Osteoporotic bone defect (OBD) is a serious bone defect resulting from the disruption of the bone structural integrity due to fractures in osteoporotic conditions. OBD not only leads to increased risk of fractures, delayed bone healing, functional loss, and chronic pain, but also reduces patients′ quality of life and even elevates the risk of death. Currently, OBD is primarily treated with systemic medications and local bone grafting. However, drug therapy is often associated with serious side effects, low bioavailability and poor bone targeting performance, while bone grafting is limited by high infection rate in donor areas, scarce bone source and severe immune rejection. Therefore, there is an urgent need for new bone repair materials to improve the bone microenvironment and stimulate bone regeneration. Bioactive molecules have shown great potential in modulating OBD treatment, but their application in organisms is hindered by their low bioavailability and short half-life. Hydrogels have emerged as an ideal vehicle to address these limitations by prolonging the retention time and half-life of bioactive molecules at the site of injury, reducing side effects and promoting cell adhesion under physiological conditions. All these advantages promote osteoblast proliferation and differentiation, providing a promising solution for OBD treatment. However, hydrogels still face challenges such as uncontrolled degradation rate, inadequate mechanical properties and poor osseointegration ability. To this end, the authors systematically elucidated the challenges of hydrogels in OBD treatment and proposed countermeasures, aiming to provide a reference for the research and clinical application of hydrogels.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective:To analyse the pathogenicity of a family with Fabry disease and to characterise its clinical phenotype and genetic variants.Methods:A proband with Fabry disease admitted to Beijing Anzhen Hospital, Capital Medical University in December 2021 was enrolled. Clinical data, including medical history, biochemical parameters, echocardiography, and electrocardiogram, were collected from the proband and family members. The proband and his daughter underwent α-galactosidase A (α-Gal A) enzyme activity assay and Sanger sequencing of the GLA gene. Candidate variants were analyzed and classified according to the American College of Medical Genetics and Genomics guidelines.Results:The male proband (69 years old) presented with chronic renal insufficiency, electrocardiogram findings of ST-T changes, bundle branch block, and left ventricular high voltage, and echocardiographic evidence of left ventricular hypertrophy. His α-Gal A activity was markedly reduced, and genetic testing identified a hemizygous GLA c.511G>C (p.Gly171Arg) variant on the X chromosome. The proband′s asymptomatic daughter also exhibited significantly decreased α-Gal A activity and carried the heterozygous GLA c.511G>C (p.Gly171Arg) variant. Based on the American College of Medical Genetics and Genomics guidelines, this variant was classified as “likely pathogenic” and considered the underlying cause of Fabry disease in this family.Conclusion:The proband manifested chronic renal insufficiency and cardiac hypertrophy, with the GLA c.511G>C (p.Gly171Arg) variant identified as the likely-pathogenic cause of Fabry disease in this family.

Objective:To analyze the characteristics of highly cited articles on spine and spinal cord injuries published in Chinese Journal of Trauma (hereinafter referred to as the "Journal") from 1985 to 2024. Methods:All the articles related to spine and spinal cord injuries published in the Journal from 1985 to 2024 were retrieved from the Wanfang Database and the articles with citation frequency ≥15 times were defined as highly cited, with the retrieval cut-off date of April 15, 2025. For articles related to spine and spinal cord injuries, the total publication count, number of cited articles, total citation frequency, average citation frequency per article, number of fund-supported articles were recorded and analyzed. For the highly cited articles among them, the total number of articles, types of literature, distribution periods, number of fund-supported articles, core authors, institution distribution, region distribution, frequency of and key words were also statistically analyzed.Results:From 1985 to 2024, the Journal published 1 182 articles on spinal and spinal cord injuries, of which 993 (84.01%) were cited, with a total citation frequency of 10 739 and an average of 10.81 citations per article. A total of 388 articles (32.83%) were supported by research funds. There were 184 highly cited articles on spinal and spinal cord injuries, with the following characteristics: (1) The most common type of highly cited literature was original articles (150 articles, 81.52%), while consensus and guideline articles achieved the highest average citation rate (44.75 citations per article). (2) The period 2015-2019 had the highest number of highly cited articles, accounting for 33.70%. (3) Fifty-four highly cited articles (29.35%) were supported by research funds, including 19 by national-level funds and 35 by funds of other levels. (4) Among the highly cited articles, 8 (4.35%) were authored by one person, and 176 (95.65%) were co-authored by two or more persons. Sixty-two authors who published ≥3 highly cited articles were identified as core authors. (5) A total of 123 highly cited articles (66.85%) were authored by researchers affiliated with a single institution, whereas 61 articles (33.15%) were the result of inter-institutional collaboration. Fifteen first-author institutions published≥3 highly cited articles. (6) Regions with ≥15 highly cited articles were Zhejiang Province (28 articles), Chongqing Municipality (23 articles), Guangdong Province (18 articles), Shaanxi Province (18 articles), Jiangsu Province (16 articles), and Shanghai Municipality (15 articles). (7) The top five key words in the highly cited articles were "spinal fractures" (71 times), "thoracic vertebrae" (45 times), "lumbar vertebrae" (44 times), "spinal cord injuries" (27 times), and "vertebroplasty" (27 times).Conclusions:Over the 40-year period, original articles constitute the majority of highly cited articles on spine and spinal cord injuries in the Journal, while consensus and guideline articles demonstrate the highest average citation frequency. Nearly 30% of the highly cited articles receive research funding support. Core authors and institutions show a relatively concentrated distribution, with spinal fractures, spinal cord injuries, and vertebroplasty emerging as research hotspots in the field.

Spinal cord injury is a debilitating neurological condition associated with a high of disability rate, leading to impairments in motor, sensory, and autonomic functions. Current early interventions such as decompression and pharmacological treatments show limited efficacy, often resulting in lifelong deficits in sensory, motor, and other functions, which impose a significant burden on patients, their families, and the society. Recently, electromagnetic neuromodulation has emerged as a promising biomedical technology encompassing a variety of invasive and non-invasive techniques such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and epidural electrical stimulation (EES) that effectively promote neurological recovery in patients with spinal cord injury. However, research on electromagnetic neuromodulation in improving functional impairments after spinal cord injury remains limited, with still uncertain clinical outcomes, necessitating further investigation to clarify its underlying mechanisms. To this end, the authors reviewed recent advances in the mechanistic understanding of electromagnetic neuromodulation in the treatment of spinal cord injury, focusing on pain control, motor function recovery, blood pressure regulation, urogenital function improvement, alleviation of respiratory dysfunction, and reduction of limb spasticity, aiming to provide a reference for the clinical application and future development of electromagnetic neuromodulation technology.

The incidence of osteoporotic fractures has demonstrated a significant upward trend, with osteoporotic thoracolumbar fracture accounting for nearly 50% of all the osteoporotic fractures. Following osteoporotic thoracolumbar fracture, the patients face significantly increased risks of disability and even mortality, severely compromising their quality of life and overall health. In recent years, the proposal and application of the concept of very high risk of fracture in osteoporosis have provided new perspectives for stratified treatment approaches in osteoporosis management. Study results demonstrate that fracture risk stratification-based treatment strategies can maximize clinical benefits for osteoporosis patients. However, osteoporosis management in China faces significant challenges characterized by high disease prevalence yet low awareness, diagnosis, and treatment rates, creating substantial barriers to implementing stratified care. To improve the screening and clinical management of very high fracture-risk patients, the authors reviewed the research progress in the diagnosis and treatment of patients with very high risk of osteoporotic thoracolumbar fracture, aiming to provide evidence-based references for formulating treatment strategies for such patients.

Thoracolumbar trauma, including fractures, dislocations and spinal cord injuries, often result from high-energy injuries such as traffic accidents and falls from heights. It not only causes severe pain and restricted movement for patients, but also leads to neurological damage and even permanent disability. Currently, the diagnosis and treatment of thoracolumbar trauma are faced with many problems, such as possible missed diagnosis and misdiagnosis, lack of individualized and standardized treatment plans, and lack of objective and quantitative metrics for postoperative assessment. Artificial intelligence (AI) technology offers innovative ideas to these problems. Among them, the core AI technology such as machine learning (ML), deep learning (DL), computer vision, and robotics has demonstrated outstanding capabilities in medical image analysis, clinical decision support, etc., which can significantly improve the diagnostic precision, surgical planning efficiency, and postoperative management level of thoracolumbar trauma. At present, application of AI technology in cross-modal data integration, clinical decision support, and long-term efficacy prediction in the field of thoracolumbar trauma remains to be systematically sorted out. To this end, the authors reviewed the research progress of AI technology in the diagnosis, treatment, and postoperative management of thoracolumbar trauma, providing a reference for a wide application of AI technology in the management of thoracolumbar trauma.

Thoracolumbar trauma, including fractures, dislocations and spinal cord injuries, often result from high-energy injuries such as traffic accidents and falls from heights. It not only causes severe pain and restricted movement for patients, but also leads to neurological damage and even permanent disability. Currently, the diagnosis and treatment of thoracolumbar trauma are faced with many problems, such as possible missed diagnosis and misdiagnosis, lack of individualized and standardized treatment plans, and lack of objective and quantitative metrics for postoperative assessment. Artificial intelligence (AI) technology offers innovative ideas to these problems. Among them, the core AI technology such as machine learning (ML), deep learning (DL), computer vision, and robotics has demonstrated outstanding capabilities in medical image analysis, clinical decision support, etc., which can significantly improve the diagnostic precision, surgical planning efficiency, and postoperative management level of thoracolumbar trauma. At present, application of AI technology in cross-modal data integration, clinical decision support, and long-term efficacy prediction in the field of thoracolumbar trauma remains to be systematically sorted out. To this end, the authors reviewed the research progress of AI technology in the diagnosis, treatment, and postoperative management of thoracolumbar trauma, providing a reference for a wide application of AI technology in the management of thoracolumbar trauma.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Osteoporotic bone defect (OBD) is a serious bone defect resulting from the disruption of the bone structural integrity due to fractures in osteoporotic conditions. OBD not only leads to increased risk of fractures, delayed bone healing, functional loss, and chronic pain, but also reduces patients′ quality of life and even elevates the risk of death. Currently, OBD is primarily treated with systemic medications and local bone grafting. However, drug therapy is often associated with serious side effects, low bioavailability and poor bone targeting performance, while bone grafting is limited by high infection rate in donor areas, scarce bone source and severe immune rejection. Therefore, there is an urgent need for new bone repair materials to improve the bone microenvironment and stimulate bone regeneration. Bioactive molecules have shown great potential in modulating OBD treatment, but their application in organisms is hindered by their low bioavailability and short half-life. Hydrogels have emerged as an ideal vehicle to address these limitations by prolonging the retention time and half-life of bioactive molecules at the site of injury, reducing side effects and promoting cell adhesion under physiological conditions. All these advantages promote osteoblast proliferation and differentiation, providing a promising solution for OBD treatment. However, hydrogels still face challenges such as uncontrolled degradation rate, inadequate mechanical properties and poor osseointegration ability. To this end, the authors systematically elucidated the challenges of hydrogels in OBD treatment and proposed countermeasures, aiming to provide a reference for the research and clinical application of hydrogels.