Pedicle subtraction osteotomy (PSO) and vertebral column decancellation (VCD) are frequently used methods for correction of thoracolumbar kyphosis resulting from ankylosing spondylitis (AS). However, there are limited reports performed to evaluate the difference of loss of correction and the effectiveness of PSO and VCD techniques in patients with thoracolumbar kyphosis secondary to AS. To retrospectively estimate the effectiveness of correction and loss of correction of PSO and VCD techniques in patients with thoracolumbar kyphosis secondary to AS. We performed a retrospective review of 61 consecutive AS kyphosis patients undergoing PSO or VCD surgery from March 2012 to April 2015. The patients were divided into PSO group (n = 25) and VCD group (n = 36) according to the types of osteotomies. Measurement of the radiographic parameters was performed and the change was analyzed. Mean loss of correction in the global kyphosis was 2.31° in the PSO group and 2.29° in VCD group at the last follow-up, respectively, with no significant difference. Progressive junctional kyphosis occurred in both groups. VCD obtained a significantly larger correction than PSO while sharing a similar incidence of complications. No serious complications were observed in the two groups. The PSO osteotomy and VCD osteotomy are both safe and effective methods in treating thoracolumbar kyphosis secondary to AS. Mild loss of correction mainly occurred in the global kyphosis in both techniques with no significant difference.

Conventional bone repair technologies such as using metal implants and autologous bone grafts, are limited due to immune rejection, donor availability, the need for secondary surgeries, and material fatigue. Here, we demonstrated a novel multifunctional bone adhesive by mixing poly (ethylene glycol) succinimidyl glutarate (PEG-SG) with tannic acid (TA), copper oxide (CuO), bioactive glass (BG), and gelatin for sealing cranial defects and facilitating bone regeneration. In the porous bone adhesive, the PEG-SG was formed into an interconnected matrix, while TA served as a polyphenolic crosslinker that reinforced interfacial adhesion and mechanical strength. The PEG-SG/TA/CuO/BG/Gel bone adhesive was biodegradable and bioactive by releasing Cu²⁺ and Ca²⁺ that promoted angiogenesis, osteogenesis, and broad-spectrum antibacterial activity. The bone adhesive demonstrated instant and robust tissue adhesion (∼100kPa) within 60 seconds of contact with bone, and exhibited antibacterial efficiencies of Escherichia coli (E.coli), Staphylococcus aureus (S.aureus) and Methicillin-resistant Staphylococcus aureus (MRSA) (∼80%), while up-regulating osteogenic markers (e.g., collagen type I, osteocalcin). In a rat cranial defect model, the bone adhesive showed remarkable healing compared to commercial product poly (methyl methacrylate) (PMMA) and controls. Micro-CT and histology revealed significantly higher bone volume fraction (BV/TV), bone mineral density, and dense collagen matrix in the bone adhesive. Immunofluorescent staining of CD163 and TNF-α indicated a favorable osteo-immunomodulatory performance using the bone adhesive, as well as facilitating bone regeneration, as displaying enhanced CD31, collagen type I and osteocalcin expressions. Transcriptomic profiling of healing tissue further identified activation of PI3K-Akt and calcium signaling pathways, which motivated inflammation modulation and osteogenesis. These results highlighted the PEG-SG/TA/CuO/BG/Gel as a promising strategy for cranial bone repair and broader regenerative medicine applications.

The coexistence of spinal degenerative diseases and hip joint degeneration is common among middle-aged and elderly individuals, causing significant suffering and economic burden for patients. Total hip arthroplasty (THA) and lumbar fusion (LF) are primary treatment options for this combined condition, but the impact of the surgical sequence on patient outcomes remains unclear. Hence, this study aims to evaluate the effects of the surgical sequence of THA and LF on symptom recovery, changes in sagittal spine-pelvis parameters, and the incidence of long-term complications in patients. A retrospective analysis was conducted on 104 patients diagnosed with hip-spine syndrome (HSS) who underwent THA and LF at the Chinese PLA General Hospital. IPTW was implemented to control potential confounding factors. The impact of surgical sequence on clinical function scores, radiological parameters, and long-term complications was evaluated before and after conducting IPTW. Patients who underwent THA surgery first, followed by LF surgery, were categorized as the THA→LF group; conversely, those who underwent LF surgery first, followed by THA surgery, were categorized as the LF→THA group. Clinical function scores included the Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, and Harris Hip Score for both groups. Long-term complications assessed in this study included instances of Proximal Junctional Kyphosis (PJK), internal fixation loosening or failure, as well as hip prosthesis dislocation. Radiological parameters included Pelvic Tilt (PT), Pelvic Incidence (PI), Pelvic Incidence minus Lumbar Lordosis (PI-LL), Sacral Slope (SS), and Lumbar Lordosis (LL). Before conducting IPTW, there were significant differences between the two groups across multiple variables, including age (P = 0.035), fixation stage (P = 0.042), preoperative PT (P = 0.005), preoperative PI-LL (P = 0.004), and preoperative LL (P = 0.040). After conducting IPTW, all baseline data variables had P-values greater than 0.50, indicating that the baseline characteristics between the two groups were comparable. Following IPTW, the study found significant improvements in postoperative ODI, JOA score, and Harris Hip Score for both groups (P < 0.001), indicating that both surgical sequences were effective in enhancing clinical functional activity. However, there were no significant differences between the groups. Additionally, there was no significant difference in the long-term complication rates between the two groups. Regarding radiological parameters, the PT in the THA→LF group was significantly lower than that in the LF→THA group (P = 0.043), while the SS was significantly higher (P = 0.028) at the last follow up after conducting IPTW. Compared to preoperative assessments, both surgical sequences significantly improve postoperative clinical function scores and radiological parameters for patients. When comparing between the two groups, the surgical sequence exhibits equivalent effects on functional improvement and complication rates. The radiological outcomes indicate that the THA→LF group shows more pronounced effects on PT and SS, suggesting a more favorable impact on pelvic alignment in patients undergoing this sequence. The use of the IPTW method successfully eliminates differences in baseline characteristics, enhancing the reliability of the results. Future research is warranted to further explore these findings and their implications for surgical decision-making in HSS patients.

Objective: Surgery to correct the cervicothoracic kyphotic deformity in ankylosing spondylitis (AS) can be associated with serious neurovascular risks. According to the literature, there are no clinical reports documenting the use of vertebral column decancellation (VCD) in the treatment of cervicothoracic kyphotic deformity in patients with AS. The purpose of the present study was to retrospectively analyze and evaluate the effect of VCD on cervicothoracic kyphotic deformity in patients with AS.Methods: Records of eight patients with cervicothoracic kyphotic deformity who underwent VCD at C7 in our institution were retrospectively reviewed. The mean duration of clinical follow‐up after surgery was 19 months. The cervical lordosis (CL) and C2–C7 sagittal vertical axis (SVA) were meticulously measured on full‐length spine radiographs. The chin‐brow vertical angle (CBVA) was measured on clinical photographs. Outcome measures utilized included the Neck Disability Index (NDI), the Japanese Orthopaedic Association (JOA) Score, and a Visual Analog Scale (VAS) for neck pain. The data analysis was performed using SPSS version 26.0 for Windows. For paired data adhering to a normal distribution, we utilized paired sample t‐tests to analyze preoperative and postoperative imaging parameters. Statistical significance was established at a p value threshold of < 0.01.Results: All eight patients successfully completed the surgery. With an average VCD osteotomy angle of 47.6° ± 8.1° (±SD), the mean preoperative CBVA was 81.1° ± 17.6° (±SD), while the immediate postoperative value was 19.9° ± 5.7° (±SD). The overall average correction was 61.2° ± 18.9°. The mean preoperative cervical sagittal imbalance was 93.4 ± 27.3 mm (±SD), while the immediate postoperative value was 40.2 ± 18.9 mm (±SD). The overall average correction was 53.2 ± 28.1 mm. None of the eight patients experienced intraoperative complications, including nerve or vascular injury, cerebrospinal fluid leakage, or any other related complications. In the cohort of eight patients, the mean values for estimated blood loss, surgical time, and hospital stay were 1313 mL, 248 min, and 18 days, respectively. In comparison to preoperative scores, statistically significant improvement was noted in all patients in the postoperative period with regard to NDI, JOA, and VAS (p < 0.01, using a paired t‐test).Conclusion: The VCD procedure proves to be a dependable and efficient approach for addressing cervicothoracic kyphotic deformities. It achieves remarkable corrections in cervical kyphosis and CBVA.Trial Registration: Chinese Clinical Trial Registry: 2400090375

The spine, pelvis, and joints maintain sagittal balance, which is often disrupted in lumbar degenerative diseases. While preoperative changes in sagittal alignment are well studied, postoperative adaptations, particularly following spinal fixation extending to the pelvis, are less understood. Therefore, the present study aimed to examine sagittal changes in the spine, pelvis, and joints in sitting and standing positions after short- or long-segment posterior spinal fixation extending to the pelvis. This cross-sectional study analyzed patients who underwent long- or short-segment instrumented fusion to the pelvis for lumbar degenerative disease at our hospital from June 2018 to October 2019. Patients were grouped based on the number of internal fixation segments, both short and long. Sagittal parameters were measured in standing and sitting positions and matched for sex, gender, height, weight, and other related parameters. Statistical analysis was performed using t-tests and Mann–Whitney U tests. A total of 98 patients were included, of whom 55 were included in the long-segmengroup (31 men, 24 women; mean age of 63.1 ± 8.5 years). In the long-segment group, no significant changes were observed between standing and sitting positions (P > 0.05). In the short-segment group, significant changes were observed in the sacral vertical axis, pelvic tilt, sacral slope, thoracic kyphosis, lumbar lordosis, T1 pelvic angle, T1 spinopelvic inclination, acetabular tilt, and pelvic-femoral angle between the two positions (P < 0.05). The difference in pelvic femoral angle changes between the groups was also significant (P < 0.05). In the short-segment group, transitioning from standing to sitting leads to greater sagittal changes, including decreased lumbar lordosis and forward trunk lean, with smaller hip joints than in the long-segment internal fixation group.