Jun Miao

Objective: C5 nerve root palsy (C5P) following cervical decompression surgery remains a frustrating complication affecting patients' quality of life. C5P primarily affects the deltoid muscle, with the biceps brachii also involved in more severe cases. This study aimed to investigate the association between the degree of biceps brachii weakness and the recovery of deltoid muscle strength in patients with severe C5P. Methods: A retrospective cohort study of 78 patients with new-onset severe C5P following unilateral open-door laminoplasty between 2010 and 2024 was analyzed. All patients were retrospectively enrolled and underwent standardized clinical follow-up assessments at 6 and 12 months postoperatively. Univariate and multivariate logistic regression analyses were performed at the 6-month and 12-month time points to investigate the predictive value of patient characteristics, radiological features, and biceps brachii muscle strength for recovery from severe C5P. Results: A total of 78 patients developed severe C5P after surgery. Univariate logistic regression analysis revealed that biceps brachii strength deficit at diagnosis, high-intensity zone (HIZ) at C3/4 and C4/5, and cervical kyphosis were potential risk factors for lack of deltoid strength recovery at the 6-month follow-up. At the 12-month follow-up, biceps brachii strength deficit at diagnosis, HIZ at C4/5, and cervical kyphosis remained potential predictors of poor recovery of deltoid strength. Multivariate logistic regression identified the degree of biceps brachii strength deficit as an independent predictor of non-recovery at both 6 months (OR = 2.18, P < 0.001) and 12 months (Model 1: OR = 3.05, P < 0.001; Model 2: OR = 3.10, P < 0.001). Conclusion: The degree of biceps brachii strength deficit is an independent predictor of intermediate- and long-term failure of deltoid muscle recovery following severe postoperative C5P. Identifying this risk factor may provide a critical time reference for timely consideration of nerve transfer surgery in affected patients.

Background: Postoperative radiculitis secondary to excessive L5 nerve root retraction is a debilitating complication of posterior lumbar interbody fusion (PLIF). Despite its clinical prevalence, surgeons lack a standardized, visual safety threshold, often relying on intraoperative experience and tactile feedback. This study utilized maximum physical retraction distance as a practical but incomplete proxy for mechanical nerve stress to explore a potential risk threshold and evaluate its mid-term clinical impact. Methods: In this retrospective cohort study, we analyzed 80 patients who underwent PLIF. All procedures were performed using a standardized technique to ensure consistency. The maximum intraoperative transverse retraction distance of the L5 nerve root was recorded. The primary endpoint was the development of postoperative radiculitis. The optimal diagnostic cutoff was determined via receiver operating characteristic (ROC) analysis. A Cochran-Armitage test assessed the dose-response relationship, and 6-month visual analog scale (VAS), Oswestry Disability Index (ODI), and reintervention rates were evaluated. Results: Postoperative radiculitis developed in 18 of 80 patients (22.5%). Multivariable regression confirmed maximum retraction distance as a robust independent predictor. ROC analysis established a 6.0 mm diagnostic cutoff (AUC = 0.678, P = 0.010; Negative Predictive Value = 87.2%). Retraction > 6.0 mm almost tripled the radiculitis rate compared to ≤ 6.0 mm (36.4% vs. 12.8%; RR = 2.85, 95% CI: 1.19–6.82, P = 0.013), yielding a massive population attributable risk (PAR) of 43.3%. Furthermore, the injury risk escalated linearly with wider displacement ( P = 0.011). By 6 months, affected patients exhibited significantly worse VAS and ODI scores ( P < 0.01, Cohen’s d > 0.8), necessitating substantially more additional interventions (RR = 2.76) and reoperations (RR = 3.44). Conclusions: Transverse L5 nerve root retraction exceeding 6.0 mm is associated with an elevated risk of postoperative radiculitis, significantly impairing mid-term clinical outcomes. In standard surgical settings lacking real-time force-sensing equipment, restricting nerve displacement to ≤ 6.0 mm provides surgeons with a practical candidate warning level.

Objective: Lumbar fusion combined with topping‐off dynamic stabilization has been used to reduce adjacent‐segment stress in lumbar degenerative diseases. However, traditional pedicle screw‐based topping‐off surgery may require relatively extensive posterior exposure, which can increase soft‐tissue injury and delay postoperative recovery. This study aimed to evaluate the feasibility and effectiveness of low‐profile lumbar fusion using cortical bone trajectory screws (CBTs) and pedicle screw (PS) internal fixation combined with Coflex dynamic stabilization, compared to traditional PS‐based topping‐off. Methods: A retrospective cohort study was conducted using data from patients with lumbar degenerative diseases treated between December 2021 and January 2023. Patients who underwent either the low‐profile topping‐off procedure or traditional topping‐off surgery were enrolled. Demographic data, perioperative parameters, radiographic outcomes, complications, and clinical outcomes were collected and compared between the two groups. Statistical analyses included Student's t ‐test, chi‐square test, two‐way analysis of variance, multivariable linear regression, and binary logistic regression. Results: A total of 229 patients undergoing single‐level L4/L5 fusion (104 in the low‐profile group and 125 in the traditional group) were followed for 35.69 ± 4.76 months (range, 24–40 months). Baseline characteristics, including age, sex, bone mineral density (BMD), diagnosis distribution, and follow‐up duration, were comparable between groups ( p > 0.05). Compared with the traditional group, the low‐profile group demonstrated improved perioperative outcomes, with less intraoperative blood loss, shorter incision length, lower drainage volume, and shorter postoperative hospital stay, while operative time was similar. Radiographically, the low‐profile group showed a higher fusion success rate at final follow‐up (Bridwell Grade I + II: 91.3% vs. 80.8%). Adjacent‐segment analyses indicated better preservation of cranial adjacent‐segment radiographic parameters (L3/4) at 24 months in the low‐profile group, whereas the overall adjacent segment degeneration (ASD) incidence did not differ significantly between groups. Both groups achieved significant improvements in Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Score (JOA); although postoperative back pain VAS and ODI were statistically lower in the low‐profile group, leg pain VAS, JOA, and overall complication rates were comparable. Multivariable regression adjusting for age, sex, BMD, diagnosis type, and baseline ODI showed that surgical approach remained independently associated with final ODI, while no significant association with overall complications was observed. Conclusion: Low‐profile topping‐off surgery is as effective as traditional topping‐off for lumbar degenerative diseases, which has the strength of being less invasive and enabling more rapid recovery.

Objectives: To analyze the risk factors for bone cement leakage during percutaneous vertebroplasty (PVP) and establish a predictive model to guide clinical prevention. Methodology: This retrospective study analyzed 120 patients with osteoporotic vertebral compression fractures (OVCF) who underwent PVP between June 2018 to June 2022. Based on postoperative imaging, patients were divided into leakage group (72 vertebral bodies) and non-leakage group (84 vertebral bodies). Univariate and multivariate logistic regression analyses were performed on 15 clinical and radiographic variables. The predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: This study included 120 patients, including 69 males and 51 females, with a mean age of 70.97 ± 5.04 years (range: 62–83 years),the analysis unit was the vertebral body, as some patients underwent multi-level PVP procedures, with the involvement of 156 vertebral bodies totally, 72 vertebral bodies had bone cement leakage and 84 vertebral bodies had no leakage, with a total leakage rate of 46.15% (72/156). Bone density (OR=4.953, P=0.001), cortical defect (OR=3.494, P=0.005), and bone cement injection volume (OR=2.885, P=0.016) were identified as independent risk factors for cement leakage. The combined predictive model incorporating these three factors demonstrated the highest diagnostic accuracy, with an area under the curve (AUC) of 0.774 (P<0.001). Conclusion: Low bone density, presence of cortical defects, and excessive cement volume independently increase leakage risk during PVP. Preoperative assessment and individualized cement injection strategies based on these factors may help reduce complication rates.

Objective: To evaluate the incidence of L5 radiculitis in patients undergoing posterior lumbar interbody fusion (PLIF) using a force-limited distance-measurable nerve root retractor (FLDM-NRR) combined with intraoperative neurophysiological monitoring (IONM), compared with conventional nerve root retraction. Methods: This retrospective cohort study examined 234 patients with L4-L5 lumbar spinal stenosis (LSS) undergoing single-level PLIF from January 2022 to March 2024. Patients were categorized into the FLDM-NRR plus IONM group ( n = 96) with force limitation ≤ 3.5 N, and the conventional nerve root retraction group ( n = 138). The primary outcome was 3-month L5 radiculitis; Secondary outcomes included 1-year persistent neurological impairment, Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI), Visual Analog Scale (VAS) pain scores, and achievement of minimal clinically important difference (MCID). Multivariable logistic regression, mixed-effects models, and hierarchical testing were applied. Results: FLDM-NRR with IONM reduced the 3-month L5 radiculitis incidence (7.29% vs 18.12%, adjusted OR = 0.31, 95% CI 0.11–0.78; P = 0.017; absolute risk reduction (ARR) = 10.83%; number needed to treat (NNT) = 9), with greatest protection in the first postoperative week (3.13% vs 13.04%, P = 0.020). No significant difference was observed in 1-year persistent neurological impairment (3.13% vs 7.25% P = 0.200). The FLDM-NRR group showed superior ODI (18.43 ± 7.85% vs 21.17 ± 8.42%, P = 0.018) and higher MCID rates in VAS leg pain (95.8% vs 93.5%, P = 0.028). IONM demonstrated 85.71% sensitivity and 96.63% specificity in predicting postoperative complications. The FLDM-NRR system consistently upheld the predetermined force threshold in all instances without any device-related problems. Conclusion: FLDM-NRR combined with IONM significantly reduces early L5 radiculitis after PLIF and provides short-term functional benefits. Long-term neuroprotection remains unproven and requires validation in prospective randomized trials.

Osteoporosis is a common skeletal disorder characterized by low bone mass and structural deterioration, leading to an increased risk of fractures. This study aimed to explore the molecular mechanisms underlying osteoporosis using bioinformatics approaches, with a focus on pattern recognition receptor-related differentially expressed genes (PRR-related DEGs). Two gene expression datasets (GSE7429 and GSE56815) were retrieved from the GEO database, comprising 30 osteoporosis samples and 30 matched controls. Data integration and batch effect correction were performed using the GEOquery and sva packages, followed by differential expression analysis with limma. A total of 1,052 pattern recognition receptor-related genes (PRR-related genes) were obtained from GeneCards, and 98 PRR-related DEGs were identified. GO and KEGG enrichment analyses revealed that these genes are primarily involved in the MAPK cascade, calcium ion homeostasis, leukocyte migration, and the regulation of inflammatory responses. A protein–protein interaction (PPI) network was constructed using STRING, and six hub genes (MDM2, AKT1, ESR1, NCOR1, CCND1, and NCOA2) were identified via CytoHubba. Regulatory networks involving miRNAs and transcription factors were constructed using ENCORI and ChIPBase. ROC curve analysis showed that ESR1 exhibited moderate diagnostic potential (AUC > 0.7). In conclusion, this study systematically identifies PRR-related DEGs and hub genes associated with osteoporosis through integrated bioinformatics analysis. These findings may contribute to a better understanding of immune-related molecular mechanisms and lay the groundwork for future research on potential diagnostic markers or therapeutic strategies.

The aim of this study is to investigate the biomechanical changes in the sandwich vertebrae (SV), fractured vertebrae, and adjacent vertebrae at the thoracolumbar vertebrae in patients with osteoporotic vertebral compression fracture (OVCF) who underwent several percutaneous vertebroplasties (PVP) with varied cement volumes. The finite element (FE) model of the T10-L2 thoracolumbar vertebral body is established. The augmented vertebrae (AV) of T11 and L1 is simulated and cylindrical bone cement is placed vertically in its center. The models are categorized into four types according to the volume of bone cement, 2mL bone cement group (model A), 4-mL bone cement group (model B), 6-mL bone cement group (model C), and 8-mL bone cement group (model D). By applying 500 N axial load on the upper surface of T10 and fixing the lower surface of L2, the maximum von Mises stress of the vertebrae and the maximum displacement of the sandwich vertebrae are analyzed and compared. The maximum von Mises stresses of the T11 and L1 augmented vertebrae of Model C are lower than those of the fractured vertebrae of Models A and B in all directions of activity. The von Mises stresses of the augmented vertebrae of Model C and Model D are similar. The von Mises stresses of the fractured adjacent vertebrae T10 and L2, and the sandwich vertebrae T12 do not change significantly with the change in cement volume. In addition, the von Mises stress of T12 is lower than that of T10 in all four groups. The minimum value of T12 displacement in Model C is 3.0 mm. Under the condition of no leakage, the stress distribution of the AV can be optimized by expanding the supporting area of bone cement to about 6 ml, which not only reduces the risk of recurrent fractures of adjacent vertebrae and AV, but also prolongs the service life of the implants by reducing the stress of bone cement, which provides the basis for the appropriate amount of bone cement required for clinical multi-level PVP.