Rectus sheath hematoma (RSH) is a rare cause of abdominal pain during pregnancy. In our case, a healthy pregnant woman presented with right upper abdominal pain at 33 weeks of gestation. Ultrasound showed a heterogeneous hypoechoic mass in the abdominal wall, which was suspected of being a rectus sheath hematoma. After half a day of conservative therapy, the progressive decrease in hemoglobin level suggested active bleeding into her rectus sheath. Consequently, surgery was initiated under general anesthesia. During the operation, we found that the right musculus rectus abdominis was ruptured and actively bleeding. The hematoma was removed, and the broken end of the bleeding rectus abdominis muscle was ligated. After the operation, a blood transfusion was given, and the patient was discharged from the hospital as scheduled. A healthy newborn was delivered by elective cesarean section at 39 weeks of gestation. We present this case to enhance the recognition of RSH during pregnancy. Although relatively rare, this condition manifests itself with an acute onset and severe symptoms. Timely and accurate diagnosis and management may effectively reduce the incidence of preterm delivery.

V-domain Ig-containing suppressor of T cell activation (VISTA) is an immune checkpoint molecule predominantly expressed on myeloid cells and has recently been recognised as a key mediator of immunosuppression within the tumour microenvironment (TME). However, its expression pattern in gastric cancer and the functional characteristics of the VISTA-high TME remain poorly understood. We conducted multiplex immunohistochemistry on tumour samples from 172 patients to characterise the immune landscape of the VISTA-high tumour microenvironment. Additionally, single-cell RNA sequencing (n = 17) and spatial transcriptomics (n = 3) were employed to delineate the cellular expression patterns of VISTA and investigate the potential immunomodulatory functions of VISTA-expressing macrophages. High VISTA expression was associated with an immunosuppressive TME characterised by increased infiltration of exhausted CD8+ T cells, regulatory T cells (Tregs), M2-like macrophages, and cancer-associated fibroblasts (CAFs). Moreover, elevated VISTA levels in the tumour region were linked to worse immune-related progression-free survival (irPFS) in patients treated with immune checkpoint inhibitors (ICIs). Mechanistically, VISTA+ monocyte-macrophage (MoMac) populations promoted T cell exhaustion via the LGALS9-PTPRC signalling axis and exhibited enhanced antigen-presenting capacity. Our findings establish VISTA as a central immunoregulatory checkpoint in gastric cancer, suggesting its potential as a promising therapeutic target for combination immunotherapeutic approaches.

Study DesignRetrospective cohort study.ObjectivesTo compare 5-year clinical and radiographic outcomes between single-level Bryan and ProDisc-C cervical disc arthroplasty (CDA).MethodsPatients undergoing single-level Bryan or ProDisc-C arthroplasty for cervical spondylosis radiculopathy and/or myelopathy between March 2004 and August 2014 were enrolled. Clinical outcomes included Visual Analog Scales for arm/neck pain (VAS-A/N), Neck Disability Index (NDI), and modified Japanese Orthopedic Association (mJOA) scores. Radiographic evaluation included cervical lordosis, range of motion (ROM), functional spinal unit (FSU) height, cervical sagittal vertical axis (cSVA), T1 slope, heterotopic ossification (HO), and adjacent segment degeneration (ASD). Evaluations were performed preoperatively and postoperatively within 3 months, 1 year and 5 years.ResultsAmong 113 patients with 5-year follow-up (51 Bryan, 62 ProDisc-C), both groups showed significant improvements in VAS-N, VAS-A, NDI, and mJOA scores at all timepoints (all P < .001). No significant intergroup differences were detected between the two cohorts at baseline (all P > .05). ROM and cervical alignment remained stable in both cohorts. Compared to Bryan arthroplasty, ProDisc-C demonstrated greater index-level segmental lordosis (4.3° ± 5.0° vs 1.2° ± 4.7°; P = .001), more FSU height restoration (35.2 ± 3.4 mm vs 32.9 ± 3.6 mm; P < .001), and less segmental kyphosis incidence (21.0% vs 39.2%; P = .032). However, ProDisc-C arthroplasty had higher rates of ASD (58.1% vs 37.3%; P = .028) and HO (67.7% vs 33.3%; P < .001).ConclusionBoth prostheses achieved comparable 5-year clinical outcomes. ProDisc-C arthroplasty better maintained cervical sagittal alignment, whereas Bryan arthroplasty demonstrated lower ASD and HO incidence.

Study DesignRetrospective cohort study.ObjectiveTo compare long-term clinical and radiographic outcomes between the Bryan and ProDisc-C cervical disc prostheses following single-level cervical disc arthroplasty (CDA), with particular focus on sagittal alignment, motion behavior, heterotopic ossification (HO), and radiographic adjacent segment degeneration.MethodsThis retrospective single-center cohort study included patients who underwent single-level CDA with either the Bryan or ProDisc-C prosthesis between 2004 and 2014 and had complete minimum 10-year clinical and radiographic follow-up data. Clinical outcomes were evaluated using the Neck Disability Index (NDI), visual analog scale for neck and arm pain, and modified Japanese Orthopaedic Association (mJOA) score. Radiographic assessments included cervical lordosis, segmental and total range of motion (ROM), functional spinal unit (FSU) height, cervical sagittal vertical axis, T1 slope, HO according to the McAfee classification, and radiographic adjacent segment degeneration assessed using the Walraevens scoring system.ResultsA total of 71 patients were included, including 40 treated with the Bryan prosthesis and 31 treated with ProDisc-C. The median follow-up duration was 141 months [IQR, 123-173 months]. Both groups demonstrated significant improvements in VAS-N, VAS-A, NDI, and mJOA scores compared with preoperative baseline values, with no significant between-group differences at final follow-up. Radiographically, final index-level ROM was comparable between groups, although a within-group reduction from baseline was observed in the Bryan group. ProDisc-C was associated with greater index-level lordosis and higher measured FSU height at final follow-up. The incidence of radiographic adjacent segment degeneration was comparable between the Bryan and ProDisc-C groups. HO was more frequent in the ProDisc-C group, with differences in HO grade and distribution between the two prostheses. Revision rates were comparable between groups.ConclusionAt a minimum 10-year follow-up, Bryan and ProDisc-C CDA provided durable and comparable clinical outcomes after single-level surgery. Direct between-group comparisons showed differences in selected radiographic parameters, including index-level lordosis, measured FSU height, and HO characteristics, whereas final index-level ROM and radiographic adjacent segment degeneration were comparable. These findings suggest that implant-related radiographic differences may exist, but they did not translate into measurable differences in long-term clinical outcomes in this cohort.

Oncogenic KRAS mutations define a distinct molecular subset of gastric adenocarcinoma (GA), yet their impact on the tumor immune microenvironment remains incompletely understood. In this study, we established a genetically faithful and immunocompetent KRASG12D-driven mouse model of GA, together with matched organoids and cell lines, to investigate how oncogenic KRAS shapes tumor-immune interactions. KRAS-mutant tumors consistently developed an immunosuppressive microenvironment characterized by enrichment of regulatory T cells (Tregs), accompanied by reduced cytotoxic lymphocyte infiltration and intrinsic resistance to PD-1 blockade. Although pharmacologic targeting of KRAS effectively suppressed tumor growth and increased immune cell infiltration, functional immune analyses revealed persistent Treg-mediated immunosuppression that limited effective antitumor immunity. Mechanistically, TGF-β signaling was required to maintain Treg dominance and suppress effector T cell function in KRAS-driven tumors. Importantly, disruption of this suppressive axis through combined KRAS inhibition and CTLA-4 blockade attenuated TGF-β activity, impaired Treg function, and enhanced antitumor immune responses in vivo. Collectively, these findings identify oncogenic KRAS as a key regulator of TGF-β-dependent immune suppression in GA and provide mechanistic insight into immune evasion within this molecular subtype.

Objective. To explore the preoperative and intraoperative factors associated with the progression of cervical kyphosis following posterior decompressive surgery in patients with degenerative cervical kyphosis and stenosis. Methods. This retrospective study reviewed patients diagnosed with multilevel cervical spinal stenosis and degenerative cervical kyphosis who underwent posterior approach surgery. Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) score, Visual Analog Scale (VAS) for neck pain, Neck Disability Index (NDI), and Short Form 36 (SF36) health survey. Radiographic parameters, including C2-C7 lordosis, cervical range of motion (flexion and extension), T1 slope, and T1S-CL, were measured preoperatively and at follow-up using cervical standing X-rays. based on whether kyphosis progressed after surgery, patients were divided into 2 groups. Results. A total of 102 patients (mean age 56.8 years; 75 men, 27 women) met the inclusion criteria. Forty-two patients (41.2

Human epidermal growth factor receptor 2 (HER2) is a key biomarker and therapeutic target in several malignancies, including breast, gastric, and other solid tumors. Recent advancements in cancer molecular profiling and the Food and Drug Administration's approval of trastuzumab deruxtecan for HER2u2010positive panu2010tumor indications have highlighted the broader relevance of HER2 alterations across diverse cancers. However, the lack of standardized guidelines for HER2 testing in a panu2010tumor context creates variability in clinical practice, hindering the optimal implementation of HER2u2010targeted therapies beyond traditional indications. To address this gap, a multidisciplinary panel of Chinese experts has developed a consensus providing comprehensive recommendations on diagnostic strategies, testing methodologies, and clinical applications of HER2 overexpression detection. By establishing a unified framework for HER2 overexpression assessment, this consensus aims to enhance the precision of HER2 testing, optimize patient selection for targeted therapies, and improve clinical outcomes across a wide spectrum of HER2 overexpression malignancies.

AIM:Disorders of consciousness (DOC) remain a major clinical challenge, and the efficacy of currently available neuromodulation strategies remains limited. The brainstem reticular formation is central to arousal regulation, but approaches directly targeting it remain technically demanding. This feasibility study aimed to explore whether epidural electrical stimulation applied via a transnasal clival approach could induce arousal and the electrocorticographic (ECoG) changes. METHODS:Three anesthetized sheep were implanted with epidural stimulating electrodes placed over the ventral brainstem via a transnasal clival approach and cortical recording electrodes on the fronto-parietal lobes. During the stimulation period, continuous behavioral monitoring was performed, and ECoG was recorded and later processed with spectral analysis. RESULTS:All three sheep successfully underwent electrode implantation without intraoperative complications, including cerebrospinal fluid leakage or neurovascular injury. Short-term stimulation reliably elicited behavioral signs of arousal. Concurrently, spectral analysis of ECoG revealed a reduction in low-frequency power (δ, θ) and an increase in high-frequency power (β, γ). CONCLUSIONS:Transnasal clival epidural stimulation is technically feasible and capable of modulating arousal-related neural activity. Further investigations with optimized electrode design and larger cohorts are required to validate its safety and efficacy.

Gastric cancer with peritoneal metastasis has a poor prognosis and limited treatment options. Claudin 18.2 (CLDN18.2) CAR T therapy has shown activity in advanced gastric cancer, but its role in peritoneal disease remains insufficiently characterized. Here, we report three patients with gastric cancer and peritoneal metastasis from a phase I trial of satri-cel (NCT03874897), all with high CLDN18.2 expression. All three patients experienced clinical and radiologic benefit after treatment and achieved durable peritoneal disease control. After CLDN18.2-targeted CAR T-cell therapy, one patient underwent conversion surgery 8 months after infusion. After resection of subsequent bilateral ovarian metastases, no further disease progression was observed, corresponding to long-term control of peritoneal metastases. The other two patients achieved overall survival of 44 and 35 months, respectively. Although circulating CAR T-cells became nearly undetectable in peripheral blood by around day 30 after infusion, CAR T-cell infiltration was still detected in resected gastric or ovarian tumor tissues months later. These findings support substantial and durable activity of CLDN18.2 CAR T-cell therapy in gastric cancer with peritoneal metastasis.

PURPOSE:Despite emerging genomic discoveries, few have been translated into practical management strategies for people with gastroenteropancreatic neuroendocrine carcinoma (GEPNEC). This study aims to identify key genes and their potential clinical relevance to improve care for this patient group. METHODS:In the analytical cohort, we reported high-frequency alteration genes, significantly mutated genes, and driver genes and defined their overlap as key genes. Genotypes were identified as Type I/II/III. For further validation, we prospectively recruited eligible patients to build a main cohort, through which we performed univariate/multivariate Cox regression analysis and sketched Kaplan-Meier survival plot. Targetable genes were defined by the OncoKB database. RESULTS:The analytical cohort consisted of 124 patients. The genes most frequently altered were TP53 (78%), RB1 (35%), APC (27%), and KRAS (17%). Key genes were identified as TP53, RB1, APC, and KRAS. The main cohort included 171 patients. We defined the genotype "Type I" (defined as TP53/RB1 co-alterations) as a reference. In midgut/hindgut NEC, we identified a "Type II" subtype characterized by mutations in either APC or KRAS alterations without TP53/RB1 co-alterations. Type II of midgut/hindgut NEC patients had elevated carcinoembryonic antigen (CEA) levels and longer median overall survival (mOS) than others (not reached vs 11.4 months, HR = 0.19[0.08, 0.44], P = .0028). In foregut NEC, we identified "Type III" (either APC/KRAS alterations or TP53/RB1 co-alterations). Type III of foregut NEC patients showed shorter mOS than others (11.6 vs 19.0 months, HR = 1.93[1.13, 3.25], P = .01). Type II patients who received non-platinum/etoposide (EP) chemotherapy had longer first-line progression-free survival (PFS) compared to EP regimen. They also benefited from second-line immunotherapy. Targeted therapy as second-line was also suitable for targetable patients (longer PFS than others: 12.5 vs 3.0 months, HR = 0.40[0.21-0.75], P = .0017). CONCLUSIONS:Our study identified key gene-based genotypes (Type II/III) of distinct GEPNEC patients and yielded their prognosis and therapeutic utility.

This study introduces eccentric cranial traction (ECT) as a traction method for congenital cervical scoliosis (CCS) at the craniovertebral junction (CVJ) and evaluates its benefits when combined with concave-side distraction surgery. A retrospective analysis was conducted on 18 patients with CCS at the CVJ treated between 2019 and 2023 using ECT followed by concave-side distraction. Radiographic parameters were assessed at five time points: pre-operation, pre-traction, post-traction, post-operation, and final follow-up. Baseline demographic and surgical data were recorded. Patients were stratified into high- and low-responder groups based on the median value of the traction correction rate, and outcomes were compared between groups. The correlation between traction correction rate and surgical correction rate was also analyzed. The median age at ECT initiation was 8 years, and the median duration of traction was 8 days. All patients presented with deformities involving the CVJ. ECT significantly reduced head–neck tilt from 16.5 ± 9.3° to 9.5 ± 5.9° (P < 0.001), yielding a mean traction correction rate of 43.1

Human epidermal growth factor receptor 2 (HER2) is a key biomarker and therapeutic target in several malignancies, including breast, gastric, and other solid tumors. Recent advancements in cancer molecular profiling and the Food and Drug Administration's approval of trastuzumab deruxtecan for HER2-positive pan-tumor indications have highlighted the broader relevance of HER2 alterations across diverse cancers. However, the lack of standardized guidelines for HER2 testing in a pan-tumor context creates variability in clinical practice, hindering the optimal implementation of HER2-targeted therapies beyond traditional indications. To address this gap, a multidisciplinary panel of Chinese experts has developed a consensus providing comprehensive recommendations on diagnostic strategies, testing methodologies, and clinical applications of HER2 overexpression detection. By establishing a unified framework for HER2 overexpression assessment, this consensus aims to enhance the precision of HER2 testing, optimize patient selection for targeted therapies, and improve clinical outcomes across a wide spectrum of HER2 overexpression malignancies.

Gastric cancer (GC) remains a formidable public health challenge in China, characterized by a high incidence and mortality rate. A significant proportion of patients are diagnosed with advanced or metastatic disease, where traditional chemotherapy has historically offered limited survival benefits. However, driven by a deeper molecular understanding of GC heterogeneity, the paradigm of GC treatment is undergoing a revolutionary shift from a "one size fits all" approach toward precision medicine. The identification of predictive biomarkers, such as human epidermal growth factor receptor 2 (HER2/ERBB2; MIM: 164870) expression, microsatellite instability-high (MSI-H) status, PD-L1 (CD274; MIM: 605402) expression, and Claudin 18.2 (CLDN18; MIM: 609210) overexpression, has established biomarker-guided strategies as the unequivocal future direction for managing advanced GC. In particular, the emergence of immune checkpoint inhibitors (ICIs) and agents targeting Claudin 18.2 has revolutionized the landscape of first-line (1L) treatment for GC. China has achieved accelerated breakthroughs in gastric cancer drug research and development, leading to more innovative therapies and improved diagnostic/treatment regimens, providing patients with more abundant and effective treatment options and significantly improving the landscape of diagnosis and treatment. Nevertheless, integrating complex biomarkers and novel agents into practice poses challenges, including inconsistencies in biomarker testing and the need for nuanced treatment regimen selection. Without standardized guidelines, inconsistent application may lead to suboptimal patient outcomes and inefficient use of healthcare resources. This expert consensus has been jointly formulated with the aim of further enhancing and standardizing the biomarker testing and precision medicine of 1L therapy for advanced GC.

Tumor-draining lymph nodes are central to anti-tumor immunity and influence the response to immunotherapy. Colorectal cancers with microsatellite instability and microsatellite stability differ substantially in tumor biology, prognosis and sensitivity to immune checkpoint blockade. However, the differences in tumor-draining lymph nodes between these two subtypes and their contribution to distinct anti-tumor immune responses remain poorly understood. Here, we performed an integrative multi-omics analysis to systematically compare tumor-draining lymph nodes and tumor microenvironments in these two colorectal cancer subtypes. We identified a distinct population of CD8+ T cells that displayed terminal exhaustion while retaining strong anti-tumor activity. These cells were highly tumor reactive, associated with tertiary lymphoid structure formation and enriched in microsatellite instability colorectal cancers. Lineage tracing indicated that they originated in tumor-draining lymph nodes. In microsatellite instability colorectal cancers, tumor-draining lymph nodes contained more pre-exhausted T cells, dendritic cells with enhanced antigen-presenting capacity and fewer regulatory T cells, thereby providing both precursors and a supportive niche for the development of these effector-exhausted T cells. Meanwhile, within tumors, IL21+CD4+ T cells and CXCL10+ myeloid cells promoted the differentiation and recruitment of these cells through cytokine signaling and increased major histocompatibility complex expression. Colorectal cancer cells with microsatellite instability further reinforced this immune ecosystem by activating the cyclic GMP-AMP synthase-stimulator of interferon genes pathway. Collectively, our findings identify effector-exhausted CD8+ T cells as key mediators of favorable immunity in microsatellite instability colorectal cancers and highlight the pivotal role of tumor-draining lymph nodes in shaping the tumor immune landscape.

Splicing dysregulation frequently occurs in cancers, yet the functional implications of most mis-spliced genes remain elusive. Through a comprehensive pan-cancer analysis of splicing dysregulation, we identified universally mis-spliced genes in cancers and were surprised to find their significant functional enrichment in cell migration. Interestingly, the STE20-like protein kinase (SLK) gene encoding a scaffold protein showed a significant splicing shift from SLK-S to SLK-L isoforms across various cancer types. Detailed studies demonstrated this splicing shift promoted cancer metastasis in cellular and animal models. Mechanistically, RNA-binding Fox-1 Homolog 2 (RBFOX2) protein was identified as a splicing factor that regulates SLK splicing. The two isoforms interact with occludin with different affinities, contributing to their unique activities in cancer metastasis. Notably, the antisense oligonucleotides designed to suppress SLK-L splicing effectively inhibited cancer migration and invasion. Collectively, this study shows a new splicing switch with a key role in controlling cancer metastasis, shedding light on new cancer therapy via splicing manipulation.

The success of novel antibody-drug conjugates, such as trastuzumab deruxtecan (T-DXd) and disitamab vedotin (RC48), has been pivotal in rendering “HER-2-low” gastric cancer (GC) a therapeutically targetable entity, expanding the population benefiting from anti-HER2 therapy by 2-3-fold. This advancement underscores the imperative to redefine and subclassify HER-2 status in GC. In this study, we innovatively proposed a four-tiered HER-2 classification standard for GC and, for the first time, conducted comparative analyses at the spatial single-cell multi-omics level across these four subgroups. HER-2 status was recategorized into absent (immunohistochemistry (IHC) 0+, HER2_N), low (IHC 1+, HER2_L), moderate (IHC 2+/fluorescence in situ hybridization (FISH)-, HER2_M), and high (IHC 2+/FISH + or IHC 3+, HER2_H) groups. Primary tumor samples from 427 GC patients were collected and analyzed using Xenium5K in situ single-cell spatial transcriptomics (n = 153) and multiplex immunofluorescence (n = 427) detection base on tissue microassays. The proportion of samples that classified as HER2_N, HER2_L, HER2_M, and HER2_H was 43.13

PURPOSE:The benefit of chemotherapy in locally advanced gastroesophageal cancer with deficient mismatch repair (dMMR) or microsatellite instability-high (MSI-H) remains uncertain. This study aimed to identify optimal postoperative management strategies for dMMR/MSI-H gastric or gastroesophageal junction (EGJ) adenocarcinoma. MATERIALS AND METHODS:Patients with pathologically confirmed stage II-IVA dMMR/MSI-H gastric or EGJ adenocarcinoma who underwent D2 gastrectomy between 2015 and 2022 were retrospectively enrolled from 4 centers. Postoperative management strategies included observation, chemotherapy, immune checkpoint inhibitors (ICIs), or ICIs combined with chemotherapy (ICI-chemo). The primary endpoint was 2-year event-free survival (EFS), and the secondary endpoints were EFS and overall survival (OS). RESULTS:A total of 156 patients were included in the analysis. The highest 2-year EFS was observed in the ICI-chemo group (87.5%), followed by the observation group (86.7%) and the ICI monotherapy group (86.5%), whereas chemotherapy alone yielded the lowest rate (75.7%). Patients with earlier-stage disease had significantly lower risks of progression (hazard ratio [HR], 0.29; 95% confidence interval [CI], 0.16-0.53) and death (HR, 0.30; 95% CI, 0.14-0.64). EFS improved progressively from chemotherapy to observation and further to ICI-containing regimens across stages. In stage III-IVA disease, ICI monotherapy significantly improved OS compared with chemotherapy (HR, 0.28; P=0.038), with a favorable trend observed for ICI-chemo (HR, 0.32). CONCLUSIONS:Pathological stage is an independent prognostic factor in resectable dMMR/MSI-H gastric and EGJ adenocarcinoma. Adjuvant chemotherapy alone demonstrated limited benefit, whereas ICI-based regimens were associated with improved outcomes, supporting their use in high-risk patients.

The low oxygen tension frequently found in tumors drives the expression of hypoxia-inducible factors (HIFs), thereby supporting rapid cancer cell proliferation and metastasis. Therefore, the prolonged expression of HIF-1α, the master regulator of the adaptation to hypoxia, is a crucial protective mechanism for solid tumor progression. Here we report that RNF122, the novel E3 ligase of HIF-1α, is a hypoxia responsive gene. Importantly, loss of RNF122 dramatically promoted breast cancer cell migration, invasion, and metastasis. In the presence of hypoxia, HIF-1α transcriptionally activates the expression of RNF122, which in turn directly interacts with HIF-1α in the cytoplasm, promoting its degradation through K27-linked polyubiquitination. Consequently, RNF122 suppresses the transcriptional activity of HIF-1α and its target gene expression, thereby inhibiting the glucose metabolism and angiogenesis of breast cancer cells under hypoxic condition. Clinically, copy number loss of RNF122 occurs in 39% of breast cancer patients, and the level of RNF122 is positively correlated with increased overall survival. Taken together, our findings discovered a negative feedback loop between RNF122 and HIF-1α that inhibits hypoxia-mediated tumorigenic activity, revealing a novel mechanism by which neoplastic cells sustain HIF-1α-dependent malignancy under hypoxic condition in RNF122-negative breast cancers.

BACKGROUND CONTEXT:For patients with high occupation rate cervical ossification of the posterior longitudinal ligament (HOR-cOPLL) that are K-line negative, laminoplasty often results in poor outcomes due to postoperative loss of cervical curvature. Preserving the posterior muscle-ligament complex (PMLC) on the hinge side during laminoplasty has been shown to reduce cervical curve loss and improve postoperative cervical alignment. We hypothesized that a modified laminoplasty (mLP) with preserving the PMLC could maintain cervical curvature and achieve similar neurological recovery to that of laminectomy with fusion (LF), regardless of K-line status. PURPOSE:To compare the clinical and radiological results between mLP and LF among patients with HOR-cOPLL during postoperative 2-year follow-up. STUDY DESIGN:Prospective observational study. PATIENTS SAMPLE:Patients with HOR-cOPLL were enrolled between December 2018 and February 2022. Among them, 30 patients underwent LF, while 34 patients received mLP. OUTCOME MEASURES:The modified Japanese Orthopedic Association (mJOA) score and the mJOA recovery rate (mJOA RR) were used for neurological improvement. The Neck Disability Index (NDI) score, Visual Analog Scale (VAS) scores were for neck and/or shoulder pain. Perioperative values included operative time, estimated blood loss, and perioperative complications. Radiological characteristics consisted of the cervical Cobb angle and cervical range of motion (ROM), etc. METHODS: Independent samples t-test and Mann-Whitney U-test were used to compare normally and nonnormally distributed continuous variables between 2 groups, respectively. Paired sample t-tests and Wilcoxon signed-rank tests were used to evaluate changes in variables before and 2 years after surgery. Subgroup based on K-line was performed to access the differences between 2 groups. RESULTS:The mLP group experienced shorter surgery times (101 min vs 122.5 min, p=.009), less blood loss (175 mL vs 200 mL, p=.020), and had complication rates comparable to those of the LF group. The mLP (12.5 vs 16.5, p<.001) and LF groups (11.5 vs 15.25, p<.001) showed significant and comparable improvements in mJOA (p=.648) and mJOA RR (65.16% vs 68.33%, p=.598) at postoperative 2-year follow-up, which were consistent in both K-line positive and negative subgroups. Postoperative NDI, VAS, and axial symptoms were also comparable between the 2 groups. While maintaining a cervical curve comparable to the LF group (3.17° vs 2.95°, p=.935), the mLP group exhibited a lesser reduction in ROM at the 2-year mark (17.77° vs 12.02°, p=.033), although this was not significant in either K-line positive or negative subgroups. CONCLUSIONS:This was the first prospective cohort to compare mLP and LF for HOR-cOPLL. Both the mLP and LF groups demonstrated significant neurological recovery and similar preservation of cervical curvature over a 2-year period, regardless of K-line status. Notably, mLP offers advantages in surgical efficiency and reduced blood loss, suggesting its potential as a less invasive alternative to LF.

3D printed artificial vertebral bodies (AVBs) have emerged as a viable alternative to traditional titanium mesh cages (TMCs) for spinal reconstruction following ACCF. However, existing comparative studies evaluating mid-term clinical and radiographic outcomes - particularly those incorporating quantitative assessments of fusion efficacy - remain inconclusive. This study aims to compare clinical and radiological outcomes between AVB and TMC in patients undergoing single-level ACCF with matched baseline characteristics. Patients who underwent single-level ACCF for degenerative cervical myelopathy (DCM) between January 2012 and December 2022, with a minimum of 2-year clinical and radiological follow-up, were included. Patients were grouped by implant type (AVB or TMC), and propensity score matching (PSM) was used to balance baseline characteristics. Outcomes were assessed at 3-month and final follow-up (more than 2 years). Radiological assessments comprised: (1) fusion status evaluated via extra graft bridging bone (ExGBB) on computed tomography (CT) scans and interspinous motion (ISM) parameters; (2) implant subsidence; and (3) cervical alignment changes. Clinical parameters included neck pain (using Visual Analogue Scale), modified Japanese Association (mJOA) score and Neck Disability Index (NDI). A total of 93 patients were included (49 in AVB and 44 in TMC group). After 1:1 PSM, 36 patients were matched for each group, and intergroup comparisons revealed comparable baseline conditions. At 3 months, the AVB group exhibited significantly smaller ISM distance (p = 0.019) and less subsidence (p = 0.028) compared to the TMC group. The final follow-up duration was 3.57 ± 1.58 years. At final follow-up, no significant differences in subsidence and cervical alignment maintenance were observed. Furthermore, in fusion status, no significant intergroup differences were found, either in ExGBB or ISM criteria. Patients in both groups exhibited comparable neurological recovery and pain relief, while the AVB group demonstrated significantly greater 3-month (p = 0.002) and final follow-up (p = 0.011) NDI improvement. However, no significant differences were observed in the proportion of patients achieving the minimal clinically important difference (MCID) for NDI. AVB and TMC resulted in similar fusion rates, subsidence, pain alleviation and neurological recovery at mid-term. However, AVB might have superior short-term implant stability with less 3-month subsidence and better fusion.