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Background The clinical outcome of a new fixation device (femoral neck system, FNS) for femoral neck fractures remains unclear. The main purpose of this study was to evaluate two different internal fixation methods for the treatment of femoral neck fractures in patients aged under 60 years. Methods We retrospectively studied patients who underwent internal fixation surgery in our hospital for femoral neck fractures between January 2017 and January 2020. Cannulated compression screws (CCS) and FNS groups were divided according to different internal fixation methods. General data (such as sex, age, body mass index, type of fracture) of all patienFemoral neck shorteningts were collected, and joint function was evaluated using the Harris Hip Score (HHS) before and 1 year after surgery. We recorded related surgical complications, including femoral head necrosis, nonunion, and femoral neck shortening. Results There were no significant differences in age, sex, or body mass index between the two groups. There was no statistical difference in HHSs between the two groups before surgery. Patients who underwent FNS treatment had longer surgery time (79.75 ± 26.35 min vs. 64.58 ± 18.56 min, p = 0.031) and more blood loss (69.45 ± 50.47 mL vs. 23.71 ± 28.13 mL, p < 0.001). The degree of femoral neck shortening in the FNS group was significantly lower than that in the CCS group (10.0% vs 37.5%, p = 0.036). Regarding postoperative complications, there was no statistical difference in the incidence of femoral head necrosis and fracture nonunion between the two groups. Conclusion Patients younger than 60 with femoral neck fractures can obtain satisfactory clinical results with CCS or FNS treatment. FNS has excellent biomechanical properties and shows significantly higher overall construct stability.

Background The quality of the paraspinal muscles has been recommended as a surrogate marker for the evaluation of the severity of the lumbar degenerative diseases (LDD). The purpose of this study is to determine the age- and sex-dependent differences in the morphology and composition of the paraspinal muscles between LDD and asymptomatic subjects. Methods We analyzed data from 370 patients and 327 asymptomatic volunteers aged between 18–85 years. The measurement of the cross-sectional area (CSA) of the erector spinae, multifidus, and psoas at the L4/5-disc level was performed by the magnetic resonance imaging (MRI). The fatty infiltration ratio (FI %) of the multifidus and erector spinae was calculated. Results FI % of the lumbar paraspinal muscles were significantly and positively correlated with the severity of LDD instead of the CSA. Males had greater CSA than females, and females showed higher FI % than males in the paraspinal muscles. With the increase of age, the CSA of the lumbar paraspinal muscles gradually decreased, and the psoas showed the most significant decreasing trend. However, the FI % gradually increased in both LDD and asymptomatic groups with aging. Conclusion Age- and sex-dependent differences were found in the morphology and composition of the paraspinal muscles between subjects with and without LDD. Further long-term follow up investigations and basic studies will continue to confirm the natural history of the paraspinal muscles with aging and their association with LDD.

PurposeTo investigate the normal values of the sagittal spinal parameters and analyze the distribution of the global spinal profiles in a Chinese population with age over 75.MethodsTwo hundred and twelve sets of the whole spine lateral radiographs were obtained from a database of an asymptomatic elderly population. Global and regional spinal parameters were measured. Sagittal profiles were determined according to the Roussouly classification compared with previous studies involving different populations.ResultsA total of 102 elderly subjects (≥ 75 years) were enrolled with an average age of 79.24 ± 3.53 years. The mean values of the spinopelvic parameters were 42.89 ± 11.64° for TK, 13.84 ± 10.78° for TLK, 44.48 ± 12.88° for LL, 44.76 ± 9.84° for PI, 17.19 ± 8.08° for PT, 28.35 ± 7.94° for SS, 3.47 ± 3.56 cm for SVA, 14.75 ± 7.85° for TPA, -0.27 ± 11.95° for PI-LL, respectively. Subjects ≥ 75 years were found to have significantly smaller LL and SS, but greater TLK, PT, SVA, TPA, and PI-LL than those 60–74 years (p < 0.05). Significant age- and sex-dependent differences were found in the Roussouly classification’s distribution between the two subgroups.ConclusionsThe normal values of the sagittal parameters were presented in the elderly Chinese asymptomatic population (≥ 75 years). Ethnic, age, and sex displayed significant effects on the behaviors of the sagittal spinal balance and profiles. These results could be served as physiological references for the planning of surgical strategies in elderly Chinese patients over 75 years.

Background Older subjects have a higher risk for vertebral compression fracture. Maintaining a higher bone mineral density (BMD) at this age can protect individuals from osteoporosis-related events. Body mass index (BMI) has been found to have a robust association with BMD. However, excessive BMI is detrimental to bone health and may cause systemic disorders. Therefore, the present study aimed to determine the association between BMI and BMD, and identify a reasonable BMI range. Methods A total of 961 participants were recruited from community-dwelling residents between August 2021 and May 2022. A weighted multivariate linear regression model was applied to identify the relationship between BMI and BMD. Meanwhile, subgroup stratified analysis by BMI quartile and gender was also performed. A non-linear relationship and threshold value were determined based on the smooth curve fittings and threshold effects analysis model. Results A robust relationship was found between BMI and BMD, which remained significant in subgroups stratified by gender and BMI quartile. The BMI inflection point values in lumbar BMD and femoral neck BMD were 25.2 kg/m 2 and 27.3 kg/m 2 , respectively. For individuals with BMI < 25.2 kg/m 2 , an increase in BMI was related to an increase in lumbar BMD. For BMI > 25.2 kg/m 2 , an increase in BMI was associated with a decrease in lumbar BMD. For subjects with BMI < 27.3 kg/m 2 , the femoral neck BMD rose by 0.008 kg/m 2 for each unit rise in BMI. However, when BMI exceeded 27.3 kg/m 2 , the femoral neck BMD increased only by 0.005 kg/m 2 . Fracture risk assessment based on the spinal deformity index (SDI) failed to determine the optimal BMI range. Conclusions This study found an inflection point between BMI and lumbar/ femoral neck BMD in older community-dwelling subjects. An appropriate BMI but not an excessive BMI may allow older adults to have a better BMD.

Objective Longitudinal changes in functional levels can provide valuable information regarding patient-reported outcome measures (PROMs). However, the longitudinal outcomes of lumbar fusion surgery in patients with metabolic syndrome (MetS) have not been well-documented, which could offer appropriate management strategies and insights for individuals with MetS. Therefore, the primary objective of this study was to investigate the 24-month longitudinal trajectory of PROMs in patients with MetS following lumbar fusion surgery. Methods This study retrospectively included patients who underwent lumbar fusion surgery for degenerative lumbar diseases from January 2021 to February 2023. The presence of MetS was determined according to the International Diabetes Federation (IDF) criteria. The Short Form-36 for physical component summary (SF-36 PCS) and mental component summary (SF-36 MCS) and the North American Spine Society (NASS) scale at baseline, 3, 6, 12, and 24 months after surgery were collected. The Wilcoxon signed-rank test and paired t-test were used to analyze differences in functional measurements across follow-up periods. Additionally, a generalized mixed-effects model was employed to analyze the longitudinal trajectories of PCS and MCS. Results A total of 238 patients were included, with a mean age of 62.5 (4.2) years, and 143 (60.1%) were female. Among them, 74 (31.1%) patients had MetS, while 164 (68.9%) did not. In patients without MetS, NASS distribution improved gradually until 6-month follow-up, and then plateaued. In contrast, for patients with MetS, the NASS distribution reached a plateau at 12 months. Regarding PCS, patients without MetS showed gradual improvement from 3 months (47.5 ± 11.3) to 12 months postoperatively (67.9 ± 7.9), and then plateaued. In contrast, patients with MetS exhibited gradual improvement from 3 months (42.3 ± 8.9) to 24 months postoperatively (66.8 ± 11.4). Concerning MCS, regardless of MetS, patients’ MCS improved gradually until 12 months postoperatively, and then plateaued. For patients without MetS, MCS scores were 49.1 (± 14.3) at 3 months and 65.3 (± 12.4) at 12 months postoperatively. For patients with MetS, MCS scores were 46.2 (± 13.7) at 3 months and 63.9 (± 13.5) at 12 months postoperatively. Conclusions This study evaluated the longitudinal trajectory of functional outcomes in patients with MetS undergoing lumbar fusion surgery, providing precise information on recovery patterns and emphasizing the importance of appropriate management and rehabilitation for both patients and physicians to achieve optimal outcomes.

Percutaneous vertebroplasty (PVP) is a highly practical treatment of osteoporotic vertebral compression fractures (OVCFs). However, cement leakage (CL) after PVP remains a challenging problem. There is a lack of effective methods to reduce CL. The objective of this study is to evaluate the effectiveness and safety of Valsalva maneuver-assisted percutaneous vertebroplasty (V-PVP) compared to conventional PVP in treating OVCFs. 302 patients were enrolled in this study. Patients were divided into the V-PVP group and the conventional PVP group according to whether they received the Valsalva maneuver intraoperatively. Postoperative CT was performed to determine CL which can be classified as no leakage, cortical leakage, venous leakage, and cortical & venous leakage. CL rate and visual analog scale (VAS), performed before surgery, 1 day, and 6 months after surgery, Operation time, cement volume, pulmonary embolism rate, and hospital stay were compared between the two groups. The age, gender, BMI, BMD, fracture segment (thoracic, thoracolumbar, lumbar), fracture type (mild, moderate), cortical disrupture and cement volume of the two groups were also recorded, Multinomial Logistic regression analysis of all factors was conducted to analyze the relationship between all factors and CL. A total of 302 patients were enrolled (150 V-PVP and 152 PVP). The V-PVP group had significantly lower overall CL rates (36.7% vs. 77.6%), lower pulmonary embolism rates (1.3% vs. 17.1%), and shorter hospital stays. Pain relief was significantly better in the V-PVP group at 1 day and 6 months post-surgery (P < 0.01). Logistic regression analysis identified male gender and absence of cortical disruption as protective factors against cortical leakage, while Genant grade 2 was a risk factor. Male gender and V-PVP treatment were protective against venous leakage, whereas thoracic fractures and higher BMD were risk factors. No significant differences were found in operation time or cement volume between the groups. V-PVP is a more effective and safer option than conventional PVP for treating OVCFs, particularly in reducing cement leakage and pulmonary embolism rates. Future prospective studies with larger sample sizes are warranted to validate these findings.

Background Degenerative lumbar disease significantly impairs the quality of life in elderly individuals, with short-segment lumbar degenerative disease being particularly prevalent. When conservative treatment proves ineffective, surgical intervention becomes the optimal choice for managing lumbar disease. The implementation of Enhanced Recovery After Surgery (ERAS) in spinal surgery has been progressively refined, leading to greater patient benefits. However, age and the associated decline in physiological function remain critical factors influencing surgical decision-making. Currently, there is a paucity of research focused on elderly patients undergoing lumbar fusion surgery to substantiate that advanced age does not diminish the benefits derived from ERAS in this demographic. Methods This is a retrospective cohort study of prospectively collected data. Patients who underwent short-segment (1 or 2 segments) transforaminal lumbar interbody fusion (TLIF) under the care of the same surgical team at our institution were recruited, and divided into no-ERAS-elder, ERAS-elder, and ERAS-younger groups. Subsequently, time to physiological function recovery and other outcomes were compared. Results The outcomes of the ERAS-elder group ( n  = 113) and the no-ERAS-elder group ( n  = 120) were compared. The overall physiological function recovery was significantly faster (6.71 ± 2.6 days vs. 8.6 ± 2.67 days, p  = 0.01) in the ERAS-elder group. Next, the outcomes of the ERAS-elder group ( n  = 113) were compared with those of the ERAS-younger group ( n  = 100), and no significant difference in total physiological function recovery was found between the two groups (6.71 ± 2.6 days vs. 6.14 ± 1.63 days, p  = 0.252). Conclusions This study shows that the implementation of the ERAS program can effectively shorten the recovery time of physiological function in elderly patients after short-segment lumbar surgery, reduce the incidence of some complications, alleviate pain, and significantly shorten the length of hospital stay. ERAS enables elderly patients to achieve outcomes comparable to those of younger patients.

Background Frailty is a condition characterized by the progressive deterioration of physiological functioning, which is closely related to adverse events. Multiple previous investigations applied frailty scales for spine research, and the purpose of this study is to investigate the differences in the morphology of the paraspinal muscles in frail and non-frail older adults evaluated through FRAIL scale. Methods The sample of this retrospectively cross-sectional study consisted of individuals who were ≥ 60 years of age and with lumbar degenerative disease. We divided patients into two groups (0–2 = non-Frail, 3–5 = Frail) according to the FRAIL scale. The cross-sectional area (CSA) and percentage of the fatty infiltration (FI%) of the paraspinal muscles were compared between the two groups. Results The fCSA (functional cross-sectional area) of the non-Frail group (32.78 [28.52, 38.28]) (cm 2 ) was significantly greater than that of the Frail group (28.50 [24.11, 34.77]) ( p  < 0.001). The ES FI% (erector spinae fatty infiltration rate) (24.83 ± 6.61 vs. 29.60 ± 7.92, p  < 0.001) and MF FI% (multifidus fatty infiltration rate) (31.68 ± 5.63 vs. 41.12 ± 7.04, p  < 0.001) of the non-Frail group were significantly lower than that of Frail group. Conclusions The paraspinal muscles of elderly Frail patients screened by the FRAIL scale are worse than those of the non-Frail patients, and the ability of the FRAIL scale to distinguish paraspinal muscle morphology has important clinical significance.

Objective To ascertain whether preoperative symptom duration elevated the risk of adverse patient-reported outcomes (PROs) and to further delve into whether the existence of a dose-response relationship in patients with adult spinal deformity (ASD). Methods The retrospective cohort comprised consecutive patients who underwent spinal corrective surgery from January 2018 to May 2022. Demographic, radiological and surgical factors were included from the electronic medical records. To identify the impact of mismatched variables, we performed conditional logistic regression after adjusting for potential confounding factors. Further, nonlinear relationship between symptom duration and postoperative unfavorable PROs at 24-month follow-up was conducted based on restricted cubic splines (RCS) analysis, with the adjustments for possible confounders. If a nonlinear relationship was identified, a two-piecewise regression model would be employed to ascertain the threshold effect. Finally, the result of receiver operating characteristic (ROC) curve was employed to further corroborated the rationality of RCS results. Results We matched 122 controls to 61 unfavorable PROs patients. In the fully adjusted linear model, for every additional month of symptom duration, the risk of unfavorable patient-reported outcomes (u-PROs) increased by 79%, with an odds ratio of 1.79 (95% CI: 1.25–2.04, p  < 0.001). Patients with 6–18 months of symptom duration had comparable risk of u-PRO, whereas patients with more than 24 months had an increasingly higher risk of u-PRO (OR = 4.74, 95% CI 3.11 − 7.93, p  < 0.001). Based on the results of the restricted cubic spline (RCS) analysis with three knots, a significant nonlinear relationship was observed. Notably, we found a substantial increase in the risk of u-PROs when the duration of symptoms exceeded 18.4 months. Additionally, ROC curve with an optimal cut-off of 18.5 months was identified, which verified the reliability of RCS analysis. Conclusions We determine that 18.4 months was a threshold of preoperative symptom duration that shifted the risk of unfavorable PROs after spinal corrective surgery, and there was a dose-response relationship.

Purpose Cervical laminoplasty (CLP) is a developed surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but only a few of those studies focus on preoperative dynamic cervical sagittal alignment and the study of different degrees of loss of cervical lordosis (LCL) is lacking. This study aimed to analyze patients who underwent CLP to investigate the effect of cervical extension and flexion function on different degrees of LCL. Methods In this retrospective case–control study, we analyzed 79 patients who underwent CLP for CSM between January 2019 and December 2020. We measured the cervical sagittal alignment parameters on lateral radiographs (neutral, flexion, and extension positions) and used Japanese Orthopedic Association (JOA) score to assess clinical outcomes. We defined the extension ratio (EXR) as 100 × Ext ROM (cervical range of extension)/ROM (cervical range of motion). We observed the relationships between collected variables (demographic and radiological variables) and LCL. Patients were classified into the following three groups according to the LCL: stability group: (LCL ≤ 5°); mild loss group (5° < LCL ≤ 10°); and severe loss group (LCL > 10°). We compared the differences of collected variables (demographic, surgical and radiological variables) among the three groups. Results Seventy-nine patients were enrolled (mean age 62.92 years; 51 men, 28 women) in the study. Among the three groups, cervical Ext ROM was the best in the stability group ( p  < 0.01). Compared with the stability group, range of flexion (Flex ROM) was significantly higher ( p  < 0.05) and EXR was significantly lower ( p  < 0.01) in the severe loss group. Compared with the severe loss group, JOA recovery rates were better ( p  < 0.01) in the stability group. Receiver-operating characteristic curve (ROC) analysis to predict LCL > 10° (area under the curve = 0.808, p  < 0.001). The cutoff value for EXR was 16.80%, with sensitivity and specificity of 72.5% and 82.4%, respectively. Conclusion CLP should be carefully considered for patients with a preoperative low Ext ROM and high Flex ROM, as a significant kyphotic change is likely to develop after surgery. EXR is a useful and simple index to predict significant kyphotic changes.