Objective: To evaluate the clinical efficacy of integrated optical-electromagnetic navigation-guided (Ng) transforaminal endoscopic lumbar discectomy (TELD) in the treatment of lumbar disc herniation (LDH). Methods: A retrospective analysis was conducted on data from patients who underwent TELD for LDH at Beijing Chaoyang Hospital, Capital Medical University, between January 2024 and May 2025. A total of 78 patients were included. Patients who underwent TELD using Ng were assigned to the Ng-TELD group (n=37), while those who underwent TELD using the conventional X-ray fluoroscopy method were assigned to the control group (n=41). The operative time, cannulation time, decompression time, number of intraoperative fluoroscopies, visual analogue scale (VAS) scores for leg and back pain, Oswestry Disability Index (ODI), European Quality of Life-5 Dimensions visual analogue scale (EQ-VAS) score, Macnab criteria, and incidence of adverse events during follow-up were recorded and compared between the two groups. Results: Among the 78 patients, the age was (60.4±16.6) years, with 46 males (59.0%) and 32 females (41.0%). At 3 months postoperatively, significant improvements were observed compared to preoperative values for leg pain VAS [(0.7±0.7) vs (6.2±1.0)], back pain VAS [(0.9±0.6) vs (4.2±1.8)], ODI [(8.4±3.1)% vs (58.5±8.2)%], and EQ-VAS score [(84.0±10.2) vs (53.3±12.0)] (all P<0.05). The Ng-TELD group demonstrated significantly shorter total operative time [(66.3±11.7) vs (81.6±15.6) min], shorter puncture and cannulation time [(5.9±1.2) vs (15.2±4.1) min], shorter endoscopic decompression time [(55.4±11.6) vs (66.3±13.9) min], and fewer intraoperative fluoroscopies [(3.2±1.5) vs (15.7±5.3) times] compared to the control group (all P<0.05). There were no statistically significant differences between the two groups in terms of efficacy evaluation metrics, MacNab criteria outcomes, or the incidence of adverse events (all P>0.05). Conclusion: Ng-TELD for the treatment of LDH is safe, accurate, and effective.

This study aims to assess the biomechanical impact of bone cement perfusion on osteoporotic vertebral compression fractures across various distribution sites through finite element simulation. The finite element model of the L1-L3 vertebral body was constructed and its efficacy was validated. Simulated compression fractures of the L2 vertebral body resulted in the distribution of cement in the anterior, middle, and posterior thirds of the L2 vertebral body. Physiological loading and boundary conditions of axial compression experienced by the spine in the upright position were established, and loading models were examined in various states of movement including forward flexion, extension, left and right lateral bending, and left and right rotational movements. The study compared the stress distribution, maximum Von-Mises stress, maximum elastic strain of the vertebral body, and maximum deformation displacement of the vertebral body and intervertebral disc based on the distribution differences of L2 vertebral bone cement. In flexion, extension, and lateral bending, the peak stress experienced by the L2 vertebral body due to the bone cement model was found to be lower in the anterior 1/3 compared to the middle and posterior 1/3. Furthermore, when the left side of the vertebral body was subjected to bending and rotation, the maximum stress values observed in the fracture model and the posterior 1/3 of the L2 vertebral body cement model on the L3 vertebral body were similar to, and significantly higher than, those seen in the anterior and middle 1/3 of the L2 vertebral body cement models. The elastic modulus of the vertebral body is enhanced when bone cement is strategically placed in the anterior middle region, potentially facilitating the transmission of pressure from the vertebral body to the upper and lower lumbar spine through the bone cement. This redistribution of pressure may alleviate stress in the central region, thereby reducing the likelihood of vertebral injury and adjacent vertebral fractures.

This study aimed to evaluate the impact of enhanced recovery after surgery (ERAS) protocols on the clinical outcomes of anterior cervical discectomy and fusion (ACDF). This retrospective study included eligible patients with 3-level cervical disc herniation treated with ACDF between April 2020 and April 2022, with a minimum 1-year follow-up. Patients were categorized into 2 groups based on whether they received an ERAS protocol (ERAS+ group) or standard perioperative care (ERAS- group). Key outcome measures included hospital length of stay, total cost, estimated blood loss, visual analogue scale pain scores, Neck Disability Index, Japanese Orthopaedic Association scores, perioperative opioid usage, complication rates, and Bridwell bone fusion grades. Statistical analyses were performed using Statistical Package for Social Sciences 24.0, with significance set at P < .05. The implementation of an ERAS protocol in patients undergoing multilevel ACDF may be associated with improved perioperative metrics, enhanced functional recovery, reduced opioid use, and lower complication rates in this retrospective analysis. Further prospective studies are warranted to confirm these observations. A total of 110 eligible patients were enrolled in our study. Compared with the ERAS- group, the ERAS+ group demonstrated significantly shorter hospital stays (3.6 ± 0.5 vs 4.3 ± 0.8 days, P < .05), lower total costs (18,569.2 ± 872.4 vs 21,201.9 ± 1160.8 CNY, P < .05), and reduced estimated blood loss (75.5 ± 14.6 vs 107.2 ± 27.5 mL, P < .05). The ERAS+ group also showed superior improvements in visual analogue scale, Neck Disability Index, and Japanese Orthopaedic Association scores at follow-up visits (P < .05). Furthermore, the ERAS+ group had significantly lower perioperative opioid consumption, a lower incidence of overall complications (P < .05), and better Bridwell fusion grades (P < .05).

This study investigated changes in neurological grades and plasma biomarker levels, including hypoxia-inducible factor-1α (HIF-1α), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and total plasma NAD(H) levels, in dogs with thoracolumbar intervertebral disc disease (TL-IVDD) undergoing acupuncture treatment. A total of 46 treatment episodes from 36 dogs with TL-IVDD were included in the neurological assessment. Plasma biomarker analyses were performed using available paired samples after exclusion of missing values and incomplete paired observations. Neurological grades improved after acupuncture treatment, with significant reductions observed in dogs treated with electroacupuncture during both the acute and preventive phases. Plasma TNF-α concentrations showed significant treatment period-, disease phase-, and treatment method-dependent changes, with significant Pre-Post differences observed in the electroacupuncture group during both phases. Plasma IL-6 concentrations showed more limited changes, with a significant Pre-Post difference detected only in the classical needle acupuncture group during the acute phase. In contrast, total plasma NAD(H) levels and plasma HIF-1α concentrations did not show significant treatment-related changes. These findings suggest that acupuncture treatment, particularly electroacupuncture, was associated with neurological improvement in dogs with TL-IVDD, and that TNF-α may reflect phase- and method-dependent inflammatory responses after acupuncture treatment. Plasma IL-6, total plasma NAD(H) levels, and HIF-1α should be interpreted as exploratory biomarkers in this clinical setting.