Minimally invasive posterior or transforaminal lumbar interbody fusion (MI-PLIF/TLIF) are widely accepted procedures for lumbar instability due to degenerative or traumatic diseases. Oblique lateral interbody fusion (OLIF) is currently receiving considerable attention because of the reductions in damage to the back muscles and neural tissue. The aim of this study was to compare clinical and radiographic outcomes of simultaneous single-position OLIF and percutaneous pedicle screw (PPS) fixation with MI-PLIF/TLIF. This retrospective comparative study included 98 patients, comprising 63 patients with single-position OLIF (Group SO) and 35 patients with MI-PLIF/TLIF (Group P/T). Cases with more than 1 year of follow-up were included in this study. Mean follow-up was 32.9 ± 7.0 months for Group SO and 33.7 ± 7.5 months for Group P/T. Clinical and radiological evaluations were performed. Comparing Group SO to Group P/T, surgical time and blood loss were 118 versus 172 min (p < 0.01) and 139 versus 374 mL (p < 0.01), respectively. Cage height, change in disk height, and postoperative foraminal height were significantly higher in Group SO than in Group P/T. The fusion rate was 96.8% in Group SO, similar to the 94.2% in Group P/T (p = 0.985). The complication rate was 6.3% in Group SO and 14.1% in Group P/T (p = 0.191). Simultaneous single position O-arm-navigated OLIF reduces the surgical time, blood loss, and time to ambulation after surgery. Good indirect decompression can be achieved with this method.

Background: DNA methyltransferase 1 (DNMT1) exerts imperative functions in neuropathic pain (NP). This study explored the action of RNA interference-mediated DNMT1 silencing in NP by regulating microglial M2 polarization. Methods: NP rat models were established using chronic constriction injury (CCI) and highly aggressive proliferating immortalized (HAPI) microglia were treated with lipopolysaccharide (LPS) to induce microglia M1 polarization, followed by treatment of DNMT1 siRNA or si-DNMT1/oe-DNMT1, respectively. The pain threshold of CCI rats was assessed by determining mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL). Levels of inflammatory factors (TNF-α/IL-1β/IL-6/IL-10) and DNMT1 in rat L4-L6 spinal cord samples and HAPI cells were measured using ELISA, RT-qPCR, and Western blot. iNOS and Arg-1 mRNA levels were measured via RT-qPCR. DNMT1, M1 marker (iNOS), and M2 marker (Arg-1) levels in microglia of CCI rats were detected by immunofluorescence. Percentages of M1 microglia phenotype (CD16) and M2 microglia phenotype (CD206) were detected by flow cytometry. The phosphorylation of PI3K/Akt pathway-related proteins was determined by Western blot. Results: CCI rats exhibited diminished MWT and TWL values, increased pro-inflammatory cytokines, and decreased anti-inflammatory cytokine IL-10. Additionally, DNMT1 was upregulated in CCI rat microglia. DNMT1 siRNA alleviated CCI-induced NP and facilitated M2 polarization of microglia in CCI rats. DNMT1 knockdown inhibited LPS-induced M1 polarization of HAPI cells and promoted M2 polarization by blocking the PI3K/Akt pathway, but DNMT1 overexpression inhibited the M1-to-M2 polarization of microglia. Conclusion: RNA interference-mediated DNMT1 silencing accelerates microglia M2 polarization by impeding the PI3K/Akt pathway, thereby alleviating CCI-induced NP.

Lumbar disc herniation (LDH) is a prevalent spinal disorder affecting 20–40% of the population. This study compared the clinical efficacy of two minimally invasive techniques, one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE), for treating single-level LDH. A retrospective analysis of 217 patients (OSE: 118; UBE: 99) treated between April 2021 and January 2025 demonstrated that while both techniques were effective, OSE offered several advantages. Incision lengths were shorter in the OSE group (2.20 ± 0.33 cm vs. 2.91 ± 0.33 cm; p < 0.001), and fewer intraoperative fluoroscopy sessions were required (2.05 ± 0.21 vs. 2.59 ± 0.59; p < 0.001). Postoperative assessments revealed lower Oswestry Disability Index(ODI) scores (19.40 ± 2.81 vs. 20.87 ± 2.88; p = 0.003) and reduced visual analog scale(VAS) scores for low back pain (1.87 ± 0.68 vs. 2.24 ± 0.58; p = 0.002) in the OSE group at 7 days. The cross-sectional area of the multifidus muscle decreased less in OSE (104.71 ± 36.10) compared to UBE (268.85 ± 40.00; p < 0.001). Complication rates were similar, with no major adverse events such as infections or nerve injuries. The minimally invasive nature of OSE may contribute to improved patient outcomes and satisfaction. Further large-scale, long-term studies are warranted to validate these findings and assess the long-term efficacy of OSE in spinal surgery. Clinical trial number: Not applicable.

Background: One-Hole Split Endoscopic (OSE) discectomy is an emerging minimally invasive technique for lumbar degenerative disease. While OSE offers advantages such as reduced tissue dissection, it is not exempt from complications inherent to spinal surgery. Postoperative spinal epidural hematoma (POSEH), though rare, is a serious complication that can lead to significant neurological deterioration if not managed promptly. Although POSEH has been documented with other endoscopic lumbar procedures, no cases of delayed POSEH (DPOSEH) following OSE have been reported in the literature to date. Case presentation: A 69-year-old male underwent OSE discectomy at L4–L5 for symptomatic disc herniation. The initial postoperative course was uneventful, with improvement in radicular symptoms and intact neurological function. However, on postoperative day 5, he developed acute back pain, bilateral lower limb weakness, saddle anesthesia, and fecal incontinence. Emergency MRI confirmed a compressive epidural hematoma extending from L4 to L5. During the urgent surgical evacuation, multiple organized blood clots of varying sizes were identified and removed. Through postoperative rehabilitation therapy, the patient's left lower limb muscle strength gradually improved, though bowel and bladder dysfunction persisted. Conclusions: The present case highlights that, despite the absence of prior literature on this complication in OSE, the risk of symptomatic epidural hematoma exists similarly to other endoscopic spinal techniques. Early recognition, prompt imaging, and immediate surgical intervention are critical to optimizing neurological recovery. Surgeons should maintain a high index of suspicion for POSEH in OSE patients presenting with acute neurological decline, even beyond the typical 72-h postoperative window.

A woman in her 20s presented with neck pain and was diagnosed with a primary giant cell tumour (GCT) involving the C5 vertebral body and encasing the left vertebral artery (VA). Denosumab therapy was initiated to reduce tumour vascularity and facilitate resection. After preoperative embolisation of the left VA, total en bloc resection of the tumour was performed. Postoperatively, the patient experienced transient left upper extremity weakness, which improved significantly over time. Follow-up imaging showed successful bony fusion and no recurrence. This case highlights the importance of multidisciplinary planning in managing cervical spine GCTs involving critical neurovascular structures. Combined denosumab therapy and VA embolisation can enable safe and complete tumour resection, potentially improving outcomes and reducing recurrence risk, especially in young patients.

BACKGROUND Spinal disorders are associated with persistent or perioperative pain, fear of movement, anxiety, functional limitation, and impaired health-related quality of life. Immersive virtual reality (IVR), delivered through head-mounted displays (HMDs), can combine attentional distraction, graded exposure, behavioral skills training, relaxation, and sensorimotor feedback. However, the evidence relevant to symptom management in spinal populations is fragmented across low back pain, neck pain, and spinal cord injury literatures, while many prior reviews combine immersive and nonimmersive technologies. OBJECTIVE Objective: To systematically review randomized evidence on HMD-based IVR interventions for symptom management in adults with spinal disorders, with emphasis on pain, anxiety or fear-related symptoms, quality of life, disability, functional outcomes, adherence, and IVR-related adverse events. METHODS Methods: We designed the review in accordance with PRISMA 2020 and structured the quantitative narrative synthesis according to the Synthesis Without Meta-analysis (SWiM) reporting guideline. The prespecified eligibility framework included adults with spinal disorders or spinal cord injury–related symptom burden; HMD-based immersive VR interventions; randomized or randomized crossover comparisons; and patient-centered symptom or functional outcomes. Searches were executed in PubMed/MEDLINE, Europe PMC, Web of Science Core Collection, OpenAlex (open multidisciplinary index), and CNKI (China National Knowledge Infrastructure; Chinese-language subject-field search) from database inception to 30 September 2026, complemented by backward and forward citation chasing of the included studies. Risk of bias was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool. RESULTS Results: Thirteen published randomized studies were identified as reasonably compatible with the strict immersive-HMD eligibility concept, spanning chronic low back pain, chronic neck pain, lumbar disc herniation, and spinal cord injury–related neuropathic pain. Across chronic low back pain, skills-based or embodied IVR showed clinically promising improvements in pain interference, fear of movement, disability, or related outcomes in several trials, although a large 2026 three-arm trial found no superiority of active skills-based or distraction IVR over sham VR for the primary pain-interference outcome. For chronic neck pain, several HMD-based sensorimotor or kinematic-training trials improved selected range-of-motion, proprioceptive, disability, or quality-of-life outcomes, but effects on pain were inconsistent and newer trials found little or no incremental benefit over conventional exercise. In spinal cord injury, small randomized trials suggest short-term reductions in neuropathic pain and improvements in embodiment/depersonalization-related outcomes. A 2025 randomized trial in lumbar disc herniation reported improvements in pain, disability, and quality of life after VR-based exercise. Adverse effects were generally mild and self-limited when reported, with cybersickness, dizziness, nausea, or discomfort being the most relevant IVR-specific concerns. CONCLUSIONS Conclusions: HMD-based IVR is a plausible adjunct for symptom management in selected spinal populations, particularly when the intervention explicitly targets pain coping, fear avoidance, relaxation, graded movement, or sensorimotor retraining. The evidence does not support a single uniform effect across all spinal disorders or all IVR modalities. The most defensible clinical interpretation is that benefit is mechanism- and context-dependent, with stronger signals for psychological and functional symptom modulation than for structural disease outcomes. Larger multisite RCTs, standardized IVR reporting, longer follow-up, and clearer separation of immersive from nonimmersive VR are needed.