OBJECTIVE: To analyze the current status and temporal trends of the disease burden of spinal fractures in China from 1990 to 2021 based on data from the Global Burden of Disease Study 2021 (GBD 2021), aiming to provide evidence for developing prevention and treatment strategies. METHODS: Epidemiological data on spinal fractures in China, the United States of America (USA), and globally were extracted from the GBD 2021 database. Joinpoint regression models were applied to analyze temporal trends. Age-standardized incidence, prevalence, and disability-adjusted life years (DALYs) rates were calculated, with comparisons of gender- and age-group disparities. RESULTS: In 2021, the number of incident cases, prevalent cases, and DALYs of spinal fractures in China increased by 52.28%, 113.68%, and 106.98%, respectively, compared to 1990. The age-standardized incidence, prevalence, and DALYs rates rose by 11.80%, 16.11%, and 14.79%, respectively. The disease burden escalated significantly with age, peaking in individuals aged ≥75 years. Males exhibited higher age-standardized incidence and DALYs rates than females. Comparative analysis revealed that the age-standardized DALYs rate in China (4.19/100 000) was lower than that in globally (6.62/100 000) and USA (15.92/100 000). However, China showed an upward trend [annual average percentage change (AAPC)=0.19%], contrasting with a declining trend in the USA (AAPC=-0.08%). CONCLUSION The escalating disease burden of spinal fractures in China is closely linked to population aging, gender disparities, and insufficient targeted prevention policies. Future strategies should integrate age- and gender-specific interventions, including strengthened osteoporosis prevention, trauma risk control, and big data-driven precision measures, to mitigate this burden.
Humans ; China/epidemiology* ; Global Burden of Disease/trends* ; Male ; Female ; Spinal Fractures/epidemiology* ; Middle Aged ; Aged ; Disability-Adjusted Life Years ; Prevalence ; Incidence ; Adult ; Young Adult ; Adolescent ; Aged, 80 and over ; United States/epidemiology* ; Cost of Illness ; Quality-Adjusted Life Years ; Child

An essential treatment for atlantoaxial dislocation is posterior atlantoaxial fusion. The current intra-articular fusion of the atlantoaxial lateral mass joint demonstrates a higher bone fusion rate, requires a smaller amount of bone graft, and has a lower incidence of complications. Although it has been employed in clinical practice, the atlantoaxial lateral mass intra-articular fusion cage is not yet widely utilized. Atlantoaxial instability and reducible atlantoaxial dislocation can be managed with simple posterior reduction, fixation, and atlantoaxial lateral mass intra-articular fusion. For patients with irreducible atlantoaxial dislocation, such as those with severe basilar invagination or obstructive anterior bone structures, transoral release is necessary, and anterior fusion cage placement is also feasible. Both posterior and anterior atlantoaxial lateral mass intra-articular fusion have seen significant improvements in surgical techniques, bone graft materials, and fusion cages. Among them, the procedure is evolving from the classic open approach to a more minimally invasive one. Bone graft materials include massive iliac bone, granular cancellous bone, fibula, autologous bone harvested from the C 1 posterior arch and C 2 lamina, and allogeneic bone, reflecting an increasingly diverse selection. Fusion cages have evolved from simple spacers to titanium blocks and further to cages that are anatomically adapted to the atlantoaxial joint, offering high bone fusion rates and various specifications of width and height. In anterior fusion cages, the circular design facilitates easy placement, while the wedge-shaped cage, when inserted transorally, better conforms to the physiological structure of the atlantoaxial lateral mass joint, resulting in improved surgical outcomes.The 3D-printed locking cage provides robust anterior support for fixation and fusion without the need for additional bone grafting. Anterior fusion cages are particularly suitable for patients with partial irreducible atlantoaxial dislocation requiring transoral release. Posterior cages, such as the cylindrical threaded cage, offer immediate stability. Customized cages exhibit more uniform stress distribution and can reduce cage subsidence. The posterior fusion cage has broad applicability and is suitable for patients with basilar invagination and atlantoaxial dislocation. The continuous advancements of fusion cages, bone graft materials, and surgical techniques will be from the aspects of stability, safety, and fusion rate to optimize the atlantoaxial lateral mass intra-articular fusion.

An essential treatment for atlantoaxial dislocation is posterior atlantoaxial fusion. The current intra-articular fusion of the atlantoaxial lateral mass joint demonstrates a higher bone fusion rate, requires a smaller amount of bone graft, and has a lower incidence of complications. Although it has been employed in clinical practice, the atlantoaxial lateral mass intra-articular fusion cage is not yet widely utilized. Atlantoaxial instability and reducible atlantoaxial dislocation can be managed with simple posterior reduction, fixation, and atlantoaxial lateral mass intra-articular fusion. For patients with irreducible atlantoaxial dislocation, such as those with severe basilar invagination or obstructive anterior bone structures, transoral release is necessary, and anterior fusion cage placement is also feasible. Both posterior and anterior atlantoaxial lateral mass intra-articular fusion have seen significant improvements in surgical techniques, bone graft materials, and fusion cages. Among them, the procedure is evolving from the classic open approach to a more minimally invasive one. Bone graft materials include massive iliac bone, granular cancellous bone, fibula, autologous bone harvested from the C 1 posterior arch and C 2 lamina, and allogeneic bone, reflecting an increasingly diverse selection. Fusion cages have evolved from simple spacers to titanium blocks and further to cages that are anatomically adapted to the atlantoaxial joint, offering high bone fusion rates and various specifications of width and height. In anterior fusion cages, the circular design facilitates easy placement, while the wedge-shaped cage, when inserted transorally, better conforms to the physiological structure of the atlantoaxial lateral mass joint, resulting in improved surgical outcomes.The 3D-printed locking cage provides robust anterior support for fixation and fusion without the need for additional bone grafting. Anterior fusion cages are particularly suitable for patients with partial irreducible atlantoaxial dislocation requiring transoral release. Posterior cages, such as the cylindrical threaded cage, offer immediate stability. Customized cages exhibit more uniform stress distribution and can reduce cage subsidence. The posterior fusion cage has broad applicability and is suitable for patients with basilar invagination and atlantoaxial dislocation. The continuous advancements of fusion cages, bone graft materials, and surgical techniques will be from the aspects of stability, safety, and fusion rate to optimize the atlantoaxial lateral mass intra-articular fusion.