts: the IDSS group (n = 112) and the UBE group (n = 97). Demographic and perioperative parameters, including age, gender, body mass index (BMI), hospital stay, operative time, intraoperative fluoroscopy frequency, blood loss, incision length and postoperative complications, were systematically documented for comparative analysis‌. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for low back and leg pain and the Oswestry Disability Index (ODI) at four intervals: Preoperative, 1-month postoperative, 3-month postoperative, and the final follow-up. Therapeutic efficacy was further quantified at the final follow-up utilizing the modified MacNab criteria. Radiographic findings compared preoperative and final follow-up measurements across four parameters: segmental range of motion (SROM), intervertebral space height (ISH), facet joint preservation rate (FJPR) and dural sac cross-sectional surface area expansion rate (DSCAER). Baseline characteristics including age, sex, BMI, surgical levels, and intraoperative fluoroscopy frequency showed no statistically significant differences between groups (P > 0.05). Regarding clinical outcomes, the UBE group demonstrated superior performance than the IDSS group, including operative duration (61.10 ± 10.39 vs. 70.59 ± 11.21 min), estimated blood loss (32.06 ± 10.11 vs. 52.94 ± 12.85 ml), incision length (1.85 ± 0.26 vs. 5.68 ± 0.69 cm), hospital stay (4.17 ± 0.93 vs. 5.82 ± 1.16 days), and complication rates (18.75

Background:Biportal endoscopic bilateral decompression (BEBD) has gained recognition for treating lumbar spinal stenosis (LSS) through preservation of posterior spinal structures while achieving bilateral neural decompression. However, the relationship between postoperative radiographic findings and clinical outcomes remains unclear. This study investigates clinical efficacy, radiographic findings, and their potential correlations following BEBD. Methods:A retrospective cohort analysis of 51 LSS patients undergoing BEBD (January 2020-December 2021) was conducted. Intraoperative parameters, complications, and clinical outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Modified Macnab criteria] were evaluated preoperatively, at 1 month, and final follow-up. Radiographic parameters included medial facetectomy surface angle (MFSA), facet joint preservation rate (FJPR), lateral recess decompression rate (LRDR), dural sac cross-sectional area expansion rate (DSCAER), and segmental range of motion (SROM). Results:The procedure demonstrated the mean operative time of 93.6 ± 13.7 min, with follow-up 36-60 months (mean 42.5 ± 6.7 months). Clinically, lower back pain (VAS: 5.9 ± 0.9-2.3 ± 0.6 at 1 month; 0.6 ± 0.5 final) and leg pain (6.8 ± 0.9-1.7 ± 0.6 at 1 month; 0.5 ± 0.6 final) showed sustained, statistically significant reductions (P < 0.05). Functional recovery was marked by ODI improvements from 64.5 ± 7.5 preoperatively to 26.1 ± 2.8 (1 month) and 11.0 ± 2.3 (final) (P < 0.05), with 88.24% (45/51) achieving excellent/good outcomes by modified Macnab criteria. Radiographically, MFSA remained <90°, FJPR exceeded 70%, and DSCAER expanded by 95.19 ± 22.5% (P < 0.05), while SROM stability was preserved (P > 0.05). Notably, no radiographic findings correlated with clinical outcomes stratification (P > 0.05), underscoring the multifactorial nature of postoperative success. Conclusions:BEBD demonstrates significant clinical improvement in LSS patients, with marked DSCA expansion and preserved FJ stability. The technique achieves effective bilateral decompression with preserved biomechanical stability. Radiographic findings showed no correlation with clinical success, indicating multifactorial postoperative influences.

BACKGROUND: Currently, unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) are increasingly being used for the treatment of lumbar disc herniation (LDH). However, there are few studies comparing the efficacy of UBE and PELD in the treatment of LDH. The aim of this study is to compare the clinical efficacy and radiological outcomes between UBE and PELD in the treatment of LDH. METHODS: A retrospective analysis was conducted on 108 patients with LDH treated with spinal endoscopy in our hospital from January 2021 to July 2023. Of these, 47 patients were included in the UBE group and 61 in the PELD group. Clinical parameters, including age, gender, BMI, length of hospital stay, operative time, intraoperative fluoroscopy frequency, intraoperative blood loss, pre- and postoperative hemoglobin (HGB) reduction values, follow-up duration, and postoperative complications, were recorded for both groups. Visual analog scale (VAS) scores for back and leg pain and the Oswestry Disability Index (ODI) were evaluated preoperatively, and at 1 month, 3 months, and 12 months postoperatively. The modified MacNab criteria were used to evaluate clinical efficacy at 12 months postoperatively. For radiological evaluation, lumbar MRI was used to compare changes in the anteroposterior diameter of the intervertebral disc (APDID) and dural sac cross-sectional area (DSCA) at the operated segment preoperatively and 12 months postoperatively. RESULTS: All surgeries were successfully completed. There were no statistically significant differences between the two groups in age, gender, BMI, length of hospital stay, operative time, follow-up duration, or postoperative complications (P > 0.05). The UBE group had a higher intraoperative blood loss compared to the PELD group (P < 0.05), but there was no significant difference in hemoglobin reduction values (P > 0.05). The fluoroscopy frequency in the UBE group was significantly lower than in the PELD group (P < 0.05). VAS scores and ODI values for back and leg pain significantly decreased in both groups at 1 month, 3 months, and 12 months postoperatively compared to preoperative values (P < 0.05), with no statistically significant differences between the two groups at any time point (P > 0.05). The excellent and good rates of clinical outcomes showed no significant differences between the two groups (P > 0.05). In terms of radiological results, at 12 months postoperatively, both groups showed a significant reduction in APDID and a significant increase in DSCA compared to preoperative values (P < 0.05). When comparing the both groups, the UBE group demonstrated a greater reduction in APDID and a greater increase in DSCA compared to the PELD group (P < 0.05). CONCLUSION: Both UBE and PELD are effective in relieving pain and improving the quality of life in patients with LDH. While UBE is associated with slightly higher intraoperative blood loss, it requires fewer intraoperative fluoroscopy instances and demonstrates superior improvements in radiological parameters compared to PELD.

ABSTRACTPurposeLong‐segment spinal fusions are associated with lumbosacral complications (LSC), but the associated risk factors are not known. This study aimed to identify the risk factors for LSC after long‐segment instrumented fusion with distal fixation to the L5 vertebral body in adult degenerative scoliosis (ADS).MethodsWe retrospectively evaluated 294 patients with ADS who underwent long‐segment floating fusion between January 2014 and March 2022, with follow‐up for at least 2 years. Patients were matched to the baseline data using fusion level > 5 as a grouping variable. Patients who completed matching were divided into two groups according to the presence or absence of LSC. Univariate logistic regression was applied to identify potential risk factors for LSC, and multivariate logistic regression was used to identify independent risk factors for postoperative LSC.ResultsThe overall incidence of LSC was 21.77% in the 294 patients, with disc degeneration in 28 (9.52%) and radiographic ASD in 44 (14.97%) patients. The mean time to LSC development after surgery was 26.91 ± 8.43 months. A total of 54 pairs of patients were matched and grouped, and the complication group had higher Oswestry Disability Index (ODI) and visual analog scale (VAS) scores at the last follow‐up. Multivariate analysis showed that gender (OR = 0.274, p = 0.026 [0.087, 0.859]); levels of fusion > 5 (OR = 3.127, p = 0.029 [1.120, 8.730]), main curve correction rate (OR = 0.009, p = 0.005 [0.000, 0.330]), and postoperative pelvic incidence minus lumbar lordosis (PI‐LL) > 15° (OR = 3.346, p = 0.022 [1.195, 9.373]) were independent risk factors for postoperative LSC. The area under the curve value of the prediction model was 0.804, with a 95% confidence interval of 0.715–0.892, indicating that the model had a high prediction accuracy. Collinearity statistics showed no collinearity between variables.ConclusionSex, level of fusion > 5, main curve correction rate, and postoperative PI‐LL > 15° were independent risk factors for the development of LSC after long‐segment floating fusion. These results will improve our ability to predict personal risk conditions and provide better medical optimisation for surgery.

Background With the increasing aging of society, osteoporotic fractures have gradually become a serious problem affecting the quality of life of elderly individuals. Osteoporotic vertebral compression fractures (OVCFs) are the most common complication of osteoporosis. Percutaneous kyphoplasty (PKP) has achieved good clinical efficacy in the treatment of OVCFs. However, how to reduce the bone cement leakage rate and improve safety during PKP surgery remains an urgent issue to be addressed in clinical practice. Therefore, the aim of this study was to identify a line, called the “warning line”, to determine whether there is leakage of bone cement during PKP surgery. Methods From February 2018 to September 2022, patients with OVCFs treated with PKP by a single surgeon at our center were included in the study. After screening from intraoperative X-ray images, we selected patients whose bone cement diffusion reached the posterior margin of the vertebral body, resulting in a total of 88 patients and 106 vertebral bodies. Clinical general data were recorded. Postoperative three-dimensional CT scans were used to assess bone cement leakage at the posterior margin. Vertebral bodies with bone cement reaching the apex of the posterior margin depression without leakage were designated Group A, whereas those with leakage were designated Group B. We compared the age, bone density, balloon pressure, contrast dose, and bone cement volume between the two groups. The posterior vertebral wall was divided into three equal parts in the postoperative three-dimensional CT scans, and the leakage rates at different positions of the posterior vertebral wall were analysed. Lateral X-ray images were used in Group A. Line a was marked as the posterior vertebral margin. Line b was marked as the apex of cement diffusion, parallel to line a. Line c was marked as the anterior vertebral margin. Line b was designated the warning line, and the ratio of ab/ac was calculated. Results All 88 patients successfully underwent surgery, with a significant decrease in the postoperative VAS score. No neurological complications occurred in any patient. On the basis of three-dimensional CT images of the 106 vertebral bodies, the posterior vertebral wall cement leakage rate was 58.5%. There were 44 vertebral bodies in Group A and 62 in Group B. No significant differences were found between the two groups in terms of age, bone density, balloon pressure, contrast dose, or cement volume (P > 0.05). In the sagittal images of the three-dimensional CT images, the bone cement leakage rates in the upper third, middle third, and lower third of the posterior vertebral wall were 25%, 61.1%, and 66.7%, respectively, with statistically significant differences in leakage rates at different positions (P < 0.05). In Group A, the ab/ac ratio in the lateral X-ray images was 6.8 ± 2.17%, indicating that the warning line was approximately 6.8% of the sagittal diameter from the posterior vertebral margin. Conclusions PKP is a relatively safe treatment for OVCFs. Most bone cement leakage occurs in the middle and lower thirds of the posterior vertebral wall. When the apex of cement diffusion remains anterior to the warning line in PKP surgery, the posterior vertebral wall cement leakage rate is low.

Objectives: To investigate the clinical efficacy of unilateral biportal endoscopy (UBE) in the treatment of degenerative lumbar disease (DLD) and its impact on postoperative lumbar stability. Methods: This is a retrospective case series study. A total of 109 cases of DLD treated with UBE in the Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University from July 2020 to June 2022 were analyzed retrospectively. There were 47 males and 62 females, aged (53.3±8.2) years (range: 21 to 80 years). The surgical segments were single segment in 80 cases, two segments in 25 cases, and three segments in 4 cases. The low back pain and leg pain of visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after operation. The modified MacNab criteria were used for evaluation of the clinical consequences. Postoperative three-dimensional lumbar CT was performed to observe the preservation of the facet joints and the angle of the medial surface of the facetectomy(β angle). At 12 months after surgery, X ray of the flexion and extension lumbar spine were reviewed. The comparison and analysis of the data were conducted using paired sample t tests or generalized estimation equations. Results: All 109 patients underwent operative procedures successfully. The operation time was (94.5±37.1) minutes (range:56 to 245 minutes), the times of X ray was 6.8±4.0 (range:4 to 16 times), and the days of hospitalization was (5.3±3.7) days (range:4 to 14 days). Complications included dural tears in 4 cases, transient lower limb numbness in 4 cases, epidural hematoma in 2 case. The follow-up time was (19.6±7.2) months (range:12 to 36 months). The postoperative low back pain VAS, leg pain VAS, JOA score and ODI were significantly improved(all P<0.05). According to the modified MacNab criteria, the excellent and good rate was 88.99%(97/109) at 12 months after surgery. One case underwent revision surgery because of recurrent lumbar disc herniation. In term of radiographic evaluation, the area of the surgical side facet joints after UBE surgery was reserved more than 60%. The β angle was less than 90° in all patients. After 12 months of surgery, there was no surgical segment instability or spondylolisthesis by the X-ray of the flexion and extension lumbar spine. Conclusion: UBE can achieve satisfactory clinical efficacy in the treatment of DLD, and maintain the stability of the lumbar spine.

Background:Unilateral biportal endoscopy-unilateral laminectomy bilateral decompression (UBE-ULBD) has been increasingly performed for the treatment of lumbar spinal stenosis (LSS). However, few researchers have investigated the relationship between the imaging parameters and clinical outcomes following UBE-ULBD. This study aimed to report the imaging parameters and clinical outcomes following UBE-ULBDin LSS patients and their possible relationship. Method: From July 2020 to December 2022, 46 LSS patients who received UBE-ULBD were retrospectively analyzed. Two patients were operated at the L3/4 segment, 27 patients at the L4/5 segment, and 17 patients at the L5/S1 segment. The operation time, intraoperative blood loss, and associated complications were recorded. The patients were assessed before surgery, at 1 month after surgery, and upon the last follow-up using the visual analog scale (VAS) for leg and lower back pain. The clinical outcomes of patients were assessed by using the Oswestry Disability Index (ODI) and the modified Macnab criteria. Imaging parameters were recorded, including the angle of the medial surface of facetectomy (MSF), residual rate of the facet joint (FJ), decompression rate of the lateral recess (LR), increase in the dural sac cross-sectional area (DSCA), and motion range of the operated lumbar segment. Result: Surgeries were performed on 46 patients. The average operation time was 93.59±13.73 min, and the average follow-up was 24.54±6.71 months. The preoperative VAS score for lower back pain was 5.87±0.94. At 1 month after surgery and at the last follow-up, the VAS score for lower back pain decreased to 2.30±0.66 and 0.61±0.54, respectively (P<0.05). The preoperative VAS score for leg pain was 6.78±0.89. At 1 month after surgery and at the last follow-up, the VAS score for leg pain decreased to 1.67±0.60 and 0.50±0.59, respectively (P<0.05). The preoperative ODI was 64.48±7.47. At 1 month after surgery and at the last follow-up, ODI decreased to 26.09±2.80 and 10.96±2.30, respectively (P<0.05). According to the modified MacNab criteria during the last follow-up, the results were excellent in 33 (71.7%), good in 8 (17.4%), fair in 5 (10.9%), with the excellent and good rate of 89.1%. As for the radiological evaluation, the average angle of MSF after surgery was below 90°, and the average residual rate of FJ was above 70%. There was no significant difference in the motion range of the operated segment before and after surgery (P>0.05). The average increase in DSCA was 95.19±22.54% (P<0.05). However, there were no significant differences in the imaging parameters between patients achieving excellent and good outcomes and those achieving fair and poor outcomes according to the modified MacNab criteria (P>0.05). Conclusion: UBE-ULBDachieved satisfactory clinical and imaging outcomes in LSS patients, resulting in a desired increase in DSCA. Postoperative stability of lumbar facet joints was effectively preserved by this procedure, which further ensured lumbar spine stability. There was no significant correlation between the imaging parameters and the improvement of clinical outcomes.

目的 对比骨科手术机器人辅助与徒手皮质骨螺钉置钉在脊柱内固定手术中的安全性与准确性.方法 回顾分析2019 年12 月至2021 年6 月于首都医科大学附属北京朝阳医院骨科接受皮质骨轨迹螺钉(cortical bone trajectory,CBT)治疗单节段退行性腰椎疾病的 71 例患者.将接受X线透视辅助徒手CBT螺钉置入的患者作为徒手组(n=35),接受机器人辅助CBT螺钉置入的作为机器人组(n=36).螺钉置钉准确性和关节突侵犯情况通过术后电子计算机断层扫描(computed tomography,CT)三维重建评估.对比两组平均单枚螺钉的置钉时间、术中出血量及医务人员术中射线暴露情况.结果 71例患者一共植入284枚CBT螺钉,其中140枚由徒手组完成,144枚由机器人组完成.机器人组的准确率显著高于徒手组(92.36%vs 82.86%,P=0.015).机器人组关节突侵犯发生率显著低于徒手组(22.22%vs 40.00%,P=0.022).但是,单颗螺钉置钉时间机器人组显著长于徒手组[(501.92±70.08)s vs(382.54±63.21)s,P=0.000].术中医务人员辐射暴露时间徒手组明显高于机器人组[(56.81±16.09)s vs(34.43±16.91)s,P=0.000].结论 机器人辅助植入CBT螺钉可以有效提高螺钉置入准确性并减少了上关节突的侵犯率和医务人员的辐射暴露,但会增加螺钉的置钉时间与手术时间.本中心大约在12台手术后获得了平稳的机器人辅助CBT技术学习曲线.

This study aimed to assess the accuracy of cortical bone trajectory (CBT) screws placement guided by a spinous process clamp (SPC) guide. A total of 32 patients who received single-level midline lumbar fusion (MIDLF) surgery between June 2019 and January 2020 were retrospectively analyzed and divided into free-hand (FH) and SPC-guided groups according to the surgical approach. In the FH group, CBT screws was implanted with the assistance of fluoroscopy, while in the SPC group, CBT screws was implanted using the SPC navigator hardwire. A total of 128 screws were assessed in this study, with higher rates of clinically acceptable screw placement (grades A and B) and grade A screws in the SPC group than in the FH guide group (92.2% vs. 79.7%, P = 0.042 and 54.7% vs. 35.9%, P = 0.033, respectively). Misplacement screws (grades C, D, and E) occurred more often in the FH group than in the SPC guide group (20.3% vs. 7.8%, P = 0.042). The incidence of proximal facet joint violation (FJV) was higher in the FH group than in the SPC group (15.6% vs. 3.1%, P = 0.030). The radiation dose and time in the SPC guide group were comparable to those in the FH group ( P = 0.063 and P = 0.078). The average operative time was significantly longer in the SPC guide group than in the FH group (267.8 ± 45.5 min vs. 210.9 ± 44.5 min, P = 0.001). Other clinical parameters, such as the average bone mineral density (BMD), intraoperative blood loss, and postoperative hospital stay, were not significantly different. Oswestry disability index (ODI) and back pain visual analogue scale (VAS) scores were significantly improved in both groups compared with preoperatively. SPC guided screw placement was more accurate than the fluoroscopy-assisted FH technique for single-level MIDLF at L4/5. Patients undergoing SPC-guided screw placement can achieve similar clinical outcomes as the fluoroscopy-assisted FH technique.

目的 探讨单侧双通道脊柱内镜（unilateral biportal endoscopy，UBE）辅助下双侧椎管减压（unilateral laminotomy for bilateral decompression，ULBD）治疗腰椎管狭窄症（lumbar spinal stenosis，LSS）的安全性和临床疗效。方法 回顾性分析2020年7月至2021年12月UBE辅助下ULBD治疗的腰椎管狭窄症患者31例。L3/4节段1例，L4/5节段17例，L5/S1节段13例。术前、术后1、3、12个月随访时进行腰痛、腿痛视觉模拟量表（Visual Analogue Scale，VAS)评分和Oswestry功能障碍指数 (Oswestry Disability Index，ODI)评估，应用改良MacNab标准评价临床疗效。术后12个月复查过屈过伸位腰椎X线片。结果 31例患者均顺利完成手术，手术时间（101.52±10.57） min。术中硬脊膜撕裂1例，短暂性下肢麻木1例。平均随访（19.97±4.27）个月。腰痛VAS评分术前（4.68±1.40）分，术后1、3、12个月随访时分别降至（2.08±0.68）分、（1.77±0.48）分、（1.36±0.55）分（P<0.05）；腿痛VAS评分术前（6.01±1.37）分，术后1、3、12个月随访时分别降至（2.61±0.68）分、（2.11±0.74）分、（1.67±0.45）分（P<0.05）；ODI评分术前（57.74±10.82）分，术后1、3、12个月随访时分别降至（31.13±3.38）分、（21.84±3.33）分、（17.06±1.60）分（P<0.05）。术后12个月随访时依据改良MacNab标准，优23例，良4例，可4例，优良率87.1%。术后12个月随访复查未见手术节段失稳。结论 UBE辅助下ULBD治疗LSS的临床效果满意，可保持腰椎的稳定性，手术创伤小、术后恢复快，并且无严重的、不可逆的手术相关并发症发生。

STUDY DESIGN:A functional, transcriptome, and long noncoding RNAs (lncRNAs) expression analysis in the spinal cord of mice after hyperbaric oxygen (HBO) treatment.OBJECTIVE:We aimed to explore the mechanism by which HBO treats spinal cord injury (SCI) at the level of lncRNAs.SUMMARY OF BACKGROUND DATA:Immense amounts of research have established that HBO treatment promotes the recovery of neurological function after SCI. The mechanism of action remains to be clarified.METHODS:High-throughput RNA sequencing, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes enrichment analysis were used to profile lncRNA expression and analyze biological function in the spinal cords of mice from sham-operated, SCI, and HBO-treated groups. The differential expression of lncRNA between the groups was assessed using real-time quantitative polymerase chain reaction.RESULTS:Differential expression across 577 lncRNAs was identified among the three groups. GO analysis showed that free ubiquitin chain polymerization, ubiquitin homeostasis, DNA replication, synthesis of RNA primer, single-stranded telomeric DNA binding, and alpha-amylase activity were significantly enriched. Kyoto Encyclopedia of Genes and Genomes enrichment analysis displayed that vitamin B6 metabolism, one carbon pool by folate, DNA replication, lysine degradation, beta-alanine metabolism, fanconi anemia pathway, and Notch signal pathway were the main pathways with enrichment significance. LncRNAs NONMMUT 092674.1, NONMMUT042986.2, and NONMMUT018850.2 showed significantly different expression between the SCI and the other two groups (P<0.05, <0.01).CONCLUSIONS:This study is the first to determine the expression profiles of lncRNAs in the injured spinal cord after HBO treatment. We identified several important dysregulated lncRNAs in this setting. These results help us better understand the mechanism by which HBO treats SCI and provide new potential therapeutic targets for SCI.

Study Design. Basic science study investigating the potential molecular mechanisms of hyperbaric oxygen (HBO) therapy in mice with spinal cord injury (SCI).Objective. We aimed to explore the intrinsic mechanisms of HBO for SCI through the lens of ferroptosis in the subacute phase.Summary of Background Data. HBO has been observed to facilitate the restoration of neurological function subsequent to SCI. Ferroptosis is a distinct cellular death mechanism that can be distinguished from apoptosis, necrosis, and autophagy. However, the precise relationship between these two phenomena remains poorly understood.Methods. We established an SCI model and employed a range of techniques, including behavioral assessments, electron microscopy, immunofluorescence, RT-qPCR, Western blotting (WB), Glutathione (GSH) measurement, and iron assay, to investigate various aspects of HBO therapy on SCI in mice. These included analyzing mitochondrial morphology, neuronal count, GSH levels, iron levels, and the expression of genes (Acyl-CoA synthetase family member-2, Iron-responsive element-binding protein-2) and proteins (Glutathione peroxidase 4; system Xc-light chain) associated with ferroptosis. The study included three groups: Sham-operated, SCI, and HBO. Group comparisons were performed using one-way analysis of variance and one-way repeated measures analysis of variance, followed by Tukey's post hoc test. Statistical significance was set at a P < 0.05.Results. Our findings revealed that HBO therapy significantly enhanced the recovery of lower limb motor function in mice following SCI in the subacute phase. This was accompanied by upregulated expression of GPX4 and system Xc-light chain proteins, elevated GSH levels, increased number of NeuN+ cells, decreased expression of the iron-responsive element-binding protein-2 gene, and reduced iron concentration.Conclusions. Our research suggests that HBO therapy has the potential to be an effective treatment for SCI in the subacute phase by mitigating ferroptosis.

目的 探讨脊柱共平面技术(vertebral coplanar alignment,VCA)对特发性脊柱侧凸的应用效果.方法 回顾性分析在我院接受VCA技术矫形的5例特发性脊柱侧凸病人的临床资料.其中男1例,女4例,平均年龄为16.3岁(14～25岁).收集术前、术后及最近一次随访时的站立位脊柱全长正侧位X线片及CT,测量主弯Cobb角、顶椎偏移、冠状面平衡、胸椎后凸角(TK)、矢状面平衡、顶椎椎体胸廓比值(apical vertebral body-rib ratio,AVB-R)、顶椎旁肋骨弥散间距(apical rib spread difference,ARSD)、剃刀背(rib hump,RH)及椎体旋转角(rotational angle to sacrum,RAsac).结果 主弯Cobb角由术前的55.7°矫正至术后的14.7°,TK由术前的26.7°矫正至19.0°.术前Lenke矢状面形态为"+"的病人矫正至"N",而术前Lenke矢状面形态为"N"的病人仍维持正常的TK.AVB-R、ARSD、RH及RAsac的矫正率分别为36.0％、60.1％、56.7％、54.9％.在24个月的随访期间,无明显矫形丢失,无冠状面、矢状面失代偿发生.结论 VCA技术应用于特发性脊柱侧凸的矫形可获得满意的椎体去旋转和矢状面重建效果.目前针对VCA技术的研究多为初步应用经验,其适应证的选择还需要在今后的临床应用中进一步总结.

Background Dual traditional growing rod (dTGR) implantation may not always be feasible for patients with severe early-onset scoliosis (EOS). The concave single traditional growing rod (sTGR) can serve as a starting construct. Distal foundation augmentation (DFA) with four pedicle screws with a cross-link can increase the spinal control provided by a dTGR. However, DFA has yet to be used with a sTGR. This study investigated the efficiency of DFA in patients with severe EOS who underwent sTGR implantation. Methods From 2010 to 2021, 74 consecutive patients with severe EOS (major curve ≥80°) who underwent traditional growing rod implantation (48 sTGR and 26 dTGR) with a minimum 24-month follow-up were recruited. The sTGR cohort was further divided into two groups by whether or not DFA was performed. In our center, patients who were admitted for sTGR implantation after 2018 routinely underwent DFA. The implantation of a dTGR was based on the severity of thoracic torsion and BMI. Baseline clinical characteristics, complications, and radiographic parameters preoperatively, postoperatively, and at the last follow-up before conversion to a dual rod instrumentation were compared between the three groups. Results There was no significant difference in baseline clinical characteristics between the three groups (P>0.05). Twenty-four patients in the sTGR cohort underwent DFA. There was no significant difference in preoperative radiographic parameters between the DFA and non-DFA group (P>0.05). Compared with the non-DFA group, the DFA group had superior results at the last follow-up in terms of maintaining the correction of the major curve (P=0.001), maximal kyphosis correction (P=0.001), the distance between the C7 plumb line and the central sacral vertical line (P=0.036), and distracting the growing thorax (P=0.032) and trunk (P=0.044). Furthermore, the incidence of implant-related complications (P=0.019), especially at the distal foundation (P=0.033), was significantly lower in the DFA group. There was no significant difference between the DFA and dTGR groups in radiographic outcomes or complications at the final follow-up (P>0.05). Conclusions For patients with severe EOS who undergo sTGR implantation, DFA might better maintain the deformity correction, distract the growing spine, preserve balance, and decrease the incidence of implant-related complications. The efficiency of sTGR with DFA was comparable to that of the gold-standard dTGR treatment. Further multicenter randomized controlled trials are needed for more convincing conclusions.

BACKGROUND CONTEXT:The optimal treatment for osteoporotic vertebral burst fracture (OVBF) without neurological symptoms is still a matter of debate. PURPOSE:To evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) for OVBF. STUDY DESIGN:The study is a prospective study and is registered in the China Clinical Trials Registry with the registration number ChiCTR-OOC-17013227. PATIENT SAMPLE:The study involved 119 patients with 137 fractured vertebrae who underwent unilateral PKP for OVBF. OUTCOME MEASURES:The measurements were carried out independently by two physicians and measured with picture archiving and communication system (PACS) and ImageJ software (National Institutes of Health, Bethesda, MD, USA). METHODS:The change in the spinal canal area and posterior wall protrusions (PWP) were measured before and after surgery via three-dimensional computed tomographic imaging (CT). Preoperative, postoperative, and final follow-up standing X-rays were used to measure the height of the anterior wall (HAW), height of the posterior wall (HPW), and local kyphotic angle (LKA). Additionally, visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were also determined. RESULTS:Among the 137 vertebrae assessed, 79 exhibited an increased postoperative canal area, while 57 showed a decrease, with mean values of 8.28±6.871 mm² and -9.04±5.991 mm², respectively. Notably, no significant change in postoperative canal area was identified on the entire dataset (p>.01). There was a significant decrease between median preoperative (3.9 [IQ1-IQ3=3.3-4.8] mm) and postoperative (3.7 [IQ1-IQ3=3.0-4.4] mm) PWP (p<.01). Preoperative and postoperative HAW measurements were 19.4±6.1 mm and 23.2±5.2 mm, respectively (p<.01). However, at the final follow-up, the HAW was lower than the postoperative value. The HPW was also significantly improved after surgery (p<.01), but at the final follow-up, it was significantly decreased compared with the postoperative measurement. Following surgery, KA was significantly corrected (p<.01); however, at the final follow-up, relapse was detected (average KA: 18.4±10.3°). At the final follow-up, both VAS and ODI were significantly improved compared with the preoperative period (p<.01). As for complications, 50 patients experienced cement leakage, and 16 patients experienced vertebral refracture. All patients did not develop neurological symptoms during the follow-up. CONCLUSIONS:OVBF without neurological deficits showed significant improvement in symptoms during the postoperative period after PKP. There was no notable alteration in the spinal canal area, but a significant decrease in PWP was observed. Consequently, we posit that PKP stands as a secure and efficacious surgical intervention for treating OVBF cases devoid of neurological symptoms.

目的 评估头盆环牵引(halo-pelvic traction,HPT)联合二期矫形手术治疗极重度僵硬性脊柱侧后凸畸形(severe and rigid scoliosis,SRS)(Cobb's角>140°)患者的疗效及并发症.方法 纳入我中心行一期HPT,二期脊柱侧凸矫形的极重度SRS的病例12例.患者主弯或后凸Cobb's角>140°,柔韧性<30％.对牵引前、一期HPT后及二期矫形术后,患者的身高,站立位脊柱全长正侧位X线片主弯及后凸Cobb's角,双肩高度差,双髂高度差,冠状面平衡(distance between C7 plumb line and center sacral vertical line,C7PL-CSVL)偏移距离等进行评估.结果 患者主弯或后凸由术前的(162.5±17.3)° 在一期HPT后改善至(75.7±14.3)°,在二期矫形术后改善至(57.7±16.1)°,改善率达64.5％.一期HPT及二期矫形术后患者身高、双肩高度差及C7PL-CSVL偏移距离等较牵引前也有明显改善,差异有统计学意义.一期HPT中1例出现C5神经根麻痹,1例出现皮肤破溃感染.二期矫形术中1例出现脑脊液漏,1例出现一过性双下肢瘫痪.患者并发症在处理后均好转.结论 HPT联合二期矫形手术是一种安全且行之有效的治疗Cobb's角>140° 的极重度SRS的方式.

The purpose of this study was to access the accuracy of cortical bone trajectory screw placement guided by spinous process clamp (SPC).