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Anterior spine decompression and reconstruction with bone grafts and fusion is a routine spinal surgery. The intervertebral fusion cage can maintain intervertebral height and provide a bone graft window. Titanium fusion cages are the most widely used metal material in spinal clinical applications. However, there is a certain incidence of complications in clinical follow-ups, such as pseudoarticulation formation and implant displacement due to nonfusion of bone grafts in the cage. With the deepening research on metal materials, the properties of these materials have been developed from being biologically inert to having biological activity and biological functionalization, promoting adhesion, cell differentiation, and bone fusion. In addition, 3D printing, thin-film, active biological material, and 4D bioprinting technology are also being used in the biofunctionalization and intelligent advanced manufacturing processes of implant devices in the spine. This review focuses on the biofunctionalization of implant materials in 3D printed intervertebral fusion cages. The surface modifications of implant materials in metal endoscopy, material biocompatibility, and bioactive functionalizationare summarized. Furthermore, the prospects and challenges of the biofunctionalization of implant materials in spinal surgery are discussed.

Study design This was a retrospective study. Objective To retrospectively analyze the safety and efficacy of anterior lesion debridement and bone grafting combined with short-segment internal fixation for the treatment of patients with thoracolumbar tuberculosis. Summary of background data There is currently no unified standard in the academic community for surgical treatment of spinal tuberculosis. This study proposes a new surgical approach for specific thoracolumbar tuberculosis. Methods Patients ( n  = 65) who underwent anterior lesion debridement and bone grafting combined with short-segment internal fixation at our institution between January 2011 and January 2021 were included in this study. The patients were followed up for at least 2 years. During each follow-up, patients were graded using the American Spinal Injury Association (ASIA) neurologic deficit grading system, and postoperative conditions were evaluated using the Oswestry Disability Index (ODI) and pain visual analog scale (VAS). Results All patients successfully completed the surgery without serious complications.Four patients had unstable vital signs during the operation, 3 patients had a water–electrolyte imbalance in the postoperative period, 5 patients had transient neurological symptoms in the postoperative period, 1 patient had cerebrospinal fluid leakage after the operation, 1 patient had a transient nerve injury, and 1 patient had delayed healing. The patient with recurrence was treated regularly with quadruple antituberculosis drugs for three months after surgery and then maintained with two oral antituberculosis drugs for the following period. The CT examination was repeated half a year later, and all the indexes showed that the prognosis was good. The patients’ mean postoperative VAS and ODI scores were significantly better than the preoperative scores. Conclusion Anterior tuberculosis lesion debridement and bone grafting combined with short-segment internal fixation in the treatment of thoracolumbar tuberculosis has certain advantages over other Surgical Procedures, and can achieve corresponding clinical results.

Background There are many reports on the treatment of sacroiliac joint dysfunction by manipulation of oblique pulling (MOP). However, the specific mechanism of MOP on the sacroiliac joint remains unclear. This study aimed to investigate the effect of MOP on the biomechanics of the sacroiliac joint and the effect of the anterior sacroiliac ligament on the stability of the sacroiliac joint. Methods First, MOP-F1 (F: force) and MOP-F2 were applied to nine cadaveric pelvises. Then, segmental resection of the anterior sacroiliac ligament was performed. The range of motion of the sacroiliac joint was observed in all procedures. Results Under MOP-F1 and F2, the average total angles were 0.84° ± 0.59° and 1.52° ± 0.83°, and the displacements were 0.61 ± 0.21 mm and 0.98 ± 0.39 mm, respectively. Compared with MOP-F1, MOP-F2 caused greater rotation angles and displacements of the sacroiliac joint ( p  = 0.00 and p  = 0.01, respectively). In addition, the rotation angles and displacements of the sacroiliac joint significantly increased after complete resection of the anterior sacroiliac ligament ( p  = 0.01 and p  = 0.02, respectively). The increase was mainly due to the transection of the upper part of the anterior sacroiliac ligament. Conclusions MOP-F2 caused greater rotation angles and displacements of the sacroiliac joint and was a more effective manipulation. The anterior sacroiliac ligament played an important role in maintaining the stability of the sacroiliac joint; the upper part of the anterior sacroiliac ligament contributed more to the stability of the joint than the lower part.

Background Recently, a percutaneous spinal endoscopy unilateral posterior interlaminar approach to perform bilateral decompression has been proposed for use in treatment of lumbar spinal stenosis, As a development and supplement to traditional surgery, its advantages regarding therapeutic effects and prognosis, such as minor soft tissue damage, little intraoperative blood loss, and a quick return to daily life. However, there are few analyses of this surgery with a follow-up of more than 1 year,we conducted this study in order to quantitatively investigate radiographic and clinical efficacies of this surgery for central lumbar spinal stenosis. Materials and methods Forty-six patients with central lumbar spinal stenosis were enrolled from January 2017 to July 2018. The visual analog scale (VAS) for back pain and leg pain, Oswestry disability index (ODI), modified MacNab criteria were used to evaluate clinical efficiency at preoperative and postoperative time points. The intervertebral height index (IHI), cross-sectional area of the spinal canal (CSAC), calibrated disc signal (CDS) and spinal stability were examined to assess radiographic decompression efficiency via magnetic resonance imaging and X-ray at preoperative and postoperative time points. Results The VAS score for lower back pain and leg pain improved from 7.50 ± 0.78 to 1.70 ± 0.66 and from 7.30 ± 0.79 to 1.74 ± 0.68, respectively, and the ODI improved from 72.35 ± 8.15 to 16.15 ± 4.51. In terms of modified MacNab criteria, 91.3% of the patients achieved good or excellent outcomes. Furthermore, significant changes after surgery were observed for the percentage of CSAC, increasing from 125.3 ± 53.9 to 201.4 ± 78 mm 2 ; however, no significant differences were observed for the remaining measurement indicators. Conclusions The clinical and radiographic efficacies of this surgery for central lumbar spinal stenosis were good in short-term follow-up, and this surgery did not cause meaningful changes in IHI, CDS, and spine stability in short-term follow-up. The effect of long-term follow-up needs further investigation.

This study aimed to develop a novel, targeted therapy for lumbar facet joint osteoarthritis (LFJ OA) by identifying a potent bone mesenchymal stem cell (BMSC) subpopulation for cartilage regeneration, engineering its exosomes (Exos) for specific delivery, and incorporating them into a sustained-release hydrogel system. The study also aimed to elucidate the underlying molecular mechanism. A CD56+CD271+ BMSCs subpopulation with potent cartilage regeneration potential within the human bone marrow was identified through single-cell RNA sequencing and then isolated. Exos were subsequently extracted from this specific subpopulation and engineered with a chondrocyte-specific antigen peptide (CAP) to generate CAP-CD56+CD271+ BMSCs Exos. A polyvinyl alcohol (PVA)/sodium alginate (SA) composite hydrogel was developed to serve as a sustained-release carrier for these targeted exosomes. Finally, the efficacy of the composite system was rigorously evaluated both in vitro and in vivo, and mechanistic insights were pursued through sequencing and molecular experiments. Compared with conventional BMSCs, the CD56+CD271+ BMSCs subpopulation and its derived exosomes demonstrated significantly enhanced pro-chondrogenic and anti-senescence capabilities compared to conventional BMSCs. CAP modification substantially improved in vivo targeting efficiency to chondrocytes, whereas the PVA/SA hydrogel enabled sustained exosome release, prolonging retention at injury sites. Implantation of the integrated CAP-Exos-PVA/SA system markedly improved osteoarthritis cartilage structure, increased matrix deposition, and suppressed the expression of matrix metalloproteinase-13 (MMP-13) and senescence markers (p16/p21/p53). Mechanistic studies revealed that the Exo-mediated delivery of miR-210-3p inhibited hypoxia-inducible factor-3α (HIF-3α) expression in chondrocytes. These therapeutic effects were abolished upon miR-210-3p blockade or HIF-3α overexpression. The CAP-CD56+CD271+ BMSCs Exos-PVA/SA hydrogel sustained-release system presents a promising and effective therapeutic approach for LFJ OA. [Display omitted] •Identified CD56+CD271+BMSC subpopulation via scRNA-seq with superior chondrogenic potential.•Engineered chondrocyte-targeted exosomes (CAP-Exos) enhancing cellular uptake in vivo.•The PVA/SA hydrogel enhances local drug delivery and sustains exosome release.•CAP-Exos-PVA/SA hydrogel improves chondrocyte senescence in LFJ OA.•Exosomal miR-210-3p inhibits HIF-3α—validated as key regenerative mechanism.

Background Destruction of the blood–spinal cord barrier (BSCB) following spinal cord injury (SCI) can result in various harmful cytokines, neutrophils, and macrophages infiltrating into the injured site, causing secondary damage. Growing evidence shows that M2 macrophages and their small extracellular vesicles (sEVs) contribute to tissue repair in various diseases. Methods and Results In our previous proteomics‐based analysis of protein expression profiles in M2 macrophages and their sEVs (M2‐sEVs), the proteoglycan perlecan, encoded by HSPG2, was found to be upregulated in M2‐sEVs. Perlecan is a crucial component of basement membranes, playing a vital role in stabilising BSCB homeostasis and functions through its interactions with other matrix components, growth factors, and receptors. Here, we verified the high levels and remarkable therapeutic effect of M2‐sEV‐derived perlecan on the permeability of spinal cord microvascular endothelial cells exposed to oxygen glucose deprivation and reoxygenation in vitro. We also decorated the surface of M2‐sEVs with a fusion protein comprising the N‐terminus of Lamp2 and arginine glycine aspartic acid (RGD) peptides, which have an affinity for integrin αvβ3 and are primarily present on neovascular endothelium surfaces. In SCI model mice, these RGD‐M2‐sEVs accumulated at injured sites, promoting BSCB restoration. Finally, we identified M2‐sEV‐derived perlecan as a key player in regulating BSCB integrity and functional recovery post‐SCI. Conclusion Our results indicate that RGD‐M2‐sEVs promote BSCB restoration by transporting perlecan to neovascular endothelial cells, representing a potential strategy for SCI treatment. Key points Perlecan, a crucial component of basement membranes that plays a vital role in stabilising BSCB homeostasis and functions, was found to be upregulated in M2‐sEVs. M2‐sEVs decorated with RGD peptide can effectively target the neovascular endothelium surfaces at the injured spinal cord site. RGD‐M2‐sEVs promote BSCB restoration by transporting perlecan to neovascular endothelial cells, representing a potential strategy for SCI treatment. Perlecan, a crucial component of basement membranes that plays a vital role in stabilising BSCB homeostasis and functions, was found to be upregulated in M2‐sEVs. M2‐sEVs decorated with RGD peptide can effectively target the neovascular endothelium surfaces at the injured spinal cord site. RGD‐M2‐sEVs promote BSCB restoration by transporting perlecan to neovascular endothelial cells, representing a potential strategy for SCI treatment.

This study aimed to investigate the biomechanical characteristics of the tandem spinal external fixation (TSEF) for treating multilevel noncontiguous spinal fracture (MNSF) using finite element analysis and provide a theoretical basis for clinical application. We constructed two models of L2 and L4 vertebral fractures that were fixed with the TSEF and the long-segment spinal inner fixation (LSIF). The range of motion (ROM), maximum stresses at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs of the two models were recorded under load control. Subsequently, the required torque, the maximum stress at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs were analyzed under displacement control. Under load control, the TSEF model reserved more ROM than the LSIF model. The maximum stresses of screws in the TSEF model were increased, while the maximum stresses of rods were reduced compared to the LSIF model. Moreover, the maximum stresses of L2 and L4 vertebrae and discs in the TSEF model were increased compared to the LSIF model. Under displacement control, the TSEF model required fewer moments (N·mm) than the LSIF model. Compared to the LSIF model, the maximum stresses of screws and rods in the TSEF model have decreased; the maximum stresses at L2 and L4 in the TSEF model were increased. In the flexion condition, the maximum stresses of discs in the TSEF model were less than the LSIF model, while the maximum stresses of discs in the TSEF model were higher in the extension condition. Compared to LSIF, the TSEF has a better stress distribution with higher overall mobility. Theoretically, it reduces the stress concentration of the connecting rods and the stress shielding of the fractured vertebral bodies.

This was a retrospective study. To retrospectively analyze the safety and efficacy of anterior lesion debridement and bone grafting combined with short-segment internal fixation for the treatment of patients with thoracolumbar tuberculosis. There is currently no unified standard in the academic community for surgical treatment of spinal tuberculosis. This study proposes a new surgical approach for specific thoracolumbar tuberculosis. All patients successfully completed the surgery without serious complications.Four patients had unstable vital signs during the operation, 3 patients had a water-electrolyte imbalance in the postoperative period, 5 patients had transient neurological symptoms in the postoperative period, 1 patient had cerebrospinal fluid leakage after the operation, 1 patient had a transient nerve injury, and 1 patient had delayed healing. The patient with recurrence was treated regularly with quadruple antituberculosis drugs for three months after surgery and then maintained with two oral antituberculosis drugs for the following period. The CT examination was repeated half a year later, and all the indexes showed that the prognosis was good. The patients' mean postoperative VAS and ODI scores were significantly better than the preoperative scores. Anterior tuberculosis lesion debridement and bone grafting combined with short-segment internal fixation in the treatment of thoracolumbar tuberculosis has certain advantages over other Surgical Procedures, and can achieve corresponding clinical results.

The objective of this study was to implement a follower load (FL) device within a robotic (universal force-moment sensor) testing system and utilize the system to explore the effect of FL on multi-segment cervical spine moment-rotation parameters and intradiscal pressure (IDP) at C45 and C56. Twelve fresh-frozen human cervical specimens (C3-C7) were biomechanically tested in a robotic testing system to a pure moment target of 2.0 Nm for flexion and extension (FE) with no compression and with 100 N of FL. Application of FL was accomplished by loading the specimens with bilateral cables passing through cable guides inserted into the vertebral bodies and attached to load controlled linear actuators. FL significantly increased neutral zone (NZ) stiffness and NZ width but resulted in no change in the range of motion (ROM) or elastic zone stiffness. C45 and C56 IDP measured in the neutral position were significantly increased with application of FL. The change in IDP with increasing flexion rotation was not significantly affected by the application of FL, whereas the change in IDP with increasing extension rotation was significantly reduced by the application of FL. Application of FL did not appear to affect the specimen’s quantity of motion (ROM) but did affect the quality (the shape of the curve). Regarding IDP, the effects of adding FL compression approximates the effect of the patient going from supine to a seated position (FL compression increased the IDP in the neutral position). The change in IDP with increasing flexion rotation was not affected by the application of FL, but the change in IDP with increasing extension rotation was, however, significantly reduced by the application of FL.

The human cervical spine supports substantial compressive load in-vivo arising from muscle forces and the weight of the head. However, the traditional in-vitro testing methods rarely include compressive loads, especially in investigations of multi-segment cervical spine constructs. Various methods of modeling physiologic loading have been reported in the literature including axial forces produced with inclined loading plates, eccentric axial force application, follower load, as well as attempts to individually apply/model muscle forces in-vitro. The importance of proper compressive loading to recreate the segmental motion patterns exhibited in-vivo has been highlighted in previous studies. However, appropriate methods of representing the weight of head and muscle loading are currently unknown. Therefore, a systematic comparison of standard pure moment with no compressive loading versus published and novel compressive loading techniques (follower load – FL, axial load – AL, and combined load – CL) was performed. The present study is unique in that a direct comparison to continuous cervical kinematics over the entire extension to flexion motion path was possible through an ongoing intra-institutional collaboration. The pure moment testing protocol without compression or with the application of follower load was not able to replicate the typical in-vivo segmental motion patterns throughout the entire motion path. Axial load or a combination of axial and follower load was necessary to mimic the in-vivo segmental contributions at the extremes of the extension-flexion motion path. It is hypothesized that dynamically altering the compressive loading throughout the motion path is necessary to mimic the segmental contribution patterns exhibited in-vivo.