Spine Journal最新文献_第10页

Adipokine dysregulation as an underlying pathology for diffuse ectopic ossification of spinal posterior longitudinal ligament in patients with obesity 肥胖症患者脊柱后纵韧带弥漫性异位骨化的潜在病理机制是脂肪因子失调。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.09.023

Masahiko Takahata MD , Yoshinao Koike MD , Tsutomu Endo MD , Shiro Ikegawa MD, PhD , Shiro Imagama MD , Satoshi Kato MD , Masahiro Kanayama MD , Kazuyoshi Kobayashi MD , Takashi Kaito MD , Hiroaki Sakai MD , Yoshiharu Kawaguchi MD , Itaru Oda MD , Chikashi Terao MD , Tomoya Kanto , Hiroshi Taneichi MD , Norimasa Iwasaki MD

BACKGROUND CONTEXT

Growing evidence suggests that obesity is implicated in the progression of heterotopic ossification of the posterior longitudinal ligament of the spine (OPLL), a major cause of myelopathy in Asians. However, it remains unclear whether dysregulation of adipokine production due to fat accumulation contributes to OPLL progression.

PURPOSE

To determine whether adipose-derived biochemical signals are associated with OPLL development or severity.

STUDY DESIGN/SETTING

A nationwide, multicenter, case-control study.

PATIENT SAMPLE

Patients with symptomatic thoracic OPLL (T-OPLL) who received treatment between June 2017 and March 2021 and 111 controls without OPLL.

OUTCOME MEASURES

OPLL severity index based on whole-spine computed tomography.

METHODS

Serum concentrations of adipokines, including leptin (Lep), tumor necrosis factor α (TNFα), and adiponectin (Adpn), as well as the Adpn/Lep ratio—an indicator of adipokine production dysregulation—were compared between the multiple-region OPLL and the single-region OPLL groups. Regression analysis was performed to examine the correlation between adipokine concentrations and OPLL severity index, which was calculated using whole-spine computed tomography images of 77 patients with T-OPLL within 3 years of onset. Using propensity score matching, the adipokine profiles of 59 patients with T-OPLL were compared with those of 59 non-OPLL controls.

RESULTS

Patients with multiple-region OPLL exhibited a higher body mass index (BMI), lower serum Adpn/Lep ratio, and higher serum concentration of osteocalcin (OCN) than those with single-region OPLL. The OPLL severity index exhibited a weak positive correlation with BMI and serum Lep levels and a weak negative correlation with the Adpn/Lep ratio. Serum TNFα and OCN concentrations were significantly higher in patients with T-OPLL than in controls with similar age, sex, and BMI.

CONCLUSIONS

Patients with diffuse OPLL over the entire spine are often metabolically obese with low Adpn/Lep ratios. In patients with OPLL, TNFα and OCN serum concentrations were essentially elevated regardless of obesity, suggesting a potential association with OPLL development. Considering the absence of therapeutic drugs for OPLL, the findings presented herein offer valuable insights that can aid in identifying therapeutic targets and formulating strategies to impede its progression.

背景情况：越来越多的证据表明，肥胖与脊柱后纵韧带异位骨化（OPLL）的进展有关，OPLL是亚洲人脊髓病的一个主要原因。目的：确定脂肪衍生的生化信号是否与 OPLL 的发展或严重程度有关：患者样本：2017年6月至2021年3月期间接受治疗的有症状胸部OPLL（T-OPLL）患者和111名无OPLL的对照组：基于全脊柱计算机断层扫描的OPLL严重程度指数：比较多区域OPLL组和单区域OPLL组血清中脂肪因子的浓度，包括瘦素（Lep）、肿瘤坏死因子α（TNFα）和脂肪连蛋白（Adpn），以及Adpn/Lep比值（脂肪因子分泌失调的指标）。对 77 名发病 3 年内的 T-OPLL 患者的全脊柱计算机断层扫描图像计算出的 OPLL 严重程度指数进行了回归分析，以检验脂肪因子浓度与 OPLL 严重程度指数之间的相关性。采用倾向得分匹配法，将 59 名 T-OPLL 患者的脂肪因子谱与 59 名非 OPLL 对照组的脂肪因子谱进行了比较：结果：与单区域 OPLL 患者相比，多区域 OPLL 患者的体重指数（BMI）较高，血清 Adpn/Lep 比率较低，血清骨钙素（OCN）浓度较高。OPLL 严重程度指数与 BMI 和血清 Lep 水平呈弱正相关，与 Adpn/Lep 比率呈弱负相关。T-OPLL患者的血清TNFα和OCN浓度明显高于年龄、性别和体重指数相似的对照组：结论：整个脊柱弥漫性OPLL患者通常代谢肥胖，Adpn/Lep比率较低。在 OPLL 患者中，无论肥胖与否，TNFα 和 OCN 的血清浓度基本上都会升高，这表明它们与 OPLL 的发展可能有关。考虑到目前还没有治疗 OPLL 的药物，本文的研究结果提供了有价值的见解，有助于确定治疗目标和制定策略以阻止其发展。

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引用次数: 0

Combined single-cell RNA sequencing and mendelian randomization to identify biomarkers associated with necrotic apoptosis in intervertebral disc degeneration 结合单细胞 RNA 测序和门德尔随机化技术，确定与椎间盘退变中坏死凋亡相关的生物标记物。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.09.011

Yi Ye, Lun Wan, Jiang Hu, Xiaoxue Li, Kun Zhang

<div><h3>BACKGROUND</h3><div>Intervertebral disc degeneration (IDD) is associated with back pain; back pain is a world-wide contributor to poor quality of life, while necroptosis has the characteristics of necroptosis and apoptosis, however, its role in IDD is still unclear. Therefore, the aim of this study was to identify biomarkers associated with necroptosis in IDD.</div></div><div><h3>PURPOSE</h3><div>To explore biomarkers associated with necroptosis in IDD, reveal the pathogenesis of IDD, as well as provide new directions for the diagnosis and treatment of this disease.</div></div><div><h3>STUDY DESIGN/SETTINGS</h3><div>Retrospective cohort study. Our study employs scRNA-seq coupled with MR analysis to investigate the causal relationship between necroptosis and IDD, laying a foundational groundwork for unveiling the intricate pathogenic mechanisms of this condition.</div></div><div><h3>METHODS</h3><div>Data quality control and normalisation was executed in single-cell dataset, GSE205535. Then, different cell types were obtained by cell annotation through marker genes. Subsequently, chi-square test was employed to assess the distribution difference of different cell types between IDD and control to screen key cells. AUCell was applied to calculate necroptosis-related genes (NRGs) scores of all cell types, further key cells were divided into high and low NRGs groups according to the median AUC scores of different cell types. Afterwards, the differentially expressed genes (DEGs) within the 2 score groups were screened. Then, the genes that had causal relationship with IDD were selected as biomarkers by univariate and multivariate Mendelian randomization (MR) analysis. Finally, the expression of biomarkers in different cell types and pseudo-time analysis was analyzed separately.</div></div><div><h3>RESULTS</h3><div>In GSE205535, 16 different cell populations identified by UMAP cluster analysis were further annotated to 8 cell types using maker genes. Afterwards, 53 DEGs were screened between the high and low NRGs groups. In addition, 9 genes with causal relationship with IDD were obtained by univariate MR analysis, further multivariate MR analysis proved that <em>NT5E</em> and <em>TMEM158</em> had a direct causal relationship with IDD, which were used as biomarkers in this study. This study not only found that the expression levels of <em>NT5E</em> and <em>TMEM158</em> were higher in IDD group, but also found that fibrochondrocytes and inflammatory chondrocytes were the key cells of <em>NT5E</em> and <em>TMEM158</em>, respectively. In the end, the biomarkers had the same expression trend in the quasi-time series, and both of them from high to low and then increased.</div></div><div><h3>CONCLUSIONS</h3><div><em>NT5E</em> and <em>TMEM158</em>, as biomarkers of necroptotic apoptotic IDD, were causally associated with IDD.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>The understanding of chondrocytes as key cells provides new perspectives for

背景：椎间盘退变（IDD）与背痛有关；背痛是导致生活质量下降的一个世界性因素，而坏死具有坏死和凋亡的特征，但其在IDD中的作用仍不清楚。因此，本研究旨在确定与IDD坏死相关的生物标志物。目的：探讨与IDD坏死相关的生物标志物，揭示IDD的发病机制，并为该病的诊断和治疗提供新的方向：回顾性队列研究。我们的研究采用scRNA-seq与MR分析相结合的方法，探讨坏死细胞增多症与IDD之间的因果关系，为揭示该病错综复杂的发病机制奠定基础：方法：在单细胞数据集 GSE205535 中进行数据质量控制和归一化。然后，通过标记基因进行细胞注释，得到不同的细胞类型。然后，采用卡方检验评估IDD和对照组不同细胞类型的分布差异，筛选出关键细胞。应用AUCell计算所有细胞类型的坏死相关基因（NRGs）得分，再根据不同细胞类型的AUC得分中位数将关键细胞分为高NRGs组和低NRGs组。然后，筛选两组中的差异表达基因（DEG）。然后，通过单变量和多变量孟德尔随机化（MR）分析，筛选出与IDD有因果关系的基因作为生物标志物。最后，分别分析了生物标志物在不同细胞类型中的表达情况和伪时间分析：结果：在 GSE205535 中，通过 UMAP 聚类分析确定了 16 种不同的细胞群，并使用 maker 基因将其进一步注释为 8 种细胞类型。随后，在高 NRGs 组和低 NRGs 组之间筛选出 53 个 DEGs。此外，通过单变量磁共振分析得到了9个与IDD有因果关系的基因，进一步的多变量磁共振分析证明，NT5E和TMEM158与IDD有直接因果关系，本研究将这两个基因作为生物标记物。本研究不仅发现 IDD 组中 NT5E 和 TMEM158 的表达水平较高，还发现纤维软骨细胞和炎性软骨细胞分别是 NT5E 和 TMEM158 的关键细胞。最后，这两个生物标志物在准时间序列中的表达趋势相同，都是由高到低，然后再升高：结论：NT5E和TMEM158作为IDD坏死凋亡的生物标志物，与IDD存在因果关系：对软骨细胞作为关键细胞的认识为深入阐明 IDD 的发病机制、改进诊断方法和开发更有效的治疗方法提供了新的视角。这些发现有望为临床诊断和治疗提供更准确和个性化的方法，从而改善 IDD 患者的预后和生活质量。

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引用次数: 0

The epidemiology of recreation-related cervical and thoracic fractures 与娱乐相关的颈椎和胸椎骨折的流行病学。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.09.027

Michael J. Kuharski BS, Mariah Balmaceno-Criss BS, Ali Mansour BS, Akash Nadella BS, Kathleen Meininger BS, Mary Lou BS, Mohammad Daher BS, Daniel Alsoof MD, Bassel G. Diebo MD, Alan H. Daniels MD

<div><h3>CONTEXT</h3><div>Recreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking.</div></div><div><h3>PURPOSE</h3><div>To characterize cervical and thoracic fractures associated with recreational activities.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>The National Electronic Injury Surveillance System (NEISS) database.</div></div><div><h3>OUTCOME MEASURE AND COMPARISONS</h3><div>Recreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics.</div></div><div><h3>METHODS</h3><div>The NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity.</div></div><div><h3>RESULTS</h3><div>Between 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38–3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18–64 (95% CI 1.85–2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68–2.22). Recreation-related cervical fracture rates in individuals 18–64 was 1.186 (95% CI 1.14–1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09–1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18–64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%).</div></div><div><h3>CONCLUSIONS</h3><div>This investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football.</div></div><div><h

背景：研究设计/设置：回顾性队列研究：研究设计/设置：回顾性队列研究：患者样本：全国电子伤害监测系统（NEISS）数据库：每年与娱乐相关的颈椎和胸部骨折发病率，按年龄和性别进行分层。通过人口统计学确定常见的致病活动：方法：通过查询 NEISS 数据库，找出 2003 年至 2022 年间与娱乐相关的颈椎骨折患者，以及 2003 年至 2022 年间与娱乐相关的胸椎骨折患者（年龄大于 2 岁）。利用美国人口普查数据生成每年的发病率。根据人口统计学变量对数据进行分层，以评估年龄和性别对发病率和致病活动的影响：2003年至2022年期间，估计有13,823例与娱乐相关的颈椎骨折，平均年发病率为每百万人年2.20±0.35例；2003年至2022年期间，估计有24,236例与娱乐相关的胸部骨折，平均发病率为3.85±1.26例。男性颈椎骨折的发生率是男性的 3.51 倍（95% CI 3.38-3.66），但胸部骨折的发生率在性别上相似。18 岁以下人群的胸部骨折率是 18-64 岁人群的 2.15 倍（95% CI 1.85-2.50），是 65 岁以上人群的 1.93 倍（95% CI 1.68-2.22）。与娱乐相关的颈椎骨折发生率，18-64 岁人群是 18 岁以下人群的 1.186 倍（95% CI 1.14-1.23），18 岁以下人群是 65 岁以上人群的 1.15 倍（95% CI 1.09-1.22）。足球（26.6%）、骑马（19.7%）和滑雪（8.35%）是造成颈椎骨折的主要原因，而骑马（46.8%）、足球（11.2%）和滑雪（10.3%）则是造成胸椎骨折的主要原因。男性颈椎骨折的主要原因是足球（24.7%），女性颈椎骨折的主要原因是骑马（44.0%）。骑马主要导致男性和女性胸椎骨折（男性=21.5%，女性=74.7%）。足球是 18 岁以下人群的主要致病活动（颈椎=42.4%，胸椎=40.7%），而骑马则是 18-64 岁人群（26.7%，56.7%）和 65 岁以上人群（52.8%，67.9%）的主要致病活动：这项调查揭示了颈椎和胸椎骨折的流行病学趋势，强调有必要采取有针对性的预防措施和安全干预措施，以减轻这些骨折造成的负担，尤其是在骑马和美式橄榄球运动中。

{"title":"The epidemiology of recreation-related cervical and thoracic fractures","authors":"Michael J. Kuharski BS, Mariah Balmaceno-Criss BS, Ali Mansour BS, Akash Nadella BS, Kathleen Meininger BS, Mary Lou BS, Mohammad Daher BS, Daniel Alsoof MD, Bassel G. Diebo MD, Alan H. Daniels MD","doi":"10.1016/j.spinee.2024.09.027","DOIUrl":"10.1016/j.spinee.2024.09.027","url":null,"abstract":"<div><h3>CONTEXT</h3><div>Recreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking.</div></div><div><h3>PURPOSE</h3><div>To characterize cervical and thoracic fractures associated with recreational activities.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>Retrospective cohort study.</div></div><div><h3>PATIENT SAMPLE</h3><div>The National Electronic Injury Surveillance System (NEISS) database.</div></div><div><h3>OUTCOME MEASURE AND COMPARISONS</h3><div>Recreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics.</div></div><div><h3>METHODS</h3><div>The NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity.</div></div><div><h3>RESULTS</h3><div>Between 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38–3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18–64 (95% CI 1.85–2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68–2.22). Recreation-related cervical fracture rates in individuals 18–64 was 1.186 (95% CI 1.14–1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09–1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18–64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%).</div></div><div><h3>CONCLUSIONS</h3><div>This investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football.</div></div><div><h","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 136-144"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increasing venture capital investment in spinal surgery: an analysis of investments from 2000 to 2023 增加脊柱外科风险投资：对 2000 年至 2023 年投资的分析。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.09.014

Ravi Dhawan MS , Alex B. Boyle MBChB, MPH , Akshay Nair BS , Denys Shay MD

BACKGROUND CONTEXT

Venture capital (VC) plays a vital role in advancing spinal surgery technologies, driven by the growing burden of spinal disorders and high healthcare costs. Despite increasing interest, trends in VC funding for spinal surgery remain understudied.

PURPOSE

This study aimed to examine temporal and thematic trends in VC investments in spinal surgery companies from 2000 to 2023.

STUDY DESIGN/SETTING

A retrospective cross-sectional study analyzing VC investment trends in privately held US-based spinal surgery companies.

METHODS

Using the PitchBook database, we analyzed 1001 VC investments in 227 spinal surgery companies between 2000 and 2023. Investments were categorized into surgical devices, noninvasive devices, biotechnology, surgical software, and clinical services. Total and annual investments were quantified in USD.

RESULTS

From 2000 to 2023, $5.37 billion was invested in spine surgery, with nonsurgical devices receiving the largest share (42.6%), followed by surgical devices (26.3%) and biotechnology (22.2%). Annual investment increased by 1782%, with a decline in 2023 likely due to macroeconomic factors.

CONCLUSIONS

VC funding in spinal surgery has grown significantly, especially in noninvasive technologies. Further research is needed to assess the long-term impact of these investments and explore alternative financing models.

背景情况：风险投资（VC）在推动脊柱外科技术发展方面发挥着至关重要的作用，而脊柱疾病和高昂的医疗费用则是推动这一发展的主要因素。目的：本研究旨在探讨 2000 年至 2023 年风险投资在脊柱外科公司投资的时间和主题趋势：一项回顾性横断面研究，分析美国私人控股脊柱外科公司的风险投资趋势：利用PitchBook数据库，我们分析了2000年至2023年期间对227家脊柱外科公司的1001笔风险投资。投资分为手术器械、无创器械、生物技术、手术软件和临床服务。投资总额和年投资额以美元为单位：从 2000 年到 2023 年，脊柱外科的投资额为 53.7 亿美元，其中非手术设备所占份额最大（42.6%），其次是手术设备（26.3%）和生物技术（22.2%）。年投资额增长了1782%，2023年可能因宏观经济因素而有所下降：脊柱外科领域的风险投资大幅增长，尤其是在无创技术方面。需要进一步研究以评估这些投资的长期影响，并探索其他融资模式。

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引用次数: 0

2024 NASS Presidential Address: Empathy vs Efficiency in the age of AI in spine care 2024 NASS 主席致辞：脊柱护理领域人工智能时代的同理心与效率。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.10.002

Zoher Ghogawala MD

引用次数: 0

Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography 利用三维计算机断层扫描评估后纵韧带病变骨化间隙的重要性。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.08.030

Hazem Alaa , Nguyen Tran Canh Tung MD, PhD , Tomoya Ueno , Hiroto Makino MD, PhD , Hayato Futakawa MD , Shoji Seki MD, PhD , Yoshiharu Kawaguchi MD, PhD

BACKGROUND CONTEXT

Evaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging.

OBJECTIVE

This study aimed to investigate the importance of evaluating gaps using 3-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Retrospective analysis of 116 patients diagnosed with cervical OPLL.

OUTCOME MEASURES

Presence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated.

METHODS

Lateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined.

RESULTS

A significant difference in gap detection accuracy was observed between CT and 3D-CT (p=.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p=.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps cooccurring with T2 high intensity exhibited significantly thinner lesions (p=.011) and larger SACs (p=.0002). Patients with gaps had a significantly lower JOA scores (p=.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms.

CONCLUSIONS

3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.

本研究旨在探讨使用三维计算机断层扫描（3D-CT）评估间隙的重要性及其与脊髓磁共振成像（MRI）T2高强度的关联。研究设计/背景回顾性队列研究.患者样本回顾性分析了116例确诊为颈椎OPLL的患者.结果测量评估了OPLL中是否存在间隙、颈椎脊髓中是否存在T2高强度以及OPLL的厚度.方法回顾侧位X光片、CT和重建的3D-CT图像，以评估病变特征和间隙的存在。核磁共振成像用于评估脊髓信号强度的变化。结果观察到 CT 和 3D-CT 在间隙检测准确性上存在显著差异（p = 0.0054）。与 3D-CT 相比，CT 在检测间隙方面显示出假阳性结果。间隙的存在与脊髓 MRI T2 高强度的可能性增加明显相关（p = 0.037）。病变较厚且脊髓可用空间较小的患者（SAC）更有可能出现 T2 高强度。与此同时，与 T2 高强度同时出现间隙的患者的病灶明显较薄（p = 0.011），SAC 较大（p = 0.0002）。有间隙的患者 JOA 评分明显较低（p = 0.0035），这表明有间隙的患者可能表现出更严重的临床神经症状。此外，间隙的存在是脊髓 MRI T2 高强度的危险因素，与病变厚度无关。此外，间隙还与更严重的临床症状有关。这项研究强调了使用 3D-CT 评估 OPLL 病变内间隙对明确神经系统发病机制的重要性。

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引用次数: 0

Machine learning in the diagnosis, management, and care of patients with low back pain: a scoping review of the literature and future directions 机器学习在腰背痛患者诊断、管理和护理中的应用：文献综述与未来方向》（Machine Learning in the Diagnosis, Management, and Care of Patients with Low Back Pain: A Scoping Review of the Literature and Future Directions.

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.09.010

Andreas Seas BSE , Tanner J. Zachem BSE , Bruno Valan ME , Christine Goertz PhD , Shiva Nischal MB, BChir, BA (Cantab), BSc (Hons) , Sully F. Chen BS , David Sykes MD , Troy Q. Tabarestani BS , Benjamin D. Wissel MD , Elizabeth R. Blackwood MS, BA , Christopher Holland MD, PhD , Oren Gottfried MD , Christopher I. Shaffrey MD , Muhammad M. Abd-El-Barr MD, PhD

BACKGROUND CONTEXT

Low back pain (LBP) remains the leading cause of disability globally. In recent years, machine learning (ML) has emerged as a potentially useful tool to aid the diagnosis, management, and prognostication of LBP.

PURPOSE

In this review, we assess the scope of ML applications in the LBP literature and outline gaps and opportunities.

STUDY DESIGN/SETTING

A scoping review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

METHODS

Articles were extracted from the Web of Science, Scopus, PubMed, and IEEE Xplore databases. Title/abstract and full-text screening was performed by two reviewers. Data on model type, model inputs, predicted outcomes, and ML methods were collected.

RESULTS

In total, 223 unique studies published between 1988 and 2023 were identified, with just over 50% focused on low-back-pain detection. Neural networks were used in 106 of these articles. Common inputs included patient history, demographics, and lab values (67% total). Articles published after 2010 were also likely to incorporate imaging data into their models (41.7% of articles). Of the 212 supervised learning articles identified, 168 (79.4%) mentioned use of a training or testing dataset, 116 (54.7%) utilized cross-validation, and 46 (21.7%) implemented hyperparameter optimization. Of all articles, only 8 included external validation and 9 had publicly available code.

CONCLUSIONS

Despite the rapid application of ML in LBP research, a majority of articles do not follow standard ML best practices. Furthermore, over 95% of articles cannot be reproduced or authenticated due to lack of code availability. Increased collaboration and code sharing are needed to support future growth and implementation of ML in the care of patients with LBP.

背景情况：腰背痛（LBP）仍然是全球致残的主要原因。近年来，机器学习（ML）已成为辅助腰背痛诊断、管理和预后的潜在有用工具。目的：在本综述中，我们评估了ML在腰背痛文献中的应用范围，并概述了差距和机遇：研究设计/背景：根据《系统综述和荟萃分析的首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews，PRISMA-ScR）指南进行了范围界定综述：从 Web of Science、Scopus、PubMed 和 IEEE Xplore 数据库中提取文章。由两名审稿人对文章标题/摘要和全文进行筛选。收集了有关模型类型、模型输入、预测结果和 ML 方法的数据：结果：总共发现了 223 项发表于 1988-2023 年间的独特研究，其中略高于 50%的研究侧重于低背痛检测。其中 106 篇文章使用了神经网络。常见的输入包括患者病史、人口统计学和化验值（共占 67%）。2010 年之后发表的文章也有可能将成像数据纳入其模型中（41.7% 的文章）。在确定的 212 篇监督学习文章中，168 篇（79.4%）提到使用了训练或测试数据集，116 篇（54.7%）使用了交叉验证，46 篇（21.7%）实施了超参数优化。在所有文章中，只有 8 篇文章包含外部验证，9 篇文章有公开代码：尽管人工智能在枸杞多糖研究中应用迅速，但大多数文章并没有遵循标准的人工智能最佳实践。此外，由于缺乏可用代码，超过 95% 的文章无法复制或验证。需要加强合作和代码共享，以支持ML在枸杞多糖症患者护理中的未来发展和实施。

{"title":"Machine learning in the diagnosis, management, and care of patients with low back pain: a scoping review of the literature and future directions","authors":"Andreas Seas BSE , Tanner J. Zachem BSE , Bruno Valan ME , Christine Goertz PhD , Shiva Nischal MB, BChir, BA (Cantab), BSc (Hons) , Sully F. Chen BS , David Sykes MD , Troy Q. Tabarestani BS , Benjamin D. Wissel MD , Elizabeth R. Blackwood MS, BA , Christopher Holland MD, PhD , Oren Gottfried MD , Christopher I. Shaffrey MD , Muhammad M. Abd-El-Barr MD, PhD","doi":"10.1016/j.spinee.2024.09.010","DOIUrl":"10.1016/j.spinee.2024.09.010","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Low back pain (LBP) remains the leading cause of disability globally. In recent years, machine learning (ML) has emerged as a potentially useful tool to aid the diagnosis, management, and prognostication of LBP.</div></div><div><h3>PURPOSE</h3><div>In this review, we assess the scope of ML applications in the LBP literature and outline gaps and opportunities.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A scoping review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.</div></div><div><h3>METHODS</h3><div>Articles were extracted from the Web of Science, Scopus, PubMed, and IEEE Xplore databases. Title/abstract and full-text screening was performed by two reviewers. Data on model type, model inputs, predicted outcomes, and ML methods were collected.</div></div><div><h3>RESULTS</h3><div>In total, 223 unique studies published between 1988 and 2023 were identified, with just over 50% focused on low-back-pain detection. Neural networks were used in 106 of these articles. Common inputs included patient history, demographics, and lab values (67% total). Articles published after 2010 were also likely to incorporate imaging data into their models (41.7% of articles). Of the 212 supervised learning articles identified, 168 (79.4%) mentioned use of a training or testing dataset, 116 (54.7%) utilized cross-validation, and 46 (21.7%) implemented hyperparameter optimization. Of all articles, only 8 included external validation and 9 had publicly available code.</div></div><div><h3>CONCLUSIONS</h3><div>Despite the rapid application of ML in LBP research, a majority of articles do not follow standard ML best practices. Furthermore, over 95% of articles cannot be reproduced or authenticated due to lack of code availability. Increased collaboration and code sharing are needed to support future growth and implementation of ML in the care of patients with LBP.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 18-31"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Senolytics cocktail dasatinib and quercetin alleviate chondrocyte senescence and facet joint osteoarthritis in mice 衰老剂鸡尾酒达沙替尼和槲皮素可缓解小鼠软骨细胞衰老和面关节骨关节炎。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2025-01-01 DOI: 10.1016/j.spinee.2024.09.017

Jinyun Zhao MD , Lifu Zheng MD , Guoyu Dai MD , Yi Sun MD , Rundong He MD , Zhide Liu MD , Yuxin Jin MD , Tianding Wu MD , Jianzhong Hu MD , Yong Cao MD , Chunyue Duan MD

<div><h3>BACKGROUND CONTEXT</h3><div>Low back pain (LBP) is a pervasive issue, causing substantial economic burden and physical distress worldwide. Facet joint osteoarthritis (FJ OA) is believed to be a significant contributor to this problem. However, the precise role of chondrocyte senescence in FJ OA remains unclear, as does whether the clearance of chondrocyte senescence can alleviate the progression of FJ OA.</div></div><div><h3>PURPOSE</h3><div>The goal of this study was to understand the potential of Dasatinib (D) and Quercetin (Q) as a treatment to clear chondrocyte senescence during the progression of FJ OA.</div></div><div><h3>STUDY DESIGN</h3><div>We used a preclinical bipedal standing mice model with the administration of Dasatinib (D) (5 mg/kg) and Quercetin (Q) (50 mg/kg) after 10 weeks of bipedal standing.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Human degenerative lumbar facet joint (LFJ) samples were obtained to investigate the relationship between chondrocyte cellular senescence and LFJ osteoarthritis (OA). Subsequently, we established an in vitro model of excessive mechanical stress on chondrocytes and an in vivo bipedal standing mice model to induce LFJ OA. IHC (immunohistochemistry) staining in vivo and SA-β-gal staining, qRT-PCR and Western blot analysis were applied to test the senolytic effect of the combination of Dasatinib (D) and Quercetin (Q). IHC staining and X-ray microscope were also performed to examine the contribution of D+Q to the anabolism in cartilage and subchondral bone recoupling. Immunofluorescence and Western blot analysis in vitro and IHC staining in vivo were conducted to assess the impact of D+Q on the regulation of the NF-κB pathway activation during chondrocyte senescence.</div></div><div><h3>RESULTS</h3><div>We observed that facet joint cartilage degeneration is associated with chondrocyte cellular senescence in both human and mouse degenerative samples. Following treatment with D+Q in vitro, cellular senescence was significantly reduced. Upon oral gavage administration of D+Q in the bipedal standing mice model, decreased cellular senescence and reversed chondrocyte anabolism were observed. Furthermore, administration of D+Q maintained subchondral bone remodeling homeostasis and potentially reversed the activation of the NF-κB pathway in chondrocytes of the lumbar facet joint.</div></div><div><h3>CONCLUSIONS</h3><div>In summary, our investigation unveiled a significant correlation between chondrocyte senescence and LFJOA. Treatment with the senolytic combination of D+Q in FJ OA yielded a notable reduction in chondrocyte senescence, along with a decrease in the release of SASP factors. Additionally, it facilitated the promotion of cartilage anabolism, maintenance of subchondral bone coupling, and amelioration of NF-κB pathway activation.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>Our outcomes revealed that D+Q, the renowned combination used for senolytic treatment, alleviate the pro

背景情况：腰背痛（LBP）是一个普遍存在的问题，在全球范围内造成了巨大的经济负担和身体痛苦。面关节骨关节炎（FJ OA）被认为是造成这一问题的重要原因。目的：本研究旨在了解达沙替尼（D）和槲皮素（Q）作为一种治疗方法在FJ OA进展过程中清除软骨细胞衰老的潜力：研究设计：我们采用临床前双足站立小鼠模型，在小鼠双足站立10周后给予达沙替尼（D）（5 mg/kg）和槲皮素（Q）（50 mg/kg）。材料与方法：我们获得了人类退行性腰椎面关节（LFJ）样本，以研究软骨细胞衰老与LFJ骨关节炎（OA）之间的关系。随后，我们建立了软骨细胞过度机械应力体外模型和体内双足站立小鼠模型，以诱导 LFJ OA。应用体内 IHC（免疫组化）染色、SA-β-gal 染色、qRT-PCR 和 Western 印迹分析来检验达沙替尼（D）和槲皮素（Q）联合应用的衰老作用。此外，还通过IHC染色和X射线显微镜检查了D+Q对软骨和软骨下骨再结合中合成代谢的贡献。在体外进行免疫荧光和 Western 印迹分析，在体内进行 IHC 染色，以评估 D+Q 对软骨细胞衰老过程中 NF-κB 通路激活调控的影响：结果：我们观察到，在人类和小鼠退行性样本中，面关节软骨退变与软骨细胞衰老有关。在体外用 D+Q 处理后，细胞衰老明显减少。在双足站立小鼠模型中口服 D+Q 后，观察到细胞衰老减少，软骨细胞合成代谢逆转。此外，D+Q还能维持软骨下骨重塑的平衡，并有可能逆转腰椎关节软骨细胞中NF-κB通路的激活：总之，我们的研究揭示了软骨细胞衰老与 LFJOA 之间的显著相关性。在 FJ OA 中使用 D+Q 组合溶解剂治疗可显著减少软骨细胞的衰老，同时减少 SASP 因子的释放。此外，它还有助于促进软骨合成代谢、维持软骨下骨耦合以及改善 NF-κB 通路的激活：临床意义：我们的研究结果表明，D+Q这种著名的解痉治疗组合能缓解LFJ OA的恶化。D+Q作为一种解毒剂，为LFJ OA的治疗提供了一种新颖而有前景的选择。

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引用次数: 0

Postsurgical outcomes differ according to baseline sagittal alignment status even in patients achieving adequate correction relative to age-adjusted alignment target for adult spinal deformity. 根据基线矢状面对齐状态的不同，即使患者相对于年龄调整的成人脊柱畸形对齐目标获得了足够的矫正，术后结果也会有所不同。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2024-12-18 DOI: 10.1016/j.spinee.2024.12.024

Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee

Background context: Baseline severities of sagittal malalignment and degrees of pelvic compensation may affect postsurgical outcomes differently after adult spinal deformity (ASD) surgery, even if the patients achieved optimal correction of sagittal malalignment.

Purpose: To investigate whether postsurgical outcomes vary according to baseline sagittal alignment and pelvic compensation status in patients achieving adequate correction relative to age-adjusted alignment target in ASD surgery.

Study design/setting: Retrospective study PATIENT SAMPLE: Patients who underwent ≥ 5-level fusion to the pelvis for ASD; achieved matched correction relative to age-adjusted pelvic incidence (PI)-lumbar lordosis (LL); and completed ≥ 2-year follow-up.

Outcome measures: Radiographic results, mechanical failures, and clinical outcomes METHODS: Patients were divided into three groups based on baseline sagittal vertical axis (SVA) and pelvic tilt (PT)/PI ratio (median value of PT/PI ratio = 0.61): Group A (SVA < 5 cm), Group B (SVA ≥ 5 cm and PT/PI ratio <0.61, and Group C (SVA ≥ 5 cm and PT/PI ratio ≥ 0.61). Radiographic results, mechanical failures, and clinical outcomes were compared among the three groups.

Results: A total of 153 patients were included in the study. They were predominantly female (89.5%), with a mean age of 68.3 years. The mean follow-up duration was 49.0 months. There were 50 patients in group A (SVA < 5cm), 53 in group B (SVA ≥ 5cm and low PT/PI), and 50 in group C (SVA ≥ 5cm and high PT/PI). No significant differences were observed in all radiographic parameters at six weeks. At the last follow-up, the PI-LL was comparable among the three groups; however, the SVA was significantly greater in groups B and C than in group A (46.5mm and 46.9mm vs. 31.5mm, p=.039). The PT at the last follow-up was significantly lower in group B than in group A and C (22.4° vs. 26.0° and 28.2°, respectively, p=.001). The rates of mechanical failure and subsequent revision surgery and did not differ among the groups. The final clinical outcomes were comparable among the three groups.

Conclusions: This study revealed that patients in groups B and C were likely to have a suboptimal sagittal alignment status at the last follow-up compared with those in group A. Tailored approaches considering patient's baseline alignment and compensatory status are recommended to optimize the final sagittal alignment status.

背景背景：成人脊柱畸形（ASD）手术后，即使患者对矢状面畸形进行了最佳矫正，矢状面畸形的基线严重程度和骨盆代偿程度也可能对术后结果产生不同的影响。目的：探讨在ASD手术中，相对于年龄调整的对齐目标，获得足够矫正的患者的基线矢状面对齐和骨盆代偿状态是否会影响术后结果。研究设计/设置：回顾性研究患者样本：接受≥5节段骨盆融合治疗ASD的患者；实现了与年龄调整骨盆发生率(PI)-腰椎前凸（LL）相匹配的矫正；并完成≥2年的随访。方法：根据基线矢状垂直轴（SVA）和骨盆倾斜(PT)/PI比值（PT /PI比值中位数 = 0.61）将患者分为三组：A组（SVA < 5 cm）， B组（SVA≥5 cm）和PT/PI比值结果：共纳入153例患者。以女性为主（89.5%），平均年龄68.3岁。平均随访时间49.0个月。A组（SVA < 5cm） 50例，B组（SVA≥5cm， PT/PI低）53例，C组（SVA≥5cm， PT/PI高）50例。6周时，所有影像学参数均无显著差异。最后一次随访时，三组间PI-LL具有可比性；但B组和C组SVA明显大于A组（46.5mm和46.9mm vs. 31.5mm, P = 0.039）。最后一次随访时，B组PT明显低于A组和C组（分别为22.4°比26.0°和28.2°，P = 0.001）。机械故障和随后的翻修手术的发生率在两组之间没有差异。三组的最终临床结果具有可比性。结论：本研究显示，与a组患者相比，B组和C组患者在最后一次随访时矢状面对齐状态可能不理想。建议根据患者的基线对齐和代偿状态量身定制方法来优化最终矢状面对齐状态。

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引用次数: 0

Effect of romosozumab administration on proximal junctional kyphosis in corrective spinal fusion surgery. 罗莫索单抗治疗矫正脊柱融合术中近端关节后凸的疗效。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal

Pub Date : 2024-12-18 DOI: 10.1016/j.spinee.2024.12.021

Yuta Sawada, Shinji Takahashi, Hiroyuki Yasuda, Masaki Terakawa, Sadahiko Konishi, Minori Kato, Hiromitsu Toyoda, Akinobu Suzuki, Koji Tamai, Masayoshi Iwamae, Yuki Okamura, Yuto Kobayashi, Hiroaki Nakamura, Hidetomi Terai

Background context: The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed.

Purpose: To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery.

Design: Retrospective cohort study PATIENT SAMPLE: A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023.

Outcome measures: The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores.

Methods: The patients were divided into the romosozumab (n=32) and non-romosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK.

Results: Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs. 13.60%, p<0.001) and reduced the incidence of PJK (39.24% vs. 18.75%, p=0.046), particularly PJK-Fx (26.58% vs. 6.25%, p=0.019) and osteoporosis-related complications (55.70% vs. 34.38%, p=0.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=0.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=0.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs. 23.62, p=0.071).

Conclusion: Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.

背景背景：romosozumab给药对脊柱矫正融合手术患者的影响尚未分析。目的：研究romosozumab在脊柱矫正融合手术患者中降低近端交界性后凸（PJK）发生率的作用，特别是骨折引起的PJK （PJK- fx）。设计：回顾性队列研究患者样本：在2010年6月至2023年7月期间，共有111例年龄> - 50岁的患者因成人脊柱畸形或椎体压缩性骨折接受了矫正融合手术（> - 2椎体）。结果测量：主要结果是PJK的发生率，而次要结果是Hounsfield单位（HU）值的变化、手术并发症和使用日本骨科协会（JOA）和视觉模拟量表评分测量的临床结果。方法：将患者分为单抗组（n=32）和非单抗组（n=79）。Romosozumab组通常在手术前2个月给药。分析了人口统计学资料、手术相关因素和影像学参数。术前和术后1年分别测量上固定椎体+1 （UIV+1）处的HU值。在对术前与PJK相关的因素进行单因素分析后，采用多因素logistic回归来确定与PJK相关的因素。结果：Romosozumab显著提高了uv +1时的HU值（-1.22% vs. 13.60%）。结论：Romosozumab可有效增加骨密度，降低PJK，特别是PJK- fx的风险，以及脊柱矫正融合手术患者骨质疏松相关并发症。术前2个月给予romosozumab可增强骨密度和强度，导致更好的手术结果和更少的并发症。需要进一步的长期研究来证实这些发现并优化治疗方案。

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