The subvastus approach preserves the extensor mechanism, but its efficacy in total knee arthroplasty (TKA) for valgus deformity remains unclear. This systematic review synthesizes available evidence on quadriceps recovery and clinical outcomes after subvastus TKA specifically in patients with valgus deformity. A systematic search of PubMed, Cochrane Library, and Embase (2000–2025) was performed. Studies reporting outcomes of the subvastus approach in valgus TKA were included. The primary outcome was time to straight leg raise (SLR). Secondary outcomes included functional scores, range of motion (ROM), pain (VAS), and complications. Due to single-arm designs and high heterogeneity, a formal meta-analysis was not appropriate; results are presented descriptively with pooled means for illustrative purposes only. Three retrospective studies (286 valgus knees) were included. Time to SLR ranged from 0.92 to 2.0 days across studies (pooled descriptive mean: 1.35 days; I2 = 99

Background Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory metabolic bone disorder marked by progressive ectopic ossification at spinal and peripheral entheses. Its molecular etiology is poorly understood. We investigated whether Ly6/uPAR domain–containing 6 (LYPD6) regulates osteoblast differentiation and drives pathological hyperostosis in DISH. Methods Primary osteoblasts from DISH patients and matched controls were assessed for ALP activity, calcium deposition, and expression of osteogenic markers. RNA sequencing identified LYPD6 as a candidate; its expression was validated by qRT-PCR, Western blot, and immunofluorescence. siRNA-mediated knockdown and lentiviral overexpression of LYPD6 were performed in patient osteoblasts and MC3T3-E1 cells. A global LYPD6 knockout mouse model underwent micro-CT, femoral fracture healing assays, and biomechanical testing. Mechanistic studies evaluated LRP6 phosphorylation, β-catenin stabilization and nuclear translocation, and in silico docking of LYPD6 to LRP6. Results DISH osteoblasts displayed increased ALP activity, mineralization, and upregulated Runx2, OPN, Col1a1, BSP II, and Osterix. LYPD6 was among the top upregulated genes and confirmed at mRNA and protein levels. LYPD6 knockdown impaired mineralization and osteogenic marker expression, whereas overexpression enhanced them. LYPD6−/− mice exhibited reduced trabecular and cortical bone mass, delayed fracture healing, and weaker biomechanical properties. At the molecular level, LYPD6 promoted LRP6 phosphorylation, stabilized β-catenin, and increased its nuclear localization; docking data predict direct LYPD6–LRP6 binding. Conclusion Aberrant upregulation of LYPD6 drives pathological hyperostosis in DISH via activation of the canonical Wnt/β-catenin pathway. The translational potential of this article LYPD6 may serve as both a biomarker for DISH and a pharmacological target. Modulating its activity could inform future therapies: transient inhibition of LYPD6 might prevent or attenuate ectopic ossification in DISH and related hyperostotic disorders, whereas short-term activation could enhance bone repair in osteoporotic or nonunion fracture settings.

Iatrogenic contralateral foraminal stenosis is a not uncommon complication following unilateral transforaminal lumbar interbody fusion (TLIF). Notably, secondary contralateral foraminal stenosis induced by overcorrection of spondylolisthesis during TLIF is not a rare clinical event but remains underrecognized. This case report presents a successful minimally invasive management of this complication via transforaminal endoscopic lumbar foraminotomy, carrying important cautionary significance for clinical practice. This study aims to alert surgeons to avoid this iatrogenic complication and provide a specific procedural approach for its management when it occurs. A 64-year-old Han Chinese male patient, diagnosed with L4-5 lumbar spondylolisthesis and L5-S1 lumbar disk herniation, experienced contralateral radiculopathy affecting the right L4 nerve root subsequent to a unilateral TLIF procedure. A computed tomography (CT) scan revealed significant right L4-5 foraminal stenosis caused by excessive correction of spondylolisthesis. Then he received transforaminal endoscopic lumbar foraminotomy, which led to significant pain reduction and functional enhancement. This case illustrates a scenario of endoscopic decompression addressing iatrogenic contralateral foraminal stenosis, resulting from overcorrection of spondylolisthesis. It effectively showcases the efficacy of this minimally invasive approach in managing such complications. Additionally, the occurrence of iatrogenic posterior spondylolisthesis should be meticulously avoided during the TLIF procedure.

To identify risk factors for distal adding-on (AO) in Lenke 1 C/2 C AIS patients with the lowest instrumented vertebra (LIV) at the lumbar apex vertebra (LAV). This study included 60 Lenke 1 C/2 C AIS patients undergoing posterior spinal fusion with LIV at LAV and > 2 years follow-up. Patients were categorized into AO (n = 17) and non-AO (n = 43) groups. Radiographic analysis assessed thoracic/lumbar curve flexibility, apical vertebral translation (AVT), LAV rotation/tilt, coronal balance, Harrington stable zone on anteroposterior(AP)and concave-side bending films, and LAV/AV + 1 disc opening/closing status. Clinical outcomes used SRS-22. Statistical comparison was performed. The AO group exhibited significantly poorer preoperative thoracic curve flexibility, greater coronal imbalance toward the lumbar convex side, larger lumbar AVT, smaller Harrington stable zones, and fewer patients with favorable LAV/AV + 1 disc status. Logistic regression identified thoracic flexibility, Harrington stable zone on concave-side bending, and disc status as significant AO predictors. Optimal thresholds for selecting LAV as LIV were thoracic flexibility > 47.4

To assess the biomechanical stability of tri-cortical pedicle screw fixation in adult thoracic vertebra using finite element analysis and to compare its performance with traditional fixation methods. A three-dimensional finite element model of T5-11 thoracic vertebrae was established based on CT data from a healthy adult volunteer. Four different fixation groups were designed: Group A (Short-segment pedicle screw fixation from T7 to T10), Group B (Long-segment pedicle screw fixation from T6 to T10), Group C (Short-segment pedicle screw fixation with a tri-cortical pedicle screw at T7), and Group D (Short-segment pedicle screw fixation with two tri-cortical pedicle screws at T7 and T8). Biomechanical analysis was performed under six physiological loading conditions (flexion, extension, left/right rotation, left/right lateral bending) with 8 Nm moment and 400 N axial preload. Groups C and D with tri-cortical pedicle screw fixation demonstrated numerically lower displacement compared to traditional fixation groups (A and B) under all loading conditions. The displacement in Group C decreased by 11.11

Spinal cord injury (SCI) can lead to severe oxidative stress, inflammation, and impaired tissue regeneration in the local microenvironment, which hinders spinal cord regeneration. Injectable hydrogels have been investigated as potential therapeutic strategies for SCI. However, the microenvironment of an injured spinal cord is complex, as hemorrhage, ischemia, glial scar formation, and demyelination occur at different times and locations. In this study, a novel injectable functional hydrogel based on sheep placenta powder (SSP), hyaluronic acid methacrylate (HAMA) and copper-tannic acid (CuTA) nanozyme was developed to provide strong reactive oxygen species (ROS) scavenging ability, inhibition of macrophage polarization, and angiogenesis sequentially. After implantation, the multifunctional hydrogel alleviated local oxidative stress, inhibited the infiltration of M1 macrophages, accelerated the switching of M1 macrophages to the M2 type, and promoted local microvessel regeneration, thereby established a satisfactory foundation for spinal cord reconstruction and further improved behavioral phenotypes and motor abilities. Therefore, the multifunctional hydrogel offers a promising approach for SCI treatment.

BACKGROUND CONTEXT:Type 3 spinal cord morphology increases neurological injury risk during three-column osteotomy (3CO). Prophylactic concave-side decompression and spinal cord medialization (PCDM) is proposed to relieve cord tension, but its clinical utility requires validation. PURPOSE:To evaluate the neuroprotective efficacy of PCDM in patients with severe kyphoscoliosis and type 3 spinal cord morphology undergoing 3CO. STUDY DESIGN:Retrospective comparative cohort study. PATIENT SAMPLE:This study included 236 patients with severe kyphoscoliosis treated with 3CO. OUTCOME MEASURES:Radiographic parameters, neurological status (Frankel grading), patient-reported outcomes (SRS-22), intraoperative neuromonitoring (IONM) alerts, and perioperative complications were analyzed and compared. METHODS:The PCDM group (n=132) underwent prophylactic multi-level resection of concave laminae, pedicles, and costovertebral elements to create a medial transposition corridor before 3CO. The non-PCDM group (n=104) received standard 3CO alone. RESULTS:Baseline demographics and preoperative radiographic profiles were comparable between groups. Both cohorts achieved substantial deformity correction. The PCDM group showed significant reductions in coronal Cobb angle (80.8°-42.2°) and global kyphosis (71.7°-27.6°), similar to the non-PCDM group (76.7°-39.6° and 66.3°-25.2°, respectively). Notably, the PCDM group exhibited a significantly lower rate of permanent neurological deficits compared to the non-PCDM group (1.5%, 2/132 vs. 6.7%, 7/104; p=.046). IONM alert rates were also lower in the PCDM group (8.3% vs. 20.2%, p=.012). Among patients with preoperative deficits, neurological recovery was more frequent in the PCDM group (86.7% vs. 50.0%, p=.009). Perioperative complication rates were not significantly different (13.6% vs. 19.2%, p=.246). CONCLUSION:PCDM appears to offer neuroprotective benefits in high-risk 3CO procedures for patients with type 3 spinal cord morphology, with reduced neurological complications and improved functional outcomes. Its use as a preparatory step prior to osteotomy may be considered as a beneficial adjunct in selected severe deformity cases. LEVEL OF EVIDENCE:Level IV.

Ischemia-reperfusion (IR) injury induces a pro-inflammatory cascade that disrupts inflammation resolution and exacerbates skeletal muscle fibrosis, leading to impaired regeneration through fibrosis and compromised myofiber regeneration. This study aimed to: (1) Demonstrate IR-induced dysregulation of muscle regeneration following acute injury; (2) Elucidating how TGF-β1 signaling within the FAP-associated inflammatory niche mediates fibrosis and impairs myofiber repair; and (3) Evaluating anti-TGF-β neutralization as a mechanism-based strategy to preserve regenerative capacity. Male C57BL6 mice (8 weeks) received CTX injections into the tibialis anterior (TA) to induce skeletal muscle injury. Transient clamping of femoral artery and vein was induced at 3 days post-injury to induce IR. Mice were stratified into CTX group and CTX-IR group depending on the induction of IR injury. TGF-β neutralizing antibody (TGF-β NAb) was administered in vivo to evaluate therapeutic potential. HE and Sirius red staining was used to assess cross-sectional area (CSA) of myofibers and percentage of fibrotic tissue. Western blotting was used to assess the expression of Collagen I, Collagen III and TGF-β. Flow cytometry was used to assess the number of fibro-adipogenic progenitors (FAPs). Collagen I and CD90 were assessed using immunostaining of TA cryosections and FAPs isolated from muscle tissues. The result shows that CTX-IR mice showed smaller myofiber cross-sectional area and more fibrotic tissue than CTX mice. Western blots revealed higher levels of Collagen I, Collagen III and TGF-β1 in CTX-IR samples. TGF-β1 stimulated the expression of collagen I in FAPs. TGF-β NAb application ameliorated the fibrosis of skeletal muscle and improved myofiber regeneration after IR. In conclusion, IR impairs muscle regeneration through TGF-β-associated FAP activation and collagen deposition. Inhibition of TGF-β attenuates fibrosis and increases the CSA of myofibers, demonstrating it as a potential target for promoting structural recovery and regenerative architecture in co-existing muscle injuries during orthopedic trauma.

Background Both ossification of the posterior longitudinal ligament (OPLL) and diffuse idiopathic skeletal hyperostosis (DISH) are characterized by abnormal calcification of the ligaments surrounding the spine and can be observed simultaneously in one patient. However, the association between cervical DISH and cevical OPLL has not been comprehensively investigated. This study aimed to investigate the influence of c-DISH on the progression of c-OPLL and to evaluate the clinical outcomes in patients with both c-DISH and c-OPLL. Methods A total of 192 patients with c-OPLL were enrolled and divided into DISH(-) (n = 152) and DISH(+) (n = 40) groups on the basis of the presence or absence of c-DISH. C-OPLL severity was evaluated via the ossification index (OP index) and canal narrowing ratio (CNR) on CT images. The distribution characteristics were analyzed by c-OPLL type and ossification range, with a focus on the most affected segment. Radiographic measurements included the C2–7 lordosis angle (CL angle), C7 slope, and C2–7 sagittal vertical axis (CSVA). Clinical outcome was assessed via both JOA and VAS scores. Results Both the OP index and the CNR were significantly greater in the DISH(+) group than in the DISH(-) group (P < 0.01). Patients in the DISH(+) group had a greater proportion of continuous-type OPLL but lower segmental and local types than those in the DISH(-) group. Patients in the DISH(+) group also had a greater incidence of OPLL at the C2, C3, and C4 levels (P < 0.05). Maximal ossification most frequently affects the C3 level in DISH(+) patients, whereas it affects the C5 level in DISH(-) patients. Compared with DISH(-) patients, DISH(+) patients had significantly poorer clinical outcomes both preoperatively and at the last follow-up. A significant negative correlation was observed between the CNR and both preoperative JOA scores. Conclusion C-OPLL in patients with c-DISH tend to have a proximal cervical distribution, more extensive lesions, and more severe spinal canal occupation, leading to poor neurological function recovery.

Objective To compare perioperative and complication outcomes, focusing on the prevention of sagittal translation (ST), between a novel “prioritized correction with multiple-rod construct” (PC-MRC) technique and traditional multiple-rod constructs (M-RC) in adult spinal deformity (ASD) patients undergoing 3-column osteotomies (3-COs). Methods In this retrospective study, 101 ASD patients with a minimum 2-year follow-up after 3-COs were divided into 2 groups: PC-MRC (n=65) and M-RC (n=36). The PC-MRC technique involved initial osteotomy closure with short rods followed by global alignment correction with long rods. Radiographic and clinical parameters were assessed preoperatively, postoperatively, and at final follow-up. Results The PC-MRC group had significantly shorter operation time and lower estimated blood loss (p=0.045 and p=0.007, respectively). Major coronal and kyphotic deformity correction rates were similar between groups. No significant correction loss occurred at the final follow-up. Crucially, the incidence of ST was significantly lower in the PC-MRC group (1.5% vs. 25.0%, p<0.001). Correspondingly, the overall rate of neurological injury was lower in the PC-MRC group (7.7% vs. 22.2%, p=0.037). Conclusion The PC-MRC technique offers a versatile and rigid fixation for 3-COs in ASD patients, facilitating significant correction of global deformity. This straightforward technique effectively prevents massive blood loss and ST caused by 3-COs, while minimizing the risk of neurological complication.

Ankylosing spondylitis (AS) often leads to spinal deformity and functional impairment, which requires surgical correction. Electrochemical sensors can detect a variety of biomarkers, such AS inflammatory factors and metabolic products, providing an important basis for the assessment of disease activity and the selection of surgical timing in patients with AS. This study aims to introduce the application of a new type of osteotomy Angle measuring instrument in AS osteotomy surgery. The clinical data of 10 AS patients who underwent single-segment pedicle osteotomy (PSO) from March 2021 to October 2022 were retrospectively analyzed. During the operation, a new type of osteotomy Angle measuring instrument was used to measure the osteotomy Angle in real time, and it was compared with the preoperative Surgimap software simulation Angle and the intraoperative Xray fluoroscopy results. Detect the changes of inflammatory markers (such as C-reactive protein and erythrocyte sedimentation rate) before and after the operation, and evaluate their application value in disease activity monitoring. The results showed that the sagittal balance of the spine in all patients was significantly improved after the operation, and the levels of inflammatory markers decreased significantly after the operation. Compared with those before the operation, the differences were statistically significant (P < 0.05), indicating that it has important value in monitoring the surgical stress response and controlling inflammation. The application of electrochemical sensors in preoperative assessment and postoperative monitoring provides new ideas and methods for the clinical management of AS patients and has broad application prospects.

We aimed to assess the diagnostic accuracy of various biomarkers, such as the systemic immune-inflammation index (SII), inflammatory burden index (IBI), pan-immune inflammation value (PIV), and systemic inflammatory response index (SIRI), in cases of infected nonunion after repair of extremity fractures. In this retrospective analysis of patients who underwent internal fixation surgery with open reduction for extremity fractures between January 2015 and June 2024, the following information was evaluated at admission: age, sex, clinical features, erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, platelet count (PC), C-reactive protein (CRP) level, monocyte count (MC), lymphocyte count (LC), neutrophil count (NC), monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), SII, IBI, SIRI, and PIV. Receiver operating characteristic (ROC) curves, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were constructed to compare the diagnostic performance of SII, IBI, SIRI, and PIV with other known serum markers. The study population consisted of 279 patients, of which 66 (23.7

BACKGROUND CONTEXT:Existing surgical alignment goals derived from populations with a high pelvic incidence (PI) are not applicable for patients with adult spinal deformity (ASD) and a low PI, who account for a high proportion of Asian populations. The surgical treatment for patients with a low PI is challenging because of their limited pelvic compensation capacity and because there are no criteria to guide corrective spinal deformity surgery in this population. PURPOSE:To develop and validate a tailored sagittal correction strategy for patients with ASD and a low PI. STUDY DESIGN/SETTING:Cross-sectional normative analysis and retrospective cohort study. PATIENT SAMPLE:Stage I included 852 asymptomatic Chinese adults (age 50-79 years). Stage II included 103 patients with ASD and a PI of ≤41° who underwent posterior long-segment fusion and follow-up evaluation for ≥2 years, stratified by kyphotic apex into a TL group (kyphotic apex at L1 or above; n=59) and an L group (kyphotic apex at L2 or below; n=44). OUTCOME MEASURES:Mechanical complications (MCs) and health-related quality of life (HRQOL), as measured by the Oswestry Disability Index and a visual analog scale for back and leg pain. METHODS:Normative spinopelvic parameters were used to define a low-PI subgroup (PI ≤ 41°) and to derive the sufficient sacral slope-lumbar lordosis matched correction (SSS-LLMC) strategy. The 25th percentile of sacral slope (SS) in asymptomatic adults with a low PI (41°) was adopted as the minimal SS target (SS ≥ 21°). Patients with ASD and a low PI were divided into the sufficient sacral slope (SSS, postoperative SS ≥ 21°) group and the insufficient sacral slope (ISS, postoperative SS < 21°) group. According to the linear sacral slope-lumbar lordosis (SS-LL) relationship (LL=1.122 × SS + 10.84) established in asymptomatic adults with a low PI, patients in SSS group was further stratified into lumbar lordosis matched correction (LLMC), lumbar lordosis undercorrection (LLUC), and lumbar lordosis overcorrection (LLOC). MCs and HRQOL over a minimum 2-year follow-up period were compared across these subgroups within the TL and L groups, and multivariate logistic regression identified independent predictors of MCs in the overall and apex-stratified cohorts. In addition, this strategy was compared with conventional alignment goals, such as the Scoliosis Research Society-Schwab modification of the pelvic incidence to lumbar lordosis (PI-LL) mismatch and the global alignment and proportion (GAP) score, to evaluate the ability of these approaches to reduce MCs. RESULTS:A low PI (≤ 41°) accounted for 32.2% (274/852) of the asymptomatic cohort. Among 103 patients with ASD and a low PI, 36 (35.0%) developed MCs. MCs occurred in 56.8% (20/34) of patients with an ISS versus 23.2% (16/69) of patients with a SSS (p<.001). Within the SSS group, MC rates were 47.4% (9/19) in LLUC, 8.6% (3/35) in LLMC, and 26.7% (4/15) in LLOC (p=.004). In the TL group, SSS-LLMC had the lowest MC rate (12.5%; 3/24), whereas in the L group no MCs occurred in SSS-LLMC (0/10) and the MC rate in SSS-LLOC (14.3%; 1/7) was lower than in SSS-LLUC (57.1%; 4/7). Preoperative SVA was an independent risk factor for MCs (odds ratio [OR]=1.224; 95% confidence interval [CI], 1.088-1.377; p<.001), and SSS-LLMC was independently protective (OR, 0.116; 95% CI, 0.031-0.435; p=.001). In the L group, SSS alone was independently protective (OR, 0.187; 95% CI, 0.047-0.753; p=.018). At the final follow-up evaluation, the ODI was similar between the ISS and the SSS groups. In the TL group, the SSS group showed a lower mean VAS for the back compared to ISS group (2.7±1.0 vs 3.4±1.0; p=.028), while all other between-group comparisons yielded no statistically significant results. CONCLUSIONS:Patients with ASD and a low PI who require posterior long-segment fusion treatment represent a distinct anatomic subtype requiring individualized correction targets. The SSS-LLMC strategy prioritizes restoring SS as a foundation before precisely matching LL to the restored pelvic orientation. In addition, the target for LL reconstruction should take into account the different locations of the kyphotic apex.

Background:Adolescent idiopathic scoliosis (AIS) causes lateral spinal curvature, affecting adolescent growth, nerve function, and cardiopulmonary health, with an incidence of 1% to 3% in adolescents. Accurate three-dimensional (3D) spinal assessment is critical for AIS management, yet clinical imaging faces dilemmas. Specifically, two-dimensional (2D) X-rays lack 3D information due to vertebral overlap, while computed tomography (CT) involves excessive ionizing radiation that increases tumor risks in adolescents. Existing biplanar X-ray-based 3D reconstruction methods suffer from feature fusion loss and poor adaptability to scoliotic deformities. This study aimed to develop a low-radiation and high-precision deep learning framework for 3D spinal reconstruction from orthogonal X-rays. Methods:We proposed a multi-scale generative adversarial network (MS-GAN) to reconstruct 3D spinal CT volumes from two orthogonal X-rays of both normal and scoliotic spines. The model incorporates three innovative designs: a residual-dense encoder for retaining fine vertebral details, an adaptive cross-view fusion module for integrating orthogonal projections, and a multi-scale fusion discriminator (MSFD) to ensure structural consistency. It was validated on a mixed dataset including 1,087 normal spines from CTSpine1K and clinical AIS data covering 138 cases with Cobb angles ranging from 15° to 85°. Reconstruction performance was evaluated using mean squared error (MSE), peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and Dice coefficient (Dice). Clinical applicability was further assessed using sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis (TK) measurements on 38 real biplanar X-ray cases. We compared the performance gap between the model on real clinical data and simulated data, and verified the effectiveness of the model improvement through ablation experiments. Results:Compared to the baseline X2CT-GAN, MS-GAN achieved a 30% reduction in MSE; its PSNR reached 73.20 dB, an improvement of 12.2%; its SSIM reached 0.956, an improvement of 5.5%; and its Dice reached 0.92, an improvement of 8%. Analysis demonstrated strong agreement between reconstructed spines and CT gold standards, with mean differences of -0.198 mm for SVA, 0.087° for LL, and 0.095° for TK. When applied to real clinical X-rays, performance decreases remained within 5% for key metrics. And the results of the ablation experiment demonstrated the effectiveness of the model improvement. Conclusions:MS-GAN resolves feature fusion and dimension mismatch in biplanar X-ray 3D reconstruction, with robust performance on scoliotic spines. It avoids CT radiation and reduces equipment reliance, providing a low-cost, high-precision tool for AIS assessment and is valuable for primary hospitals.

To evaluate the effectiveness and safety of interlaminar versus transforaminal endoscopic lumbar discectomy (IELD versus TELD) in treating L4/5 highly migrated lumbar disc herniation (HM-LDH), and to analyze factors influencing surgical approach selection. From January 2022 to June 2024, patients with L4/5 HM-LDH treated with IELD or TELD were retrospectively included. Patients were divided into two groups based on the approach used: IELD (under general anesthesia) and TELD (under local anesthesia with intravenous sedation). Baseline data, perioperative data, radiological data, patient-reported outcomes (PROs) including the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria were recorded. All data were compared and analyzed by independent t-tests and χ² tests. There were 50 patients in the IELD group and 80 patients in the TELD group respectively. The baseline data between the two groups did not show significant difference. The IELD group had relatively wider interlaminar window and thinner intervertebral foramen at L4/5, while there is no significant difference in the height of the intervertebral foramen between the two groups. No significant differences were found in intraoperative blood loss and postoperative length of stay. However, IELD had a shorter operation time (86.6 ± 12.6 min vs.99.4 ± 27.4 min, P < 0.001) and less fluoroscopy times (4.3 ± 1.1 vs. 11.6 ± 1.9, P < 0.001) compared to TELD. Both groups achieved a significant improvement in VAS and ODI after surgery. Satisfaction rates were 92.0

Abstract Background Respiratory complications in pediatric spinal deformities are most commonly attributed to thoracic insufficiency syndrome resulting from reduced thoracic volume and impaired chest wall compliance. Severe airway compromise caused by extrinsic tracheal compression is rare and remains under-recognized. Here, we report a rare case of extrinsic tracheal compression caused by progressive upper thoracic hyperlordosis after successive growing-rod interventions. Case presentation A 6-year-old girl with progressive thoracolumbar kyphoscoliosis and compensatory upper thoracic lordosis (straight back) underwent halo-gravity traction and dual growing rod insertion surgery uneventfully, achieving considerable curve correction. In the subsequent first distraction surgery one year later, she developed airway spasm and hypoxemia during anesthetic intubation and encountered substantial difficulty in extubation postoperatively. Subsequent imaging and bronchoscopy showed severe tracheal narrowing at the thoracic inlet due to extrinsic compression. Initial attempts of rod adjustment provided little improvement. After thorough literature review and carefully weighing the pros and cons of various methods, a third posterior spinal procedure with multi-level posterior column osteotomies (PCOs) and kyphotic-contoured rods successfully restored upper thoracic kyphosis, widening the thoracic inlet and trachea. She was successfully extubated on postoperative day two and remained respiratory asymptomatic with stable deformity correction at 1-year follow-up. Conclusions This case highlights that the accompanying upper thoracic hyperlordosis (straight back) in pediatric spinal deformity may cause thoracic inlet narrowing and occult asymptomatic airway compression which may become critically aggravated after distraction-based growing rod surgery. Posterior restoration of upper thoracic kyphosis may be an effective and less invasive strategy for relieving tracheal compression in selected cases.

Background:Genetic factors have been increasingly recognized as important contributors to the development and progression of adolescent idiopathic scoliosis (AIS). However, the genetic basis underlying AIS curve severity remains largely unclear. The objective of this study is to identify novel genetic variants associated with curve severity in AIS through a genome-wide association study (GWAS). Methods:In the discovery stage, 620 female AIS patients were enrolled, including 323 with severe curves (> 40°) and 297 with mild curves (< 30°). Top single nucleotide polymorphisms (SNPs) from each locus were selected for replication in an independent cohort of 634 severe and 546 mild cases. Associations between gene expression and Cobb angle were evaluated using Spearman correlation, while correlations with myofiber-related genes were analyzed using Pearson correlation. Results:Fifteen novel SNPs showed potential association with AIS curve severity in the discovery stage (P < 1 × 10-4). Six lead SNPs were selected for replication, including rs2061846 (GAK), rs12200301 (DST), rs10820637 (SMC2/NIPSNAP3A), rs7330031 (KLF12), rs2469472 (ST8SIA5-DT), and rs738650 (SEZ6L). Among these, rs2061846 and rs7330031 were successfully replicated. For rs2061846 in GAK, the frequency of the G allele was significantly higher in the severe group (P = 0.001; OR = 1.32). For rs7330031 in KLF12, the C allele was significantly more frequent in the severe group than in the mild group (P = 0.001; OR = 1.46). Moreover, KLF12 mRNA expression in the paraspinal muscle of AIS patients was negatively correlated with Cobb angle and associated with muscle fiber-specific gene expression. Conclusions:This study identified GAK and KLF12 as novel susceptibility genes associated with AIS curve severity, providing new insights into the genetic basis of curve progression. These findings may contribute to improved risk stratification and personalized management in AIS.

Neural stem cells (NSCs) transplantation represents a promising therapeutic strategy for spinal cord injury (SCI). However, the acquisition of functional neurons through their natural differentiation is limited and maintaining the viability of implanted NSCs poses significant challenges. In this study, based on barium titanate (BTO), polydopamine (PDA), and triphenylphosphine (TPP), mitochondria‐targeted piezoelectric nanoparticles (TPP‐PDA@BTO) are synthesized and an injectable piezoelectric nanocomposite hydrogel (BT‐Gel) is developed responsive to reactive oxygen species (ROS). The TPP‐PDA@BTO loaded within BT‐Gel effectively promotes NSCs neural differentiation under ultrasound (US) irradiation, a process confirmed by transcriptomic sequencing to be closely associated with the enhanced mitochondrial function in NSCs due to piezoelectric stimulation targeting mitochondria. Additionally, BT‐Gel under US significantly facilitates the M2 polarization of microglia and enhances myelinated axons regeneration. The bioactive hydrogel also effectively promotes the integration of transplanted NSCs with host neural circuits, supplemented damaged neurons, alleviated neuroinflammation, and inhibited glial scar formation, thereby significantly accelerating the recovery of motor function of SCI rats. Therefore, mitochondrion‐targeting piezoelectric nanocomposite hydrogel capable of delivering NSCs, based on the therapeutic concept of promoting neural differentiation of exogenous NSCs and comprehensively regulating the pathological microenvironment post‐SCI, offers a novel perspective for stem cell therapy in central nervous system injuries.

Background Adolescent idiopathic scoliosis (AIS) is the most common three-dimensional (3D) spinal deformity occurring during puberty, with girls at a higher risk of curve progression to the surgical threshold. Ladybird homeobox 1 (LBX1) is the most promising AIS predisposing gene based on GWAS studies, but its role in curve progression remains elusive. Methods The role of LBX1 in muscle phenotype and curve progression was investigated in clinical samples and mouse models. Additionally, metabolomic analysis was used to explore signaling pathway and potential therapeutic target. Results In this study, we found elevated LBX1 and myogenic genes expression, along with increased proportion of type I muscle fibers, in the convex paraspinal muscle (PSM) of AIS patients. Notably, the concave/convex LBX1 ratio in PSM negatively correlates with curve severity. Using a 3D-printed asymmetric hypokyphosing thoracic restrainer, we established AIS-like 3D spinal deformities in young female mice, consistently inducing a thoracic right curve. AAV-mediated Lbx1 knockdown in concave PSM of Lbx1fl/fl mice exacerbated curve progression by 50%. Mechanistically, Lbx1 knockdown inhibited myogenesis and muscle regeneration, and altered polyamine synthesis pathway. Key polyamine pathway enzymes ODC1 and SAT1 were reduced in concave PSM of AIS patients. The resultant lower serum level of spermidine, a key polyamine metabolite, was found in progressive AIS patients at their initial clinical visits. Importantly, daily spermidine supplementation significantly mitigated curve progression in scoliosis-like mice. Conclusion Our findings provide new evidence that differential Lbx1 expression in bilateral PSM exacerbates curve progression. The associated altered polyamine pathway and reduced circulating spermidine level represent novel therapeutic target and prognostic biomarker, respectively. The translational potential of this article This study presents a straightforward and reproducible protocol for establishing a mouse model of spinal deformity with consistent curvature pattern for AIS research, and illustrates the potential role of the LBX1-mediated polyamine pathway in driving curve progression in AIS, which can be ameliorated by oral spermidine administration. Our findings highlight the modulation of paraspinal muscles as a viable approach to halting curve progression.