Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

BACKGROUND:Osteoporotic vertebral fractures are the most common complication in patients with osteoporosis.As a new imaging technique,spine magnetic resonance imaging(MRI)is much more sensitive than X-ray film in the diagnosis of osteoporotic vertebral fractures.However,total spine MRI is costly and takes a long time to scan.Therefore,there is no consensus on whether all patients with osteoporotic vertebral fractures need to undergo total spine MRI scan and which patients need to undergo total spine MRI. OBJECTIVE:To analyze the distribution characteristics of vertebral fractures and explore their clinical significance by observing the whole spine MRI data of osteoporotic vertebral fractures patients. METHODS:Data of cases and MRI images of all patients diagnosed with fresh osteoporotic vertebral fractures who visited the Department of Orthopedics,Affiliated Hospital of Southwest Medical University from August 2018 to September 2022 were retrospectively analyzed.903 patients were included in the study based on inclusion and exclusion criteria.General information(age,gender,and body mass index),medical history characteristics(duration of illness,history of trauma surgery,percussion pain area,and pain score)were collected.The characteristics of vertebral fractures were analyzed through whole spine magnetic resonance imaging.Firstly,based on the number of vertebral fractures in patients,they were divided into the single vertebral fracture group(484 cases)and the multi-vertebral fracture group(419 cases),and the differences were analyzed between the two groups.Then,based on whether the farthest interval between the fractured vertebrae was greater than or equal to 5,the multi vertebral fracture group was further divided into two subgroups.Among them,Group A(the farthest interval between the fractured vertebrae was less than 5)contained 306 cases;Group B(with the farthest interval between fractured vertebral bodies greater than 5)included 113 cases.The differences were analyzed between two subgroups. RESULTS AND CONCLUSION:(1)Among 903 patients,419 patients(46.4%)had more than two fractured vertebrae.There were 654 patients(72.4%)with thoracolumbar fractures,and 54 patients(6%)with fractures in the thoracic plus lumbar region and the entire thoracic to lumbar region.In group B,96.5%of patients had multiregional percussion pain.(2)Compared with the patients in the single vertebral fracture group and the multi-vertebral fracture group,there were significant differences in bone mineral density,whether the medical history was greater than or equal to 1 month,the history of low energy injury,and the distribution and number of axial percussion pain areas in the spine during physical examination between the two groups(P<0.05).Age,gender,body mass index,whether there was underlying disease,pain visual analog scale score,whether there was a history of elderly thoracolumbar fracture,and whether there was a history of thoracolumbar surgery,and the number of fractured vertebrae had no statistical significance(P>0.05).(3)There were statistically significant differences between the Groups A and B in bone mineral density,the distribution and quantity of percussion pain area,and the history of low energy injury(P<0.05).There were no significant differences in age,gender,history of old fractures,visual analog scale score,body mass index,whether the medical history was longer than or equal to 1 month,history of underlying diseases,and history of thoracolumbar surgery between the two groups(P>0.05).(4)Patients with multiple low-energy trauma history,history of more than 1 month,multiple percussion pain,and the lower bone mineral density should be alert to the occurrence of multiple vertebral fracture and jump fracture.We recommend the whole spinal MRI for these patients.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Objective: Based on spinopelvic parameters and biomechanical principles, the pedicle-facet joint (PFJ) morphological characteristics of isthmic and degenerative spondylolisthesis were analyzed, and the mechanism of their onset and progression was discussed. Methods: This retrospective cross-sectional study included 194 patients with L5 spondylolysis or L5–S1 low-grade isthmic spondylolisthesis (IS group), 172 patients with L4–5 degenerative spondylolisthesis (DS group), and 366 patients with nonlumbar spondylolysis (NL group). The spinopelvic parameters and PFJ morphological parameters of the patients were measured, the differences in these parameters among and within the 3 groups were compared, and the correlations were analyzed. Results: Sacral slope (SS) and lumbar lordosis (LL) were the highest in the IS group, the second highest in the DS group, and the lowest in the NL group. Among the 3 groups, the L4 facet joint angle (FJA) was the largest in the IS group, the second largest in the NL group, and the smallest in the DS group. The L4 pedicle-facet joint angle (PFA) was the largest in the DS group, the second largest in the IS group, and the smallest in the NL group. Pearson correlation analysis showed that within each group, SS and LL were negatively correlated with FJA and positively correlated with PFA. Conclusion This study found a correlation between the PFJ morphological characteristics of patients with lumbar spondylolisthesis and spinopelvic parameters, suggesting that the morphological characteristics of PFJs may be caused by varying stresses under different spinopelvic morphologies.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Background::Liver cancer remains the sixth most commonly diagnosed cancer and the third leading cause of cancer-related deaths worldwide, causing a heavy burden globally. An updated assessment of the global epidemiology of the liver cancer burden that addresses geographical disparities is necessary to better understand and promote healthcare delivery.Methods::Data were extracted from the GLOBOCAN 2022 database, including the number, crude, and age-standardized rates of incidence and mortality at the global, country, continent, and human development index (HDI) regional levels. Age-standardized rates (incidence and mortality) per 100,000 person-years were adjusted based on the Segi-Doll World standard population. The mortality-to-incidence ratios (MIR) for each region and country were calculated. The HDI and gross national income (GNI) for 2022 were obtained, and a Pearson correlation analysis was conducted with the incidence, mortality, and MIR.Results::In 2022, approximately 866,136 new liver cancer cases and 758,725 related deaths were recorded worldwide, with a global MIR of 0.86. Males had a disproportionately higher burden than females across all levels, and the highest burden was observed in the elderly population. Geographically, the regions with the highest incidence rates included Micronesia, Eastern Asia, and Northern Africa, and the regions with the highest mortality rates included Northern Africa, Southeastern Asia, Eastern Asia, and Micronesia. Notably, Mongolia had a strikingly high burden compared to other countries. The highest MIR was observed in North America and the lowest in Africa. Negative associations of HDI and GNI with liver cancer mortality and MIR were identified, irrespective of sex.Conclusions::The current liver cancer burden underscores the presence of remarkable geographic heterogeneity, which is particularly evident across countries with varying HDI levels, highlighting the urgent need to prioritize health accessibility and availability to achieve health inequities.

Objective To compare clinical efficacy and complication rate of percutaneous endoscopic transforaminal discec-tomy(PETD),percutaneous endoscopic interlaminar discectomy(PEID)and unilateral biportal endoscopic(UBE)in treating single-segment lumbar disc herniation(LDH).Methods From October 2019 to August 2021,121 LDH patients with single-segment treated by spinal endoscopy were retrospectively analyzed and divided into three groups.In PETD group,there were 48 patients,including 19 males and 29 females,aged from 18 to 72 years old with an average of(44.0±13.9)years old;3 patients with L3,4 segments,27 patients with L4,5 segments,and 18 patients with L5S1 segments.In PEID group,there were 43 patients,including 23 males and 20 females,aged from 20 to 69 years old with an average of(40.1±12.1)years old;1 patient with L3.4 segments,15 patients with L4.5 segments,and 27 patients with L5S1 segments.In UBE group,there were 30 patients,including 12 males and 18 females,agedfrom29 to 72 years old with an average of(41.2±15.0)years old;1 patient with L3,4 segments,18 patients with L4,5 segments,and 11 patients with L5S1 segments.Operation time,blood loss,fluoroscopy times and complica-tions among three groups were observed and compared.Before opertaion,3 months after operation and at the latest follow-up,visual analogue scale(VAS)was used to evaluate low back pain and lower extremity pain,Oswestry disfunction index(ODI)was used to evaluate lumbar function,and modified MacNab was used to evaluate clinical efficacy at the latest follow-up.Re-sults All patients were performed endoscopic spinal surgery completely and were followed up for at least 12 months.One patient occurred dural sac rupture both in PETD and PEID group,and dural sac rupture was small,and there was no obvious discomfort after operation.Two patients were occurred intraoperative rupture of dural sac in UBE group.One patient was occurred cere-brospinal fluid leakage after operation,and was improved after rest in supine position and fluid rehydration.One patient without no significant postoperative discomfort.(1)There were no significant difference in operating time,blood loss and hospital stay between PETD and PEID group(P＞0.05),while UBE group was higher than those of PETD and PEID group(P＜0.05).There was no statistical significance in fluoroscopy times between PEID and UBE group(P＞0.05),but PETD group was higher than that of PEID and UBE group(P＜0.05).(2)VAS of low back pain at 3 months after operation in UBE group was higher than that in PETD and PEID group(P＜0.05),but there was no significant difference between PETD and PEID group(P＞0.05).At the latest follow-up,there was no significant difference in VAS of low back pain among three groups(P＞0.05).(3)Lower ex-tremity pain of VAS and ODI among 3 groups after operation were significantly improved at all time points compared with those before opertaion(P＜0.05),and there were no statistical significance between groups(P＞0.05),and there were no statistical significance in interaction between different time points and operation groups(P＞0.05).(4)At the latest follow-up,according to the modified MacNab standard,the results of PETD group were excellent in 27 patients,good in 16 patients,moderate in 4 patients,poor in 1 patient;in PEID group,27 patients got excellent result,12 good,3 moderate,and 1 poor;in UBE group,16 patients got excellent,10 good,2 moderate,and 2 poor.There was no significant difference among three groups(x2=0.308,P＞0.05).Recurrence of lumbar disc herniation occurred in 1 patient among each three groups,symptoms were improved in 2 pa-tients after symptomatic treatment,and 1 patient was treated in other hospitals.Conclusion PETD,PEID and UBE techniques could achieve good early clinical effects in treating lumbar disc herniation with similar complication rates.Both of PETD and PEID are single-channel minimally invasive surgery,with mild intraoperative tissue damage and quick postoperative recovery;while intraoperative fluoroscopy of PETD was relatively more frequent,and PEID was more suitable for L5S1 segment;UBE is a two-channel surgery,in which the intraoperative soft tissue damage is more severe,but exposure is broad,which is more suit-able for complex cases.

Objective To prospectively compare the clinical efficacy and radiographic outcomes between interlaminar per-cutaneous endoscopic lumbar decompression(IL-PELD)and transforaminar percutaneous endoscopic lumbar decompression(TF-PELD)in the treatment of single-segment lumbar lateral recess stenosis.Methods From April 2018 to July 2021,85 pa-tients with single-segment lumbar lateral recess stenosis underment percutaneous endoscopic lumbar decompression.There were 44 males and 41 females,aged from 49 to 81 years old with an average of(65.5±8.3)years old,duration of lumbar lateral re-cess stenosis ranging from 3 to 83 months with an average of(26.7±16.5)months.They were divided into IL-PELD group and TF-PELD group according to the different operation methods.There were 47 patients in the IL-PELD group,including 28 males and 19 females aged from 50 to 80 yeaes old with an average age was(66.7±9.3)years old.The disease duration ranged from 3 to 65 months with an average of(25.7±15.0)months.There were 38 patients in the TF-PELD group,including 16 males and 22 females,aged from 51 to 78 years old with an average of(64.1±7.6)years old.The disease duration ranged from 4 to 73 months with an average of(27.9±18.3)months The operation time,intraoperative blood loss,intraoperative fluoroscopy,hospi-talization day and complications of the two groups were recorded.Visual analogue scale(VAS)to evaluate low back pain and lower limb pain,Oswestry disability index(ODI)to evaluate lumbar function in preoperative and postoperative period(1 month,6 months and last follow-up)were recorded.the sagittal diameter of the lateral recess of the responsible intervertebral space in preoperative and 1 week after the operation were recorded.Results The operation was successfully completed in both groups without serious complications such as vascular injury,dural sac tear and nerve injury.The operation time in IL-PED group(69.3±19.3)min was significantly longer than that in TF-PELD group(57.5±14.5)min(P＜0.05).There was no significant dif-ference in the intraoperative blood loss between the two groups(P＞0.05).The number of intraoperative fluoroscopy in TF-PELD group(8.8±2.6)times was significantly higher than that in IL-PED group(4.8±1.2)times(P＜0.05).The hospitalization days of the two groups were not statistically significant(P＞0.05).VAS for low back and lower extremity pain and ODI were(5.1±2.2),(6.9±1.3)scores and(71.4±12.6)％in IL-PELD group,and(4.7±1.8),(6.9±1.3)scores and(68.4±13.9)％in TF-PELD group.In the IL-PELD group,the VAS of low back pain was(2.4±1.5),(1.6±0.8),(1.4±0.9)scores,and the VAS of lower extremity pain was(3.0±1.2),(1.6±0.7),(1.5±1.0)scores,ODI was(32.6±11.9)％,(17.4±6.5)％,(19.3±9.3)％;In TF-PELD group,the VAS of low back pain was(2.6±1.4),(1.5±0.6),(1.4±1.0)scores,and the VAS of lower extremity pain was(2.8±1.2),(1.6±0.6),(1.5±1.2)scores,The ODI was(32.0±11.2)％,(15.0±6.1)％,and(20.0±11.3)％.The VAS and ODI of the two groups at each time point after operation were significantly improved compared with those before operation(P＜0.05),but there was no statistically significant difference between the groups(P＞0.05),and there was no statistically sig-nificant difference in the interaction between different time points and groups(P＞0.05).At 1 week after operation,the sagittal diameter of lateral recess in both groups was significantly increased compared with that before operation(P＜0.05),but there was no significant difference between the two groups at each time point(P＞0.05).According to the modified Macnab criteria,IL-PELD group was rated as excellent in 24 cases,good in 19 cases and fair in 4 cases.In TF-PELD group the results were ex-cellent in 19 cases,good in 15 cases,fair in 3 cases and poor in 1 case.There was no significant difference between the two groups(P＞0.05).Conclusion IL-PELD and TF-PELD can expand the lateral recess in the treatment of single level lumbar lateral recess stenosis,and have achieved good clinical effects.