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Purpose Anterior cervical X -shape-corpectomy and fusion (ACXF) is a novel cervical surgery, designed as partial alternative to the classic technique, anterior cervical corpectomy and fusion (ACCF). The aim of this study was to evaluate the early-stage outcomes of ACXF in treating two-level cervical spondylosis (CS) through comparisons with ACCF. Methods A retrospectively comparative study was conducted in two cohorts of patients who underwent single-vertebral ACXF or ACCF to treat two-level CS during September 2019 and October 2021. Clinical and radiological data of all the patients were collected from pre-operation to 1 year after the surgery, following by intra- and intergroup analyses and comparisons. Results Fifty-seven patients were included, with 24 undergoing ACXF and 33 undergoing ACCF. ACXF group had significantly shorter drainage duration (2.13 ± 0.61 days vs. 3.48 ± 1.30 days, P  < 0.001) and less drainage volume (30.21 ± 26.88 ml vs. 69.30 ± 37.65 ml, P  < 0.001) than ACCF group. Both techniques significantly improved all the clinical parameters ( P < 0.01) with comparable effects ( P  > 0.05). Each complication rate in ACXF group was lower than that in ACCF group without significant difference ( P  > 0.05). ACXF showed a significantly smaller transverse decompression range than ACCF (11.93 ± 1.27 mm vs. 16.29 ± 1.88 mm, P  < 0.001). Postoperatively, ACXF yielded a comparable fusion rate ( P  > 0.05) and a significantly lower subsidence rate ( P  < 0.01) than ACCF technique at all time points. Conclusions ACXF is a potential surgical alternative for certain patients with two-level CS, as it provides both adequate decompression range and fewer adverse events than ACCF. The further modifications on ACXF worth exploration.

Background Back pain is a debilitating condition hampering horses’ athletic careers. Thoracic spondylosis (TS), a known cause of back pain, leads to osteophytes formation across intervertebral joints. In horses, TS is poorly reported, with anecdotal signs and response to treatment. Objectives To report clinical presentation, diagnostic imaging findings, treatment and outcome in horses with TS. Methods The clinical records of horses diagnosed with TS between 2010 and 2023 were reviewed. Signalment, clinical and imaging findings, treatment, and outcome were analysed. Thoracic spondylosis was graded from 1 to 5. Grades, concurrent pathologies, treatment, and outcome were assessed. The median TS grade and number of lesions and outcome were compared using the Mann–Whitney test. Results Thirteen horses met inclusion criteria, eight of which performed a discipline involving jumping. All horses exhibited signs consistent with back pain. Thoracic spondylosis sites varied from 1 to 6 (mean 2) with a total of 32 lesions. The most affected site was T13–T14. Five horses had concurrent dorsal spinous processes impingement and three were lame. Treatment included physiotherapy, tiludronate, anti‐inflammatory and extracorporeal shockwave therapy. Long‐term follow‐up (>12 months) was available for 11 horses: the outcome was poor in seven horses, good in one and excellent in three. No statistically significant association was found between TS grade (p = 0.4), number of lesions (p = 0.2) and outcome categories. Conclusions Although rare, TS can cause back pain. The outcome is generally poor, but some horses may continue athletic activity despite severe lesions. The aim of this study is to describe for the first time clinical signs, treatment and long‐term outcomes of horses diagnosed with thoracic spondylosis. Of the 13 horses that met the inclusion criteria, four were able to continue their athletic careers with good results, after treatment and rehabilitation.

Background Treatment methods for low back pain (LBP) can be divided into conservative, invasive and surgical treatment approaches with traction therapy as a non-surgical therapeutic option. A clinical study analysed the effect of using a traction-bed-device (Movento) on 35 patients suffering from osteoarthritis/spondylosis of the lumbar spine. Methods The study was performed as a multicentric, double-blind, randomised, controlled interventional study. The patients were treated over three weeks while staying in rehabilitation clinics. All patients were assessed initially at study entry, weekly and after 3 weeks as well as 12 weeks after discharge. The following outcome measures were used: Numerical Rating Scale (NRS), Roland-Morris Disability Questionnaire (RMDQ), (12) Progressive Isoinertial Lifting Evaluation (PILE-Tests) and the 36-Item Short Form Health Survey (SF36). One hundred ten patients between 40 and 75 years of age with a diagnosed osteochondrosis/spondylarthrosis with chronification stadium 1 and 2 according to Gerbershagen were enrolled in the study. Both study groups received conventional rehabilitation therapy. The intervention group additionally received additional therapy with a minimum of five hours with the Movento traction device per night with seven sessions per week and a duration of 21 days. The therapy is based on the unloading and loading of spinal tissueThe duration of the treatment was limited to a minimum of 5 h and a maximum of 8 h. Results The intervention group was able to show significantly better results in pain reduction (NRS) ( p  < 0.05), the Roland-Morris Questionnaire ( p  < 0.05), the PILE-Test ( p  < 0.05), the morning start-up time and the Finger-Floor-Distance measurement ( p  < 0.05) as well as the improvements in quality of life (SF-36). Conclusions The presented results show that an additional traction device can improve pain score, function, clinical scores as well as improvements in quality of life in patients with spondylosis. Key Points Findings Therapy with the traction-bed-device (Movento) in combination with specific back pain rehabilitation achieves statistically significant results compared to treatment without this device. Implications The results show that an additional traction device improves pain score, function, clinical scores as well as life quality and should be added to conservative rehabilitation methods. Caution It cannot be assumed that traction is always the same. In addition the effect of a 3 weeks treatment was not be maintained at 12 weeks after cessation of the intervention

Background Cervical spondylosis adversely affects life quality for its heavy disease burden. The report on the community-based prevalence and associated factors of cervical spondylosis is rare, especially in Chinese population. Whether prevention is needed and how to prevent it is not clear. This study aims to explore its prevalence and related lifestyle factors and provide evidence on prevention of cervical spondylosis. Methods A community-based multistage cross-sectional survey of six communities from the Chinese population was conducted. A face-to-face interview was conducted to obtain individual information, and prevalence was calculated. Single-factor analysis and multivariable logistic regressions were used to explore the associated factors in total and subgroup populations. Results A total of 3859 adults were analyzed. The prevalence of cervical spondylosis was 13.76%, although it differed significantly among the urban, suburban, and rural populations (13.07%, 15.97%, and 12.25%, respectively). Moreover, it was higher in females than in males (16.51% vs 10.49%). The prevalence among different age groups had an inverted U shape. The highest prevalence was in the age group from 45 to 60 years old. The associated factors differed by subgroups. There were positive associations between engaging in mental work, high housework intensity, and sleep duration of less than 7 h/day with cervical spondylosis. Going to work on foot was a negative factor of cervical spondylosis in the total population. For people aged less than 30 years, keeping the same work posture for 1–2.9 h/day was a special related factor. Exposure to vibration was an associated factor for females aged 45–60 years. Menopause was a special related factor for women. Conclusions Prevalence of cervical spondylosis was high in Chinese population. People younger than 60 years were the focus of prevention for cervical spondylosis. Moreover, the characters between male and female and among different age groups were different and required targeted interventions.

ObjectivesTo investigate the effect of cervical spondylosis (CS) in the brain with a combination of advanced neuroimaging techniques.MethodsTwenty-seven patients with CS and 24 age- and gender-matched healthy controls were studied. Disease severity was quantified using the Modified Japanese Orthopaedic Association Scoring System (mJOHA). Magnetic resonance (MR) imaging of the brain and spinal cord, functional MR imaging (fMRI) with a bilateral rest/finger-tapping paradigm, brain diffusion tensor imaging (DTI), voxel-based morphometry (VBM), and MR spectroscopy of the sensorimotor cortex were performed.ResultsA total of 92.3% of patients had more than one herniated disc. In the MRI, 33.33% presented signs of myelopathy. The mJOHA score was 13.03 ± 2.83. Compared with controls, DTI results showed significant lower FA values in Corpus callosum, both corticospinal tracts and middle cerebellar peduncles (p < 0.05 corrected). Only in CS patients fMRI results showed activation in both globus pallidi, caudate nucleus, and left thalamus (p < 0.001). Subject-specific activation of the BOLD signal showed in CS patients lower activation in the sensorimotor cortex and increased activation in both cerebellum hemispheres (p < 0.05 corrected). VBM showed bilateral clusters of gray matter loss in the sensorimotor cortex and pulvinar nucleus (p < 0.05 corrected) of CS patients. NAA/Cr was reduced in the sensorimotor cortex of CS patients (p < 0.05). Linear discriminant and support vector machine analyses were able to classify > 97% of CS patients with parameters obtained from the fMRI, DTI, and MRS results.ConclusionCS may lead to distal brain damage affecting the white and gray matter of the sensorimotor cortex causing brain atrophy and functional adaptive changes.Key Points• This study suggests that patients with cervical spondylosis may present anatomical and functional adaptive changes in the brain.• Cervical spondylosis may lead to white matter damage, gray matter volume loss, and functional adaptive changes in the sensorimotor cortex.• The results reported in this work may be of value to better understand the effect of prolonged cervical spine compression in the brain.

To assess the knowledge, attitude, and practice (KAP) regarding cervical spondylosis (CS) among the general public in China, and to identify factors associated with these KAP components. This cross-sectional study was conducted between January and June 2023 among general public, using a self-designed questionnaire. A total of 536 valid questionnaires were included. The KAP scores were 6 (5–7) for knowledge, 25 (24–39) for attitude, and 25 (23–29) for practice, respectively. Spearman correlation analysis showed positive correlation between knowledge and attitude ( r  = 0.093, P  = 0.030), between knowledge and practice ( r  = 0.325, P  < 0.001). Multivariate analysis showed that sitting time per day (OR   0.371, P  = 0.020), household income above 5,000 Yuan per month (OR  0.488 ~ 0.555, P  < 0.05), and unclear family history of CS were statistically associated with knowledge. Education (OR  3.577, P  = 0.027), household income above 10,000 Yuan per month (OR 2.417, P  = 0.012) were independently associated with attitude. Knowledge (OR   1.491, P  < 0.001), middle aged participants (OR 1.918, P  = 0.011) were independently associated with practice. The general public showed relatively adequate knowledge, and moderate attitude and practice towards CS. Associations were observed between KAP and demographic factors. Due to the cross-sectional design, causality cannot be established. Therefore, implications for health education should be viewed as preliminary and require confirmation through larger, multi-center, longitudinal studies.

Objective The cervical spine’s mobility affects the compression level of the cervical cord which varies with dynamic positioning. High signal on MRI T2-weight imaging (MRI-T2WI) of the cervical cord indicates a poorer prognosis. This study investigates the relationship between high-signal intensity on MRI-T2WI and cervical dynamic change using kinematic MRI. The objective of this study was to explore changes in the degree of cervical spinal cord compression during flexion–extension motions and identify risk factors linked to the occurrence of high signals. Materials and methods We collected data on patients who underwent surgical treatment for cervical spondylotic myelopathy (CSM) in our department from 2023 to 2024. Patients were classified into two groups based on high-intensity signal presence: the high-signal group and non-high-signal group. Using kinematic MRI, the area and width of cervical cord compression in the responsible segment were measured in the axial and sagittal positions. Differences between the two groups were assessed using univariate analysis, binary logistic analysis, receiver operating characteristic (ROC) curve, and restricted cubic spline (RCS) regression model. Results A total of 40 patients in the high-signal group and 30 in the non-high-signal group were included in the study. There was no significant difference in baseline characteristics between two groups. The degree of cord compression was remarkably increased in both groups with cervical ranging from flexion to extension. Additionally, the neutral position and extension compression degrees (area and width) were significantly greater in the high-signal group than in the non-high-signal group, indicating that stenosis is a risk factor for high-signal occurrence. Furthermore, the degree of dynamic compression change of kinematic MRI was significantly higher in the high-signal group compared to the non-high-signal group. Statistical analysis confirmed that cervical dynamic change was an independent risk factor for high-signal occurrence. The RCS curve demonstrated that the incidence of high signal significantly increased when the compression degree of extension/flexion exceeded 1.4. Conclusion Cervical cord compression worsens with cervical dynamic change from flexion to extension. The degree of compression change is considered a risk factor for high signals on MRI-T2WI. An extension/flexion value greater than 1.4 indicates an increased likelihood of a high-signal occurrence.

Purpose To explore the relationship between cervical spine and the global spine alignment and to postulate the hypotheses that a lordotic alignment of cervical spine is not the only standard to identify asymptomatic subjects, and the degenerative modification of cervical curves depends primarily on their spinal-pelvic alignment. Methods A cohort of 120 cases of Chinese asymptomatic subjects and a cohort of 121 cases of Chinese cervical spondylotic patients were recruited prospectively from 2011 to 2012. Roussouly Classification was utilized to categorize all subjects and patients according to their thoracic spine, lumbar spine and pelvic alignment. The cervical alignments were evaluated as lordosis, straight, sigmoid or kyphosis. Through the lateral X-ray images of neutral cervical and global spine, a number of parameters were measured and analyzed, including pelvic incidence, pelvic tilt, sacral slope, thoracic kyphosis (TK), lumbar lordosis, global cervical angles (angles between two lines parallel with posterior walls of C2 and C7), practical cervical angles (the addition of different cervical end plate angles from C3 to C7, and inter-vertebral angles from C23 to C67), T1 slope, spinal sacral angles (SSA), Hip to C7/Hip to Sacrum and C0–C2 angle. Results The percentages of cervical lordosis were 28.3 % and 36.4 % in asymptomatic and spondylotic group, respectively. The cervical spine alignments correlated with Roussouly types of global spine alignment in both asymptomatic and cervical spondylotic group ( P  < 0.001). And there were significant differences between Roussouly Type 2 and 4, Type 3 and 4, Type 1 and 3 in cervical angles in spondylotic group ( P  < 0.05). In the comparison of the two cohorts, significant differences were found in both general and practical cervical angles in Roussouly Type 4 ( P  = 0.00 and 0.01, respectively), and there were significant differences in inter-vertebral angle in Roussouly Type 2 at C4–5 and C5–6 levels ( P  = 0.04 and 0.04, respectively), and in Roussouly Type 3 at C6–7 level ( P  = 0.01). The SSA showed significant difference between Roussouly Type 2 and 4 in asymptomatic subjects ( P  = 0.00), and between Type 1 and 3, 1 and 4, 2 and 3, 2 and 4 in cervical spondylotic patients ( P  = 0.01, 0.02, 0.00 and 0.01, respectively). The T1 slope was significantly different among Roussouly types ( P  = 0.04) with its largest value in Type 1 in cervical spondylotic group. There are significant differences in C0–C2 angles in all Roussouly types ( P  = 0.01, 0.02, 0.00 and 0.01, respectively), as well as in the ratio of Hip to C7/hip to sacrum in Type 2 ( P  = 0.01), and Type 3 ( P  = 0.00) in the comparison of the two cohorts. The multiple linear regression of all parameters showed both general and practical cervical angles were significantly related to TK, C0–C2 and T1 slope ( P  = 0.01, 0.00 and 0.00, respectively). Conclusion The cervical alignment correlates with their global spine and pelvic curves. And lordosis is not the only presentation in asymptomatic subjects. The degenerative modification of cervical disc angles was the compensation of global spine degeneration for horizontal gaze. Cervical angles are influenced by their TK angles, occipital-C2 joint and the tilt of T1 vertebral body. The occipital-C2 joint has a compensating mechanism in all Roussouly types in cervical spondylosis.

Background Cervical spondylosis (CS), including myelopathy and radiculopathy, is the most common degenerative cervical spine disease. This study aims to evaluate the clinical outcomes of unilateral biportal endoscopy (UBE) compared to those of conventional anterior cervical decompression and fusion (ACDF) for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. Methods A prospective, randomized, controlled, noninferiority trial was conducted. The sample consisted of 131 patients who underwent UBE or ACDF was conducted between September 2021 and September 2022. Patients with cervical nerve roots or coexisting spinal cord compression symptoms and imaging-defined unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs were randomized into two groups: a UBE group ( n  = 63) and an ACDF group ( n  = 68). The operative time, blood loss, length of hospital stay after surgery, and perioperative complications were recorded. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) scale scores, visual analog scale (VAS) scores, neck disability index (NDI) scores, and recovery rate (RR) of the mJOA were utilized to evaluate clinical outcomes. Results The hospital stay after surgery was significantly shorter in patients treated with UBE than in those treated with ACDF ( p  < 0.05). There were no significant differences in the neck or arm VAS score, NDI score, mJOA score, or mean RR of the mJOA between the two groups ( p  < 0.05). Only mild complications were observed in both groups, with no significant difference ( p  = 0.30). Conclusion UBE can significantly relieve pain and disability without severe complications, and most patients are satisfied with this technique. Consequently, this procedure can be used safely and effectively as an alternative to ACDF for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. Trial registration This study was registered in the Chinese Clinical Trial Registry on 02/08/2023 ( http://www.chictr.org.cn , #ChiCTR2300074273).

The proportion of the population over age 65 in the United States continues to increase over time, from 12% in 2000 to a projected 20% by 2030. There is an associated rise in the prevalence of degenerative spinal disorders with this aging population. This will lead to an increase in demand for both nonsurgical and surgical treatment for these disabling conditions, which will stress an already overburdened healthcare system. Utilization of spinal procedures and services has grown considerably. Comparing 1999 to 2009, lumbar epidural steroid injections have increased by nearly 900 000 procedures performed per year, while physical therapy evaluations have increased by nearly 1.4 million visits per year. We review the literature regarding the cost-effectiveness of spinal surgery compared to conservative treatment. Decompressive lumbar spinal surgery has been shown to be cost-effective in several studies, while adult spinal deformity surgery has higher total cost per quality-adjusted life year gained in the short term. With an aging population and unsustainable healthcare costs, we may be faced with a shortfall of beneficial spine care as demand for spinal surgery in our elderly population continues to rise. ABBREVIATION:QALY, quality-adjusted life year