Objective This study aims to evaluate the clinical and radiological outcomes of posterior reduction and fusion strategies, with or without interfacet joints distraction and cage implantation, based on reducibility, in the surgical management of atlantoaxial dislocation (AAD).
Methods Patients who underwent posterior reduction and fusion surgery for AAD in our institution were included. They were categorized into 2 groups based on reducibility. Japanese Orthopaedic Association (JOA), visual analogue scale (VAS), and patient-reported satisfaction scores were collected. The atlantodental interval, distance of the tip of the odontoid to Chamberlain’s line (DOCL), clivus-axial angle (CXA) and mean obliquity of the atlantoaxial articular facet (OAAF) were measured on computed tomography (CT) images. Fusion was evaluated using CT and dynamic x-rays.
Results A total of 90 patients (45 males and 45 females) were included. Among them, 54 patients in the reducible group underwent direct posterior reduction and fusion, and 36 patients in the irreducible group were treated with additional interfacet joint distraction and cage implantation. All patients showed significant improvements in JOA and VAS scores postoperatively. In the irreducible group, the preoperative CXA was smaller, whereas the OAAF was greater. Receiver operating characteristic curve analysis identified optimal cutoff value of OAAF in predicting reducibility was 32.4° (sensitivity: 86.1%, specificity: 81.5%). Postoperative changes in DOCL and CXA were more pronounced in irreducible group. The fusion rates were comparable in the 2 groups (92.6% vs. 94.4%, p=0.730).
Conclusion The reducibility-based posterior reduction fusion strategy achieves satisfactory clinical and radiological outcomes in the surgical management of AAD. For reducible cases, direct reduction under continuous intraoperative skull traction is preferred to minimize surgical trauma. In contrast, interfacet joints distraction and cage implantation are essential for irreducible cases. Preoperative OAAF may act as a potential predictor of reducibility.
Objective To develop and externally validate a dual-mechanism deep learning (DL) model that integrates vertebral segmentation and lesion detection for automated evaluation of lumbar degeneration and structured report generation on plain radiographs.
Methods In this retrospective study, 5,964 patients who underwent standing anteroposterior and lateral lumbar radiographs at a single institution and 600 patients from a public dataset (BUU-Spine) were included. Vertebral corners from T11–L5 (and S1 on lateral views) and 7 degenerative findings (scoliosis, straightened/preserved lordosis, spondylolisthesis, disc space narrowing, osteophytes, vertebral compression, and abdominal aortic calcification) were annotated by 3 spine surgeons. Two independently trained, parallel networks were developed, including a ResNet-based segmentation network and a YOLOv8-based detection network. A rule-based integration strategy reconciled both outputs and generated structured diagnostic reports. Segmentation accuracy, quantitative measurement agreement, diagnostic performance, and clinical acceptability of reports were evaluated.
Results Intra- and interobserver landmark distances within 3 mm reached 96% and >95%, respectively. On the internal test set, the percentage of correct keypoints within 3 mm was 95.7%–98.6%, with intraclass correlation coefficients of 0.84–0.89 and Pearson correlation coefficient (r) of 0.90–0.94 for key radiographic parameters. The segmentation- and detection-based models achieved precision of 92.2%–96.9% and 91.7%–95.5%, and recall of 91.6%–94.8% and 93.3%–95.2%, respectively. Under the dual-positive condition, the integrated model yielded the highest precision (93.8%–97.3%), whereas the any-positive condition achieved the highest recall (94.1%–97.6%). Of 596 automatically generated structured reports, 557 (93.4%) were deemed clinically acceptable.
Conclusion The proposed dual-mechanism DL framework enables accurate, multilesion assessment of lumbar degeneration and generation of clinically acceptable structured reports from plain radiographs, supporting workflow optimization in lumbar spine imaging.
Low back pain is a leading cause of disability worldwide, with intervertebral disc herniation contributing substantially to its burden. Most patients improve with conservative care, often associated with disc resorption. Although increasingly recognized as a major determinant of recovery, the mechanisms underlying resorption remain poorly understood. Herniated disc tissue induces immune cell infiltration and release of cytokines and proteolytic enzymes, yet standard anti-inflammatory treatments may paradoxically impede this process. Outcomes are also influenced by physical therapy, lifestyle, herniation characteristics, and immunological background, but predictive biomarkers are lacking. This review summarizes the current knowledge gap and explores strategies to harness intrinsic healing for personalized management.
Objective To assess the effectiveness of vertebral cement augmentation (VCA) at upper instrumented vertebra (UIV) and UIV+1 in preventing proximal junction complications in correction surgery for adult spinal deformity patients.
Methods A literature search was conducted on Web of Science, PubMed, and Cochrane Library databases for comparative studies published before December 30th, 2024. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed study quality with Newcastle-Ottawa scale, and extracted data like study characteristics, surgical details, primary and secondary outcomes. Data analysis was performed using Review Manager 5.4 and Stata software.
Results Of all 513 papers screened, a meta-analysis was conducted on 7 articles, which included 333 cases in the VCA group and 827 cases in the control group. Patients in the VCA group had significantly older age and lower T score than patients in the control group. Although there was no statistically significant difference in the incidence of proximal junctional failure between the 2 groups, the results of the meta-analysis showed that the incidence of proximal junctional failure and the need for revision surgery were reduced by 36% and 71%, respectively, in the VCA group. One study reported 2 clinically silent pulmonary cement embolism and 1 patient requiring surgical decompression for cement leak into the spinal canal.
Conclusion This meta-analysis supported the use of VCA in corrective surgery for spinal deformities patients, especially in patients with advanced age and osteoporosis.
Citations
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Proximal Junctional Kyphosis Prevention in Adult Spinal Deformity Surgery: A Technical Review of Tethering and Adjunctive Strategies Paritash Tahmasebpour, Pawel P. Jankowski, Jason Liang, Joshua Lin, Kyriakos D. Chatzis, Peter S. Tretiakov, Spencer Matthews, Louis Boissiere, John F. Burke, Christopher I. Shaffrey, Aaron Hockley, Peter Passias Operative Neurosurgery.2026;[Epub] CrossRef
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Methods An SCI model was established in rats, and changes in autophagy-related proteins, m6A methylation levels, and miR-30c levels were analyzed. Hydrogen peroxide (H2O2)-stimulated spinal cord neuron cells (SCNCs) were used to assess the impact of METTL3 overexpression. The effects of STM2457, an antagonist of METTL3, were evaluated on cell viability, apoptosis, and autophagy markers in H2O2-stimulated SCNCs.
Results In the SCI model, decreased levels of autophagy markers and increased m6A methylation, miR-30c levels, and METTL3 were observed. Overexpression of METTL3 in SCNCs led to reduced cell viability, increased apoptosis, and suppressed autophagy. Conversely, co-overexpression of autophagy-related protein 5 (ATG5) or miR-30c inhibition reversed these effects. Knocking out METTL3 yielded opposite results. STM2457 treatment improved cell viability, reduced apoptosis, and upregulated autophagy markers in SCNCs, which also enhanced functional recovery in rats as measured by the Basso-Beattie-Bresnahan score and inclined plate test.
Conclusion STM2457 alleviated SCI by suppressing METTL3-mediated m6A modification of miR-30c, which in turn induces ATG5-mediated autophagy. This study provides insights into the role of m6A modification in SCI and suggests a potential therapeutic approach through targeting METTL3.
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