Background/Aim. Lumbar degenerative diseases (LDD) are diseases that occur due to normal aging and degeneration of the lumbar spine. In addition to conservative therapies, surgical procedures become necessary to achieve satisfactory clinical outcomes. The aim of this study was to evaluate the effectiveness of the Isobar TTL and Isobar Evolution (EVO) systems of dynamic internal stabilization in the treatment of LDD and their effects on adjacent segment degeneration. Methods. This research involved 78 LDD patients treated with Isobar TTL or Isobar EVO dynamic internal stabilization devices. Patients were divided into two groups: TTL (n = 40) and EVO (n = 38). Visual analog scale (VAS) pain ratings, Oswestry Disability Index (ODI) scores, and modified MacNab criteria effectiveness evaluations were performed preoperatively, 1 and 3 months postoperatively, and at the final follow-up. Range of motion (ROM) and intervertebral space ratio (IVSR) were measured preoperatively and after the final follow-up. Results. In almost two years, 37 TTL and 33 EVO patients completed every examination. After surgery, VAS and ODI ratings in both groups improved significantly compared to preoperative levels (p < 0.05). The surgical effectiveness of the TTL and EVO groups was rated as excellent or good using the modified MacNab criteria (91.89% and 93.94%, respectively). Preoperative ROM and IVSR values did not differ between the groups (p > 0.05). At the final follow-up, the EVO group had a significantly higher ROM than the TTL group (4.46 ± 1.19° vs. 2.58 ± 0.71°; p < 0.05) and the ROM of adjacent segments in the TTL group was significantly higher than that of the EVO group (6.74 ± 1.55° vs. 5.83 ± 1.32°; p < 0.05). The IVSR of the operated and surrounding segments did not change substantially from preoperative to final follow-up (p > 0.05). Moreover, there was no significant difference in IVSRs between the two groups for the operated and neighboring segments at the final follow-up (p > 0.05). Conclusion. Isobar TTL and Isobar EVO dynamic stabilization systems demonstrated good clinical outcomes. The ability of Isobar EVO to inhibit neighboring segment motion may prevent degeneration.

Secondary injuries following spinal cord injury (SCI) are closely associated with the activation of microglia and neuroinflammation. Tanshinone IIA (TIIA), a traditional Chinese medicine monomer with anti-inflammatory and antioxidant properties, has shown neuroprotective effects after SCI. Our previous studies indicated that TIIA exhibited inhibitory effects on early inflammatory responses and microglial activation after SCI, but its underlying mechanisms remained unclear. Due to TIIA’s poor water solubility and low bioavailability, its sulfonated derivative, sodium tanshinone IIA sulfonate (STS), was developed to address these issues. However, STS still faced challenges in crossing the blood-spinal cord barrier and exhibited poor stability. In this study, we utilized an emulsion electrospinning technique to load TIIA into poly (lactic-co-glycolic) acid (PLGA) microspheres, creating TIIA-loaded PLGA sustained-release microspheres (TIIA-PLGA SRMs). A single injection of an adequate amount of TIIA-PLGA SRMs was administered into the subarachnoid space through the atlanto-occipital membrane, and its regulatory effects on microglia after SCI were compared with a traditional continuous intraperitoneal injection of STS. Our experimental results demonstrated that intrathecal injection of TIIA-PLGA SRMs effectively promoted the transition of microglial phenotypes from M1 to M2 in the early stages in rats after SCI, alleviating neuroinflammation and improving motor dysfunction and neuropathic pain after SCI. Furthermore, the efficacy of TIIA-PLGA SRMs was superior to the traditional continuous intraperitoneal injection of STS. Additionally, our experiments suggested that the mechanism underlying TIIA-PLGA SRMs in regulating microglial polarization after SCI may be associated with the inhibition of the Notch signaling pathway.

Abstract Calvarial defect repair remains challenging due to the dual requirements for brain-protective structural reconstruction and accelerated regeneration within a relatively limited endogenous healing environment. To address this challenge, we developed RgR@ALB, a bioactive artificial lamellar bone scaffold that integrates a compatibility-guided dual-saponin formulation with a biomimetic mineralized collagen lamellar framework. In this design, the ALB framework provides osteoconductive guidance, whereas the defined combination of ginsenoside Rg1 and notoginsenoside R1 provides localized bioactive regulation inspired by the compatibility principle of traditional Chinese medicine. Compatibility-guided screening identified an optimized dual-saponin formulation with favorable cytocompatibility and osteogenic–angiogenic potential in BMSCs. After incorporation into ALB, RgR@ALB preserved the lamellar architecture and enabled sustained dual-saponin release. Functionally, RgR@ALB further enhanced BMSC osteogenic differentiation and angiogenesis-associated gene responses compared with ALB alone. In a rat calvarial defect model, RgR@ALB implantation promoted progressive tissue integration, collagen matrix deposition and mineralized tissue formation, accompanied by enhanced osteogenic and angiogenic responses within the defect region. These findings suggest that RgR@ALB functions as a dual-functional bioactive scaffold coupling ALB-mediated osteoconductive guidance with compatibility-guided dual-saponin regulation, thereby promoting cranial bone regeneration through osteogenesis–angiogenesis coupling.

Study Design Retrospective Study. Objectives To compare long-term adjacent-segment kinematic changes and radiographic adjacent segment degeneration (rASD) after two-level cervical hybrid surgery using Bryan or Mobi-C prostheses. Methods We retrospectively reviewed 78 patients who underwent contiguous two-level anterior cervical hybrid surgery between 2010 and 2018, including 38 treated with Bryan and 40 with Mobi-C prostheses. All patients had more than 7 years of follow-up. Flexion-extension center of rotation (FE-COR) trajectories at the superior adjacent segment were measured on dynamic radiographs. Long-term rASD was evaluated using the Walraevens score. Results Clinical outcomes improved significantly in both groups (P < 0.001), with no significant between-group differences. Segmental range of motion remained stable and comparable between groups (P > 0.05). However, FE-COR trajectories differed. At 1 year, the Mobi-C group showed anterior-inferior FE-COR displacement, with FE-COR_Y decreasing to 44.92% ± 12.55%, whereas the Bryan group maintained a relatively stable FE-COR_Y of 59.01% ± 10.66% (P < 0.001). At final follow-up, rASD occurred in 12.5% of Mobi-C patients and 23.7% of Bryan patients, although this difference was not statistically significant (P = 0.198). Conclusion Conventional ROM measurements alone cannot fully capture segmental biomechanics. Early anterior-inferior FE-COR displacement in the Mobi-C group was observed and was associated with a numerically lower, but statistically non-significant, rASD rate. These findings suggest that FE-COR may be a sensitive radiographic parameter for describing postoperative micro-kinematic patterns, but its causal relationship with long-term adjacent segment degeneration requires further biomechanical and MRI-based validation.

A systematic review of animal models for endplate injury was conducted to identify an appropriate model for investigating the pathophysiological mechanisms underlying endplate injury and its association with low back pain (LBP). A comprehensive search of relevant literature was conducted using electronic databases. The identified studies were then evaluated based on predefined inclusion and exclusion criteria. Subsequently, key information and primary experimental findings from the selected literature were extracted and synthesized. This research was performed in accordance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our study incorporated a total of 10 papers, covering a span of 8 years. Among these, 2 studies specifically induced injury to the endplate and intervertebral disc, respectively. 6 studies involved puncturing the endplate or intervertebral disc followed by the injection of various substances. Additionally, 1 study focused on modeling lumbar instability, while another modeled the tamponade of the nucleus pulposus within the vertebral body. The subjects primarily consisted of mice and rabbits, with 2 studies utilizing mice and 5 studies selecting rats. The remaining 3 studies employed New Zealand White rabbits. The observation period for the experimental models ranged from 4 to 24 weeks postoperatively. The assessment of the animal models predominantly included imaging, behavioral evaluations, histological analyses, and molecular biological tests, with MRI and histological examination being the most frequently utilized methods. The research has found that endplate Modic changes and endplate injuries are closely related to LBP. Animal experiments provide a model reference for exploring the intrinsic mechanism between the two and the corresponding therapeutic options. Although different modeling methods all induce varying degrees of endplate damage, each has its own advantages and disadvantages. The occurrence process of diseases in animal models is not completely equivalent to that in the human body, and there is currently no unified standard for clinical judgment of such models. Therefore, when choosing an animal model, multiple considerations should be integrated.

STUDY DESIGN:Bibliometric analysis. OBJECTIVE:To optimize pain management and identify future research trends through bibliometric analysis. SUMMARY OF BACKGROUND DATA:Postoperative lumbar spine pain is multifactorial and often persists despite successful surgery, reducing patients' quality of life, increasing healthcare use, and increasing the risks of opioid dependence and psychological distress. METHODS:Data from eligible studies were extracted through a comprehensive search and various analyses, including descriptive bibliometrics, citations, keywords, and thematic analyses. Group comparisons were made between Asian and non-Asian groups to assess differences and trends between the two regions. RESULTS:Between 1984 and 2025, 197 studies were published, with an average annual increase of 1.70%. At least 10 studies were contributed by the USA, Turkey, Iran, China, and Korea. Studies from the USA had the highest annual citations, whereas those from Spain had the highest citations per article. The focus of most studies (96.45%) was on pharmacological interventions, including anesthetics, opioids, nonsteroidal anti-inflammatory drugs, antipyretic-analgesic drugs, corticosteroids, serotonin-norepinephrine reuptake inhibitors, nonopioid centrally acting analgesics, and nondepolarizing neuromuscular blockers. Among these, intravenous administration was used in 48.22% of the studies, and 58.38% employed a placebo as the control. Additionally, 77.16% of the studies used the Visual Analog Scale to assess pain. Overall, the field has shifted from basic pain management to more personalized and multifaceted perioperative strategies, especially for patients undergoing complex spinal surgeries. Significant differences were observed between the Asian and non-Asian groups regarding publication year and age. CONCLUSIONS:The number of randomized controlled trials on lumbar postoperative pain has increased, with the USA, Turkey, Iran, and Korea dominating the research. China's lower citation ranking was lower on citation-based indicators; limited international visibility is proposed as a hypothesis for this pattern rather than an established explanation. Driven by the opioid crisis, the field has evolved from opioid-sparing strategies to multimodal, personalized care.

Spinal cord injury (SCI) induces severe functional impairments and involves intricate secondary injury mechanisms. Tanshinone IIA (TIIA), a key bioactive component of Salvia miltiorrhiza, exhibits neuroprotective potential, yet its role in ferroptosis regulation post-SCI remains undefined. This study explored the protective effects and underlying mechanisms of TIIA in SCI. In a rat SCI model, TIIA markedly enhanced hind limb motor function and preserved histopathological integrity while mitigating mitochondrial damage, ferroptosis, and oxidative stress. TIIA attenuated ferroptosis by reducing reactive oxygen species (ROS), malondialdehyde (MDA), and acyl-CoA synthetase long-chain family member 4 (ACSL4) while elevating glutathione (GSH), superoxide dismutase (SOD), and glutathione peroxidase 4 (GPX4) levels. Mechanistically, TIIA suppressed ferroptosis through modulation of the GPX4/ACSL4 axis. The ferroptosis inducer RSL3 abrogated these protective effects, further validating this mechanism. These findings highlight the therapeutic potential of TIIA in SCI by targeting the GPX4/ACSL4 pathway to attenuate ferroptosis and promote functional recovery.

Interventions that promote the proliferation of endogenous neural stem cells (ENSCs) and induce their differentiation into neurons after spinal cord injury (SCI) hold significant potential for SCI repair. Tanshinone IIA (TIIA) exhibits extensive neuroprotective effects, and its derivative, sodium tanshinone IIA sulfonate (STS), has enhanced water solubility, making it easier to prepare injectable formulations and increasing bioavailability. STS injections have been extensively utilized in the treatment of cardiovascular and cerebrovascular diseases, and their clinical application in SCI shows promising potential. However, it remains unclear whether STS can promote spinal cord injury repair in rats by modulating the proliferation and differentiation of ENSCs, and the underlying regulatory mechanisms are yet to be elucidated. In this study, an incomplete spinal cord injury model was established in rats using the NYU spinal cord impactor. The regulatory effects of STS on ENSCs in rats post-SCI were observed by detecting the NSC marker Nestin, the neuronal marker NeuN, and the astrocyte marker GFAP. Additionally, rat behavioral assessments, histopathology, serum inflammation indices, and Notch signaling pathway activation were evaluated. In vitro experiments utilized an lipopolysaccharide (LPS)-induced rats spinal cord NSCs inflammation model. The effects of STS on the proliferation and viability of rats spinal cord NSCs were assessed using the CCK-8 assay and immunofluorescence cell counting. The mechanisms by which STS regulates NSC proliferation and differentiation via the Notch pathway were verified using immunofluorescence, Western blot, and RT-PCR techniques. In vitro, STS significantly reduced the levels of inflammatory indices in the LPS-induced rats NSCs inflammation model and improved the viability of rats NSCs following inflammatory injury. STS also significantly increased the proliferation of NSCs and their differentiation into neurons while reducing their differentiation into astrocytes. Moreover, LPS significantly activated the Notch pathway, similar to the effects of the Notch pathway agonist valproic acid (VPA), whereas STS intervention could inhibit the LPS- or VPA-induced activation of the Notch pathway. In vivo, STS markedly improved the hindlimb motor function of rats with SCI, decreased the levels of pro-inflammatory factors IL-6 and TNF-α, and increased the level of the anti-inflammatory factor IL-10, thereby improving the pathological morphology of the injured spinal cord in rats post-SCI. STS effectively promoted the proliferation of ENSCs post-SCI, facilitated their differentiation into neurons, and inhibited their differentiation into astrocytes. Additionally, STS suppressed the excessive activation of the Notch signaling pathway following SCI. STS promotes the proliferation of ENSCs post-SCI in rats, induces their differentiation into neurons, and inhibits their differentiation into astrocytes, thereby improving the pathological morphology of the injured spinal cord and promoting the recovery of hindlimb motor function in rats post-SCI. Furthermore, the regulatory effects of STS on the proliferation and differentiation of ENSCs post-SCI in rats may be related to its inhibition of the excessive activation of the Notch signaling pathway.

Oscillating Field Stimulation (OFS) is an emerging therapeutic approach for spinal cord injury (SCI) that is currently undergoing extensive investigation in preclinical in vivo studies. However, there has yet to be a comprehensive systematic review and meta-analysis of the existing literature. This systematic review and meta-analysis aims to evaluate the effectiveness of OFS technology in treating spinal cord injuries based on studies conducted with experimental animal models. A thorough search was performed across PubMed-MEDLINE, Embase, and Web of Science. Studies that were not in vivo preclinical research or were published in languages other than English were excluded. The SYRCLE tool was utilized to assess the risk of bias, and the extracted data underwent qualitative synthesis and meta-analysis. Out of the 89 studies identified from the electronic databases, 8 fulfilled the inclusion criteria. Among these, 7 studies utilized a contusion model, while 1 employed a compression model. The application of OFS consistently resulted in significant enhancements in motor function scores compared to untreated SCI rats across all studies. This observed functional recovery correlated with histological improvements at the injury site. Although all studies were deemed to have a low risk of bias, some displayed incomplete reporting in specific areas. Our results indicate that OFS is a promising therapeutic approach for SCI, significantly enhancing functional recovery through multiple mechanisms. These include promoting nerve regeneration, aiding in myelin repair, and minimizing glial scarring. Future studies should concentrate on determining the optimal timing for OFS intervention, refining the electric field application methods, and investigating potential synergies with stem cell therapies. Thorough validation is essential before progressing to clinical applications.

OBJECTIVE:To compare the therapeutic effects of nine acupuncture-related therapies (acupuncture, scrapping therapy, catgut embedding, blood-letting, electro-acupuncture, warm acupuncture, cupping, moxibustion, and needle knife) in the treatment of nonspecific low back pain (NLBP), providing evidence-based medical support for clinical treatment. METHODS:Randomized controlled trials evaluating various acupuncture therapies for NLBP were screened from the China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, PubMed, Web of Science, Chinese Biomedical Literature Database, Embase, and the Cochrane Library. Methodological quality was assessed using the Cochrane 5.1.0 risk of bias assessment tool, and the data were analyzed using STATA 15.1. RESULTS:This study included 19 randomized controlled trials involving 1356 participants and assessing pain using the visual analog scale (VAS), improvement in dysfunction using the oswestry disability index (ODI), and the effective rate. Blood-letting [surface under the cumulative ranking curve (SUCRA) = 81.4] exhibited a significant clinical effect in relieving NLBP in studies with the VAS score as the outcome indicator, followed by cupping (SUCRA = 70.4) and moxibustion (SUCRA = 58.5). Scrapping therapy (SUCRA = 77.7) had the most significant effect on improving NLBP-related functional impairment, followed by moxibustion (SUCRA = 59.8), and then bloodletting (SUCRA = 58.2). The effective rates of warm acupuncture (SUCRA = 78.0), scrapping therapy (SUCRA = 77.2) and blood-letting (SUCRA = 58.6) were better than those of acupuncture (SUCRA = 12.0), especially for cold and wet NLBP. These findings demonstrate the importance of syndrome differentiation during clinical decision making when determining diagnosis and treatment. CONCLUSION:Blood-letting was the most effective treatment for relieving pain, and scrapping therapy was the most effective treatment for improving dysfunction. Warm acupuncture was the preferred treatment for cold and wet NLBP. However, further high-quality clinical studies are needed for validation.

To investigate the relationship between segmental motion and paraspinal muscle degeneration at the surgical level in patients with single-level lumbar degenerative disease (LDD) who have undergone either fusion or dynamic stabilization surgery. Patients treated with posterolateral intertransverse fusion (PITF group), Isobar TTL dynamic internal fixation (TTL group), or Isobar EVO dynamic internal fixation (EVO group) for single-level lumbar degenerative disease (LDD) between March 2012 and September 2020 were included in the study. Cases were selected with complete records and follow-up times ranging from 2 to 5 years, taking into account the effects of postoperative muscle edema and age-related muscle degeneration. The study compared operative time, intraoperative blood loss, preoperative and postoperative Oswestry Disability Index (ODI) scores, Lumbar Stiffness Disability Index (LSDI) scores, range of motion (ROM) at the surgical segment, cross-sectional area (CSA) of the paraspinal muscles, and functional cross-sectional area (FCSA) of the paraspinal muscles before and after surgery across all groups. A total of 73 patients were included in this study: 23 in the PITF group, 26 in the TTL group, and 24 in the EVO group. There were no statistically significant differences among the three groups in terms of age, gender, follow-up duration, body mass index (BMI), preoperative lumbar VAS score, preoperative ODI score, and preoperative LSDI score (P > 0.05). Postoperative ODI scores were significantly higher in the PITF group compared to the TTL and EVO groups, with ODI scores demonstrating a moderate negative correlation with postoperative range of motion (ROM) of the surgical segment (Pearson’s r = -0.333, P < 0.004). A strong negative monotonic relationship was observed between ROM of the surgical segment and the rate of change in functional cross-sectional area (FCSA) of the paraspinal muscles across all groups, as evidenced by Spearman’s correlation coefficients (PITF: r = -0.766, P < 0.001; TTL: r = -0.818, P < 0.001; EVO: r = -0.865, P < 0.001) (Fig. 7). Multiple linear regression models confirmed that age, BMI, and gender had no significant effect on the rate of FCSA change. For the PITF, TTL, and EVO groups, the regression coefficients for ROM’s association with FCSA change were β = -0.653 (P < 0.005), β = -0.956 (P < 0.001), and β = -0.908 (P < 0.001), respectively. Similarly, postoperative LSDI scores were significantly elevated in the PITF group compared to the TTL and EVO groups, with LSDI scores exhibiting a strong negative correlation with postoperative ROM (r = -0.802, P < 0.001). Compared to traditional decompression combined with rigid fusion surgery, decompression coupled with dynamic stabilization techniques can more effectively alleviate postoperative lumbar stiffness and functional impairment in patients. Moderately enhancing the range of motion at the surgical level facilitates the remodeling of paraspinal muscle tissue following surgery.

To compare the long-term clinical outcomes and radiographic changes between the Topping-off technique and lumbar fusion surgery for lumbar degenerative diseases, and to evaluate their effects on Adjacent Segment Degeneration (ASD). A retrospective analysis was conducted on 97 patients who underwent lumbar fusion surgery at Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2010 to October 2013, with a minimum of 8 years of follow-up data. Patients were divided into the Topping-off group and the Fusion group based on whether a Wallis interspinous device was implanted at the adjacent upper segment. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), and reoperation rate. Radiographic progression of ASD was evaluated by range of motion (ROM) of the adjacent upper segment, intervertebral disc height (IDH), intervertebral foramen height (IFH), ligamentum flavum thickness, dural sac sagittal diameter, University of California at Los Angeles (UCLA) grading of intervertebral space degeneration, Pfirrmann classification of disc degeneration, and Pathria-CT grading of facet joint degeneration. The mean follow-up duration for the 97 patients was 107.4 ± 13.0 months. At the final follow-up, all patients showed significant improvement in VAS, JOA, and ODI scores compared to preoperative values. Between groups, the Topping-off group had better ODI and VAS scores than the Fusion group (P < 0.05). At the final follow-up, ROM, IDH, IFH, and dural sac sagittal diameter at the adjacent upper segment decreased in all patients compared to preoperative measurements. However, the Topping-off group showed significantly smaller ROM (P < 0.05) and greater IDH, IFH, and dural sac sagittal diameter (P < 0.05) compared to the Fusion group. The ligamentum flavum thickness did not increase significantly in the Topping-off group (P = 0.078), while it increased significantly in the Fusion group (P < 0.05). The Topping-off group demonstrated significantly less radiographic degeneration in UCLA grading of intervertebral space, Pfirrmann classification of disc degeneration, and Pathria-CT grading of facet joint degeneration (P < 0.001). The incidence of ASD in the Topping-off group (31.1

To investigate the association between paravertebral muscle quality and Modic changes (MCs) in patients with chronic nonspecific low back pain (CNLBP). The cases and imaging data of patients with CLBP who were treated in our hospital from December 2020 to December 2023 were retrospectively collected. Patients were categorized into MCs group and non-MCs group according to the presence or absence of Modic changes in lumbar spine MRI. Based on lumbar MRI, the cross-sectional areas (CSA) of bilateral multifidus, erector spinae and psoas major muscles, fat infiltration rate (FIR) and lumbar indentation value (LIV) were measured in the L2-S1 segments of both groups of patients, respectively. The VAS score of patients in the MCs group was significantly higher than that of patients in non-MCs group, and the degree of intervertebral disc degeneration was more severe than that of patients in non-MCs group (P < 0.05). At the L2-L3 and L3-L4 segments, the CSA of the bilateral erector spinae muscles in the MCs group was significantly smaller than that of patients in non-MCs group (P < 0.05). On the contrary, the FIR of paravertebral muscle was higher than that of patients in non-MCs group (P < 0.05). At the L4-L5 and L5-S1 segments, the CSA of bilateral erector spinae and multifus muscles in the MCs group were smaller than those in the non-MCs group, and the FIR was higher than that in the non-MCs group (P < 0.05). The LIV of the L4-L5 and L5-S1 segments in the MCs group were significantly lower than those in the non-MCs group (P < 0.05). Binary logistic regression analysis showed that there might be a association between low bilateral multifidus, erector spinae CSA and LIV, and high multifidus, erector spinae FIR and Modic changes. Our research results indicate that there is a association between paravertebral muscle quality and Modic changes in patients with CNLBP. There may be an interaction between low bilateral multifidus, erector spinae CSA and LIV, high bilateral multifidus, erector spinae FIR and lumbar Modic changes.

Spinal cord injury without radiographic abnormality (SCIWORA) occurs in patients with cervical spinal stenosis (CSS) following minor trauma, often leading to significant neurological deficits. While surgical decompression reduces SCIWORA risk, some patients are ineligible or reluctant to undergo surgery. Consequently, reducing the risk of SCIWORA in the absence of surgical intervention and optimizing spinal cord function recovery remain pivotal challenges. This study explores the potential of Tanshinone IIA (TIIA) in preventing and treating SCIWORA by modulating microglial polarization and attenuating neuroinflammation. Asymptomatic CSS was induced in Sprague-Dawley rats by implanting hydrogels into the spinal canal for four weeks, followed by mild cervical trauma using the NYU Impactor. Rats were divided into sham, SCIWORA, prevention, and prevention + treatment groups. Preventive administration of TIIA significantly alleviated motor and histological damage, notably reducing glial scar formation and neuronal, myelin, and microvascular degeneration associated with SCIWORA. TIIA also inhibited the activation of pro-inflammatory M1 microglia while promoting the expansion of anti-inflammatory M2 microglia. Continued TIIA treatment after SCIWORA further enhanced motor function recovery, improved spinal cord tissue repair, provided ongoing protection to neurons, myelin, and microvasculature, reduced glial scar formation, modulated microglial polarization, inhibited NF-κB signaling pathway activation, and reduced neuroinflammation. These findings suggest that TIIA may serve as a non-surgical strategy to mitigate SCIWORA risk and promote recovery after SCIWORA in rats.

Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures (OVCFs) after percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) using a network meta-analysis. Methods A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database (SinoMed) from their inception to January 15, 2025. Outcome measures included the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, and overall efficacy rate. Literature screening, data extraction, and risk-of-bias assessment were independently performed by two researchers. Data analysis was conducted using Stata 17.0 software. Results A total of 35 randomized controlled trials involving 2860 patients were included. The data analysis revealed that, in terms of improving VAS and ODI scores, the top three effective therapies were Fu's subcutaneous needling, wrist-ankle acupuncture, and acupotomy. For the overall efficacy rates in pain treatment, the top three therapies were wrist-ankle acupuncture, warm acupuncture and moxibustion, and Fu's subcutaneous needling. Based on the combined results across the three outcome measures, Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function. Conclusion Fu's subcutaneous needling, wrist-ankle acupuncture, warm acupuncture and moxibustion, and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function. However, further high-quality, large-sample studies are required to confirm these findings.

Objective Screw loosening is a common complication following lumbar spine fixation surgery, yet the biomechanical outcomes after screw loosening remain rarely reported. This study aims to utilize finite element (FE) models to compare the biomechanical performance of PEEK rod dynamic fixation and titanium rod rigid fixation in the postoperative lumbar spine, exploring potential biomechanical mechanisms for re-stabilization of loosened screws.Methods A FE model of the lumbar spine from L3 to the sacrum was developed using CT image segmentation. Four L4-S1 fixation models were constructed: PEEK rod dynamic fixation (PEEK model), titanium rod rigid fixation (titanium model), PEEK rod with pedicle screw loosening (PEEK-PSL model), and titanium rod with pedicle screw loosening (titanium -PSL model). A preload of 300 N was applied to the superior surface of L3. Stress distributions in the intervertebral discs, facet joints, pedicle screws, and rods were calculated to evaluate the biomechanical effects of different fixation methods.Results Across four physiological loading conditions, the stress differences in intervertebral discs, facet joints, and nucleus pulposus between the PEEK model and titanium model were minimal. However, vertebral body stress was significantly higher in the PEEK model, whereas screw and rod stresses were greater in the titanium model. Screw loosening further increased stress in all models. The S1 screw in the PEEK-PSL model exhibited lower and more uniform stress, while stress was concentrated at the screw-rod junction in the titanium-PSL model.Conclusion The PEEK rod fixation system demonstrated superior stress distribution, reducing stress concentration risks and improving stability while minimizing screw loosening rates. In contrast, the titanium rod system offers advantages in scenarios requiring high rigidity, potentially making it more suitable for patients with greater stability needs.

To compare the long-term clinical outcomes and radiographic findings between hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) for three-level cervical degenerative disc disease (CDDD). And the incidence, prognosis, and potential risk factors of heterotopic ossification (HO) more than 10 years after Bryan prosthesis replacement in HS has been explored. From January 2007 to December 2014, a total of 46 patients who underwent either HS (n = 26) or ACDF (n = 20) for consecutive three-level CDDD were retrospectively analyzed. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI). Radiographic evaluations included cervical lordosis (CL), C2–7 range of motion (C2–7 ROM), ROM of surgical segments (SROM), and adjacent segment degeneration (ASD). Potential risk factors for HO development at the 10-year follow-up after HS, including age, sex, ossification of the anterior longitudinal ligament (OALL), and anterior vertebral osteophytes (AVO), were evaluated. Univariate analysis was followed by multivariate logistic regression to identify independent predictors. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of AVO for HO, including the area under the curve (AUC) and cutoff value. Spearman correlation was used to assess the relationship between ROM and ASD. Postoperative complications were also recorded. The mean follow-up duration was 141.85 ± 17.20 months. Both groups demonstrated significant improvements in VAS, JOA, and NDI scores at 3 days postoperatively and at the final follow-up compared to preoperative values (P < 0.05). However, there were no statistically significant differences in these scores between the groups at any time point (P > 0.05). At the final follow-up, the HS group exhibited significantly greater C2–7 ROM and SROM compared to the ACDF group (P < 0.05). Both groups showed significant improvement in CL at postoperative day 3 compared to preoperative measurements (P < 0.05). At the 10-year follow-up, the incidence of ASD was lower in the HS group (53.85

OBJECTIVE:To retrospectively analyze screw loosening rates following dynamic fixation with polyetheretherketone (PEEK) rods and rigid fixation with titanium rods and assess mid-term outcomes of loosened screws. METHODS:This retrospective analysis included 203 patients who underwent lumbar pedicle screw fixation between March 2017 and June 2020 (57 with PEEK rods, 146 with titanium rods). Patients were followed for at least 48 months to evaluate screw loosening postoperatively and investigate outcomes of loosened screws. Multivariate logistic regression identified factors influencing screw restabilization. RESULTS:Both PEEK rod and titanium rod groups exhibited peak screw loosening rates approximately 1 year after surgery, decreasing with longer follow-up. At 48 months, screw loosening rates were 5.3% and 15.8% for PEEK and titanium rods, respectively (P < 0.05). Among patients experiencing early loosening (within 12 months), the proportion of stabilized screws was significantly higher with PEEK rods (84% vs. 34%, P < 0.001). Regression analysis revealed dynamic fixation (odds ratio 4.579; 95% confidence interval 1.611-12.519), lowest fixed vertebra S1 (odds ratio 3.151; 95% confidence interval 1.352-9.233), and L1-L4 average computed tomography value (odds ratio 1.132; 95% confidence interval 1.015-1.263) as independent risk factors for screw restabilization. The area under the receiver operating characteristic curve for L1-L4 average computed tomography value predicting restabilization was 0.713 (P < 0.05), with an optimal threshold of 106 Hounsfield units (sensitivity 0.771, specificity 0.803). CONCLUSIONS:Following PEEK rod dynamic fixation surgery, a certain proportion of screw loosening may occur in the short term. With prolonged follow-up, screws gradually restabilize at the bone interface, with most loosened screws returning to a stable state.

OBJECTIVE:To explore the effect of nano-hydroxyapatite/collagen composite (nHAC) on bone graft fusion after anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylosis and low bone mass. METHODS:A retrospective analysis was conducted on 47 patients with low bone mass who underwent ACDF from 2017 to 2021. They were divided into the nHAC group and the allogeneic bone group according to different bone graft materials. The nHAC group included 26 cases, with 8 males and 18 females;aged 50 to 78 years old with an average of (62.81±7.79) years old;the CT value of C2-C7 vertebrae was (264.16±36.33) HU. The allogeneic bone group included 21 cases, with 9 males and 12 females;aged 54 to 75 years old with an average of (65.95±6.58) years old;the CT value of C2-C7 vertebrae was (272.39±40.44) HU. The visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopaedic Association (JOA) spinal cord function score were compared before surgery, 1 week after surgery, and at the last follow-up to evaluate the clinical efficacy. Imaging assessment included C2-C7 Cobb angle, surgical segment height, intervertebral fusion, and whether the cage subsidence occurred at 1 week after surgery and the last follow-up. RESULTS:The follow-up duration ranged from 26 to 39 months with an average of (33.27±3.34) months in the nHAC group and 26 to 41 months with an average of (31.86±3.57) months in the allogeneic bone group. At 1 week after surgery and the last follow-up, the VAS, NDI scores, and JOA scores in both groups were significantly improved compared with those before surgery, with statistically significant differences (P<0.05). At 1 week after surgery, the C2-C7 Cobb angles in the nHAC group and the allogeneic bone group were (14.26±10.32)° and (14.28±8.20)° respectively, which were significantly different from those before surgery (P<0.05). At the last follow-up, the C2-C7 Cobb angles in both groups were smaller than those at 1 week after surgery, with statistically significant differences (P<0.05). At 1 week after surgery, the height of the surgical segment in the nHAC group was (31.65±2.55) mm, and that in the allogeneic bone group was (33.63±3.26) mm, which were significantly different from those before surgery (P<0.05). At the last follow-up, the height of the surgical segment in both groups decreased compared with that at 1 week after surgery, with statistically significant differences (P<0.05). At the last follow-up, 39 surgical segments were fused and 6 cages subsided in the nHAC group;40 surgical segments were fused and 7 cages subsided in the allogeneic bone group;there was no statistically significant difference between the two groups (P>0.05). Compared with the CT value of vertebrae without cage subsidence, the CT value of vertebrae with cage subsidence in both groups was significantly lower, with a statistically significant difference (P<0.05). CONCLUSION:The application of nHAC in ACDF for patients with low bone mass can achieve effective fusion of the surgical segment. There is no significant difference in improving clinical efficacy, intervertebral fusion, and cage subsidence compared with the allogeneic bone group. With the extension of follow-up time, the C2-C7 Cobb angle decreases, the height of the surgical segment is lost, and the cage subsides in both the nHAC group and the allogeneic bone group, which may be related to low bone mass. Low bone mass may be one of the risk factors for cervical spine sequence changes, surgical segment height loss, and cage subsidence after ACDF.