Among the papers published in the June issue of Neurospine, the featured articles selected by editors are as follows.
“Different Ways to Die: Cell Death Pathways and Their Association With Spinal Cord Injury” by Guha et al. [1]
This paper reviews the complex processes of cell death, integral to cell replacement, and potentially inciting inflammation in cases of spinal cord injury. It emphasizes the impact of these pathways on neuronal cells, especially following acute or chronic injury, given the restricted regenerative and recuperative abilities of neurons. These process malfunctions are correlated with spinal cord injuries, leading to disrupted motor activity and axonal degeneration. A deeper understanding of these processes could enhance neuronal survival and mitigate neurological deficits, offering new avenues for therapeutic strategies in spinal cord injury treatment.
“Three-Dimensional-Printed Titanium Versus Polyetheretherketone Cages for Lumbar Interbody Fusion: A Systematic Review of Comparative In Vitro, Animal, and Human Studies” by Patel et al. [2]
The paper conducts a systematic review comparing outcomes of interbody spinal cages made of polyetheretherketone (PEEK) and 3-dimensional printed porous titanium (3D-pTi), focusing on fusion results and subsidence rates. Across 7 studies involving human and ovine subjects, most showed 3D-pTi to have superior fusion outcomes and osseointegration without increased risk of subsidence or reoperation compared to PEEK. Despite limited data, the paper suggests that 3D-pTi interbodies might offer superior results due to their osteoinductive properties, warranting further clinical investigation.
“Intra-Articular Distraction Versus Decompression to Treat Basilar Invagination Without Atlanto-Axial Dislocation: A Retrospective Cohort Study of 54 Patients” by Zhang et al. [3]
This retrospective cohort study compares 2 surgical treatments for type B basilar invagination: posterior intra-articular C1–2 facet distraction, fixation, and cantilever reduction versus foramen magnum decompression. Results from 54 patients suggest the former technique results in better basilar invagination reduction, improved nerve pressure relief, and superior patient outcomes as assessed by Japanese Orthopedic Association and 12-item Short Form health survey scores. A preoperative craniovertebral junction triangle area cutoff value of 2.00 cm2 is proposed as a surgical indication. Despite positive results, the study recommends investigating alternative treatment strategies due to the multifactorial nature of the condition.
“Mini-Open Intercostal Retroperitoneal Approach for Upper Lumbar Spine Lateral Interbody Fusion” by Lee et al. [4]
This study compares 2 surgical methods: conventional oblique lumbar interbody fusion (OLIF) and the proposed intercostal retroperitoneal (ICRP) approach for upper lumbar spine access. Results from 121 patients show a significantly lower incidence of endplate injury with the ICRP approach (9.1% vs. 34.3% in conventional OLIF). This is particularly evident in patients with a lower rib line. The ICRP approach offers these benefits without requiring pleural exposure or rib resection. The use of ICRP has increased nearly threefold since 2022.
“METTL3 Affects Spinal Cord Neuronal Apoptosis by Regulating Bcl-2 m6A Modifications After Spinal Cord Injury” by Guo et al. [5]
The study investigates the role of methyltransferase METTL3, a key enzyme in the m6A RNA modification, in spinal cord injury (SCI). In both oxygen-glucose deprivation models of PC12 cells and rat spinal cord hemisection models, METTL3 expression and overall m6A modification levels increased significantly. Inhibiting METTL3 activity or expression raised Bcl-2 mRNA and protein levels, reduced neuronal apoptosis, and improved viability in the spinal cord post-SCI. This suggests that inhibiting METTL3 could potentially protect spinal cord neurons following injury via the m6A/Bcl-2 signaling pathway.
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