Spine update

Clinical evidence indicates that inflammatory bowel disease (IBD) and ankylosing spondylitis (AS) often co-occur, but their genetic mechanisms remain unclear. Our objective is to explore the genetic relationship between IBD and AS./r/nUsing large-scale summary statistics from genome-wide association study (GWAS), we investigated the shared genetic architecture between IBD, including ulcerative colitis (UC) and Crohn's disease (CD), and AS. Starting with genetic correlation, we then examined shared genetic structures and genes, followed by causal inference, and explored potential functional genes and biological pathways in tissue and cell types./r/nWe observed a positive genetic correlation between IBD and AS (IBD-AS:  = 0.252, =3.78e - 06; CD-AS:  = 0.268, =5.19e - 06; UC-AS:  = 0.171, =6.64e - 03). Multitrait analysis of GWAS (MTAG) and cross-phenotype association analysis (CPASSOC) identified 24 pleiotropic single-nucleotide polymorphisms (SNPs) across three trait pairs. Gene association analysis from three methods collectively identified eight shared functional genes for IBD and AS. Shared tissue-specific genetic enrichment was found in lung, spleen, small intestine, and whole blood tissues. Additionally, common enrichment was observed in specific cell types, such as T and B cells. Bidirectional Mendelian randomization (MR) analysis revealed no causal relationship between the two conditions./r/nThis study confirms the genetic correlation between IBD and AS, identifies their shared genetic architecture and biological pathways, providing strong evidence for the genetic comorbidity of IBD and AS. These findings offer directions for future research.

To compare the risk of incident uveitis among patients with axial spondyloarthritis initiating treatment with Janus kinase inhibitors (JAKi) versus tumor necrosis factor inhibitors (TNFi)./r/nWe conducted an emulated target trial using real-world electronic health records from the TriNetX US Collaborative Network. Adults with ankylosing spondylitis (AS), psoriasis (PsO), or psoriatic arthritis (PsA) who newly initiated a JAKi or a TNFi between January 1, 2016, and December 31, 2023, were identified. Patients were stratified into JAKi and TNFi cohorts based on initial treatment exposure. Propensity score matching (1:1) was performed to balance baseline demographics, comorbidities, prior medication use, and laboratory values. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval(CI) for the development of incident uveitis, with TNFi as the reference. Kaplan-Meier analysis was conducted to compare the 9-year cumulative incidence of uveitis between cohorts. The primary outcome was incident uveitis following initiation of therapy, with follow-up extending up to nine years./r/nAmong 697,850 patients identified, 5,874 were included in each group after 1:1 propensity score matching. JAKi use was associated with a lower risk of incident uveitis compared with TNFi (HR = 0.630; 95% CI, 0.418-0.948). These findings remained consistent after further adjustment for comorbidities, medications, and laboratory data. Subgroup analyses showed a consistent protective association in older patients (≥ 51 years: HR = 0.43, 95% CI = 0.24-0.79), White individuals (HR = 0.59, 95% CI = 0.38-0.93), and those with elevated inflammatory markers (CRP ≥ 3 mg/L: HR = 0.50, 95% CI = 0.26-0.96; ESR ≥ 20 mm/h: HR = 0.41, 95% CI = 0.19-0.87). The reduced risk persisted regardless of concomitant use of conventional synthetic DMARDs (with csDMARDs: HR = 0.50, 95% CI = 0.28-0.92; without csDMARDs: HR = 0.56, 95% CI = 0.33-0.94)./r/nIn this large-scale, real-world cohort study, JAKi therapy was associated with a significantly reduced risk of incident uveitis compared to TNFi therapy in patients with AS, PsO, or PsA. These findings suggest a potential role for JAKi in mitigating ocular inflammation in this population. Further prospective studies and randomized controlled trials are warranted to validate these results and inform future clinical guidelines.

Patients with ankylosing spondylitis (AS) may require biological therapy, particularly tumour necrosis factor (TNF) inhibitors, which are effective but increase the risk of tuberculosis (TB). Secukinumab, an interleukin-17A inhibitor, has not been linked to TB reactivation; however, its safety in the setting of active TB remains unclear. We report two patients with AS who developed active TB during long-term anti-TNF treatment. Both experienced disease flares while receiving anti-TB therapy and needed alternative biologic treatment. Secukinumab was started 2 months after initiating standard four-drug TB therapy and achieved rapid and sustained control of AS activity without compromising TB management. Both patients completed 9 months of anti-TB treatment without adverse events or TB reactivation during 1 year follow-up. These observations suggest that secukinumab may be a safe and effective therapeutic option for patients with AS with concomitant active TB when anti-TNF agents are contraindicated, though confirmation in larger studies is warranted.

Spinal cord stimulation (SCS) is considered an efficient and safe method of treating intractable chronic pain from various origins such as persistent spinal pain syndrome (PSPS) or complex regional pain syndrome (CRPS). The complications related to SCS therapy are usually classified as mechanical or biological. Myelopathy related to dense scar tissue formation around epidural paddle electrodes implanted for SCS therapy is extremely rarely reported. We have studied all reported cases of surgical management of this complication and we sought to find predisposing factors responsible for development of this rare but dangerous complication./r/nWe report on 2 cases of thoracic spinal cord compression by scar tissue encountered around epidural electrodes implanted for SCS. Both patients had their implantable pulse generators (IPGs) removed due to biological complications (skin erosions with subsequent infection at IPG site confirmed in one patient). During the waiting time for further placement of new IPGs, both patients developed myelopathic symptoms. Magnetic resonance imaging (MRI) in both cases showed severe compression of the spinal cord by scar tissue around the electrode. Surgical decompression resulted in full and partial recovery in each patient. In both cases, during surgery, excessive epidural fibrosis was encountered, without signs of active infection. Surgical decompression in patient 1 resulted in full recovery, while patient 2 had a complicated postoperative course with partial recovery./r/nTo our knowledge, both cases constitute extremely rare complications of SCS therapy resulting in thoracic spinal myelopathy. The predisposing factors found in our patients were surgically placed paddle electrodes with a prior history of IPG removal due to biological complications (skin erosions and infection). In the literature, surgical electrodes placed in the cervical spine rather than the thoracic spine were more often found to result in excessive epidural scarring, resulting in spinal compression syndromes. Prompt surgical decompression with scar tissue removal is mandatory to achieve full recovery.

BACKGROUND Paravertebral extraskeletal Ewing sarcoma located in the extradural region is uncommon. Muscle denervation can be caused by nerve injury, destruction of the neuromuscular junctions, and aging-related loss of motor neurons. Psoas denervation caused by spinal extraskeletal Ewing sarcoma is extremely rare. CASE REPORT A 38-year-old Chinese man presented to our hospital with back pain lasting for 1 month. He presented thoracolumbar mobility limitations. Magnetic resonance imaging revealed a well-defined margin extradural soft tissue mass involving the intervertebral foramen and paravertebral region at level L1-L2. The mass measured approximately 31×47×42 mm and demonstrated heterogeneous signal intensity on T1-weighted imaging and hyperintensity on STIR images. Imaging showed psoas compression, with diffuse homogeneous edema. On post-contrast images, the mass showed heterogeneous enhancement, and the edematous psoas showed homogeneous enhancement. Pathological examination of the biopsy specimen revealed clusters of atypical small blue round cells with hyperchromatic nuclei, scant cytoplasm, and frequent mitotic figures. Immunohistochemical analysis of tumor cells demonstrated strong membranous positivity for CD99 and nuclear positivity for NKX2.2. The final diagnosis was extraskeletal Ewing sarcoma. Chest computed tomography revealed multiple nodal metastases. The patient underwent chemotherapy for 4 cycles, and the tumor showed no response to treatment. The patient refused further chemotherapy and took only oral analgesic. He died 12 months after presenting to our hospital. CONCLUSIONS Extraskeletal Ewing sarcoma is a rare subtype in the Ewing sarcoma family of tumors. Spinal extradural extraskeletal Ewing sarcoma is uncommon, and masses compressing the lumbar plexus and causing psoas denervation is extremely rare.

The superoxide dismutase type 1 (SOD1) gene has been implicated in both sporadic and familial forms of amyotrophic lateral sclerosis (ALS). We report four ALS cases carrying pathogenic or likely pathogenic SOD1 variants, characterized by albuminocytologic dissociation and nerve root enhancement./r/nWe present the results of the diagnostic work-up, including lumbosacral magnetic resonance imaging (MRI) with gadolinium, electromyography (EMG), and cerebrospinal fluid (CSF) analysis. We also assessed the relationship between the albumin quotient (Q-Alb)-an index of blood-brain barrier (BBB) dysfunction-and the disease progression rate (DPR) in 12 SOD1-linked ALS patients (including the four described above) and in a cohort of 137 non-genetic ALS (NgALS) cases./r/nThe four patients presented with spinal onset (progressive lower limb weakness). The EMG ultimately showed diffuse subacute neurogenic changes, while CSF analysis revealed albuminocytologic dissociation. Lumbosacral MRI demonstrated contrast enhancement of the cauda equina roots. Immunomodulatory treatment was administered due to suspected immune-mediated neuropathy, but all patients continued to deteriorate. Genetic testing revealed pathogenic or likely pathogenic variants in the SOD1 gene, confirming the diagnosis of ALS. CSF Q-Alb and protein levels were similarly distributed between SOD1-linked and NgALS patients. Q-Alb and CSF protein levels showed a positive correlation with DPR in SOD1-linked patients (Rho = 0.625, p = 0.03; Rho = 0.755, p = 0.005), but not in NgALS patients./r/nAlbuminocytologic dissociation and nerve root enhancement may occur in SOD1-related ALS, expanding the spectrum of atypical ALS phenotypes.

Lumbar disc herniation (LDH) is one of the most common causes of lower back pain, radiculopathy, and functional impairment. Intra-articular (IA) steroid injections, including transforaminal (TFESI), interlaminar (IESI), and caudal (CESI) epidural steroid injections, are commonly administered to alleviate these symptoms when surgery is not indicated or opted for. This systematic review and meta-analysis evaluates the efficacy of these injection modalities in reducing pain and disability in LDH patients./r/nFollowing PRISMA, 19,664 studies on IA steroid injections for LDH were screened, yielding 41 eligible studies. Random-effects and fixed effects meta-analyses computed pooled standardized mean changes (SMC), depending on heterogeneity (I)./r/nTFESI showed strong short-term efficacy, with the greatest pooled NRS improvement of -5.15 (95% CI: -6.59, -3.72, p < 0.001, I = 99.14%) at 3 months and the largest VAS reduction of -30.53 (95% CI: -43.89, -17.17, p < 0.001, I = 99.99%) at 3 months. CESI had the highest ODI improvement at 1 month (-18.99, 95% CI: -26.88, -11.10, p < 0.001, I = 99.35%), while IESI demonstrated the greatest ODI reduction at 6 months (-16.06, 95% CI: -16.83, -15.28, p < 0.001, I = 18.85%)./r/nThis meta-analysis suggests that IA injections may relieve LDH symptoms, with TFESI showing the greatest pain relief and functional improvement. However, significant heterogeneity calls for standardized protocols and further research. Demographic factors minimally influenced outcomes, whereas methodological variability underscores treatment complexity. Future studies should emphasize methodological consistency and personalized approaches to optimize patient outcomes.

The ASAS consensus defines 'early axial spondyloarthritis (axSpA)' as symptom duration ≤2 years, a definition derived from expert opinion due to limited evidence. We performed a meta-analysis of randomized placebo-controlled trials (RCTs) of biologic and targeted synthetic DMARDs (bDMARDs/tsDMARDs) in axSpA to assess the impact of symptom duration on treatment response./r/nRCTs in adult axSpA patients comparing b/tsDMARDs to placebo were identified through systematic literature reviews supporting the ASAS-EULAR management recommendations. Primary outcome was ASAS40 response, with secondary outcomes including disease activity, function and quality of life at each trial's primary end point. Relative risks (RRs) comparing two groups (shorter vs longer symptom duration) were calculated for efficacy outcomes for each arm and for several thresholds of symptom duration (1-5 years). RR ratios (RRRs) were calculated as the ratio of RR of the b/tsDMARD and placebo arms. Pooled effects were obtained with random-effects meta-analysis./r/nEleven bDMARD RCTs, comprising 3272 axSpA patients, were included. No studies involving tsDMARDs met the eligibility criteria. At the 2-year threshold, pooled RR for ASAS40 response was 2.04 (95% CI, 1.48-2.84) in early axSpA and 2.28 (95% CI, 1.65-3.15) in established disease, yielding an RRR of 0.89 (95% CI, 0.63-1.26), with no statistical significance. There were no significant differences between efficacy in shorter and longer symptom duration for other outcomes or across other symptom duration thresholds (3-5 years)./r/nBased on a meta-analysis of 11 trials, no significant differences were found in the efficacy of bDMARDs compared with placebo in patients with axSpA with shorter vs longer symptom duration, across thresholds from 2 to 5 years.

Less than 1% of head and neck tumors are in the parapharyngeal space (PPS). With complex anatomy, conventional surgery is challenging. Endoscopy-assisted transoral approach (EATA) minimizes trauma and scarring; however, criticism regarding infeasibility with large tumors led to the introduction of transoral robotic surgery (TORS), which gives a 3D view of the field, reduces operative time, and is effective for larger tumors but faces technical and operational issues. This review compares the outcomes and complications of TORS and EATA./r/nWe searched four databases for relevant articles up to January 2025. Two independent reviewers extracted data from the selected studies, including baseline information, operative time, blood loss, and hospitalization time./r/nWe reviewed 32 studies, of which 27 provided sufficient data for analysis. These studies involved 348 patients treated for PPS tumors using either EATA or TORS. Operative times were similar for both methods, with EATA averaging 92.31 min and TORS averaging 93.93 min (p = 0.9385). However, compared to EATA, TORS was associated with reduced blood loss (16.98 ml, 95% CI: 9.38-24.59; p < 0.0001) and a shorter hospitalization duration (3.39 days, 95% CI: 2.51-4.27; p = 0.0278). Common complications associated with endoscopy included Horner's syndrome and wound dehiscence, whereas TORS rarely reported severe complications. No fatalities were documented for either method./r/nTORS is not inferior to EATA regarding operative time, with reduced blood loss and shorter hospital stays..

A 10-year-old girl presented with a 16-month history of persistent head tilt, restricted neck motion, and neck pain. Imaging demonstrated chronic atlantoaxial rotatory subluxation (AARS) with underlying congenital C1 arch diastasis. Preoperative halo-gravity traction (HGT) was performed over 2.5 weeks, achieving partial realignment, followed by C1 to C2 posterior spinal fusion with iliac crest autograft. Postoperatively, the patient demonstrated stable alignment and resolution of neck pain./r/nChronic AARS may be successfully treated using a staged approach with preoperative HGT followed by cervical arthrodesis.

Accurate diagnosis of sacral insufficiency fractures in oncology patients may be challenging. We describe 18 F-PSMA-1007 PET/CT findings of sacral insufficiency fracture in a patient with a history of prostate cancer and pelvic radiotherapy. The insufficiency fracture in the left sacral ala showed no oblivious structural changes and diffuse heterogeneous activity with SUV max of 7.7 on 18 F-PSMA-1007 PET/CT mimicking metastatic prostate cancer. A follow-up 99m Tc-MDP SPECT/CT showed progression of the insufficiency fracture from the left sacral ala to the right sacral ala. A low level of serum prostate-specific antigen may be helpful for the diagnosis.

Neuroendocrine tumors (NETs) are a heterogeneous group of tumors, which are usually indolent with metastatic disease at the initial presentation in most clinical situations. Intramedullary spinal cord metastasis (ICSM) is usually rare in the case of neuroendocrine tumors. Peptide receptor radionuclide therapy (PRRT) with Lu-177 DOTATATE has been in use for treatment of metastatic NETs for a long time. Here, the authors present favorable response to PRRT in a treatment-naive patient with metastatic NET of the pineal gland with brain and spinal cord metastases.

Sacroiliac joint dysfunction (SIJD) accounts for 15-25% of chronic low back pain and often follows lumbar fusion. When conservative therapies fail, minimally invasive (MIS) SIJ fusion (SIJF) is indicated. The robot-assisted technique is feasible and safe, enhancing accuracy and reducing radiation exposure./r/nA 26-year-old woman, eight years after L4-S1 fusion, presented with bilateral SIJD refractory to physiotherapy and intraarticular steroids injection. SIJF was indicated. Here we describe the robot-assisted technique and its advantages./r/nRobot-assisted SIJF is a safe and accurate technique to treat SIJD while reducing radiation exposure. Trajectories planification and consideration of anatomical variations give the robot-assisted technique an advantage over conventional techniques such as fluoroscopy or navigation.

Complex and Revision Surgery: ASC and Beyond - Steven Girdler, MD & Brandon Hirsch, MD

MIS Lateral Lumbar Corpectomy - Kevin Swong, M.D.

The study was carried out to inform Medicare acupuncture coverage decisions addressing the gap in evidence on acupuncture effectiveness, specifically for older adults with chronic low back pain (CLBP)./r/nTo determine the effectiveness of standard acupuncture (SA) or SA plus maintenance (enhanced acupuncture [EA]) to improve CLBP-related disability relative to usual medical care (UMC) at 3, 6, and 12 months after randomization./r/nThis multisite, 3-arm, parallel-group randomized clinical trial of older adults with CLBP collected data from 4 US health care systems in 3 geographic areas and compared SA and EA treatment with UMC only. Study enrollment was conducted from August 12, 2021, to October 27, 2022; follow-up concluded on November 7, 2023./r/nBoth SA (8-15 treatment sessions over 12 weeks plus UMC) and EA (SA plus 4-6 maintenance sessions during the next 12 weeks) were provided by experienced, community-based licensed acupuncturists. Participants were randomized 1:1:1 to the 3 groups./r/nThe primary outcome was CLBP-related disability measured by a baseline-to-6-month change in the Roland-Morris Disability Questionnaire (RMDQ) score. Secondary outcomes included pain intensity and the percentage of participants with clinically meaningful (≥30%) improvements./r/nThe trial identified 800 individuals who were randomized to 3 groups (mean [SD] age, 73.6 [6.0] years; 496 females [62.0%]). At 6 months, RMDQ change scores were significantly better in both the SA and EA groups compared with the UMC only group (SA vs UMC: adjusted mean difference, -1.0 [95% CI, -1.9 to -0.1] and EA vs UMC: adjusted mean difference, -1.5 [95% CI, -2.5 to -0.6]). SA and EA change scores did not differ significantly from one another. The relative benefit of acupuncture compared with UMC on disability persisted at 12 months. Pain intensity exhibited a relative benefit of EA over SA at 6 months, and both acupuncture groups had significant improvement over UMC. The adjusted percentage with clinically meaningful improvements in RMDQ at 6 months was greater for SA (39.1% [95% CI, 33.1%-46.1%]; adjusted relative risk, 1.33 [95% CI, 1.04-1.70]) and for EA (43.8% [95% CI, 38.0%-50.4%]; adjusted relative risk, 1.49 [95% CI, 1.19-1.86]) compared with UMC (29.4% [95% CI, 24.3%-35.5%]) and persisted at 12 months. Rates of serious adverse events were low and similar among groups, with less than 1% that was possibly acupuncture-intervention related./r/nThe findings of this randomized clinical trial of older adults with CLBP suggest that acupuncture needling provided greater improvements in back pain-related disability at 6 months and at 12 months compared with UMC alone. These findings support acupuncture needling as an effective and safe treatment option for older adults with CLBP./r/nClinicalTrials.gov Identifier: NCT04982315.

A 19-year-old man presented with a progressive kyphoscoliosis deformity, pelvic obliquity, neck flexion, and bilateral lower limb contractures. Evaluation showed previously undiagnosed spinal osteoid osteoma. The patient underwent surgical resection with instrumentation of L3-L4. At the 2-year follow-up, the patient showed almost complete resolution of his complex spine deformity and improvement in radiological parameters./r/nThe current case described the most severe thoracolumbar deformity secondary to an osteoid osteoma of the lumbar spine in the literature. An intralesional curettage with short, instrumented fusion showed satisfactory outcomes without the need for further deformity correction.

Cage migration (CR) after lumbar interbody fusion may result in intractable complications to patients. This meta-analysis was aimed to figure out risk factors of cage migration after posterior approaches for lumbar interbody fusion./r/nLiterature was searched in the PubMed, Embase, Web of Science and Cochrane Library between Feb 2013 to Feb 2023. PRISMA guidelines were followed in this review. The keywords used in the search included: cage, retropulsion, migration, lumbar interbody fusion, spinal fusion. Odds ratio (OR) and 95% confidence interval (CI) of a potential risk factor was calculated via RevMan5.4./r/n8 studies were finally included in this meta-analysis. 10 risk factors were assessed and the outcome showed that Screw loosening (OR 12.98, 95% CI 4.63 to 36.36, P < 0.01), endplate injury (OR 10.14, 95% CI 5.20 to 19.79, P < 0.01) and pear-shaped disc (OR 4.03, 95% CI 1.41 to 11.55, P < 0.01) were associated with cage migration, and poly-ether-ether-ketone (PEEK) cage (OR 0.51, 95% CI 0.27 to 0.96, P = 0.04) could reduce risk of cage migration./r/nScrew loosening, endplate injury and pear-shaped disc increased risk of CM after posterior approaches for lumbar interbody fusion, and PEEK cage probably reduce risk of postoperative cage migration.

Three-column osteotomy (3CO) offers substantial spinal deformity correction. Thoracic neurovascular bundle sacrifice is often required, and anterior spinal artery (ASA) perfusion can be compromised. Spinal angiography allows localization of variable ASA vascular contribution. This study's objective was to describe a series of patients who underwent preoperative spinal angiography and discuss the impact on surgical planning and execution of thoracic 3CO for deformity correction./r/nPatients who underwent preoperative spinal angiograms and thoracic 3CO for deformity correction were reviewed. Preoperative, angiographic, and postoperative information was recorded. A literature review on preoperative spinal angiography in deformity surgery was performed./r/nEight patients were identified: single-level pedicle subtraction osteotomies (1), single-level vertebral column resections (2), and multilevel vertebral column resections (5). The average age was 40.0 years, and 75.0% were female. Thoracic scoliosis ranged from 0 to 105° preoperatively and 0 to 45.1° postoperatively. Thoracic kyphosis ranged from 29° to 120° preoperatively and 20.6° to 54.9° postoperatively. Twelve ASA supply vessels were identified bilaterally in 6 patients. Four patients had nontraditional ASA supply at T4 (1), T6 (1), and L2 (2), and 4 had multiple ASA feeders. Based on angiographic results, osteotomy site was changed (1), and neurovascular bundles were spared (2), a 37.5% rate of surgical plan alteration. There were no permanent neuromonitoring changes or postoperative neurologic deficits. No articles reported on using spinal angiography specifically for deformity surgery./r/nSpinal angiography is low risk and provides critical information regarding ASA supply to potentially mitigate ischemic risk during neurovascular bundle takedown during thoracic 3CO. Further case series are warranted to evaluate the benefits in larger populations, but its clinical applications appear practical.

Low back pain, often resulting from degenerative disc disease, affects up to 80% of the population at some point in their lives. The impact of preoperative radicular pain duration on discectomy outcomes remains inconclusive. We aim to compare the outcomes of lumbar discectomy for patients with different symptom durations to determine the optimal timing of surgery./r/nMedline, Embase, and Central databases were searched for studies comparing the outcomes of discectomy in patients with different durations of radicular pain secondary to lumbar disc herniation. Cutoffs at three months (very early), six months (early), and after 12 months (delayed) were selected based on pilot searches for symptom durations comparisons. Mean differences (MD) and standardised mean differerences (SMD) were calculated using the inverse-variance method, and risk ratios (RR) were calculated using the Mantel-Haenszel method./r/n29 studies with a total of 23,550 patients were included in this study. No statistically significant differences were found in the postoperative improvement in back pain, Oswestry Disability Index (ODI) or one-year reoperation rate for all of the cutoffs used (three months, six months, and 12 months). Sensitivity analyses found significant improvement in leg pain for symptom durations of < 12 months compared to > 12 months (SMD = 0.26, 95%CI: 0.11; 0.41, p = 0.02), which equates to a score of 1 point on the Visual Analogue Scale (VAS). Existing studies suffer from high risk of bias, inconsistent outcome measures, and varied timepoint assessment postoperatively./r/nThere is low quality evidence suggesting that discectomy within 12 months of symptom onset can improve postoperative leg pain. There was no significant effect of symptom duration on postoperative back pain, disability, quality of life and reoperation risk. As a precaution, we recommend surgeons to operate within 12 months of symptom onset after a trial of nonoperative management has failed. We recommend the collection of discectomy outcomes in national registry programmes for detailed assessment of factors affecting postoperative outcomes.

To report the long-term follow-up outcome of a 15-day-old neonate with congenital scoliosis treated with posterior-only hemivertebra bone-disc-bone osteotomy (BDBO) without internal fixation./r/nA 15-day-old neonate presented with a lumbar dorsal bulge exhibiting central ulceration and fluid discharge, necessitating emergency hospital admission. The comprehensive imaging study showed a fully segmented right L5 hemivertebra, L3-L4 fusion, and anterior bone bar of T10-T11, syringomyelia at the L2 level, type I diastematomyelia at the L3-L4 level, open spinal meningocele, and tethered cord. Prior to surgery, the patient received a 3-day course of antibiotics to address potential infection concerns. Subsequently, the patient underwent concurrent procedures including repair of the spinal meningocele, resection of the bone crest, release of tethering, and posterior-only hemivertebra type 1 BDBO without internal fixation./r/nThe surgical procedure lasted 165 min, accompanied by an intraoperative blood loss of approximately 50 mL and a blood transfusion of 50 mL. Preoperatively, the patient's hemoglobin level was 159 g/L, which decreased to 138 g/L postoperatively, with no complications. After the operation, the patient achieved a good correction of the spinal curve. The 18-year postoperative follow-up showed further improvement in the correction with good coronal and sagittal balance. The facet joint between the residual L5 hemivertebra and S1, as well as the contralateral facet joint was well preserved, with no pseudoarthrosis formation and a good spinal range of motion./r/nPosterior-only hemivertebra BDBO without internal fixation might be a simple, safe, effective and feasible surgical procedure for managing lumbosacral hemivertebra in very young children.

BackgroundAdolescent idiopathic scoliosis represents a complex three-dimensional spinal deformity of unknown etiology. It frequently results in visible deformities, decreased daily functional capacity, impaired pulmonary function, and psychological distress. Personalized treatment options for adolescent idiopathic scoliosis include exercise therapy, brace use, and surgical intervention, tailored to individual patient needs. Exercise therapy is often employed for patients with mild-to-moderate adolescent idiopathic scoliosis, those undergoing postoperative rehabilitation, or those ineligible for surgery because of its noninvasive nature, low cost, ease of application, and avoidance of prolonged brace use. However, a unified standard or guideline for the use of exercise therapy in managing adolescent idiopathic scoliosis is lacking. This study aimed to investigate the clinical efficacy of exercise therapy for adolescent idiopathic scoliosis and evaluate its therapeutic significance.MethodsWe conducted a systematic review by searching several databases, including China National Knowledge Infrastructure, Wanfang, PubMed, Web of Science, Excerpta Medica Database, MEDLINE, Ovid, and Cochrane Library, with no language restriction, to retrieve randomized controlled trials on exercise therapy for scoliosis. Meta-analysis was performed using RevMan 5.4. The protocol was registered with PROSPERO (registry number: CRD420251106878).ResultsA total of 9 studies involving 571 patients with adolescent idiopathic scoliosis were included. The pooled results revealed that the mean difference for the impact on Cobb angle was 3.31 (95% confidence interval: 2.56-4.05; 0.00001), indicating a statistically significant difference (<0.05). Regarding angulation of trunk rotation, the mean difference was 2.80 (95% confidence interval: 1.90-3.70; 0.00001), indicating a statistically significant difference (<0.05). For the Scoliosis Research Society-22 scores, the mean differences were as follows: pain, mean difference = 0.64 (95% confidence interval: 0.10-1.19; =0.02); function/activity, mean difference = 0.83 (95% confidence interval: 0.20-1.45; =0.009); self-image, mean difference = 0.51 (95% confidence interval: 0.10-0.91; =0.01); mental health, mean difference = 0.18 (95% confidence interval: 0.13-0.48; =0.25); and satisfaction with treatment, mean difference = 1.36 (95% confidence interval: 0.41-2.32; =0.005). Statistically significant differences were observed in all scores except for mental health (<0.05).ConclusionSpecific spinal exercise therapy has demonstrated effectiveness in improving Cobb angle, correcting angulation of trunk rotation measurements, and positively impacting pain, functional activity, and self-image compared with other non-exercise conservative treatments, resulting in higher patient satisfaction with treatment outcomes.

Suicides by power tools such as grinders are rare and present significant challenges in forensic investigation. Accurate differentiation between suicidal, homicidal, or accidental injuries is crucial, particularly when the circumstances surrounding the death are ambiguous. We report the case of a 64-year-old man found dead in his workshop. The body was discovered lying near a grinder, with a deep cervical wound. The scene revealed multiple blood droplets scattered across the room, along with two large blood pools located approximately one meter from the body and a stepladder securing the discovery scene from the inside. Footprints were observed on the floor, further complicating the interpretation of the events. A complete forensic autopsy was performed to determine the cause and manner of death. External examination revealed a gaping cervical wound involving a partial sectioning of the left internal jugular vein, laceration of the anterior wall of the C6 vertebra, and complete transection of the trachea upon the autopsy findings. No signs of defensive injuries or indications of third-party involvement were identified. Scene findings and autopsy results were analyzed in conjunction with a review of the literature on suicides involving grinders and other power tools. Based on the injury pattern, absence of evidence suggestive of assault, and the scene reconstruction, the cause of death was attributed to hemorrhagic shock secondary to self-inflicted cervical trauma. The manner of death was concluded as suicide.

To evaluate the relationship between pain catastrophizing, treatment modality, pain intensity, and functional disability in patients with chronic lower back pain, while also accounting for the effects of kinesiophobia and self-efficacy using generalized linear mixed models. Secondary analysis of a randomized controlled trial. Outpatient clinical setting. Forty-eight adults with chronic low back pain participated in the study. Participants were randomized into three intervention groups receiving therapeutic exercise (ET) either alone, combined with manual therapy (ET), or with kinesiotape (ET). Each group underwent two sessions per week for 12 weeks. Disability, pain intensity, kinesiophobia, pain catastrophizing, and self-efficacy were assessed at baseline, 3, 6, and 12 weeks. Generalized linear mixed models revealed a significant reduction in pain over time in all intervention groups (p < 0.001). A significant interaction was identified between the treatment group and catastrophizing levels (p = 0.023), with the Kinesiotape group being the only one showing increased pain scores associated with higher PCS levels. Regarding disability, significant effects were found for catastrophizing (p = 0.015), kinesiophobia (p < 0.001), and self-efficacy (p = 0.008), as well as a significant interaction between the group and self-efficacy (p = 0.003). In the groups without kinesiotaping, lower self-efficacy was associated with increased disability; however, this pattern was not observed in the kinesiotape group. The study found that pain and disability improved over time in all the intervention groups. However, psychological factors influenced outcomes differently depending on the treatment, with catastrophizing increasing pain only in the kinesiotape group. Thus, kinesiotaping may offer a protective effect by modulating psychological influences in chronic lower back pain.Trial registration NCT05544890.

Osteoporosis is a common complication in patients with primary biliary cholangitis (PBC). This study aimed to compare the efficacy and safety of denosumab and zoledronic acid (ZOL) in treating osteoporosis in PBC patients./r/nThis multicenter, randomized, open-label trial enrolled Japanese patients with PBC and osteoporosis. Patients were randomized to receive either subcutaneous denosumab 60 mg every 6 months (denosumab group) or i.v. zoledronic acid 5 mg yearly (ZOL group). The primary endpoint was the mean percent change in bone mineral density (BMD) at the lumbar spine and total hip from baseline to 12 months./r/nOf 47 enrolled patients, 41 (87.2%) completed the study (denosumab: n=21; ZOL: n=20). At 12 months, lumbar spine BMD increased by 7.5% in the denosumab group and 6.4% in the ZOL group, demonstrating the non-inferiority of denosumab (95% CI: -1.6% to 3.8%). Although the total hip BMD increased more in the denosumab group than in the ZOL group (5.0% vs. 2.6%, p<0.01), the difference did not meet the predefined non-inferiority margin (95% CI: -1.3% to 6.2%). Serum ALP to upper limit of normal ratio and bone turnover markers significantly decreased in both groups; however, the rates of change were not significantly different between them. The incidence of adverse events was significantly lower in the denosumab group compared with the ZOL group (14.3% vs. 50.0%, p=0.013)./r/nDenosumab is a safe and effective treatment option for osteoporosis in patients with PBC.

: Congenital scoliosis (CS) is a developmental disorder characterized by abnormal vertebral development during embryogenesis. Despite the identification of genes involved in vertebral development, the underlying genetic causes of CS remain largely unknown. Monozygotic (MZ) twins discordant for CS offer a unique opportunity to explore de novo or postzygotic causes. This exploratory case study aimed to investigate potential causative variants underlying CS using whole-exome sequencing (WES). : We performed WES on a Kazakhstani family with MZ twins discordant for congenital scoliosis. Variant prioritization included homozygous mutation analysis in the affected twin, family-based comparisons via de novo, autosomal recessive, and autosomal dominant models, and cross-referencing with variants previously implicated in spinal deformities. : Key findings include potential associations of the (storkhead box 1), (homeobox D8), and (C1q- and TNF-related 9) genes with congenital scoliosis. However, subsequent validation revealed low read depth and strand bias. Notably, no unique variants were detected in genes previously known to cause CS. : The first WES analysis of CS-discordant twins from a single family highlights the feasibility of a combined family-based and twin-comparative analytical pipeline. Our results provide new insights into the genetic architecture of CS and establish a foundation for future twin studies to elucidate the genetic basis of rare developmental disorders.

Synthesised data on the global prevalence of scoliosis in children and adolescents and its associated risk factors remain scarce. This systematic review aimed to estimate the global prevalence of scoliosis in children and adolescents and identify associated risk factors in children and adolescents./r/nWe conducted a systematic review and meta-analysis, searching nine electronic databases for observational population-based studies on scoliosis in children and adolescents published until June 02, 2024, without language or geographical restrictions. We estimated the global prevalence using the DerSimonian-Laird random-effects model with Free-Tukey double arcsine transformation and stratified prevalence through prespecified subgroup analyses. Fixed-effects models were used for consistent risk factors across studies, while random-effects models were applied for factors with high heterogeneity./r/nWe initially identified 12,339 records, of which 239 studies comprising 46,565,512 participants were included. The estimated global prevalence of scoliosis in children and adolescents was 1.65% (95% CI 1.38-1.94), varying from 0.05% in Ecuador to 16.67% in Romania. We found higher prevalence in European (2.88%) and Americas (2.54%) than other regions (Eastern Mediterranean 1.22%, South-East Asia 1.35%, Western Pacific 1.35%, and African 1.46%). The higher prevalence was in high-latitude regions (2.96% vs mid-latitude 1.62% vs low-latitude 1.73%). The prevalence in girls was nearly double that in boys (1.76% vs 0.87%), with a steady increase observed from ages 7 to 16 years, peaking at 12-14 years for girls and 15-16 years for boys. The prevalence in adolescents (10-18 years) was nearly four times higher than that in children (6-9 years) (1.13% vs 0.26%). Idiopathic scoliosis in children and adolescents constituted the majority of cases, predominantly presenting as mild scoliosis (Cobb angle 10°-19°, 86.65%) with the single thoracolumbar curve being the most common subtype (36.67%). Additionally, the prevalence may increase since 2020 year (3.02%). Scoliosis in children and adolescents was significantly associated with sex (girls, odds ratio 2.16, 95% CI 2.01-2.33), family history (1.92, 95% CI 1.47-2.50), sedentary behavior (≥ 11 h, 1.64, 95% CI 1.20-2.25), poor sitting posture (3.48, 95% CI 2.85-4.24), short outdoor time (< 1 h, 1.32, 95% CI 1.10-1.59), long screen time (≥ 2 h, 2.74, 95% CI 2.29-3.28), unilateral physical activity (1.36, 95% CI 1.20-1.55), and low BMI (1.15, 95% CI 1.08-1.22)./r/nScoliosis in children and adolescents remains highly prevalent globally. Our findings can help to guide epidemiological characteristics and development of tailored preventive and therapeutic strategies, ultimately enhancing primary prevention and controlling disease progression./r/nCRD42024584704.

The optimal surgical approach for managing multilevel cervical disc degeneration remains debatable, particularly regarding the comparative efficacy and safety of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF). This meta-analysis aimed to evaluate the efficacy and safety of HS compared to ACDF in patients with multilevel cervical degenerative disc disease (CDDD)./r/nThis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched for studies published between January 2000 and December 2024 comparing HS and ACDF in multilevel CDDD. A random-effects model was used to analyze the visual analog scale scores, neck disability index, C2-C7 range of motion (ROM), superior and inferior adjacent segments ROM, adjacent segment degeneration (ASD), heterotopic ossification (HO), intraoperative blood loss, operation time, and complication rates. Subgroup and sensitivity analyses were performed. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool./r/nNine studies (eight observational and one randomized controlled trial), including 394 patients, were analyzed. The postoperative C2-C7 ROM was significantly greater after HS than after ACDF. The ROM at superior and inferior adjacent segments was significantly lower after HS than after ACDF. No significant differences were observed in the visual analog scale scores, neck disability index, adjacent segment degeneration, heterotopic ossification, intraoperative blood loss, operation time, or complication rates./r/nCompared to ACDF, HS better preserves C2-C7 cervical mobility and reduces adjacent segments ROM but does not lower ASD incidence or improve clinical outcomes or complication rates compared to ACDF.

Obesity and the development of osteoporosis are closely related to abnormal visceral fat metabolism. The METS-VF is a novel body fat measurement method that integrates gender, waist circumference, and insulin resistance index. The purpose of this study was to look into the connection between METS-VF and lumbar spine bone mineral density (LS BMD). We performed a cross-sectional study to look into the connection between METS-VF and LS BMD using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. The association between METS-VF and LS BMD was analyzed using multiple linear regression with restricted cubic spline (RCS) curve analysis to assess nonlinear correlations, and threshold effects analysis to identify inflection points. Robustness checks included subgroup analysis. We also performed a sensitivity analysis. A total of 5005 participants with a weighted mean age of 39.57 ± 11.71 years were included in this study. After controlling for potential confounders, there was a significant negative correlation between METS-VF levels and LS BMD. According to further Restricted Cubic Splines (RCS) curve, METS-VF and LS BMD showed a substantial nonlinear association. According to threshold effect analysis, METS-VF's inflection point was 5.47. To the right of the inflection point, LS BMD decreased by 0.09 g/cm per unit increase in METS-VF. Subgroup analyses showed that the correlation between METS-VF and LS BMD varied by diabetes status (P < 0.05 for interaction). Significantly reduced LS BMD was linked to elevated METS-VF levels. This study supports the hypothesis that there is an association between visceral fat metabolism levels and LS BMD in the US population, and specifically, individuals with higher METS-VF levels should be of particular concern for their increased risk of osteoporosis.

For decades, researchers have worked to unravel the mysteries of post-traumatic epilepsy (PTE), a form of epilepsy that emerges after a traumatic brain injury (TBI). Now, a new study led by Texas A&M University neuroscientist Dr. Samba Reddy offers a sweeping view of how far the science has come and how far it needs to go.

AO Spine NA Webinar— Managing Complications

A research collaboration involving scientists and students at The University of Texas at Dallas has found a clear connection between chronic sickle cell disease pain and the bacteria present in the gastrointestinal tract.

As a minimally invasive technique, Fu's subcutaneous needling (FSN) has been widely adopted in Chinese clinical practice for managing neck-type cervical spondylosis (CS). However, current evidence regarding its therapeutic efficacy remains inconclusive due to methodological limitations in existing studies. This systematic review and meta-analysis therefore sought to quantitatively synthesize available randomized controlled trials to evaluate the clinical effectiveness and safety of FSN for this prevalent musculoskeletal disorder./r/nThis study protocol was prospectively registered in PROSPERO (Registration ID: CRD420251036627). The databases searched include PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform (Wanfang), VIP Database (VIP), and China Biology Medicine disc (CBM). A comprehensive search was conducted across the 8 electronic databases from their inception through April 18, 2025. Eligible studies included randomized controlled trials comparing FSN with non-FSN therapies for neck-type CS./r/nThis study included 10 clinical studies with a total of 696 patients suffering from neck-type CS. The results of the meta - analysis revealed that the experimental group had significant advantages over the control group in terms of clinical efficacy. Specifically, for the total effective rate (odds ratio = 5.45, 95% confidence intervals [CI] = [2.75, 10.81], Z = 4.85, P  < .00001), cure rate (odds ratio = 2.25, 95% CI = [1.51, 3.34], Z = 4.01, P < .00001), visual analogue scale score (VAS, mean difference = -1.21, 95% CI = [-1.30, -1.12], Z = 25.10, P < .00001), and Neck Disability Index score (NDI, mean difference = -1.33, 95% CI = [-1.92, -0.75], Z = 4.48, P < .00001), the experimental group outperformed the control group./r/nThis study indicates that FSN is a safe and effective strategy for managing neck-type CS. Therefore, it can be considered as a common clinical treatment modality for neck-type CS.

AO Spine NA Webinar—Pediatric Deformity

January 2023 In this month's update you will find the new export functionality that allows you to safely export your clinical cases directly from CaseFolio to your device. The post New in January: case export appeared first on myAO.

December 2022 You can now choose what you want to see on your myAO feed! In this month's update you will find a new feed design and experience divided into network activity and knowledge updates. The post New in December – A new feed experience appeared first on myAO.

Call for applications: AO Spine Education Commission Chairperson

Open call: AO Spine 2021 Research Start-up Grant