Journal of Orthopaedic Surgery and Research最新文献

{"title":"Impact of unilateral periacetabular osteotomy on bony birth canal in female hip dysplasia patients with gynecoid and anthropoid type pelvis: a pelvic three-dimensional computed tomography measurement using maximum- inscribed-sphere method.","authors":"Yanjun Wang, Hui Cheng, Dianzhong Luo, Zhendong Zhang, Hong Zhang","doi":"10.1186/s13018-025-05718-y","DOIUrl":"10.1186/s13018-025-05718-y","url":null,"abstract":"<p><strong>Background: </strong>To explore the application of a new three-dimensional computed tomography measurement (maximum-inscribed-sphere method) in female DDH (developmental dysplasia of the hip) patients with gynecoid and anthropoid type pelvis on measuring the bony birth canal before and after unilateral PAO (periacetabular osteotomy).</p><p><strong>Methods: </strong>A total of 19 female DDH patients of childbearing age were included in this study. The pelvis types were classified as gynecoid (11 patients) and anthropoid (8 patients). The maximum-inscribed-sphere method was applied to measure the bony birth canal. The lateral central edge angle (LCE), the anterior central edge angle (ACE), the Tönnis angle, and the distance between the femoral head and Koher's line were measured.</p><p><strong>Results: </strong>For the gynecoid type, the narrowest part of the bony birth canal before and after the surgery occurred both at the 21st layer of bilateral ischial spines and the 4th sacrum (107.39 mm ± 4.33 mm; 106.27 mm ± 4.76 mm). In anthropoid patients, the narrowest part of the bony birth canal was found at the 21st layer before surgery (105.89 mm ± 6.58 mm), and the 19th layer after surgery (103.48 mm ± 7.36 mm). The most significant narrowing was found at the 8th layer (4.25 mm ± 3.51 mm p < 0.05) in those with gynecoid type pelvis, and at the 9th layer (5.8 mm ± 3.15 mm p < 0.001) in those with anthropoid type pelvis after PAO. There was no statistical significant difference between acetabular dysplasia and bony birth canal in the two type groups before surgery. For the anthropoid type, the increment of LCE angle and the narrowing of bony birth canal from the 13th to 19th layer after PAO was also more significant. As the impact of unilateral PAO on the gynecoid type pelvis was caused by a decreased distance between the femoral head and Kohler's line, resulting in the narrowing of bony birth canal between the 1st and 12th layer.</p><p><strong>Conclusions: </strong>Unilateral PAO did not affect the narrowest part of the bony birth canal in either pelvis type but caused mild narrowing above the ischial spine, with notable effects in the anthropoid group. In gynecoid pelvis patients, it led to narrowing through changes in the relation between the femoral head and Kohler's line.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"314"},"PeriodicalIF":2.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"METTL3-mediated m6A modification of circSTAT6 modulates miR-188-3p/Beclin1 axis to promote osteogenic differentiation of mesenchymal stem cells.","authors":"Yue Luo, Yubo Shi, Yanqing Wu, Hui Cao","doi":"10.1186/s13018-025-05720-4","DOIUrl":"10.1186/s13018-025-05720-4","url":null,"abstract":"<p><strong>Background: </strong>The role of N6-methyladenosine (m6A)-modified circRNAs in disease progression is of great significance. However, the specific impact of m6A modification of circSTAT6 on osteoporosis (OP) is still uncertain.</p><p><strong>Methods: </strong>The qRT-PCR was employed to assess the levels of METTL3, circSTAT6, miR-188-3p, and Beclin1. To investigate the interaction between miR-188-3p and circSTAT6 or Beclin, a dual-luciferase reporter assay was performed. To evaluate osteogenic differentiation in bone marrow mesenchymal stem cell (BMSC), western blot analysis was conducted to evaluate the protein expression of osteogenic markers, including ALP, OPN, and Runx2. In addition, alizarin red and alkaline phosphatase (ALP) staining assays were employed to assess osteogenesis.</p><p><strong>Results: </strong>The findings revealed that the downregulation of circSTAT6 was observed in OP. On the other hand, the overexpression of circSTAT6 was found to enhance the osteogenic differentiation of BMSC. In addition, the involvement of METTL3 in mediating m6A methylation of circSTAT6 was identified, which ultimately promoted osteogenesis. Furthermore, circSTAT6 functioned as an miR-188-3p sponge to regulate the expression of Beclin1. Further study revealed that the osteogenic-enhancing effect caused by circSTAT6 overexpression was counteracted by introducing a miR-188-3p mimic. Similarly, the osteogenic-promoting impact of the miR-188-3p inhibitor was reversed by suppressing Beclin1 expression.</p><p><strong>Conclusions: </strong>The present study revealed, for the first time, that METTL3-mediated m6A modification of circSTAT6 regulated the miR-188-3p/Beclin1 axis to promote the osteogenic differentiation of BMSC. These findings offer a potential therapeutic target for the treatment of OP.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"313"},"PeriodicalIF":2.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic adhesiolysis in elderly patients with post-traumatic frozen shoulder.","authors":"Zhusha Wang, Yulong Shi, Xu Yang, Qubo Ni, Kai Tie","doi":"10.1186/s13018-025-05734-y","DOIUrl":"10.1186/s13018-025-05734-y","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of the current study is to investigate the efficacy and risk factors associated with arthroscopic adhesiolysis in treating elderly traumatic frozen shoulder.</p><p><strong>Methods: </strong>One hundred and two elderly patients with post-traumatic frozen shoulder treated at our Hospital were selected. The patients were randomly divided into a study group and a control group, with 51 cases in each group. The study group was treated with arthroscopic adhesiolysis, and the control group received physical therapy combined with joint manipulation.</p><p><strong>Results: </strong>The operation time and intraoperative blood loss of the study group were (54.98 ± 5.94) min and (53.28 ± 4.93) ml, respectively. The Visual Analogue Scale (VAS) (0.87 ± 0.12, P = 0.021), Present Pain Intensity (PPI) (0.76 ± 0.07, P = 0.016), and Pain Rating Index (PRI) (5.32 ± 0.32, P < 0.001) scores were lower in the study group than the control group at 3 months post-treatment. Moreover, no significant differences were seen in terms of pain relief, daily living activities, shoulder joint function, and muscle strength between the two groups before the treatment; however, at 3 months post-treatment, the study group demonstrated better outcomes in these dimensions compared to the control group (all P ≤ 0.021), with notably improved shoulder joint mobility (all P < 0.001).</p><p><strong>Conclusion: </strong>Arthroscopic adhesiolysis exerts beneficial outcomes for elderly patients with post-traumatic frozen shoulder. Age and fat infiltration are identified as risk factors influencing the efficacy of arthroscopic adhesiolysis in this patient population.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"311"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparation of tumor-free margin or intralesional spondylectomy for chondrosarcoma in mobile spine: a retrospective study of surgery management, complications and prognosis.","authors":"Fangzhi Liu, Ben Wang, Xiaoguang Liu, Fengliang Wu, Hua Zhou, Lei Dang, Yan Li, Yanchao Tang, Xiao Liu, Panpan Hu, Zihe Li, Feng Wei, Zhongjun Liu","doi":"10.1186/s13018-025-05712-4","DOIUrl":"10.1186/s13018-025-05712-4","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Cohort Study.</p><p><strong>Objectives: </strong>Chondrosarcoma of mobile spine is a rare aggressive malignant tumor and postsurgical local recurrence rates remain high. En bloc resection is currently the preferred treatment. Resection that achieves tumor-free margin removal of the tumor may enable more complete removal of tumor tissue but significantly increases the complexity and risk of surgery and results in more postoperative complications. We sought to compare surgical outcomes, complications, and prognoses between patients who underwent en bloc resection with and without intralesional removal of the tumor.</p><p><strong>Methods: </strong>We reviewed 56 patients with spinal chondrosarcoma who underwent en bloc tumor resection and reconstructive surgery at our center between 2000 and 2024 with a minimum postoperative follow-up of 1 year. We collected and analyzed data regarding surgical procedures, complication characteristics, and local tumor control and recurrence.</p><p><strong>Results: </strong>We included 56 patients. Of these, 36 patients underwent the first surgery, and 20 experienced recurrences. All patients underwent en bloc tumor resection; 36 and 20 underwent intralesional and tumor-free margin resections, respectively. We recorded 83 complications; the incidence and the number of major complications were significantly higher in the tumor-free margin surgery group. Thirty patients experienced tumor recurrence and 26 patients died. Tumor-free margin en bloc resection and conventional-type chondrosarcoma were predictive factors for reduced long-term postoperative recurrence and mortality risk.</p><p><strong>Conclusions: </strong>Tumor-free margin resection carries higher risks and is associated with a greater number of perioperative complications, but reduces the risk of local tumor recurrence and prolongs recurrence-free survival and overall survival, providing patients with better prognoses.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"307"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic interventions of platelet-rich plasma versus corticosteroid injections for lumbar radicular pain: a systematic review and meta-analysis.","authors":"Xinan Wang, Ying Zhang","doi":"10.1186/s13018-025-05725-z","DOIUrl":"10.1186/s13018-025-05725-z","url":null,"abstract":"<p><strong>Objective: </strong>Although epidural corticosteroid injections (ESIs) provide short-term relief for lumbar radicular pain caused by disc herniation, concerns remain regarding their long-term efficacy and complications. Platelet-rich plasma (PRP), with its dual anti-inflammatory and regenerative properties, is a promising alternative, but the comparative evidence between the two treatments remains inconclusive.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, with a cutoff date of January 10, 2025. The primary outcomes were the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The risk of bias in the included studies was assessed using Cochrane ROB and ROBINS-I. The primary outcome measures were analyzed by evaluating standardized mean differences (SMDs).</p><p><strong>Results: </strong>A total of seven studies (four randomized controlled trials and three prospective studies) were included in the meta-analysis, comprising 416 patients. The results indicated that corticosteroids significantly reduced ODI scores at the initial follow-up (4 weeks) (SMD = 0.48, 95% CI: 0.20 to 0.75, p = 0.0008, I² = 15%), with no significant differences observed in VAS and ODI scores between the two groups at other time points. The complication rates for the PRP and corticosteroid groups were reported, with no severe adverse events reported.</p><p><strong>Conclusions: </strong>Compared to PRP, corticosteroid injections showed significant early functional improvements in patients. Although no significant differences in pain and functional improvements were observed between the PRP and corticosteroid groups at other follow-up time points, future studies are needed to assess the efficacy and safety of PRP versus corticosteroid injections in treating lumbar radicular pain by standardizing PRP preparation, extending follow-up durations, and increasing sample sizes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"306"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel rat model of lumbar disc herniation induced by puncture: accurate positioning and controllable degree of herniation.","authors":"Ming Yang, Jiangling Zhou, Qiandong Yang, Bo Yu, Juan Cai, Tianyong Hou","doi":"10.1186/s13018-025-05710-6","DOIUrl":"10.1186/s13018-025-05710-6","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) is the serious stage of intervertebral disc degeneration (IDD), and the location and degree of intervertebral disc herniation are closely related to clinical symptoms and signs. However, there is currently no low-cost, high-benefit animal model to support in vivo research on LDH.</p><p><strong>Method: </strong>Expose the rat's lumbar 5/6 intervertebral disc through the space between the psoas major and erector spine muscles, and then use different lengths of puncture needles to control the degree of herniation and different puncture angles to push the nucleus pulposus tissue backwards to the different position. Observe the protrusion of intervertebral discs through MRI. Von Frey mechanical pain test and BBB score were used to evaluate the behavior of LDH rats. H&E and SF staining were used to observe the morphological changes after intervertebral disc herniation. Immunofluorescence was used to analyze the expression of Aggrecan (ACAN), IL-1β, TNF-α, and CD31 in intervertebral disc tissue.</p><p><strong>Results: </strong>LDH rat exhibit varying degrees of motor and sensory dysfunction. The nucleus pulposus tissue in the center of the intervertebral disc undergoes degenerative changes, with a decrease in the content of nucleus pulposus cells and proteoglycans, an increase in the expression of inflammatory factors in the protruding tissue, and neovascularization.</p><p><strong>Conclusion: </strong>We have successfully constructed rat models of different types of intervertebral disc herniation, including disc degeneration, bulging, central herniation, and lateral herniation, using the method of puncture of intervertebral discs. This animal model is consistent with the characteristics of LDH in terms of behavior, imaging, and histopathology.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"309"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroacupuncture attenuates intervertebral disc degeneration by upregulating aquaporins via the cAMP/PKA pathway.","authors":"Min Wang, Jia-Bao Huang, Jing Zou, Guo-Fu Huang","doi":"10.1186/s13018-025-05729-9","DOIUrl":"10.1186/s13018-025-05729-9","url":null,"abstract":"<p><strong>Background: </strong>Intervertebral disc degeneration (IVDD) is characterized by a decrease in extracellular matrix (ECM) and water loss, which is a major cause of low back pain (LBP). Electroacupuncture (EA) has long been used to relieve LBP in IVDD. To investigate whether EA can upregulate aquaporins (AQPs) in IVDD via the cAMP/PKA pathway in a rabbit model of disc degeneration.</p><p><strong>Methods: </strong>A homemade loading device was adapted to trigger a disc degeneration model. After 28 days, EA treatment was performed. Magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI) were performed to evaluate AQP content and water diffusion. AQP protein expression in the slices was observed by Western blot and immunofluorescence (IF) staining. The pathology of the intervertebral discs was determined by staining. cAMP and PKA levels were examined using ELISA, and the expression of AQP genes as well as the cAMP/PKA pathway and its related molecules were examined using quantitative reverse transcription-PCR (qRT-PCR) and Western blot analysis.</p><p><strong>Results: </strong>The EA intervention reduced MRI Pfirrmann scores, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values. EA can upregulate the expression of AQP1 and AQP3, thereby improving the pathological morphology of the nucleus pulposus (NP) and the cartilage endplate of the intervertebral disc. cAMP and PKA levels were significantly increased after EA intervention in rabbits with IVDD. EA intervention can partially improve the expression of related molecules in the cAMP/PKA pathway, but H-89 reverses the effect of EA.</p><p><strong>Conclusion: </strong>EA can attenuate intervertebral disc degeneration by regulating AQP expression, a process that may be mediated by the cAMP/PKA pathway.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"310"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of screw hole inserts for the unused screw holes on the strength of a plate.","authors":"Onur Basci, Selahaddin Aydemir, Ahmet Emrah Acan, Onur Gursan, Bora Uzun, Mehmet Erduran","doi":"10.1186/s13018-025-05686-3","DOIUrl":"10.1186/s13018-025-05686-3","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to determine if the use of specially designed screw hole inserts in empty locking screw holes improves the strength and failure characteristics of locking plates.</p><p><strong>Methods: </strong>Forty-two 7-hole locking LC/DCP plates were mounted on cylindric UHMW Polyethylene blocks with a 1-cm gap between blocks, simulating a fracture with comminution and bone loss. 21 plates had a screw hole insert placed in the center hole (centered over the simulated fracture), while 21 of the plates remained empty in the center hole. The plate-block constructs were placed in a mechanical testing machine and subjected to loading conditions. The axial, bending, and torsional stiffness and displacements needed for the failure of each plate-block construct were calculated. The statistical analysis was performed using the Mann-Whitney U test for independent variables.</p><p><strong>Results: </strong>All plates were then loaded to failure. There were significant differences in the axial load to failure (p = 0.017), bending load to failure (p < 0.01), and bending displacements (p < 0.01) of the test groups favoring the screw hole insert group as higher mechanical strength.</p><p><strong>Discussion/conclusion: </strong>In conclusion, the study demonstrates that the addition of the specially designed locking screw hole insert does significantly change the strength of the locking LC/DCP plates and might be suggested in the clinical application.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"312"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone marrow mesenchymal stem cell exosomes improve fracture union via remodeling metabolism in nonunion rat model.","authors":"Cheng Li, Ming Chen, Lijun Guo, Dadong Yu, Zhonghai Xu, Bin Chen, Zhijian Xiao","doi":"10.1186/s13018-025-05721-3","DOIUrl":"10.1186/s13018-025-05721-3","url":null,"abstract":"<p><strong>Background: </strong>Nonunion of fractures is a major unsolved problem in clinical treatment and prognosis of orthopedics. Bone marrow mesenchymal stem cell (BMSC) exosomes have been proven to be involved in mediating tissue and bone regeneration in a variety of diseases. However, the role of BMSC exosomes in fracture nonunion is unclear.</p><p><strong>Methods: </strong>BMSC exosomes were injected into a rat model of nonunion fracture, and the fracture-healing site was detected by micro-CT and the serum metabolites were analyzed by LC-MS/MS.</p><p><strong>Results: </strong>The results showed that the exosomes could be successfully isolated from rat BMSCs cultured in an exosome-free medium. Compared with the model group, the fracture site of the exosome-treated rats were healing obviously. Compared with the PBS group, there were 158 up-regulated differential abundance metabolites (DAMs) and 79 down-regulated DAMs in the BMSC-exo group. The DAMs were enriched in 'Th1 and Th2 cell differentiation', 'ErbB signaling pathway', 'PPAR signaling pathway' and 'HIF-1 signaling pathway' that were related to the function of cell proliferation and differentiation. DAMs-PE in HIF-1 signaling pathway were the major metabolite to promote fracture healing.</p><p><strong>Conclusions: </strong>Our study reveals the mechanism by which BMSC-exosome improves the fracture healing process through metabolic reprogramming and provides a reference for the treatment of fracture nonunion.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"308"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deformity angular distance ratio independently predicts intraoperative neuromonitoring alerts in spinal deformity correction.","authors":"Jiajun Ni, Xinhu Guo, Zhuoran Sun, Chunwei Zhao, Zhongqiang Chen, Yan Zeng","doi":"10.1186/s13018-025-05693-4","DOIUrl":"10.1186/s13018-025-05693-4","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative neuromonitoring (IONM) alerts are critical concerns for surgeons performing spinal deformity corrective surgeries, as they indicate a heighteded risk of postoperative neurological deficits. Previous studies have demonstrated that patients with large Cobb angle or elevated deformity angular ratio (DAR) are at an increased risk of IONM alerts. However, spinal curves with similar Cobb angles and DARs may exhibit significantly different risks of IONM alerts during surgery. Current methods for evaluating spinal deformity fail to comprehensively and accurately reflect its severity. The purpose of this study was to investigate whether the deformity angular distance ratio (DADR) serves as an independent predictor of IONM alerts during corrective surgery for spinal deformity.</p><p><strong>Methods: </strong>This study analyzed a consecutive series of 404 patients undergoing corrective surgery at a single academic center. Preoperative radiographs were used to calculate the DAR and DADR. Twelve clinically relevant candidate variables were selected for univariable analysis. Multivariable logistic regression analysis was then conducted to identify independent predictors of IONM alerts.</p><p><strong>Results: </strong>The incidence of IONM alerts in this cohort was 25.2%. Univariable analysis identified several factors potentially associated with IONM alerts, including older age, type-III spinal cord morphology, location of apex, etiological diagnosis, preoperative sagittal Cobb angle, sagittal DAR, sagittal DADR, coronal DADR, total DAR, total DADR, three-column osteotomy, and preoperative neurological deficits. Multivariable analysis revealed that an apex location at C7-T4, preoperative neurological deficits, sagittal DADR, and total DADR were independent predictors of IONM alerts.</p><p><strong>Conclusions: </strong>Among patients undergoing corrective surgeries for spinal deformities, the DADR is a robust measure of spinal deformity severity and is strongly correlated with the risk of IONM alerts. Compared to other deformity parameters, DADR is an independent predictor of IONM alerts. Additional independent predictors include the location of the apex and the presence of preoperative neurological deficits.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"305"},"PeriodicalIF":2.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}