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Background As the most prevalent fragility fracture caused by osteoporosis, increasing attention was paid to vertebral compression fractures (VCF) day by day. Percutaneous vertebroplasty (PVP) had unique advantages in treatment of VCF and was used widely. However, there were still part patients suffering from residual or unrelieved pain after the surgery. The purpose of our study was to identified the associated factors for good clinical outcomes and provide evidence for surgical strategy. Material and methods 186 patients who underwent PVP from January 2021 to January 2023 were reviewed retrospectively in the study. The patients were divided into two groups according to clinical outcomes. Preoperative general data and surgical data were collected for statistical analysis. Multivariate logistic regression analysis and the receiver operating characteristic curve were used to identify the associated factors with good clinical outcomes. Results There were statistically significant differences between two groups in volume of bone cement ( p  = 0.012), standardized treatment for osteoporosis ( p  = 0.004) and bone cement continuity ( p  = 0.006). The associated factors with good clinical outcomes after PVP were continuous bone cement (OR = 2.237, 95% CI = 1.191–4.201, p  = 0.012), standardized treatment for osteoporosis (OR = 2.105, 95% CI = 1.089–4.068, p  = 0.027) and volume of bone cement > 5.5 ml (OR = 1.271, 95% CI = 1.023–1.579, p  = 0.030). Conclusion PVP effectively released the back pain of patients and was worthy of promotion. However, postoperative residual pain was an important factor that reduced the clinical outcomes. Continuous bone cement and standardized treatment for osteoporosis were guarantee of good clinical outcomes for PVP and injected bone cement > 5.5 ml might be a guarantee.

Osteosarcoma (OS), with a high tendency for recurrence and metastasis, is associated with severe impairment of bone regeneration. The inherent temperature-sensitive property of tumors positions magnetic hyperthermia (MH) as an increasingly significant area in non-pharmacological cancer treatments. However, the temperature threshold for tumor ablation often causes tissue damage and bone homeostasis imbalance. Therefore, development of moderate MH for OS, capable of achieving tumor ablation while concurrently restoring bone homeostasis, offers significant potential for addressing this challenge. This study integrates magnetothermal nanoparticles with defined temperature thresholds and borosilicate bioactive glass (BSG) to create an injectable magnetothermal bioactive system that allows for regulation of MH temperature. The ionic and alkaline microenvironment from BSG degradation primarily impairs the malignant behavior of OS cells by activating the TNF signaling pathway. This sickening effect diminishes the hyperthermia tolerance of OS cells, thereby boosting apoptosis of OS cells, even in the presence of the limited anti-tumor effects of moderate MH. Furthermore, the combination of moderate MH and BSG also promotes optimal bone formation by stimulating human bone marrow mesenchymal stem cells (hBMSCs) via calcium and JAK-STAT3 signaling pathways. Collectively, this flourishes the therapeutic approaches and theories for the prevention and management of clinically refractory bone tumors. The development of moderate magnetic hyperthermia (MH) for tumor ablation while concurrently restoring bone homeostasis shows potential for osteosarcoma (OS) therapy. Here this group combines magnetothermal nanoparticles with MH temperature-controlled borosilicate bioactive glass achieving OS cell impair while activating TNF signaling pathway for therapeutic purpose.

Background Sarcopenia had been identified as a factor influencing the postoperative outcomes of lumbar surgery. The effect of sarcopenia on the surgical outcomes in patients who underwent oblique lateral interbody fusion (OLIF) had not yet been examined. Objective The aim of our study was to investigate the association between sarcopenia and postoperative low back pain (LBP) in patients following OLIF and provide recommendations for surgical strategy. Methods 116 patients who underwent OLIF were retrospectively reviewed. Patients were classified into sarcopenia group (Group SP) and non-sarcopenia group (Group NSP). According to whether instruments was performed, Group SP was further divided into OLIF stand-alone group (Group SP-SA) and OLIF with instruments group (Group SP-IN). The patient characteristics, surgical data and questionnaire scores were collected. Oswestry Disability Index (ODI) score was used to evaluate lumbar function and pain intensity. Multivariable logistic regression analysis was used to identify the risk factors for postoperative LBP. Results There were 38 patients in Group SP and 78 patients in Group NSP. The incident rare of osteoporosis in Group SP was higher than that in Group NSP ( P  = 0.012). In Group SP, last follow-up intervertebral height (IH) was lower ( P  = 0.045) and incident rate of cage subsidence was higher (( P  = 0.044). No significant difference ( P  = 0.229) showed in preoperative ODI scores, however, last follow-up ODI scores in Group SP was significantly higher ( P  = 0.017) than that in Group NSP. Multivariable logistic regression analysis showed that sarcopenia ( P  = 0.004), osteoporosis ( P  = 0.012) and cage subsidence ( P  = 0.002) were identified as risk factors for postoperative LBP. In Group SP-IN, last follow-up ODI score ( P  = 0.024) and incident rate of cage subsidence ( P  = 0.027) were significantly lower Compared to Group SP-SA. Conclusions LBP was a common complication following OLIF with the incidence rate of 18.1%. Sarcopenia, osteoporosis and cage subsidence were risk factors for LBP following OLIF. Instruments effectively reduced the incidence and degree of postoperative LBP in patients with sarcopenia following OLIF. Consequently, we suggest incorporating supplementary instruments for patients with sarcopenia in surgical strategy.

Objectives. To explore the influencing factors of satisfaction with postoperative treatment in patients diagnosed with thoracic ossification of the ligamentum flavum during different follow-up periods. Methods. This was a retrospective study of 57 patients who were diagnosed with thoracic ossification of ligamentum flavum (TOLF) and treated with laminectomy in the Spine Surgery Department of the Third Hospital of Hebei Medical University from January 2010 to January 2017. The Patient Satisfaction Index (PSI) was collected at discharge and at 6-month, 1-year, and the last follow-up. According to the evaluation results, the patients could be divided into a satisfied group and a dissatisfied group. The patient’s Japanese Orthopaedic Association (JOA) score improvement rate was evaluated at the last follow-up. Possible influencing factors of the two groups of patients were compared and the related influencing factors of satisfaction with postoperative treatment in patients during different follow-up periods were summarized. Results. At the time of discharge, the dissatisfied and satisfied groups had significant differences in variables of diabetes mellitus, duration of preoperative symptoms, urination disorder, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, hospital stay, hospitalization expenses, postoperative pain in LE VAS, delayed wound healing, postoperative depression, and intercostal pain (P<0.05). There were also significant differences in urination disorder, postoperative pain according to the LE VAS, JOA score, and postoperative depression during the 6-month follow-up (P<0.05). There were no significant differences in other variables between the two groups (P>0.05). One year after the operation, there were significant differences between the dissatisfied group and the satisfied group in urination disorder, JOA score, and symptom recurrence (P<0.05). There were also significant differences in the JOA score and symptom recurrence at the final follow-up (P<0.05). For further analysis, the duration of preoperative symptoms in the satisfied group was less than 24 months and the duration of preoperative symptoms in the dissatisfied group was more than 24 months. The JOA scores of patients in the satisfied group and the dissatisfied group increased gradually with the improvement of neurological function in different follow-up periods, but, at the last follow-up, the JOA scores of patients in the satisfied group were significantly higher than those in the dissatisfied group. Conclusions. In conclusion, for thoracic ossification of ligamentum flavum patients who received laminectomy, dissatisfaction with the early and medium-term postoperative results may be related to diabetes, the duration of preoperative symptoms, hospitalization expenses, delayed wound healing, intercostal pain, and urination disorder, and dissatisfaction with the long-term postoperative results might be related to the low JOA score improvement rate and symptom recurrence.

Background Tandem spinal stenosis (TSS) has a complex clinical presentation, and there is no consensus on the optimal surgical strategy. This study retrospectively compared the efficacy of different staged operations and simultaneous decompression for patients with TSS. Methods We reviewed data from 132 patients with TSS who received surgical procedures from January 2011 to June 2018. Patients were classified into three groups according to the most symptomatic area of compression (group C: first-stage surgery for cervical compression; group L: first-stage surgery for lumbar compression; group CL: simultaneous surgery for both). Medical records were reviewed for age, gender, comorbidities, operation time, combined estimated blood loss, and time of hospitalization. The JOA-C, JOA-L, NDI, and ODI scores, and complications were also examined. Results Postoperative outcomes were followed for 32.1 ± 5.4 months. There were significant differences in the re-operation rate and the interval time between the two types of staged operations ( p = 0.005 and p = 0.001, respectively). There were no significant differences in gender ( p = 0.639), operation time ( p = 0.138), combined estimated blood loss ( p = 0.116), or complications ( p = 0.652) among the three groups, while the simultaneous group was significantly younger ( p = 0.027), with fewer comorbidities ( p < 0.001) and a shorter hospitalization time ( p < 0.001). At the final follow-up, the JOA-C and JOA-L scores were increased, while the NDI and ODI scores were decreased, compared with the preoperative scores. Conclusions TSS can be effectively managed by either simultaneous or staged decompressions. First-stage surgery for cervical stenosis significantly lowers the requirement for second-stage lumbar surgery. One-stage simultaneous decompression is safe and effective with the advantage of reduce hospitalization time, without an increase in operative time or bleeding. However, the surgical indications should be strictly controlled and is recommended for younger patients with fewer comorbidities.

Background The subsequent L5-S1 disc degeneration associated with long fusion arthrodesis terminating at L5 in patients with adult scoliosis has been a common concern. However, few studies paid attention to its preoperative predictors, especially in spinopelvic parameters. The purpose of the present study was to clarify the preoperative predictors of subsequent L5-S1 disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis on spinopelvic parameters. Methods In this retrospective study, we enrolled 67 patients with adult scoliosis, and the patients were divided into disc degeneration group (DD) and no disc degeneration group (NDD), based on the presence or absence of subsequent L5-S1 disc degeneration. The status of L5-S1 disc was evaluated by a modified version of radiographic classification. Characteristics and spinopelvic parameters of preoperative patients were collected as potential predictors for subsequent lumbosacral disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis. Multivariate logistic regression analysis and the receiver operating characteristic curve were used to identify the preoperative predictors, with an adjusted odds ratio (OR) and 95% confidence intervals (CI). Results Thirty-six patients (53.73%) with subsequent L5-S1 disc degeneration were divided into group DD (preoperative score 0.81 ± 0.57, last follow-up score 1.83 ± 0.60, P <  0.001 ), and the other 31 patients were divided into group NDD (preoperative and last follow-up score 0.87 ± 0.49). There was no statistical difference in preoperative score ( P  = 0.583) of lumbosacral disc between two groups; however, significant statistical difference showed in last follow-up score ( P  <  0.001). Multivariate logistic regression identified three preoperative predictors: pelvic incidence (PI) ( P  = 0.018), sagittal vertical axis (SVA) ( P  = 0.024), and sacrum-femoral distance (SFD) ( P =  0.023). PI < 48.5° (OR = 0.911, 95% CI = 0.843–0.984), SVA > 4.43 cm (OR = 1.308, 95% CI = 1.036–1.649), and SFD > 5.65 cm (OR = 1.337, 95% CI = 1.041–1.718) showed satisfied accuracy for predicting subsequent L5-S1 disc degeneration. Conclusion The prevalence of the subsequent L5-S1 disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis was 57.3% (36 of 67 patients). PI < 48.5°, SVA > 4.43 cm, and SFD > 5.65 cm were preoperative predictors for the subsequent L5-S1 disc degeneration. More attention should be paid to prevent the L5-S1 disc from degeneration when these preoperative predictors exist, especially with two or more.

Background The current study aimed to discuss the prevalence and surgical outcomes of the asymmetrical Modic changes and identify its correlative factors by multivariate logistic regression analysis. Methods Two hundred seventy-eight patients with single-level Modic changes and nerve compression symptoms were reviewed retrospectively from January 2008 to January 2015. 1.5-T MRI was performed to determine the Modic changes. Multivariate logistic regression analysis was used to identify the correlative factors of asymmetrical Modic changes. Surgeries were performed according to the surgical indications. The outcomes were recorded by Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and recovery rate. Results Asymmetrical Modic changes were observed in 76 patients (27.34%) with 4 type 1, 69 type 2, and 3 type 3. C5/6 was the most frequently affected segment with 39 patients showing signal changes on MRI. Statistically significant difference was showed in conservative rehabilitation rate between two groups ( p  = 0.043). Multiple logistic regression analysis identified disc herniation and neurological symptoms as correlative factors of asymmetrical Modic changes, and the adjusted odds ratios (95% CI) were 2.079 (1.348–3.208) and 0.231 (0.143–0.373) respectively. No statistically significant difference was found in JOA scores and NDI scores between the two kinds of Modic changes. Conclusions C5/6 was the most commonly affected level by Modic changes. Disc herniation and nerve root compression symptom were more closely correlated with asymmetrical Modic changes than conventional Modic changes. Asymmetrical Modic changes indicated poor result in conservative treatment; however, the final operation rate was similar between the two kinds of Modic changes. The outcomes of surgical treatment were satisfactory both in patients with asymmetrical Modic changes and conventional Modic changes.

PurposeThis study aimed to evaluate the clinical outcomes of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) in the treatment of symptomatic lumbar disc herniation (LDH).MethodsFrom January 2020 and May 2021, 128 patients with single-level LDH at L4-5 or L5-S1 received FEFLD, UBE discectomy or MD. Patients were divided into three groups according to surgical method: the FEFLD group (n = 43), the UBE group (n = 42), and the MD group (n = 43). Operative time, fluoroscopy frequency, in-bed time, length of hospital stays, total expenses, complications, visual analogue scale (VAS, 0–10), and Oswestry Disability Index (ODI, 0–100%) were assessed and compared among three groups.ResultsThere were no significant differences in VAS or ODI scores at 12 months after surgery among three groups. In comparison with the MD group, the FEFLD and UBE group yield better VAS scores for back pain on the first day following surgery (P < 0.05). The FEFLD group was superior to the UBE group or MD group with less time in bed and shorter hospital stay (P < 0.05). The operation time and total expenses in the UBE group were significantly longer and higher than those in the FEFLD group or MD group (P < 0.05).ConclusionsFEFLD and UBE discectomy yield comparable results to conventional MD concerning pain relief and functional outcomes. In addition, FEFLD and UBE discectomy enable less back pain in the immediate postoperative period. FEFLD offers advantages in rapid recovery. Conventional MD is still an efficient and cost-effective surgical procedure.

PurposeThis study aims to report a new distribution pattern of Modic changes (MCs) in patients with lumbar disc herniation (LDH) and investigate the prevalence, correlative factors and clinical outcomes of asymmetric Modic changes (AMCs).MethodsThe study population consisted of 289 Chinese Han patients who were diagnosed with LDH and single-segment MCs from January 2017 to December 2019. Demographic, clinical and imagological information was collected. Lumbar MRI was performed to assess MCs and intervertebral discs. The visual analogue score (VAS) and Oswestry disability index (ODI) were evaluated in patients undergoing surgery preoperatively and at the final follow-up. Correlative factors contributing to AMCs were analysed by multivariate logistic regression.ResultsThe study population included 197 patients with AMCs and 92 patients with symmetric Modic changes (SMCs). The incidence of leg pain (P < 0.001) and surgical treatment (P = 0.027) in the AMC group was higher than that in the SMC group. The VAS of low back pain was lower (P = 0.048), and the VAS of leg pain was higher (P = 0.036) in the AMC group than in the SMC group preoperatively. Multivariate logistic regression analysis revealed that leg pain (OR = 2.169, 95% CI = 1.218 ~ 3.864) and asymmetric LDH (OR = 7.342, 95% CI = 4.170 ~ 12.926) were independently associated with AMCs. The receiver operating characteristic curve showed an AUC of 0.765 (P < 0.001).ConclusionAMCs were a more common phenomenon than SMCs in this study. The asymmetric and symmetric distribution of MCs was closely related to LDH position. AMCs were related to leg pain and higher pain levels. Surgery can achieve satisfactory clinical improvement for asymmetric and symmetric MCs.

PurposeIt has not been determined which factors were related to multilevel lumbar disc degeneration (MLDD). The objective of this study was to determine the prevalence of MLDD among symptomatic patients using the magnetic resonance imaging method. The study also aimed to clarify the associations between MLDD and suspected risk factors through a multivariate model.MethodsA total of 530 young and middle-aged patients, suffered from low back pain were retrospectively assessed by 2 independent observers, who used sagittal T2-weighted MR imaging. Subjects were divided into two groups, MLDD group and non-MLDD group, according to the number of degenerated discs. Demographic and radiological data included age, gender, weight, height, body mass index, smoking status, alcohol drinking, lumbar lordosis, presence of hypertension (HT), diabetes mellitus and anemia.ResultsThere were 309 men and 221 women with an average age of 37.5  ±  8.5 years. In general, 37.7% of patients were diagnosed with disc degeneration (DD) at more than two levels. Triple level DD was the most common pattern and was more prevalent in women (p <0.05). Using multivariate analyses, age (odds ratio [OR]: 1.14; 95% confidence interval [CI] 1.11–1.18; p <0.001), hypertension (OR: 2.67; 95% CI 1.38–5.16; p = 0.03) and anemia (OR: 3.84; 95% CI 2.03–7.28; p <0.001) were significantly associated with MLDD.ConclusionDespite the young age of this cohort, MLDD is common among patients with low back pain. A significant independent association exists between age, HT, anemia and multilevel disc degeneration in the lumbar region.