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.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

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.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objectives:To analyze the characteristics of adjacent vertebral compression fracture(AVCF)after lumbar spinal fusion,and to investigate its treatment modality and clinical efficacy.Methods:353 patients treated with lumbar fixation and fusion for lumbar degenerative diseases at our center from January 2013 to January 2019 were retrospectively analyzed,and a total of 11 patients had AVCF after fusion,all were female,aged 70±7.2 years(61-83 years)old,including 1 case of T12 vertebral fracture,1 case of T12 combined with L1 vertebral fracture,4 cases of L1 vertebral fracture,2 cases of L2 vertebral fracture,1 case of L1 combined with L2 vertebral fracture,1 case of L3 vertebral fracture,and 1 case of L3 combined with T11 vertebral fracture.The fractures were treated accordingly based on the AVCF.characteristics,three cases underwent conservative treatments such as anti-osteoporosis due to healed fractures or other underlying diseases that were not suitable for surgery;Three cases of simple fractures without severe neurological damage symptoms were treated with percutaneous kyphoplasty(PKP)under local anesthesia;Five cases of fractures combined with lower limb nerve compression symptoms were treated with posterior revision surgery,spinal canal decompression,and upward extension and pedicle screws fixation.The mean follow-up time was 24.5±6.4 months(24-31 months).The visual analogue scale(VAS)score for low back pain and lower extremity pain and Japanese Orthopaedic Association(JOA)score for lumbar spine were performed preoperatively,1 week postoperatively,and at the final follow-up,and the occurrence of complications during the perioperative period and the follow-up were recorded.Results:The incidence of AVCF after lumbar fusion was 3.1％(11/353).The VAS score for low back pain was 5.2±2.3 preoperatively,3.5±1.8 at 1 week postoperatively(P＜0.05),and 3.9±2.0 at the final follow-up(P＜0.05);the VAS score for lower extremity pain was 7.1±2.2 preoperatively,3.0±1.6 at 1 week postoperatively(P＜0.05),and 3.7±1.9 at the final follow-up(P＜0.05);The JOA score of lumbar spine was 14.8±5.6 before operation,21.5±4.2 at one week after operation(P＜0.05)and 18.7±3.9 at the final follow-up(P＜0.05).According to the recovery rate(RR)of JOA at the final follow-up,5 cases were excellent,3 cases were good,2 cases were fair and 1 case was poor,and the satisfaction rate of clinical efficacy was 72％.A total of 4 patients(36％)had 5 complications.One patient developed a deep infection of staphylococcus aureus in the wound was treated with incision,debridement,irrigation,drainage,and sensitive antibiotics,and was cured afterward;One patient suffered from increased weakness of both lower extremities and urinary retention after surgery,and was treated with vertebral canal decompression and bone cement screw lengthening and fixation again,while after revision surgery,the patient suffered from temporary cardiac insufficiency,and recovered after treatment of salt and water restriction,cardiotonic diuresis,etc;One patient developed vertebral compression fracture after surgery and was treated with PKP bone cement reinforcement;One patient developed AVCF again and combined with intervertebral disc herniation and spinal stenosis after surgery,who underwent further revision and extended fixation.Conclusions:AVCF after lumbar fusion mostly occurs in the thoracolumbar segment and in elderly women,and simple AVCF without neurological symptoms can be treated with PKP,while AVCF with intervertebral disc herniation or spinal stenosis can be treated with lumbar revision and spinal decompression,and good clinical results can be achieved.

Objective: To define radiographic features that response to serial casting and bracing for progressive early-onset scoliosis (EOS). Methods: A retrospective study of a total of 20 patients (10 females and 10 males) with complete radiographic data diagnosed as progressive early onset scoliosis treated with serial cast or brace for at least 12 months in the 306th Hospital of PLA from June 2011 to April 2018. Ages at initial diagnosis were all less than 5 years old. They were divided into two groups according to the main curve degree, those with cobbs angles more than 50 degree treated with serial cast, or else with brace. All the cases have radiographs of pretreatment, posttreatment, and last follow-up, and anteroposterior (lateral) film of the full length spine in standing position were taken to evaluate magnitudes and balance of coronal and sagittal malformations. We compared the general data of the two groups by independent sample t test and that of pretreatment, posttreatment and the last follow-up by paired-sample t test. Results: According to the effective standard of not less than 10 degrees improvement, 9 of them were effective, 4 cast and 5 brace, the effective rates were 44.44% and 45.45%, 3 cases from brace group progressed. The magnitudes of the main curve improved significantly after the first treatment of cast and brace (55.4±24.36 vs 42.35±23.62) degree (t=5.850, P=0.000), and at the last follow up, the curve decreased slightly compared of that before interventions (55.4±24.36 vs 51.8±26.33). The compensatory curves, segmental kyphosis, thoracic kyphosis, lumbar lordosis, balance of both coronal and sagittal also had no significant differences between the primal and the latest follow up. The widths 159.63±19.27 mm, 160.81±14.54 mm, 176.08±28.10 mm (t=3.942, P=0.001; t=-3.096, P=0.006) and heights 153.78±29.24 mm, 161.14±29.53 mm, 175.01±36.91 mm of the thoracic were significantly different between pre-posttreatment and the last follow up (t=-5.950, P=0.000; t=-3.997, P=0.001). Serial cast and brace application can preserve the growth of the thorax. Conclusion Serial cast and brace are viable growth friendly methods to deal with progressed EOS, Although a cure improvement cannot be always expected, they can stabilize relatively large curves in young children and may help delay eventual surgical intervention.

Objective To investigate the safety and efficacy of three column osteotomy (3-CO) procedures through previous spinal fusion site for the revision surgical treatment in severe spinal deformity patients.Methods From Oct.2010 to May 2014 in our hospital,a total of 12 severe spinal deformity patients underwent 3-CO for the revision surgical treatment.There were 7 males and 5 females with the average age of (21.8±3.8) years,ranging from 18 to 30 years.The mean time from the initial operation to the revision surgery was (10.2±4.8) years (ranging from 3 to 17 years).The reasons for revision were:curve progression in 7 patients,neurologic deficit in 2 cases,implant failure in 1 patient and pseudarthrosis in 2 patients.The coronal parameters including major Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),and the sagittal parameters including global kyphosis curve and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at last followup,respectively.The operation time,intraoperative blood loss and complications were recorded.The paired t test was used to evaluate the difference among pre-revision,post-revision and last follow-up.Results The average operation time was (451.7±83.1) min (range,320-600 min) and the average blood loss was (4 016.7± 1 080.0) ml (range,2 700-6 000 ml).The average follow-up time after revision operation was (35.4±9.8) months (range,24-49 months).The coronal Cobb angles of pre-revision and post-revision were 83.8°±23.3°and 34.6°± 13.7°.The average correction rate was 60.1％ ±8.8％.At last follow-up,the average coronal Cobb angle was 34.9°±13.8°,there was no significant loss of correction.The pre-revision and post-revision values of global kyphosis were 99.1°±13.3°and 38.7°±7.8° with a mean correction rate of 60.8％ ±6.7％.At the last follow-up,the average global kyphosis was 39.3°±7.5°and no loss of correction was found.For the C7PL-CSVL and SVA,pre-revision (30.3± 17.1) mm and (40.1±31.1) mm were corrected to (14.3 ±7.6) mm and (19.1± 12.3) mm immediately after revision operation,respectively.At final follow-up,the average C7PL-CSVL and SVA were(14.1 ± 7.6) mm and (19.6± 12.1) mm,the correction was well maintained.Obviously,two patient's neurological status improved from Frankel C before revision surgery to Frankel E.Complications were encountered in five patients (41.7％),including SEP signal changed in 1 patient (8.3％),transient neurologic deficit after revision surgery in 1 patient (8.3％),cerebrospinal fluid leak in 1 patient (8.3％),and pleural effusion in 2 patients (16.7％).During the follow-up time,there was no patient experienced pseudarthrosis,implant failure,infection or significant loss of correction.Conclusion Based on results of this study,it was concluded that 3-CO procedures through previous spinal fusion sites could obtain satisfactory and safety results in severe spinal deformity revision surgery.However,it is a technique-demanding procedure with more blood loss,longer operative time and higher risk of perioperative complications.

Objective: To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management. Methods: A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306^th Hospital of People′s Liberation Army from May 2010 to December 2015 were retrospectively reviewed. Six patients required reoperation within 30 days after PVCR, including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years). Four cases were congenital kyphoscoliosis, 1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis. Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients). The causes, management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded. Results: The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% (6/112). There was 1 case due to cerebrospinal fluid leak, 5 cases with varying degrees of new neurologic deficits, the causes were as followed: dural buckling in 1 case, residual bone compression in 1 case, epidural hematoma compression in 2 cases, spinal subdural hematoma in 1 case. All the 6 cases underwent surgical exploration again, including further dural repair, decompression and hematoma clearance. After unplanned reoperation, 6 cases recovered completely. The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months). The major curve at coronal plane was improved from preoperative 87.7° to 34.2°, with a mean correction of 61.0% at final follow-up; the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°, with a mean correction of 61.9% at final follow-up. Two patients′ neurological status improved from Frankel D to Frankel E, one patient′s neurological status improved from Frankel C to Frankel E. Conclusions One-stage PVCR could be an effective method for treatment of severe spinal deformity. The causes of 30-day unplanned reoperation after PVCR are as followed: cerebrospinal fluid leak, dural buckling, residual bone compression and hematoma compression. Timely surgical exploration can gain good clinical outcomes.

Objective To study the effect of osgentide (OST) on proliferation of mouse preosteoblast MC3T3-E1 under simulated microgravity ( SMG ) .Methods Under normal conditions , cell proliferation was evaluated by MTT assay to screen an OST compound of an effective concentration after MC 3T3-E1 cells were treated with series OSTs .Furthermore, cell proliferation and cell cycle distribution of MC 3T3-E1 cells were analyzed after treatment with 1 nmol/L OST5 by MTT assay and by flow cytometry ( FCM) scanning under SMG .Results Under normal conditions , 1 nmol/L OST5 was able to significantly promote the proliferation of MC3T3-E1 cells (P<0.01).Under SMG, proliferation of MC3T3-E1 cells was significantly inhibited and more cells entered G 1 than under normal conditions (CN).The proportion of S phase of MC3T3-E1 cells after treatment with 1 nmol/L OST5 ( OST-SMG) for 3 d was higher than that of untreated MC 3T3-E1 cells under SMG,suggesting that OST5 could promote DNA synthesis ( P<0.05 ) .Conclusion OST5 facilitates the proliferation of MC3T3-E1 cells under SMG, which provides a basis for the use of OST5 in the prevention and treatment of bone loss relat-ed to microgravity .

Objective To discuss the experience of medical treatment and rescue of the ‘SHENZHOU' astronauts in the landing place in the past 10 years,and to establish more effective mobile ICU in medical helicopters to ensure ‘SHENJIU' astronauts safety.Methods The data collected from foreign nations and our country was reviewed.Formerly experience in first-aid and rescue astronauts of our team was summerized.The important reasons of accidental injuries of astronaut during aerospace flight were listed.More effective and reasonable prophylactic measurements and clinical treatments of the accidental injuries of astronauts were brought forward.Results we established three effective mobile ICU that could ensure the safety of the astronauts.The carriers of the ICU were helicopters,and damage control surgery can be performed there.Fine armature made us more effective.Conclusions Reasonable and effective prophylactic measurements and clinical treatments were the important aspect of the successful manned aerospace flight.The first-aid system in helicopters could realize the destination of swift response and first-aid.