Objectives:To investigate the clinical efficacy and safety of posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior oblique lumbar interbody fusion(OLIF)+posterior O-arm navi-gated internal fixation in the treatment of patients with degenerative scoliosis.Methods:A retrospective anal-ysis was performed on the 55 patients with degenerative scoliosis who were treated in our hospital between May 2016 and June 2023.According to surgical method,the patients were divided into posterior O-arm navi-gated internal fixation+osteotomy orthopedic group(group A,20 cases)and anterior OLIF+posterior O-arm navi-gated internal fixation group(group B,25 cases).Group A consisted of 8 males and 12 females,aged 47-81(66.4±7.4)years old;Group B consisted of 8 males and 17 females,aged 52-81(67.4±8.2)years old.The pe-rioperative data of the patients were collected,and the visual analogue scale(VAS)score and Oswestry disabil-ity index(ODI)were recorded before operation,at postoperative 1 week and final follow-up to evaluate the clinical efficacy,and full-length spinal X-ray were taken in the standing position at the same time point to measure the coronal Cobb angle,sagittal vertical axis(SVA),lumbar lordosis(LL),intervertebral space height,vertebral fusion rate.The complications were recorded and compared between groups.Results:The patients were followed up for 18-38(26.5±5.3)months in group A and 20-36(24.3±4.2)months in group B,with no statistical difference(P＞0.05).Statistical differences(P＜0.05)were observed between group A and group B in operative time(219.0±25.7min vs 169.4±25.6min),intraoperative blood loss(1087.5±353.1mL vs 672.5±308.6mL),postoperative drainage volume(364.7±22.9mL vs 109.3±25.3mL),postoperative ambulation time(11.0±3.4d vs 6.3±1.8d),and number of blood transfusions(18 vs 8).The VAS scores were 6.2±0.9 points and 1.8±0.8 points in group A at postoperative 1 week and final follow-up respectively,which were 4.4±0.9 and 1.3±0.5 in group B,and group B was lower than group A at the same postoperative time point(P＜0.05).The ODI of group A and group B at postoperative 1 week were(22.8±4.8)％and(19.9±2.9)％,and group B was lower than group A(P＜0.05),while there was no significant difference between the two groups at final follow-up(P＞0.05).At postoperative 1 week and final follow-up,the sagittal SVA of group A was 47.0±1 1.5mm and 43.9±19.7mm,which was 35.2±19.9mm and 30.9±19.9mm in group B,and the sagittal correction in group A was better than that in group B(P＜0.05).There was no statistical difference between the two groups in coronal Cobb angle and LL at postoperative 1 week and final follow-up(P＞0.05).The intervertebral space height of group A was 48.1±8.2mm and 46.1±8.5mm at postoperative 1 week and final follow-up,which was 57.4±5.4mm and 56.3±5.6mm in group B,and group B was better than group A(P＜0.05).There were 2 cases of postoperative cerebrospinal fluid leakage,2 cases of delayed incision healing,1 case of nail and rod fracture,1 case of screw loosening in group A,and the complication rate was 30％(6/20);2 cases in group B had postoperative pain on the anteromedial side of the left thigh,and 2 cases had transient left hip flexion weak-ness,all of which recovered at follow-up,and the complication rate was 16％(4/25).The complication rate was higher in group A than group B(P＜0.05).Both groups had no incision infection or spinal cord injury complications.At final follow-up,the bone graft and fusion device were osseous fusion in both groups.Con-clusions:Both posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior OLIF+posterior O-arm navigated internal fixation can achieve satisfactory clinical efficacy in the treatment of degen-erative scoliosis,the former has better sagittal orthopedic effect,but has the problems of long operative time,large amount of bleeding,long postoperative bed rest,and many complications,while the latter has a similar scoliosis correction,as well as the advantages of minimally invasive,less traumatic,fast recovery and fewer complications,which can provide a new option for the minimally invasive treatment of degenerative scoliosis.

Objectives:To investigate the feasibility and ideal trajectory of medialized entry iliac screws(MEIS)placed in the posterior superior iliac in spinopelvic fixation through imaging and anatomic analyses,and to validate in clinical practice.Methods:The imaging data of 90 patients(45 males,45 females;57.5±1.6 years)without spinal or pelvic pathology who underwent pelvic CT scan in the radiology department of our hospital between June 2022 and September 2024 were collected.Three-dimensional pelvic reconstruction was performed using Mimics 21.0 software.The parameters of the bony channels of the iliac were measured and compared between males and females,including short and long axes of teardrop cross-section,the narrowest and widest inter-cortical distances of the iliac corridors,sacroiliac joint angles,and screw-to-sagittal plane angles.The ideal screw trajectory for MEIS was determined based on imaging and anatomical characteristics,and standard surgical procedures were formulated,which were applied in 5 patients.Results:No significant gender differences were observed in the narrowest iliac corridor width(males:15.19±1.81mm vs.females:15.01±2.24mm,P＞0.05),widest corridor width(males:24.16±1.66mm vs.females:24.44±2.92mm,P＞0.05),or sacroiliac joint angle(males:39.63°±4.13° vs.females:40.76°±2.94°,P＞0.05).However,significant gender dif-ferences were found in the screw-to-sagittal angle(males:30.38°±3.15° vs.females:26.72°±5.64°,P＜0.05),as well as in the teardrop short axis(males:22.00±1.25mm vs.females:20.47±1.73mm,P＜0.05)and long axis(males:32.92±2.85mm vs.females:30.80±1.48mm,P＜0.05).Notably,the narrowest and widest inter-cortical distances of the iliac corridors,and short and long axes of teardrop cross-section exceeded the diameter(9mm)of a iliac screw(P＜0.001).Postoperative imaging examinations of the 5 patients who underwent this surgical procedure showed that all implants were stably positioned,with satisfactory improvement in symptoms and functional outcomes.Conclusions:The MEIS placement in the posterior superior iliac is safe and feasible,which can serve as a new option for iliac screw placement trajectory in spinopelvic fixation.

Objectives:To compare the differences in three rat intervertebral disc degeneration(IDD)models constructed by needle injections of ethanol into the nucleus pulposus,annulus fibrosus,and endplate,respectively.Methods:45 6-week-old Sprague-Dawley rats were randomly divided into three groups using a random number table method,with 15 rats in each group.Three different needle injection of ethanol methods including nucleus pulposus injection(nucleus pulposus injection group),annulus fibrosus injection(annulus fibrosus injection group),and endplate injection(endplate injection group)were used to construct IDD models at the Co6/7 intervertebral disc in rats.At 1,2,3,and 4 weeks post-modeling,3 rats from each group were randomly selected using a random number table for X-ray examination to measure and calculate the disc height index(DHI)of the Co6/7 in rats.Subsequently,rats were euthanized under excessive anesthesia,and the Co6/7 intervertebral disc along with adjacent vertebral bodies were harvested for hematoxylin-eosin(HE)staining to observe degeneration,and the degeneration degree was histologically scored.Results:One rat in each of the nucleus pulposus injection group and annulus fibrosus injection group died unexpectedly due to anesthesia;In the endplate injection group,two rats died due to postoperative infection.At 1,2,3,and 4 weeks after modeling,3 rats were selected from each group of the remaining rats,and a total of 36 rats were included in the result analysis.The remaining rats were sacrificed by excessive anesthesia.One week after modeling,the Co6/7 DHI in each group was lower than that before modeling(Nucleus pulposus injection group:0.117±0.002 vs 0.134±0.005;Annulus fibrosus injection group:0.126±0.005 vs 0.133±0.005;Endplate injection group:0.127±0.002 vs 0.130±0.007,all P＜0.05),which gradually decreased over time.After modeling in each group,the annulus fibrosus broke,the arrangement of fibers gradually became disordered,the matrix and cells of the nucleus pulposus were gradually lost or even completely disappeared,the intervertebral discs gradually collapsed,and the intervertebral spaces gradually narrowed.The degeneration rate and degree of the nucleus pulposus injection group were faster and higher than those of the other two groups.Four weeks after modeling,the DHI of the nucleus pulposus injection group was 0.090±0.008,which was lower than that of the annulus fibrosus injection group(0.106±0.007,P＜0.05)and endplate injection group(0.109±0.000,P＜0.05);The histological score of the nucleus pulposus injection group was 10.00±0.82,which was higher than that of the annulus fibrosus injection group(9.00±1.41,P＜0.05)and endplate injection group(8.75±0.96,P＜0.05).Conclusions:The three needle injection of ethanol methods have their own unique characteristics for constructing IDD models.Nucleus pulposus injection induces the fastest and most severe degeneration,endplate injection leads to slower degeneration but is more in line with natural degeneration processes,and annulus fibrosus injection falls between the other two methods in terms of degeneration characteristics.

Objectives:To retrospectively analyze the preoperative imaging and echocardiographic data of pa-tients with thoracic lordosis,and to investigate the relationship between thoracic lordosis and the cardiac structure and function by comparing with normal people.Methods:The imaging and echocardiographic data of patients with thoracic lordosis and normal people obtained between January 2013 and December 2023 were collected and analyzed.According to thoracic angle,the patients were divided into group A of 27 cases[tho-racic lordosis(TL)group,T5-T12≤0°]and group B of 29 cases[red uced thoracic kyphotic(TK)group,0°＜T5-T12≤20°].A control group of 29 normal people was set up as group C(normal group,20°＜T5-T 12 ≤ 40°).General clinical data including gender,age,height,weight,body mass index(BMI),body surface area(BSA),imaging parameters on X-ray films such as thoracic sagittal and coronal Cobb angles,imaging findings on CT such as spinal penetration index volume(SPIV)and cardiac volume ratio in apical vertebra region(CVRA)were collected,as well as the echocardiographic parameters including left ventricular end-diastolic diameter(LVDd),right ventricular end-diastolic diameter(RVDd),left atrial diameter(LAD),right atrial diameter(RAD),right ven-tricular outflow tract(RVOT),aortic diameter(AO),ascending aortic diameter(AAO),main pulmonary artery diam-eter(MPA),end-diastolic interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),ejection fraction(EF),fraction shortening(FS),stroke volume(SV),cardiac output(CO),cardiac index(CI),systolic pulmonary artery pressure(SPAP).Statistical analysis was conducted using SPSS 25.0 software for data comparison and correlation analysis between the three groups.Results:SPIV was negatively correlated with sagittal Cobb angle and not correlated with coronal Cobb angle;SPIV was negatively correlated with LVDd,RVDd,LAD,RAD,RVOT,AO,AAO,MPA,IVST,and LVPWT;SPIV wasn't correlated with EF,FS,SV,CO,CI,and SPAP;CVRA was negatively correlated with sagittal Cobb angle and not correlated with coronal Cobb angle;CVRA was negatively correlated with RVDd,IVST,and LVPWT;There was no correla-tion between CVRA and LVDd,LAD,RAD,RVOT,AO,AAO,MPA;CVRA wasn't correlated with EF,FS,SV,CO,CI,and SPAP.Conclusions:SPIV can more effectively reflect the impact of thoracic lordosis on cardiac structure and function than CVRA,and a reduction in thoracic kyphosis angle may exacerbate the workload on cardiac blood vessels.During the orthopedic surgery for patients with thoracic lordosis,significant changes may occur in the structural and functional parameters of the thoracic cavity and cardiac chambers due to factors such as general anesthesia,prone positioning,compression of the sternum and thoracic cage,and muscle relaxant administration,therefore particular attention should be paid to the risks of airway ob-struction and hemodynamic instability.

Objectives:To investigate the effect of lower-level three-column osteotomies(L-3COs)on the restoration of coronal and sagittal balance in adult spinal deformity(ASD).Methods:The clinical data of ASD patients treated with L-3COs(L4,L5 level)in our hospital between January 2012 and May 2022 were retrospectively analyzed.A total of 34 patients were included in this study,including 7 males and 27 females,aged 51.4±16.2 years(range 18-72 years).According to the Qiu classification,10 cases were classifies as type A,13 cases as type B,and 11 cases as type C;9 cases were of congenital spinal deformity,3 cases were of idiopathic scoliosis,20 cases were of degenerative scoliosis,and 2 cases were of neurogenic scoliosis;7 patients underwent subsequent revision.All the patients underwent L-3COs+pelvic fixation and were followed up for ≥2 years.Imaging parameters assessing coronal and sagittal spine and trunk balance were measured at preoperation,immediate postoperatively,and at the final follow-up to evaluate the corrective outcomes.Coronal parameters included the Cobb angle,coronal balance distance(CBD),and L4 tilt angle.Sagittal parameters included sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),lumbar lordosis(LL),L4-Sl lordosis,thoracic kyphosis(TK),and sagittal vertical axis(SVA).The operative time,intraoperative blood loss,osteotomy level,and complications were documented,and clinical outcomes were appraised using the Scoliosis Research Society-22(SRS-22)questionnaire.Results:The operative time was 5.7±0.9h(4.6-7.0h),and the intraoperative blood loss was 1870±550mL(1320-3840mL).The osteotomy level was L4 in 25 cases and L5 in 9 cases.Except for PI,all the coronal and sagittal parameters significantly improved postoperatively compared to preoperative values(P＜0.05).The CBD of the patients was 24.52±19.60mm preoperatively and was corrected to 11.94±10.74mm immediately postoperatively(P=0.032).The SVA was 98.25±48.40mm preoperatively and reconstructed to 31.26±36.06mm immediately postoperatively(P＜0.001).The LL was 8.59°±11.76° preoperatively and was significantly corrected to 36.82°±10.73° immediately postoperatively(P＜0.001).8 patients suffered with postoperative mechanical complication,no revision for complications,and there were 2 cases of proximal junctional kyphosis(PJK),5 instances of rod or screw breakage,1 case of screw loosening or pullout,and 1 case of coronal imbalance(1 case presented with both PJK and coronal imbalance).The scores of all dimensions of SRS-22 questionaire(function,pain,self-image,mental health,total score)at final follow-up were significantly higher than those preoperatively(P＜0.001).Conclusions:L-3COs demonstrate significant correction effects for ASD patients with severe coronal and sagittal imbalance and loss of LL,which successfully alleviates pain and enhances long-term quality of life,with a relatively low incidence of postoperative mechanical complications,making it an effective orthopaedic technique.

Objectives:To investigate the relationship between the improvement of lumbar symptoms and imaging parameters in patients with tandem spinal stenosis(TSS)primarily manifesting as cervical spondylotic myelopathy(CSM)after initial cervical decompression surgery,and to explore related imaging predictive factors.Methods:A retrospective analysis was conducted on 69 TSS patients who underwent primary cervical decom-pression surgery,with an average age of 64.3±10.5 years(ranging from 41 to 86 years old)and a follow-up period of 33.8±5.5 months(ranging from 24 to 48 months).Preoperative symptoms and signs,Nurick gait clas-sification,and preoperative and final follow-up Japanese Orthopaedic Association(JOA)scores for both the cer-vical and lumbar spine were recorded and analyzed.The patients were divided into an improvement group(n=37)and a non-improvement group(n=32)based on the improvement conditions of lumbar spine JOA scores at the final follow-up.Imaging parameters were measured including spinal cord compression ratio,cross-sectional area of the dural sac at the narrowest point of the cervical spinal cord,the ratio of the vertebral canal to the vertebral body and the actual spinal canal width from C3 to C7,and the actual width of the vertebral canal from L1 to L5.The conditions of spinal canal stenosis were evaluated according to the grading system of spinal canal stenosis of cervical and lumbar spine proposed by Lee et al,and the number of cervical verte-brae with a stenosis score ≥1,score at the narrowest part of cervical spinal canal,and the total score of cervical stenosis,as well as the number of lumbar vertebrae with a stenosis score ≥1,score at the narrowest part of lumbar spinal canal,and the total score of lumbar stenosis were calculated.Intergroup comparisons were performed using t tests,chi-square tests,and Mann-Whitney U tests.For the statistic data with statisti-cal differences between the two groups,receiver operating characteristic(ROC)curve was used to determine op-timal thresholds for each parameter,and the area under the ROC curve(AUC)and its corresponding 95％ con-fidence interval(CI)were calculated.Multivariate logistic regression analysis was conducted to identify radiolog-ical predictive factors for non-improvement of lumbar symptoms in TSS patients.Results:The non-improvement group was significantly higher than the improvement group in the total score of lumbar stenosis(5.00±1.68 vs 2.68±1.23,P＜0.001),the number of lumbar vertebrae with a stenosis score≥1(2.47±0.84 vs 1.86±0.95,P=0.004),and the prevalence of redundant nerve roots(14/18 vs 6/13,P=0.017).The AUC of the total lumbar stenosis score was 0.864(P＜0.001,95％CI 0.779-0.950),with an optimal threshold of 3.5(sensitivity:81.3％;specificity:75.7％).The AUC of the number of lumbar vertebrae with a stenosis score ≥1 was 0.691(P=0.007;95％CI 0.565-0.817),with an optimal threshold of 1.5(sensitivity:87.5％;specificity:56.8％).Multivariate logistic regression showed that the number of lumbar spinal stenosis＞1.5(OR=1.493;95％CI 0.392-5.686;P=0.557)and presence of redundant nerve roots(OR=2.815;95％CI 0.740-10.711;P=0.129)had no significant relationship with improvement of lumbar symptoms.The total lumbar stenosis score＞3.5 was significantly related with improvement of lumbar symptoms(OR=10.983;95％CI 3.261-36.994;P＜0.001),which was an independent risk factor for non-improvement in lumbar symtoms after initial cervical decompression in TSS patients.Conclusions:When the total score of lumbar spinal stenosis exceeds 3.5 in TSS patients,the possibility of improvement in lumbar symptoms after initial cervical decompression is small.

Objectives:To provide a new perspective on the epidemiological characteristics of vertebral column fracture in China and to guide the formulation of targeted public health strategies.Methods:The Global Burden of Disease 2021 database was utilized to analyze the epidemiological trends of vertebral column fracture in China from 1990 to 2021.The study further explored the disease burden characteristics related to age,sex,and etiology.The Joinpoint regression model was employed to calculate the average annual percent change(AAPC)to analyze the temporal trends of age-standardized rates.The Bayesian age-period-cohort(BAPC)model was used to forecast the age-standardized rates for 2035.Results:In 2021,the incidence and prevalence of vertebral column fracture in China were 1194465[95％uncertainty interval(UI):888994-1594120]and 717078(95％UI:619114-835347),respectively,representing increases of 52.28％and 113.66％compared to 1990.From 1990 to 2021,the age-standardized incidence rate(ASIR)in China showed no significant upward trend,with an AAPC of 0.45％[95％confidence interval(CI):-0.29％to 1.20％,P＞0.05],while the age-standardized prevalence rate(ASPR)showed a significant upward trend,with an AAPC of 0.53％(95％CI:0.24％to 0.83％,P＜0.05).The BAPC prediction results for 2022-2035 indicated a downward trend for both ASIR and ASPR.Analysis by age group revealed that the peak age groups for incidence and preva-lence have increased,with the crude incidence rate(CIR)and crude prevalence rate(CPR)increasing with age,reflecting an aging trend.Gender analysis found that the disease burden was more prominent among middle-aged men and elderly women.Etiological analysis revealed that falls were the leading cause of spinal frac-tures in China,followed by road injuries.Conclusions:From 1990 to 2021,the disease burden of spinal fractures in China has significantly increased and shown an aging trend.Although the predicted disease bur-den for 2035 is expected to decline,it is still necessary to remain vigilant.Middle-aged men and elderly women are the key populations of concern,and emphasis should be placed on preventing falls and road in-juries.

Objectives:To explore the establishment and validation of a simple and stable model of inter-vertebral disc degeneration(IDD)induced by endplate injury in the rat caudal vertebrae.Methods:32 male Sprague-Dawley(SD)rats,aged 2 months,weighed 180-220g,were used.Among them,24 rats were randomly selected.After anesthesia by intraperitoneal injection,the skin was incised and a scalpel was used to cut a-long the edge of the coccygeal 6(Co6)vertebral bone to injure the unilateral cartilaginous endplate.Specimens were harvested for study on the modeling day(modeling day group),at 2 weeks post-modeling(modeling 2-week group),and at 4 weeks post-modeling(modeling 4-week group).The remaining 8 rats served as a sham surgery group,and the skin was incised with a scalpel and then sutured.The bony endplate was observed using Micro-CT,and sagittal plane images were captured for measurement and calculation of the disc height index(DHI).Hematoxylin and eosin(HE)staining,safranin O-fast green(SO)staining,and TdT-mediated dUTP nick-end labeling(TUNEL)staining were carried on sample slices.The structure of the nucleus pulposus,an-nulus fibrosus,and endplate injury were observed via HE and SO staining.Histological scoring of the inter-vertebral disc was performed using SO staining to evaluate the degree of disc degeneration.Cell apoptosis was observed via TUNEL staining.Results:Micro-CT showed that 2 weeks after modeling,the overall bony struc-ture of the vertebrae remained intact.The endplate thickness increased,and the bony endplate structure was relatively intact,but large areas of defect appeared within it.The vertebrae showed a tendency towards flat-tening,and large osteophytes appeared around them.The DHIs for the sham group,modeling day group,modeling 2-week group,and modeling 4-week group were(9.29±0.74)％,(9.20±1.64)％,(6.05±1.30)％,and(5.10±1.15)％,respectively.Disc space height significantly decreased in both the 2-week and 4-week post-modeling groups compared to the sham group(P＜0.05).SO and HE staining showed that the endplate morphol-ogy in the modeling day group was similar to the sham group.At 2 weeks post-modeling,changes in carti-laginous endplate morphology and a decrease in porosity were visible.At 4 weeks post-modeling,endplate injury was more pronounced,the cartilaginous endplate protruded towards the disc side,and porosity was es-sentially absent.The annulus fibrosus and nucleus pulposus exhibited degenerative phenotypes:the lamellar structure of the annulus fibrosus was disrupted and disorganized,nucleus pulposus cell numbers were signifi-cantly reduced,and the matrix became fibrotic.Histological scoring revealed significantly increased degenera-tion scores in the 2-week(12.0±0.80)and 4-week post-modeling groups(13.0±1.20)compared to the sham(6.8±0.64)and modeling day groups(6.8±1.36).The intervertebral discs degenerated obviously in the 2-week post-modeling group and 4-week post-modeling group,and statistically significant differences(P＜0.05)were observed between the sham,modeling day,and 4-week post-modeling groups,while no significant differences existed between the other group(P＞0.05).TUNEL staining showed that the percentage of TUNEL-positive cells was(4.43±0.46)％in the sham group,(5.82±0.90)％in the modeling day group,(12.07±1.57)％at 2 weeks post-surgery,and(98.26±4.34)％at 4 weeks post-surgery.Compared to the sham group,both modeling groups showed a reduction in disc cell count and an increased proportion of apoptotic cells(P＜0.05).Conclusions:The modeling method we constructed for rat caudal intervertebral disc cartilaginous endplate injury can cause cartilaginous endplate damage,thereby inducing intervertebral disc degeneration.Its modeling effect is rapid and stable,making it a relatively ideal research model for studying intervertebral disc degeneration induced by endplate injury.

Objectives:To apply the anterior tilt slope(ATS)for the first time to assess the degree of cervical anteversion,and to explore and analyze the correlations between the cervical anteversion and cervical curvature changes and sagittal spinal alignment parameters in patients with cervical spondylosis.Methods:A total of 201 patients with cervical spondylosis who were treated in the Department of Orthopedics(Cervical Spine)outpatient clinic from May 2020 to July 2023 were included in the study,consisting of 79(39％)males and 122(61％)females,aged 25.6±6.5(18-40)years.Imaging parameters were measured on the total spinal lateral X-ray films,including the cervical parameters,such as cervical lordosis(CL),upper cervical Cobb an-gle,C1-7 Cobb angle,and T1 slope(T1S),cervical sagittal vertical axis(cSVA),Borden value of cervical cur-vature,anterior tilt slope(ATS);thoracolumbar parameters,such as thoracic kyphosis(TK)and lumbar lordosis(LL);as well as pelvic parameters,such as sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),sagittal vertical axis(SVA).The curvature changes and cervical anteversion were staged according to the Borden value and ATS in the cervical spine parameters,and their relationships with each spinal sagittal parameter in different classification were compared.Results:According to ATS,the cercical anteversion of patients was classified into type Ⅰ of 67 cases,type Ⅱ of 70 cases,type Ⅲ of 40 cases,and type Ⅳ of 24 cases.According to the Borden value,the cervical curvature was classified into type kyphotic of 65 cases,type straight of 92 cases,type lordotic of 29 cases,and type sigmoid of 15 cases.There were significant positive correlations between Borden values and CL,C1-7 Cobb angle,and T1S(P＜0.001).ATS had significant positive correlations with T1S and cSVA(P＜0.001),and positive correlations with CL,C1-7 Cobb angle,and Borden value(P＜0.05).SVA was significantly positively correlated with C1-7 Cobb angle,T1S,cSVA,Borden value,ATS,and SS(P＜0.001),whereas there was no significant correlation between each of the cervical spine parameters and pelvic parameters.In different cervical anteversion classifications,significant differences were observed between cSVA,T1S,TK,and SVA(P＜0.001),and severe degree of cervical anteversion further aggravated the sagittal imbalance.In different types of cervical curvature,there were significant differences between CL,C1-7 Cobb angle,T1S,Borden value,TK,SS,SVA,and ATS(P＜0.05),and when the curvature straightened or became kyphotic,it would cause compensatory reduction of the cervicothoracic junction.Conclusions:In patients with cervical spondylosis,cervical anteversion and curvature changes exhibit significant correlations with thoracic parameters among the sagittal parameters.When cervical anteversion is aggravated and changes in cervical curvature mainly cause compensatory changes in the T1S and TK angles,the SVA is significantly larger in those with significant cervical anteversion.

Objectives:This study aimed to investigate the early clinical efficacies of bilateral spinal joint release(SJR)and pedicle subtraction osteotomy(PSO)in treating rigid post-traumatic thoracolumbar kyphosis(RPTK).Methods:45 patients with RPTK who underwent either SJR or PSO at the Affiliated Hospital of Southwest Medical University between January 2016 and June 2022 were retrospectively analyzed.The patients were divided into SJR group(n=25;13 males,12 females;Apical vertebrae distribution:T11 in 4 cases,T12 in 10,L1 in 10,L2 in1)and PSO group(n=20;9 males,11 females;Apical vertebrae distribution:T11 in 4,T12 in 6,L1 in7,L2 in 3).There wasn't statistical difference in gender,age,body mass index,disease duration,follow-up period,or apical vertebral distribution between the two groups(P＞0.05).The number of fixed segments,operative time,intraoperative blood loss,postoperative drainage volume,intra-and post-operative complications were collected and compared between the two groups.The visual analogue scale(VAS)of low back pain and Oswestry disability index(ODI)were collected and evaluated before operation,at 14d,3 months,and final follow-up after operation.American Spinal Injury Association(ASIA)grades,SF-36 physical component score(PCS)and SF-36 mental component score(MCS)were evaluated for neurological function and living quality before operation,at 3 months and final follow-up after operation.The imaging parameters such as global kyphosis(GK)Cobb angle,GK correction rate,and thoracolumbar kyphosis(TLK)were recorded and compared before operation,at postoperative 14d,3 months,and final follow-up between the two groups.Results:All patients successfully completed the operation,and there was 1 case of dural rupture and 1 case of intercostal neuralgia in both SJR group and PSO group,and no other complications occurred.The operative time,intraoperative blood loss and postoperative drainage volume were 261.2±43.5min,446.0±144.1mL,292.3±99.0mL in the SJR group,and 326.5±68.4min,1166.0±390.1mL,505.8±99.2mL in the PSO group,respectively.SJR group was shorter in operative time,less in intraoperative blood loss and postoperative drainage volume than PSO group(P＜0.05).There was no statistical difference in the number of fixed segments between the two groups(P＞0.05).The low back pain VAS score and ODI of the two groups at 14d,3 months,and final follow-up after operation were significantly lower than those before operation(P＜0.05),and there was no statistical difference between the two groups at each time point(P＞0.05).The PCS and MCS were significantly increased in both groups at 3 months after operation and at final follow-up.The PCS was higher in the SJR group(51.3±3.9)than that in the PSO group(46.2±5.0)at 3 months after operation(P＜0.001).There was no significant difference in GK and TLK between the two groups before operation,which decreased at 14d,3 months and final follow-up after operation in both groups(P＜0.05)and showed no statistical difference in intergroup comparisons at each time point.There was no significant difference in GK correction rate between the SJR and PSO groups at each follow-up time point(P＞0.05).Conclusions:Both SJR and PSO can achieve satisfactory early clinical outcomes in the treatment of RPTK,while SJR technique is shorter in operative time,less in intraoperative blood loss and postoperative drainage,and better in early postoperative improvement of SF-36 scale score.