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.

Diffuse pediatric-type high-grade glioma (pHGG), H3- and isocitrate dehydrogenase (IDH)-wild-type, is a World Health Organization (WHO) grade 4 diffuse glioma with malignant histological features, which typically affects in children and adolescents. This multidisciplinary treatment case involves a 24-year-old young female patient initially diagnosed via biopsy. After concurrent chemoradiotherapy reduced the tumor size, complete resection was achieved, followed by adjuvant therapy with temozolomide and regorafenib. After recurrence, the tumor was resected again, and a second course of radiotherapy was administered, but the disease ultimately progressed rapidly, with an overall survival exceeding 32 months. pHGGs are highly malignant, aggressive, and associated with poor prognosis. Accurate diagnosis and targeted intervention require close collaboration among a multidisciplinary team, which highlights the critical value of multidisciplinary manage-ment in clinical practice.

Objective:To summarized the clinical characteristics of intracranial germ cell tumors（iGCTs）in children, with the ultimate goal of facilitating early tumor identification and guiding the prompt selection of appropriate treatment strategies.Methods:A retrospective analysis was conducted on pediatric patients with primary iGCTs admitted to Beijing Tiantan Hospital Affiliated to Capital Medical University between March 2021 and June 2022. Patient age, gender, clinical manifestations, tumor marker levels in cerebrospinal fluid (CSF) and blood, imaging features, and histopathological examination results were meticulously collected and statistically analyzed.Results:A total of 126 pediatric patients with iGCTs were included in the study, of which 86 cases (68.3%) were male,and 40 cases (31.7%) were female.The average age was (10.0 ± 3.5) years old. The mean age of onset was found between 6~14 years old(80.1%), with a male-to-female ratio of 2.2:1.The tumors were predominantly located in the sellar region (30.2%), basal ganglia (23.8%), and pineal region (19.8%). Notably, there were distinct differences in tumor location across different age groups: pineal region tumors were most prevalent in preschool children (71.4%), basal ganglia tumors were more common in school-age children (41.9%), and sellar region involvement was highest among adolescent patients(44.8%). Based on molecular marker analysis and biopsy diagnosis, 79 cases were classified as germinoma, 3 as teratoma, 2 as yolk sac tumor, 1 as choriocarcinoma, and 41 as mixed germinoma.All children underwent head CT and MRI examinations. Among them, 99 cases showed high-density lesions on CT,while 27 cases showed mixed density,including 39 cases of calcification and 35 cases of hydrocephalus.MRI revealed atrophy of the cerebral peduncle, caudate nucleus head, or cerebral cortex in 38 cases, involvement of the basal ganglia in 33 cases, and midbrain involvement in 5 cases.Blood β-human chorionic gonadotropin (β-HCG) and alpha-fetoprotein (AFP) levels were examined in all patients, while CSF tumor marker levels were analyzed in 103 cases. There were 76 cases with elevated β-HCG in blood and/or cerebrospinal fluid, and 24 cases with elevated AFP in blood and/or CSF.Additionally, all 86 male patients underwent genital ultrasound, revealed testicular microlithiasis in 12 cases and testicular cysts in 6 cases.Conclusion:The clinical presentation of iGCTs in pediatric patients exhibits significant heterogeneity in terms of epidemiology, classification, tumor location, and molecular markers. Notably, CSF β-HCG and AFP levels are equally crucial diagnostic indicators alongside blood tumor markers.Histological examination should be performed as early as possible in clinically suspected cases with negative tumor markers. Clinicians should remain vigilant for early imaging negative potential cases. In addition, male children with testicular microlithiasis or cysts should be closely followed up.

Objective:To summarized the clinical characteristics of intracranial germ cell tumors（iGCTs）in children, with the ultimate goal of facilitating early tumor identification and guiding the prompt selection of appropriate treatment strategies.Methods:A retrospective analysis was conducted on pediatric patients with primary iGCTs admitted to Beijing Tiantan Hospital Affiliated to Capital Medical University between March 2021 and June 2022. Patient age, gender, clinical manifestations, tumor marker levels in cerebrospinal fluid (CSF) and blood, imaging features, and histopathological examination results were meticulously collected and statistically analyzed.Results:A total of 126 pediatric patients with iGCTs were included in the study, of which 86 cases (68.3%) were male,and 40 cases (31.7%) were female.The average age was (10.0 ± 3.5) years old. The mean age of onset was found between 6~14 years old(80.1%), with a male-to-female ratio of 2.2:1.The tumors were predominantly located in the sellar region (30.2%), basal ganglia (23.8%), and pineal region (19.8%). Notably, there were distinct differences in tumor location across different age groups: pineal region tumors were most prevalent in preschool children (71.4%), basal ganglia tumors were more common in school-age children (41.9%), and sellar region involvement was highest among adolescent patients(44.8%). Based on molecular marker analysis and biopsy diagnosis, 79 cases were classified as germinoma, 3 as teratoma, 2 as yolk sac tumor, 1 as choriocarcinoma, and 41 as mixed germinoma.All children underwent head CT and MRI examinations. Among them, 99 cases showed high-density lesions on CT,while 27 cases showed mixed density,including 39 cases of calcification and 35 cases of hydrocephalus.MRI revealed atrophy of the cerebral peduncle, caudate nucleus head, or cerebral cortex in 38 cases, involvement of the basal ganglia in 33 cases, and midbrain involvement in 5 cases.Blood β-human chorionic gonadotropin (β-HCG) and alpha-fetoprotein (AFP) levels were examined in all patients, while CSF tumor marker levels were analyzed in 103 cases. There were 76 cases with elevated β-HCG in blood and/or cerebrospinal fluid, and 24 cases with elevated AFP in blood and/or CSF.Additionally, all 86 male patients underwent genital ultrasound, revealed testicular microlithiasis in 12 cases and testicular cysts in 6 cases.Conclusion:The clinical presentation of iGCTs in pediatric patients exhibits significant heterogeneity in terms of epidemiology, classification, tumor location, and molecular markers. Notably, CSF β-HCG and AFP levels are equally crucial diagnostic indicators alongside blood tumor markers.Histological examination should be performed as early as possible in clinically suspected cases with negative tumor markers. Clinicians should remain vigilant for early imaging negative potential cases. In addition, male children with testicular microlithiasis or cysts should be closely followed up.

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.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective:To evaluate clinical efficacy of adjuvant radiotherapy (RT) for central neurocytoma (CN) after surgical resection.Methods:Clinical data of 136 CN patients admitted to Beijing Tiantan Hospital and Xuanwu Hospital from January 2001 to December 2020 were retrospectively analyzed. Preliminary interventions consisted of craniotomy (gross total resection, subtotal resection and partial resection, the latter two belonging to incomplete resection) and postoperative radiotherapy. Three-dimensional conformal or intensity-modulated radiotherapy was adopted, with a median radiotherapy dose of 54 Gy. Post-recurrence treatment included salvage surgery and radiotherapy. The overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Univariate analysis was performed by log-rank test to evaluate the effect of each prognostic factor on OS and PFS. The effects of multiple prognostic factors on PFS and OS were assessed by Cox regression model.Results:The median age was 28 years (range: 6-66 years). The median follow-up was 94.5 months (12-237 months). Among all patients, 79 cases underwent total resection, and 68 of them received adjuvant radiotherapy. Thirty-eight patients underwent subtotal resection, and 37 of them were treated with adjuvant radiotherapy. Sixteen patients received partial resection and adjuvant radiotherapy. Three cases received biopsy and postoperative radiotherapy. Among all patients, 3 cases died, including 2 from tumor recurrence and 1 from postoperative complication. Eight patients had recurrences during follow-up. Among them, 7 patients had recurrences at the primary site,1 had tumor dissemination to the spinal cord. The 5- and 10-year OS rates were 98.5% and 96.8%, and the 5- and 10-year PFS rates were 95.3% and 91.6% for the in the entire cohort. In the gross total resection without radiotherapy group, the 5- and 10-year PFS rates were 90.9% and 90.9%, and 96.6% and 96.6% in the gross total resection + radiotherapy group ( P=0.338). The 5- and 10-year OS rates were 100% and 100% in the gross total resection without radiotherapy group, and 98.5% and 98.5% in the gross total resection + radiotherapy group ( P=0.693). The 10-year PFS rates between the gross total resection±radiotherapy group and the incomplete resection+radiotherapy group was 95.8% vs. 90.3% ( P=0.368), and the 10-year OS rate was 98.6% vs. 94.7% ( P=0.436). Multivariate analysis showed that tumor site, degree of surgical resection, adjuvant radiotherapy and age exerted no significant effects on PFS and OS. A total of 81 patients had late neurotoxicities, including 69 cases at grade 1, 9 cases at grade 2, and 3 cases at grade 3. And 64.2% (52/81 cases) of patients suffered from short-term memory impairment. Conclusions:Gross total resection alone yields high efficacy for CN. Postoperative radiotherapy is not required. Incomplete resection combined with postoperative adjuvant radiotherapy can achieve equivalent clinical efficacy to gross total resection.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

As an important modality in the treatment of central nervous system malignancies of pediatric patients, radiotherapy could improve both local control and long-term survival.However, both short-term and long-term adverse effects are of concerns.In the current review, the role of radiotherapy in the pediatric setting were introduced.