Introduction: To investigate the mid-to long-term clinical and radiographic outcomes of cervical disc arthroplasty (CDA) for the treatment of noncontiguous cervical spondylosis and to explore whether the intermediate segment degenerated faster after CDA than that of other non-operative adjacent segments. Methods: From January 2008 to December 2019, patients with noncontiguous cervical spondylosis who underwent CDA in our department were retrospectively analyzed. Clinical outcomes were evaluated using Japanese orthopaedic association (JOA) score, neck disability index (NDI), and visual analogue scale (VAS). Radiographic outcomes were evaluated including cervical lordosis, C2-C7 range of motion (ROM), segmental ROM, disc angle (DA) at the arthroplasty level, DH at the arthroplasty levels. Prosthesis subsidence, heterotopic ossification (HO) at the arthroplasty levels, adjacent segment degeneration (ASDeg) was also evaluated. Results: Sixty-four patients (31 in CDA group vs. 33 in hybrid surgery (HS) group) with 97 Prestige-LP discs completed the at least 48 months follow-up. The C4/5 and C5/6 were the most involved intermediate segment, which accounted for 69% and 28%, respectively. The value of JOA, NDI, and VAS was significantly improved after surgery. The ROM of the intermediated segment in the HS group was significantly increased at the last follow-up (P<0.05), while the value in the CDA group was found similar to preoperative levels. At the last follow-up, 20.6% superior adjacent segment, 22.7% intermediated segment and 21.9% inferior adjacent segment developed ASDeg.

Introduction: To investigate the clinical effectiveness of anterior cervical X-shape-corpectomy and fusion (ACXF) in treating cervical spondylosis (CS) according to the IDEAL framework. Methods: From a patient cohort diagnosed with CS and treated by ACXF, collected information including Japanese Orthopaedic Association (JOA) score, visual analogue score (VAS), neck disability index (NDI), cervical curvature, height and range of motion (ROM) of the functional segment unit (FSU), anteroposterior (AP) diameter of the spinal cord, dural sac area (DSA), subsidence, and fusion rates was reviewed and analyzed. Results: Total 16 patients with CS who underwent ACXF comprised the study cohort. The JOA score increased from 8.19 ± 1.28 preoperatively to 16.00 ± 0.73 at 12-month follow-up (P < 0.00). The VAS decreased from 7.63 ± 1.02 preoperatively to 1.06 ± 0.25 at 12-month follow-up (P < 0.00), as same as the NDI (56.13% ± 9.28% preoperatively vs. 7.88% ± 1.71% 12-month postoperatively, P<0.00). The AP diameter of the spinal cord and DSA both increased significantly after surgery (3.81 ± 1.48 mm preoperatively vs. 8.91 ± 0.79 mm 12-month postoperatively, P < 0.00; 97.98 ± 24.11 mm2 preoperatively vs.198.64 ± 27.55 mm2 12-month postoperatively, P < 0.00, respectively). At 3-, 6- and 12-month follow-up, the subsidence rate was 18.8%, 25.0%, and 25.0%, and the fusion rate was 56.3%, 68.8%, and 81.3%, respectively. Conclusion: ACXF may be a safe and effective procedure to treat CS patients with transverse width of posterior compression less than 13 mm, which could provide adequate decompression after surgery.

To investigate the independent associations of back pain with sarcopenia and with back muscle degeneration, and to introduce a new risk index for back muscle degeneration.

Patients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed.

The ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index.

We suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.

Introduction;To evaluate the difference in efficacy, pain relief and functional outcome scores between Leucocyte rich- platelet rich plasma (LR-PRP) and methylprednisolone acetate preparations in fluoroscopically guided injections for patients with chronic back pain due to lumbar spondylosis.
Methods: A prospective comparative study, including 100 patients with chronic back pain due to lumbar spondylosis, divided into 2 groups of 50 patients each without any randomization. Group 1 and group 2 received LR-PRP (isolated from 60 mL autologous blood) and methylprednisolone (40 mg) injection preparation respectively under fluoroscopic guidance. All patients had 6 months follow-up. VAS score for back pain was assessed pre-injection and post-injection at 1,2,4,8,12,16,20 & 24 weeks. Modified ODI and Short Form 12-Item Health Survey (SF-12) were assessed pre-injection and post-injection at 4, 12, & 24 weeks.
Results: Both the groups had significant pain relief post intervention at all follow-ups. The VAS score at 20 and 24 weeks were lower in group 1 (5.75 ± 0.6 and 1.78 ± 1.0) as compared to group 2 (6.50 ± 0.5 and 2.5 ± 0.8) and the difference was significant (P = 0.0007 and p = 0.002 respectively). There were no statistically significant differences in modified ODI and SF-12 scores between the two groups. There were no complications or adverse effects related to treatment at 6-month follow-up.
Conclusion: Both autologous LR-PRP and methylprednisolone preparations are safe and effective in treatment of patients with chronic back pain due to lumbar spondylosis. LR-PRP preparation offers better pain relief at weeks 20 and 24.

C5 palsy is a frequent sequela of cervical decompression surgeries for cervical myeloradiculopathy. Although many researchers have suggested various risk factors, such as cord shifting and the correction of lordotic angles, the tethering of the C5 root beneath the narrow foramen is an inde-pendent risk factor for C5 palsy. In this study, we tried to investigate different techniques for foramen decompression with posterior cervical fusion and assess the incidence of C5 palsy with each technique depending on the order of foraminal decompression. A combined 540⁰ approach with LMS and uncovertebrectomy was used in group 1. Group 2 combined a 540⁰ approach with pedicle screws and posterior foraminotomy, while posterior approach only with pedicle screws and foraminotomy was used in group 3. For groups 2 and 3, prophylactic posterior foraminotomy was performed before laminectomy. MRI and CT scans, were obtained to assess radiologic parameters preoperatively and postopera-tively. A total of 362 patients were enrolled in this study: 208 in group 1, 72 in group 2, and 82 in group 3. The incidence of C5 palsy was significantly lower in posterior foraminotomy groups with pedicle screws (groups 2 and 3) than in LMS with uncovertebrectomy (group 1) (p< 0.001). Thus, preventive expansive foraminotomy before decompressive laminectomy is able to significantly decrease the root tethering by stenotic lesion, and subsequently, decrease incidence of C5 palsy associated with posterior and combined posterior and anterior cervical fusion surgeries. Additionally, such expansive foraminotomy might be appropriate with pedicle screw insertion based on biomechanical considerations.

Objective: To establish the mode of anterior cervical surgery (ACS) in outpatient setting, and evaluate its preliminary clinical application effect. Methods: A clinical data of patients who underwent ACS between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. Among them, 35 cases were performed in outpatient setting (outpatient setting group) and 35 cases were performed in traditional mode (inpatient setting group). The satisfaction with a score of 1-10 was also recorded. Results: There was no significant difference between the two groups (P>0.05) in preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group (P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group (P<0.05). The JOA score, VAS-neck score and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation (P<0.05). There was no significant difference in the improvement of the above scores between the two groups (P>0.05). Conclusion: The safety and efficiency of ACS performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the length of hospital stay, reduce hospital expenses, and improve the patients’ medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement and fine perioperative management.

Purpose: To confirm the efficacy and safety of Escherichia coli-derived BMP-2 (E.BMP-2) with a hydroxyapatite carrier when applied to one-sided posterolateral fusion (PLF) in addition to lumbar interbody fusion (LIF), and to measure the lower dose of E.BMP-2 ever reported achieving solid fusion.
Methods: A total of 121 patients who received surgery for 1 or 2 levels of fusion for lumbar degenerative spinal stenosis or spondylolisthesis from January 2009 to December 2019 were included. Fusion rates were evaluated by computed tomography at six months and one year after surgery. In addition, a subgroup analysis of group E according to number of fusion levels was conducted, and the fusion rates in the one-level and two-level fusion groups were compared. LIF and additional one-sided PLF was performed in all patients. They received autogenous iliac bone grafts (Group C, n=69) or 1mg of E.BMP-2 (Group E, n=52).
Results: The PLF rate was 79.7% for Group C and 82.7% for Group E at postoperative six months, and 94.2% for Group C and 100% for Group E at postoperative one year (P = 0.679, 0.134, respectively). In terms of numbers of fusion levels in Group E, PLF rates at six months (P = 0.486) and one year after surgery were similar in the two groups.
Conclusions: One milligram of E.BMP-2 is a safe and effective osteoinductive material in short-level lumbar PLF surgery.

Introduction: Bradycardia often occur in patients with cervical spinal cord injury and may require resuscitation. However, bradycardia often improve in a short time by intervention. Therefore, we will report on the factors involved in bradycardia that required intervention among patients with cervical spinal cord injury. Methods: The subjects were 48 patients with ASIA A-C who were admitted to our hospital from 2011 to 2021. Gender, age, ASIA classification, level of injury and MMT of leg at admission and 3 days after admission, duration of hospitalization, pulse rate and mean blood pressure at admission, presence or absence of vasopressors until bradycardia, ISS, presence or absence of tracheostomy, respiratory pattern at admission, and level of MRI intensity change. Results: There were 42 males and 6 females, with an average age of 76.2 years, ASIA: A 10 cases, B 28 cases, C 10 cases. The injury level at the time of admission was C3 9, C4 12, C5 21, below C6 6. The average hospitalization period was 36 days, the average pulse at admission was 63.8 beats/min , the average blood pressure was 81.4 mmHg, and the average ISS was 20.92. Tracheostomy was performed in 21 cases, and 13 cases were hospitalized abdominal breathing. Among them, 10 cases of bradycardia requiring medical intervention. There were 8 males and 2 female, with an average age of 64.2 years. Conclusion:
As factors for severe bradycardia, we found a significant correlation with the level of injury and MMT of leg on the 3rd day of hospitalization..

Introduction: Spondylolisthesis is a sagittal plane deformity. It’s most prevalent issue is either back or leg pain. Major neuro-deficit is rare. Objective: Primary aim of this study was to compare clinical and radiological results of transforaminal lumbar interbody fusion (TLIF) with posterolateral (interlaminar) instrumented lumbar fusion (PLF) in adult low grade (Meyerding 1 & 2) spondylolisthesis patients. Method: It’s a prospective randomized study. 24 patients of low grade adult spondylolisthesis were randomly allocated to one of the two groups. Group 1- PLF and group 2-TLIF. Study period was between August 2017 to December 2021. All patients were operated by a single surgeon (CN). Surgery was performed only if at least 6 months of conservative treatment was failed. Posterior decompression was performed in all patients. Average follow up period was 18.4 months.Quality of life was accessed with visual analogue scale and Oswestry low back pain disability Index. Fusion was assessed radiologically by CT scan and/or x-ray. Result: Though fusion was significantly better in TLIF group, clinical outcome including relief of back pain and neurogenic claudication were better in PLF group. Rate of complication was also lower in PLF group. Conclusion: Considering the low complication rate and similar or better clinical results, posterolateral instrumented lumbar fusion is the better option than transforaminal lumbar interbody fusion in low grade adult spondylolisthesis.

Objective: Study evaluated the relationship and correlation between the cross-sectional area (CSA) and bulk of the paraspinal muscles on Magnetic resonance imaging (MRI) and severity/chronicity of symptomatic low backache (CLBA). Methods: 100 patients with CLBA having MRI, bilateral paraspinal muscles' [quadrates lumborum (QL), psoas major (PM), multifidus (MF) and erector spinae (ES)] CSAs and mean signal intensities and the degree of fat infiltration was computed. The data between both sides and group comparison were tested. Patients with unilateral CLBA could indicate the problem level, and the CSA and mean intensity of the MF muscle were analysed at the problem, one above and one level below. Result: The CSAs of PM and ES were significantly decreased in acute LBA group, while in chronic LBP group, the MF and ES on the painful side had a considerable drop in CSA when compared to the non-painful side. The mean signal intensity and fat content of the ES muscle on the painful side in the chronic LBA group was significantly higher than that on the painful side in the acute LBA group. The significant decrease of CSA in the MF muscle was found at multiple levels on the painful side. Conclusion: Selective ipsilateral atrophy to the symptomatic side, in patients with acute and chronic LBP. The reduction of CSA and increased fatty infiltration occurred synchronously, and it is significant in CLBP in the ES muscle. Atrophy is at the multiple levels of the MF but side specific in relation to symptoms in chronic LBP.

Introduction and Objectives: The pivotal aim of our work was to review our established practices in percutaneous vertebroplasty and kyphoplasty, to quantify the share of periprocedural complications and to determine which of those complications had any clinical sequelae. Study Design & Methods: 127 women (66.8%) and 63 men (33.2%) were included in this study, the mean age was 74.8 years. All patients had a single – level traumatic vertebral compression of the thoracic or lumbar spine verified on
pre – operative CT scan. We used the AO classification of spine fractures, and the Yeom classification
to determine the subtype of vertebral cement leakage. Visual analogue score was assessed
preoperatively and then in regular intervals after the surgery. Neurological deficit was assessed according to Frankel’s classification. Results: Cement leakage was recorded in 32 cases (16.8%). There was one case of a dural sac puncture with subsequent paraplegia. Solitary cases of a vertebral refracture and a rupture of kyphoplastic tamp were registered. 182 patients (95.8%) had a Visual analogue score of lower than 3 at three months post – surgery and therefore did not require regular administration of analgetics. Conclusions: No significant difference in the risk of cement leakage when comparing kyphoplasties and
vertebroplasties was found. Unipedicular cement application through a transpedicular approach appears to be sufficient for most situations. These minimally inasive procedures allow timely verticalization of the patient. Exact perioperative radiographic control is crucial to avoid serious complications.

Introduction: Anterior bone loss (ABL) is a common phenomenon after cervical disc replacement (CDR), while it is also observed after anterior cervical discectomy and fusion (ACDF). We aimed to investigate the incidence and severity of ABL in single-level CDR and ACDF and explore the association of cervical sagittal alignment with ABL. Methods: 113 patients treated with CDR and 99 patients treated with ACDF were retrospectively reviewed. Cervical sagittal alignment parameters, including cervical lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope, functional spinal unit angle, disc angle, and surgical level slope, were evaluated. Results: ABL was identified in 75 (66.4%) patients in the CDR group and 57 (57.6%) patients in the ACDF group. There were no significant differences in the incidence, severity, and location of ABL between the ACDF and CDR groups. For patients who underwent ACDF, the proportion of females was significantly higher in ABL group (P=0.002), while the BMI was significantly lower in the ABL group (P=0.002). The effect of ABL on clinical outcomes of ACDF and CDR was not observed. Patients with ABL had significantly smaller postoperative CL (P=0.045), T1 slope (P=0.033), cSVA (P=0.007), and surgical level slope (P=0.020). ABL after CDR was less correlated to the cervical sagittal alignment. Conclusion: ABL is common after both CDR and ACDF. The incidence, severity, and location of ABL were all comparable between CDR and ACDF. Cervical sagittal alignment was closely related to ABL after ACDF while had less influence on ABL after CDR.

Objectives: This study aims to evaluate the association of fatty infiltration (FI) of CPM with postoperative outcomes in patients undergoing hybrid surgery (HS) and explore the relationship between FI and cross-sectional area (CSA) of CPM. Methods: A retrospective analysis was performed on 110 consecutive patients undergoing continuous 2-level HS with a minimum of 1-year follow-up. According to Goutallier classification of multifidus FI, the patients were divided into normal, moderate, and severe groups. Image J software was employed to outline and analyze CPM. Clinical outcomes and radiographic parameters were collected and evaluated for relevant comparisons. Results: Visible FI was identified in 69.1% of patients (76/110), with a propensity in elderly patients (p = 0.053). The cervical lordosis (CL) was significantly higher in the normal group than the severe group before surgery (p = 0.029). Likewise, the sagittal vertical axis (SVA) was significantly higher in the severe group than the normal group at the final follow-up (p = 0.046). The function spine unit angle and disc angle of arthroplasty levels were significantly lower in the severe group than the normal group at follow-ups. Moreover, no statistically significant relationship existed between CSA ratio and FI degree. Conclusion: CPM degeneration is common and age-related in patients with cervical disc degenerative disease. More importantly, there was a significant positive correlation between severe FI of CPM and post-operative sagittal balance disorder, particularly in SVA, CL, and segmental alignment of arthroplasty level. FI of CPM was unrelated to CSA or clinical outcomes.

Objective: To explore the risk factors of anterior bone loss (ABL) after cervical disc arthroplasty （CDA）and whether ABL affects the clinical and radiographic outcomes. Methods: We retrospectively reviewed the patients who underwent Prestige-LP CDA in our hospital. The JOA, NDI and VAS scores was evaluated for clinical outcomes. Radiographic parameters including cervical lordosis (CL), range of motion (ROM), disc angle (DA), endplate length (EL), and heterotopic ossification (HO) were assessed. Results: There were 94 cases (60.6%) in the ABL group and 61 cases (39.4%) in the non-ABL group. The occurrence of ABL was related to age and BMI. The JOA, NDI, and VAS scores improved in the two groups after surgery (P<0.05). The preoperative CL of the ABL group was significantly smaller than that of the non-ABL group (P<0.05). The segmental ROM in the ABL group was significantly greater than that in the non-ABL group at the last follow-up (P<0.05). 86.2% (81/94) of ABL occurred within 3 months after surgery and continued until approximately 12 months. The incidence of HO in the ABL group was 34.0% (32/94), which was significantly lower than 57.4% (35/61) in the non-ABL group (P<0.05). Conclusion: The incidence of ABL after CDA was 60.6%, which mainly occurred within 3 months after surgery, and no longer progressing with stable radiographic features after the first 12 months. Age and BMI were independent risk factors for ABL. ABL does not affect the clinical outcomes and may have a positive effect on the preservation of segmental ROM.