Objective To explore the optimal warning threshold of motor evoked potentials(MEP)in decompression surgery for ossification of the posterior longitudinal ligament(OPLL)at cervical and thoracic segments,and the predictive role of different MEP parameters on postoperative lower extremity motor function.Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital.There were 131 males and 96 females,with an average age of(60±10)years.All patients underwent continuous neuro-physiological monitoring during the operation,and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation(Dmax)and the ratio of MEP terminal amplitude change to the baseline at the end of the operation(Dend)were recorded.The correlations between these two ratios and the lower extremity motor func-tion immediately after the operation and at 1 year were compared.According to the Medical Research Council muscle strength score(MRC)standard,a postoperative score increase of≥1 point compared to preoperative was defined as postoperative motor dysfunction.Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year.Receiver operating characteristic(ROC)curves were drawn to predict postoperative lower extremity motor dysfunc-tion using Dmax and Dend.Results Among the 227 patients,186 had cervical OPLL and 41 had thoracic OPLL.The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases(3.76%)and 2 cases(1.08%)in the cervical group,and 9 cases(21.95%)and 3 cases(7.32%)in the thoracic group,respectively.The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group(P<0.001).The baseline induction rate of bilateral lower extremity MEPs was 98.92%(368/372)in the cervical group and 96.34%(79/82)in the thoracic group.The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax,and the differences were statistically significant(cervical group:r=0.669,0.517,P=0.001 2;thoracic group:r=0.882,0.727,P=0.003 6),while the differences in the Pearson corre-lation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant(cervical group:r=0.457,0.352,P=0.088;thoracic group:r=0.760,0.625,P=0.098).The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year,and the cut-off values of Dmax were 0.881 and 0.978,respectively.For the thoracic group,the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year,and the cut-off values of Dmax were 0.532 and 0.640,respec-tively.Conclusions In OPLL surgery,the MEP monitoring strategy should be adjusted according to the surgical segment.For the cervical segment,Dmax should be emphasized to balance high sensitivity and specificity,while for the thoracic segment,Dmax or Dend can be flexibly selected.Higher MEP warning thresholds are required for cervical OPLL surgery(Dmax:0.881 immediately after the operation and 0.978 at 1 year;Dend:0.853),while significantly lower thresholds are needed for thoracic OPLL(Dmax/Dend:0.532 immediately after the operation and 0.640 at 1 year).

Objectives:To investigate the clinical efficacy of bilateral mini-open Wiltse approach transforami-nal lumbar interbody fusion(MO-TLIF)in the treatment of degenerative lumbar diseases in the elderly.Meth-ods:A retrospective analysis was conducted on 62 elderly patients with single-segment degenerative lumbar diseases who underwent MO-TLIF or minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)inthe First Affiliated Hospital of Naval Medical University between September 2017 and August 2020.Among them,37 were male and 25 were female,aged 68.0±5.5 years.The patients were divided into the MO-TLIF group(32 cases)and the MIS-TLIF group(30 cases).There were no statistically significant differences between the two groups in terms of gender ratio,age,body mass index(BMI),surgical segment,disease duration,or follow-up time(P＞0.05).The differences between the two groups were compared in terms of operative time,in-traoperative blood loss,intraoperative fluoroscopy,postoperative wound drainage,time to ambulation,hospital stay,complications,and fusion rate.The visual analogue scale(VAS),lumbar Japanese Orthopedic Association(JOA)scores,and Oswestry disability index(ODI)before surgery,at 3 months postoperatively,and at the final follow-up were recorded and compared.Results:The two groups of patients all successfully completed the surgery without significant surgery-related complications.There were no statistically significant differences be-tween the MO-TLIF and MIS-TLIF groups in terms of intraoperative blood loss(80.3±25.1mL vs.72.3±21.8mL),postoperative wound drainage volume(30.7±10.2mL vs.29.3±9.0mL),or hospital stay(5.4±0.9d vs.5.4±0.8d)(P＞0.05).Compared with the MIS-TLIF group,the MO-TLIF group had shorter operative time(90.8±8.8min vs.98.3±8.0min,P=0.001)and fewer number of intraoperative fluoroscopy(4.7±0.7 times vs.7.2±1.4 times,P＜0.001).Both groups showed significant improvement in low back pain VAS score,lumbar JOA score,and ODI at postoperative 3 months and final follow-up compared with preoperative values(P＜0.001),but there were no statistically significant differences between the two groups at the same time points(P＞0.05).At the fi-nal follow-up,no internal fixation-related complications such as screw or rod breakage were observed in both groups,and all the cases achieved bone fusion.Conclusions:Bilateral MO-TLIF can achieve good therapeutic outcomes in treating single-segment degenerative lumbar diseases,which can reduce intraoperative fluoroscopy frequency and shorten operative time comparing with MIS-TLIF.

Objective To explore the optimal warning threshold of motor evoked potentials(MEP)in decompression surgery for ossification of the posterior longitudinal ligament(OPLL)at cervical and thoracic segments,and the predictive role of different MEP parameters on postoperative lower extremity motor function.Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital.There were 131 males and 96 females,with an average age of(60±10)years.All patients underwent continuous neuro-physiological monitoring during the operation,and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation(Dmax)and the ratio of MEP terminal amplitude change to the baseline at the end of the operation(Dend)were recorded.The correlations between these two ratios and the lower extremity motor func-tion immediately after the operation and at 1 year were compared.According to the Medical Research Council muscle strength score(MRC)standard,a postoperative score increase of≥1 point compared to preoperative was defined as postoperative motor dysfunction.Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year.Receiver operating characteristic(ROC)curves were drawn to predict postoperative lower extremity motor dysfunc-tion using Dmax and Dend.Results Among the 227 patients,186 had cervical OPLL and 41 had thoracic OPLL.The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases(3.76%)and 2 cases(1.08%)in the cervical group,and 9 cases(21.95%)and 3 cases(7.32%)in the thoracic group,respectively.The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group(P<0.001).The baseline induction rate of bilateral lower extremity MEPs was 98.92%(368/372)in the cervical group and 96.34%(79/82)in the thoracic group.The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax,and the differences were statistically significant(cervical group:r=0.669,0.517,P=0.001 2;thoracic group:r=0.882,0.727,P=0.003 6),while the differences in the Pearson corre-lation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant(cervical group:r=0.457,0.352,P=0.088;thoracic group:r=0.760,0.625,P=0.098).The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year,and the cut-off values of Dmax were 0.881 and 0.978,respectively.For the thoracic group,the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year,and the cut-off values of Dmax were 0.532 and 0.640,respec-tively.Conclusions In OPLL surgery,the MEP monitoring strategy should be adjusted according to the surgical segment.For the cervical segment,Dmax should be emphasized to balance high sensitivity and specificity,while for the thoracic segment,Dmax or Dend can be flexibly selected.Higher MEP warning thresholds are required for cervical OPLL surgery(Dmax:0.881 immediately after the operation and 0.978 at 1 year;Dend:0.853),while significantly lower thresholds are needed for thoracic OPLL(Dmax/Dend:0.532 immediately after the operation and 0.640 at 1 year).

Adolescent idiopathic scoliosis(AIS)is a complex three-dimensional deformity involving coronal,sagittal,and axial planes,with a prevalence that should not be overlooked.With advancements in technology and in-depth research,an increasing number of hospitals and physicians are exploring standardized diagnostic and treatment approaches for AIS.Comprehensive and in-depth understanding is required for AIS,including its etiology,screening and diagnosis,classification,assessment and examination,treatment options,exploration of current focus,and evaluation of quality of life.Such understanding ensures that the diagnostic and treatment are scientific,standardized,and timely.Based on the principles of evidence-based medicine,a consensus on the diagnosis and treatment of AIS is reached after multiple discussions among spinal surgery experts,aiming to provide reference and guidance for clinical practice.

Adolescent idiopathic scoliosis(AIS)is a complex spinal deformity that occurs in adolescents aged 10-18 years.It is more common in female adolescents.Despite extensive research,the precise pathological mechanisms underlying AIS are yet to be fully elucidated.Given its links to abnormal bone growth and reduced bone mineral density,the involvement of mesenchymal stem cells(MSCs)in bone metabolic disorders is considered a plausible contributing factor of AIS.This review summarizes the role of MSCs in the pathogenesis of AIS and provides a forward-looking perspective on the potential clinical application.

Objective To investigate the influence of basic condition,surgical strategy,and postoperative condition of adolescent idiopathic scoliosis(AIS)patients on the length of hospitalization.Methods A total of 145 AIS patients who underwent posterior spinal fusion and internal fixation in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.1,2014 to Dec.31,2023 with more than 2 years of follow-up were retrospectively enrolled.According to the surgical strategy,they were assigned to selective fusion group(n=50)and non-selective fusion group(n=95).AIS patients were assigned to intensive care unit(ICU)group(n=81)and non-ICU group(n=64)according to whether they were admitted to ICU.Parameters related to basic,surgical and postoperative conditions,hospital stay and postoperative hospital stay were analyzed.Multiple linear regression analysis was used to study the influencing factors of hospital stay and postoperative hospital stay.Results The number of surgical segments,surgical time,intraoperative blood loss,drainage volume on the 3rd day postoperatively,hospital stay,and postoperative hospital stay in the selective fusion group were significantly less than those in the non-selective fusion group(all P＜0.05).The patients in the ICU group were younger,had longer surgery time,had more intraoperative blood loss and blood transfusion,and had longer hospital stay and postoperative hospital stay compared with those in the non-ICU group(all P＜0.05).Correlation analysis showed that hospital stay and postoperative hospital stay were both positively correlated with ICU admission(r=0.179,0.240;both P＜0.05)and were both negatively correlated with selective fusion(r=-0.187,-0.242;both P＜0.05).Conclusion The hospital stay and postoperative hospital stay of AIS patients with non-selective fusion in posterior spinal fusion and internal fixation is longer than those of patients with selective fusion.Non-selective fusion and ICU admission may be factors contributing to the prolonged hospital stay and postoperative hospital stay in AIS patients.

Objective To compare the surgical outcomes of the sequence of screw and rod placement for Lenke type 5C adolescent idiopathic scoliosis(AIS).Methods Lenke type 5C AIS patients who underwent posterior orthopedic fusion and fixation in our hospital from Jan.2013 to Dec.2020 were recruited.Based on surgical sequences,22 cases were assigned to bilateral group(after bilateral screw placement,orthopedics was performed on the convex side and then on the concave side),and 20 cases were assigned to convex group(screws placed on the convex side and performed orthopedics,followed by the concave side).The operation-related indicators(including operation time),imaging parameters,quality of life scores were compared between the 2 groups before and 2 years after surgery.Complications of the 2 groups were analyzed.Results The operation time in the bilateral group was significantly longer than that in the convex group([232.8±13.1]min vs[198.4±16.5]min,P＜0.01).At the last follow-up 2 years after operation,the Cobb angle and its correction rate in the convex group were better than those in the bilateral group([8.0±2.3]° vs[9.9±3.2]°,P=0.03;[81.9±5.4]%vs[77.8±5.8]%,P=0.02).The rate of pedicle screw breach rate was 5.4%(17/312)in the bilateral group and 1.4%(4/280)in the convex group,with significant difference(P＜0.01).At the last follow-up 2 years after operation,the treatment satisfaction of quality of life assessment of the bilateral group was 4.61±1.38,and that of the convex group was 4.50±1.44,but there was no significant difference between the 2 groups(P＞0.05).There were no abnormal electrophysiological monitoring or operation-related complications in the 2 groups.Conclusion For Lenke type 5C AIS,the convex side of pedicle screw placement and orthopedics followed by concave side of pedicle screw placement and orthopedics can achieve better surgical effect.

Objective To explore the clinical effect of nursing guided by Neuman's systems model on adolescent idiopathic scoliosis surgery patients.Methods This study is a randomized controlled trial.A total of 120 patients with adolescent idiopathic scoliosis who underwent surgery in our hospital from Jan.to Dec.2023 were enrolled.According to the order of enrollment,they were randomly assigned to experimental group or control group,with 60 patients in each group.The control group received routine nursing,while the experimental group received nursing guided by Neuman's systems model.Independent-sample t test and χ2 test were used to compare the surgical efficacy,postoperative recovery,quality of life,and self-management ability of the 2 groups.Results Six months post-surgery,the main curve Cobb angle in the experimental group was significantly smaller than that in the control group([14.33±0.78]° vs[16.65±1.02]°,P＜0.001).The postoperative bedtime([4.78±1.32])d vs[6.13±1.26]d),incision healing time([13.43±3.29]d vs[15.32±5.23]d),and hospital stay([13.17±5.36]d vs[16.93±3.14]d)were all significantly shorter in the experimental group than those in the control group(all P＜0.05).The overall complication rate in the experimental group was significantly lower than that in the control group(5.00%[3/60]vs 21.67%[13/60],P=0.016).Six months post-surgery,the experimental group scored better in terms of physical functioning,bodily pain,general health,vitality,social functioning,role-emotional,and mental health compared to the control group(all P＜0.05).In terms of patient self-management,the experimental group also had significantly higher scores in common management(17.53±5.98 vs 13.34±7.32)and symptom management(30.95±8.12 vs 27.32±7.87)compared to the control group(both P＜0.05).Conclusion The nursing guided by Neuman's systems model for adolescent idiopathic scoliosis surgery patients can promote their postoperative recovery and improve their quality of life and self-management capabilities.

Objective To summarize the perioperative nursing experience of a child with Angelman syndrome(AS)complicated with moderate scoliosis undergoing posterior 3-dimensional osteotomy correction,fusion,and internal fixation under general anesthesia.Methods The clinical data of the child with AS and moderate scoliosis who underwent surgical treatment in our hospital on Aug.4,2023,were analyzed.A multidisciplinary team was established upon admission.Relevant literatures and evidences were reviewed to develop and implement a"1+X"nursing plan,which included 2 components:"1"(core perioperative nursing priorities for scoliosis)and"X"(multiple AS-related nursing issues and corresponding strategies).Results The surgery was successful,with stable postoperative conditions and significant improvement in spinal curvature.The child's height increased by 7 cm.Discharge occurred on postoperative day 10,with 100%follow-up compliance.The child regained preoperative independent walking ability during follow-up.Conclusion The"1+X"nursing protocol for AS complicated with scoliosis can effectively ensure perioperative safety and promote recovery,which providing insights for perioperative nursing care of other rare diseases complicated with scoliosis.

Objectives:To investigate the clinical efficacy of bilateral mini-open Wiltse approach transforami-nal lumbar interbody fusion(MO-TLIF)in the treatment of degenerative lumbar diseases in the elderly.Meth-ods:A retrospective analysis was conducted on 62 elderly patients with single-segment degenerative lumbar diseases who underwent MO-TLIF or minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)inthe First Affiliated Hospital of Naval Medical University between September 2017 and August 2020.Among them,37 were male and 25 were female,aged 68.0±5.5 years.The patients were divided into the MO-TLIF group(32 cases)and the MIS-TLIF group(30 cases).There were no statistically significant differences between the two groups in terms of gender ratio,age,body mass index(BMI),surgical segment,disease duration,or follow-up time(P＞0.05).The differences between the two groups were compared in terms of operative time,in-traoperative blood loss,intraoperative fluoroscopy,postoperative wound drainage,time to ambulation,hospital stay,complications,and fusion rate.The visual analogue scale(VAS),lumbar Japanese Orthopedic Association(JOA)scores,and Oswestry disability index(ODI)before surgery,at 3 months postoperatively,and at the final follow-up were recorded and compared.Results:The two groups of patients all successfully completed the surgery without significant surgery-related complications.There were no statistically significant differences be-tween the MO-TLIF and MIS-TLIF groups in terms of intraoperative blood loss(80.3±25.1mL vs.72.3±21.8mL),postoperative wound drainage volume(30.7±10.2mL vs.29.3±9.0mL),or hospital stay(5.4±0.9d vs.5.4±0.8d)(P＞0.05).Compared with the MIS-TLIF group,the MO-TLIF group had shorter operative time(90.8±8.8min vs.98.3±8.0min,P=0.001)and fewer number of intraoperative fluoroscopy(4.7±0.7 times vs.7.2±1.4 times,P＜0.001).Both groups showed significant improvement in low back pain VAS score,lumbar JOA score,and ODI at postoperative 3 months and final follow-up compared with preoperative values(P＜0.001),but there were no statistically significant differences between the two groups at the same time points(P＞0.05).At the fi-nal follow-up,no internal fixation-related complications such as screw or rod breakage were observed in both groups,and all the cases achieved bone fusion.Conclusions:Bilateral MO-TLIF can achieve good therapeutic outcomes in treating single-segment degenerative lumbar diseases,which can reduce intraoperative fluoroscopy frequency and shorten operative time comparing with MIS-TLIF.