Search Results (28)

Background/Objectives: Diffuse idiopathic skeleton hyperostosis (DISH) is also known as Forestier–Rotes-Querol syndrome. The etiology of DISH is unknown. DISH is characterized by ossification of the anterior longitudinal ligaments of the spine. The area most frequently involved in the disease is the thoracic region of the spine. DISH in most cases is asymptomatic. If the cervical spine is involved, the most common symptoms are dysphagia and dyspnea. The ossifications in the cervical region of the spine are localized most frequently in its lower segments. Case presentation: The authors present the case of a 92-year-old cachectic female patient (body mass index (BMI) of 17; lost 13% of her body weight within the last 6 months). The patient underwent resection of the anterior osteophytes C2-T1. Results: At one-year follow up, the patient had gained weight (BMI—20) and regained her ability to consume solid products. To our knowledge, this is the oldest patient treated surgically for DISH. Conclusions: If dysphagia or dyspnea appears among elderly patients, cervical spine inspection should be conducted. If DISH is diagnosed safe, effective surgical treatment should be considered. Full article

Background: Lateral lumbar or thoracic interbody fusion (LLIF) is increasingly considered for anterior column reconstruction and restoring segmental lordosis in degenerative, infectious, or deformity conditions. Reports about using LLIF with expandable interbody spacers for spine trauma are scarce. Methods: In this retrospective, single-center observational cohort study, we reviewed all patients treated by an expandable LLIF interbody spacer (ELSA^® Expandable Integrated LLIF Spacer, Globus Medical Inc) for trauma indication at our spine center between September 2018 and January 2024. The primary outcome measures were fusion rate at 12 months, change in segmental sagittal Cobb angle, and clinical outcome according to the MacNab criteria. Secondary outcomes included adverse events and complications. Results: We identified n = 21 patients with a mean age of 48.3 (standard deviation (SD) 15.7), 47.6% were female. LLIF was mostly performed at T11/12 (n = 4; 19.1%) and T12/L1 (n = 10; 47.5%). Indications were AO Spine type A2 (n = 4, 19.1%), A3 (n = 14; 66.7%) or A4 fractures (n = 3; 14.3%) with ligamentous (B2-type) in eight (38.1%) and hyperextension (B3-type) injury in one patient (4.8%). Surgery included the release of the anterior longitudinal ligament in four cases (19.1%). Intraoperative AEs were noted in n = 1 (4.8%), postoperative AEs in n = 3 (14.3%) at discharge, n = 4 (19.1%) at three, and n = 2 (9.5%) at twelve months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.3° at twelve months (p < 0.001). Functional outcome was excellent/good in n = 15 (71.4%; four missing) at 12 months. The fusion rate at the LLIF level was 100% at the 12-month follow-up. Conclusions: LLIF with expandable interbody spacers for spine trauma (off-label use) is safe, promotes solid fusion (100% fusion rate at 12 months), and enables correction of sagittal segmental Cobb angle (mean improvement of 12°), with good or excellent clinical outcomes in most patients (71.4%). Full article

Background: Arthrogenic muscle inhibition (AMI), anterior knee laxity, and kinesiophobia are key barriers to recovery after anterior cruciate ligament reconstruction (ACLR). While each has been independently studied, their interrelationships during the early postoperative phase remain unclear. Methods: This cross-sectional study included 56 patients (mean age: 26.5 ± 5.7 years) who underwent ACLR using hamstring autografts. Clinical AMI grading, GNRB^® arthrometer measurements of anterior tibial translation, and the Tampa Scale for Kinesiophobia-11 (TSK-11) were used to assess neuromuscular inhibition, mechanical laxity, and psychological fear, respectively. All evaluations were performed at 34.9 ± 4.2 postoperative days. Statistical analyses included one-way ANOVA, Kruskal–Wallis, and Spearman correlation. Results: No significant differences in TSK-11 scores were observed across AMI grades (p = 0.327). Similarly, anterior laxity did not differ significantly between AMI groups (p = 0.182). Correlation between GNRB measurements and TSK-11 scores was non-significant (rho = −0.220, p = 0.103). Conclusions: In the early phase following ACLR, AMI, anterior laxity, and kinesiophobia appear to be independent domains. These findings suggest that early postoperative rehabilitation should address each dimension individually. Further longitudinal studies are needed to explore their potential interactions over time. Full article

Background/Objectives: Soccer players, particularly females, exhibit an increased risk of both concussions and Anterior Cruciate Ligament (ACL) injuries. Emerging evidence suggests that neurcognitive deficits following concussions may impair neuromuscular control, increasing ACL injury susceptibility. This study aims to explore the interplay between concussions, neuromuscular deficits, and ACL injury risk, while proposing targeted prevention strategies. Methods: A comprehensive review of current literature was conducted to analyze the biomechanical and neurophysiological impact of concussions on ACL injury risk. Key areas investigated include the effect of sub-concussive impacts on proprioception, reaction time, and postural stability, as well as sex-based differences in injury susceptibility. Results: Findings indicate that post-concussion neuromuscular impairments—such as altered proprioception, delayed reaction times, and compromised joint stability—heighten ACL injury risk. Female athletes, due to biomechanical and hormonal factors, are particularly vulnerable. Preventive measures, including neuromuscular training, cervical spine strengthening, and optimized return-to-play protocols, are essential to mitigate these risks. Conclusions: Longitudinal research is needed to further elucidate the connection between head trauma and ACL injuries. Implementing evidence-based interventions and policy changes, such as modifying heading exposure in youth athletes, may enhance player safety and reduce long-term injury burden in female soccer players. Full article

The cervical spine ligaments, including the anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL), play a key role in maintaining spinal stability by limiting excessive movements. This study investigates how ageing affects the mechanical properties of these ligaments. We analysed 33 samples from 12 human cervical spines (15 ALL, 18 PLL), averaging data from the same donors for independent analysis, resulting in 18 final samples (8 ALL, 10 PLL). To explore age-related changes, we classified the samples into two groups—below and above 50 years old—aligning with the peak incidence of major musculoskeletal disorders. The investigation concentrated on the effects of age on four mechanical parameters of the uniaxial stress–stretch curve: initial tangent stiffness ($E_0$), maximum tangent stiffness ($E_m$), ultimate stress ($P_u$) and ultimate stretch (${\lambda }_u$). When the age effect is neglected, then the behaviours of both the ALL and PLL appeared similar. However, when introducing age as a variable into the context of the ALL and PLL, statistically significant differences became evident. The findings underscored a reduction in maximum tangent stiffness (p-value = 0.0147), ultimate stress (p-value = 0.0009), and ultimate stretch (p-value = 0.0024) when the ALL and PLL were grouped under and above 50 years as a consequence of ageing. Full article

Pelvic organ prolapse impacts an increasing number of women in the United States. The standard approach to correcting apical pelvic organ prolapse uses the sacral anterior longitudinal ligament (SALL) to lift the vaginal apex; however, this approach may result in recurrent prolapse. A newer procedure utilizes the pectineal ligament (PL), which may be a more reliable anchor point. This study compares the biomechanical properties of these two ligaments to elucidate which can withstand more stress to provide long-term stability following prolapse. Seventeen formalin-embalmed donors were used (PL: 17 right, 16 left; SALL, 15). The PL was evaluated to better characterize the ligament’s properties within the pelvis using digital calipers and descriptive statistics. Mean values were statistically evaluated using an independent t test (p = 0.05) but no differences in laterality were appreciable. The PL and SALL samples were harvested and evaluated using a mechanical tester to determine their force at failure (N), toughness (Jm⁻²), and elastic modulus (MPa). The PL had increased values in the mean force at failure and toughness than the SALL when evaluated by each side as well as a combined mean value. These differences were statistically significant (p = 0.05) for toughness as evaluated using an independent t-test (right, p = 0.004; left, p = 0.005; combined, p = 0.002) and force at failure [right, p = 0.001 (independent t-test); left, p = 0.004 and combined, p = 0.005 (Mann–Whitney U test)], indicating that the PL may permit more deformation, but greater resistance to catastrophic failure as compared to the SALL. When evaluating any statistical differences in modulus, the individual and combined values were increased for the PL as compared to the SALL but were not significant (right, p = 0.290; left, p = 0.143; combined, p = 0.110) suggesting a stiffer material that may be more prone to catastrophic failure once a tear has begun. Collectively, these inherent biomechanical properties of the pectineal ligament indicate the ligament may be a more reliable anchor point for pelvic organ prolapse repair than the SALL. Full article

Background: POP (pelvic organ prolapse) involves the descent of one or more pelvic organs downwards with or without protrusion from the vaginal opening, caused by the relaxation and weakening of ligaments, connective tissue, and pelvic muscles. Such an outcome negatively impacts the quality of life. The gold standard procedure for repairing apical compartment prolapse is colposacropexy (CS) to secure the anterior and posterior walls of the vagina to the anterior longitudinal sacral ligament, located anteriorly to the sacral promontory, using a mesh. Several surgical approaches are feasible. Laparotomic or minimally invasive methods, including laparoscopic or robotic ones, can restore the horizontal axis of the vagina and typically involve concomitant hysterectomy. Methods: This study is based on 80 patients who underwent CS at Palermo’s Ospedali Riuniti Villa Sofia-Cervello from 2019 to 2023. Women aged 35–85 at the time of surgery were divided into two groups: 40 patients underwent mini-laparoscopic surgery, and 40 patients underwent robotic surgery. The following parameters were accounted for: demographic data (initials of name and surname, age), preoperative clinical diagnosis, date of surgery, surgical procedure performed, estimated intraoperative blood loss, duration of surgical intervention, length of hospital stay, postoperative pain assessed at 24 h using the VAS scale, and any complications occurring in the postoperative period. Mini-laparoscopic CS (Minilap) and robotic CS (Rob) were then compared in terms of outcomes. Results: In the Minilap group, 11 patients out of 40 had a preoperative diagnosis of vaginal vault prolapse. The average age in this group was 61.6. Five of these patients had isolated cystocele, while the rest presented vaginal stump prolapse linked to cystocele, rectocele, or both. The remaining 29 patients in the Minilap group had a preoperative diagnosis of uterovaginal prolapse, also associated with cystocele, rectocele, or both, or isolated in nine cases. In the Rob group (average age: 60.1), 13 patients were diagnosed with vaginal prolapse (isolated or associated with cystocele), while the remaining 27 had a diagnosis of uterovaginal prolapse. In the Minilap group, the average procedure duration was 123.3 min, shorter than the Rob group (160.1 min). Conclusions: The data collected throughout this prospective study point to the mini-laparoscopic approach as being preferable over the robotic one in terms of surgical procedure length, intraoperative blood loss, postoperative pain, and aesthetic outcome. Hospital stay duration and post operative complication rates were similar for both groups. The innovative and ever-progressing nature of such procedures calls for novel standards prioritizing patient care as well as medicolegal viability. Full article

This study aimed to compare functional outcomes including knee muscle strength in the quadriceps and hamstrings, and proprioception, assessed through dynamic postural stability (overall stability index [OSI]) and self-reported outcomes in the operated and non-operated knees between anterior cruciate ligament reconstruction (ACLR) with meniscal repair for unstable (root and radial tears) and stable (longitudinal, horizontal, and bucket handle tears) meniscal tears. A total of 76 patients were randomly selected (41 with ACLR with meniscal repair for unstable meniscal tears and 35 with ACLR with meniscal repair for stable meniscal tears) at three different time points (preoperative, 6 months, and 12 months). Repeated measures analysis of variance was used to investigate the differences in outcomes for between-subject and within-subject factors. In the operated knees, there were no significant differences for functional outcomes between the two groups (all p > 0.05). In the non-operated knees, a significant difference was observed for the OSI between the two groups, which was significantly higher in ACLR with meniscal repair for unstable meniscal tears than for stable meniscal tears at 6 months (p < 0.001). Multiple linear regression analysis showed that age (p = 0.027), preoperative OSI in the operated knees (p = 0.005), and postoperative OSI in the operated knees at 6 months (p = 0.002) were significant and independent predictors for OSI in the non-operated knees at 6 months postoperatively. Therefore, while no differences were observed in functional outcomes between the two groups in the operated knees, dynamic postural stability was poorer at 6 months postoperatively in the non-operated knees of patients with ACLR with meniscal repair for unstable meniscal tears. Furthermore, a significant correlation was observed between preoperative/postoperative dynamic postural stability in the operated knees and postoperative dynamic postural stability in the non-operated knees. Hence, we recommend incorporating balance exercises for both knees in post-surgical rehabilitation, particularly for patients with unstable meniscal tears. Full article

This study aims to develop an integrated approach for 3D lumbar vertebral biomodel design and analysis, specifically targeting unilevel disc degeneration and the replacement of lumbar artificial discs. Key objectives include improving existing design methods through 3D techniques, inverse modeling, and an engineering biomodel preparation protocol. Additionally, the study evaluates mechanical properties in the implantation area and between disc components to gauge the effectiveness of artificial discs in restoring functional movement within the studied biological model. The construction of a biological model representing the L3–L4 functional spinal unit was based on measurements from radiographic images and computed tomography data obtained from the study sample. The 3D finite element method in Ansys software (v. 19.2, ANSYS, Inc., Canonsburg, PA, USA) was used to monitor the distribution of equivalent stress values within the core of the two artificial discs and the behavior of vertebral bone components in the model. This approach enabled the creation of personalized digital models tailored to the specific implantation requirements of each patient. Stress analysis identified critical areas within the disc cores, suggesting potential design modifications to optimize artificial disc performance, such as selectively increasing core thickness in specific regions and considering adjustments during implantation. For example, preserving part of the lateral annulus fibrosus from the degenerative disc and maintaining the anterior and posterior longitudinal ligaments may play a crucial role in balancing the forces and moments experienced by the lumbar section. This study provides valuable insights into the development of patient-specific solutions for lumbar disc degeneration cases, with the potential for enhancing artificial disc design and implantation techniques for improved functional outcomes. Full article

Background and Objectives: This longitudinal study investigated the correlation between imaging findings and self-reported questionnaire outcomes in patients with tibiofibular diastasis, exploring the effects of surgical screw removal versus conservative treatment. This study was conducted at “Victor Babes” University of Medicine and Pharmacy in Timisoara between 2018 and 2023. Materials and Methods: The study involved 85 patients in the screw removal group and 44 in the conservative group, assessed at 2 and 6 months post-surgery, answering the SF-36, HADS, and WHOQOL questionnaires. Results: Significant differences were observed at 2 months post-surgery, with the screw removal group showing lower shear wave velocities in ankle dorsiflexion (8.9 ± 1.4) and anterior talofibular ligament (2.8 ± 0.9), indicating better mobility compared to the conservative group (ankle dorsiflexion: 10.1 ± 1.8, ATFL: 3.2 ± 1.1). Radiographically, lower tibiofibular overlap (8.1 ± 2.1) in the screw removal group suggested improved joint fixation quality. These physical improvements were mirrored in the quality-of-life assessments, where the screw removal group reported higher physical health scores on the SF-36 survey at 2 months, a trend that continued at 6 months. At 2 months, ankle dorsiflexion demonstrated a strong negative correlation with the SF-36 Physical score (r = −0.417) and WHOQOL Physical domain (r = −0.394), and a positive correlation with HADS Anxiety (r = 0.312). Similarly, ATFL and CFL velocities negatively correlated with the SF-36 Physical score (ATFL: r = −0.251; CFL: r = −0.237). Radiographic tibiofibular overlap and clear space positively correlated with WHOQOL Physical domain (TOL: r = 0.291; TCS: r = 0.276), with TCS also negatively correlating with HADS Anxiety (r = −0.228). At 6 months, these correlations persisted, with notable negative correlations between ultrasound ankle dorsiflexion and both SF-36 Physical score and WHOQOL Physical domain. Conclusions: These findings underscore the advantages of screw removal in enhancing physical recovery and reducing anxiety in the short term, while indicating similar long-term mental health outcomes between treatment approaches. Full article

Background and Objectives: There are several advantages of using lateral lumbar interbody fusion (LLIF) for correction surgeries for adult spinal deformity (ASD); however, we currently have unresolved new issues, including occasional anterior longitudinal ligament (ALL) rupture during the posterior correction procedure. When LLIF was initially introduced, only less lordotic cages were available and ALL rupture was more frequently experienced compared with later periods when more lordotic cages were available. We performed finite element analysis (FEA) regarding the mechanism of ALL rupture during a posterior correction procedure. Methods: A spring (which mimics ALL) was introduced at the location of ALL in the FEA and an LLIF cage with two different lordotic angles, 6 and 12 degrees (6DC/12DC), was employed. To assess the extent of burden on the ALL, the extension length of the spring during the correction procedure was measured and the location of the rotation center was examined. Results: We observed a significantly higher degree of length extension of the spring during the correction procedure in the FEA model with 6DC compared with that of 12DC. We also observed that the location of the rotation center was shifted posteriorly in the FEA model with 6DC compared with that of 12DC. Conclusions: It is considered that the posterior and rostral edge of the less lordotic angle cage became a hinge, and the longer lever arm increased the burden on ALL as the principle of leverage. It is important to use an LLIF cage with a sufficient lordotic angle, that is compatible with the degree of posterior osteotomy in ASD correction. Full article

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory spondyloarthropathy characterized by ectopic calcification of spinal cord tissue. Its etiology is possibly polygenic. However, its pathogenesis and systemic effects remain unclear. Recent studies have reported a high prevalence of DISH in heart failure patients. The authors investigated how the incidence and severity of DISH are associated with vascular calcification and the occurrence of cardiovascular events. In this retrospective chart review study, 500 patients with cardiovascular disease who underwent surgery (cardiovascular events group) and 500 patients with non-cardiovascular disease who underwent computed tomography scans (non-cardiovascular events group) were randomly selected to investigate the degree of ossification of the anterior longitudinal ligament and the incidence of DISH. We found that the incidence of DISH was higher in patients with cardiovascular events and that patients with DISH had more calcification of the coronary arteries and aorta. Next, we examined the relationship between the degree of coronary and aortic calcification, the incidence of DISH, and the degree of ossification of the anterior longitudinal ligament in the non-cardiovascular event group. The prevalence of DISH in the cardiovascular and non-cardiovascular groups was 31.4% and 16.5%, respectively (p = 0.007). Aortic calcification and a predominant degree of vascular calcification with a certain level of ossification of the anterior longitudinal ligament suggest some correlation between DISH and cardiovascular events. This study is important in understanding the pathophysiology and pathogenesis of DISH. Full article

Background: The study aimed to assess the reliability, validity, and responsiveness of the Polish version of Knee Outcome Survey Activities of the Daily Living Scale (KOS-ADLS) in a group of patients after arthroscopic reconstruction of the anterior cruciate ligament (ACL). Methods: The study was a longitudinal study with repeated measures. One hundred and twelve subjects who qualified for arthroscopic ACL reconstruction (mean age = 31.8 years) were initially enrolled in this study. The Polish version of KOS-ADLS and Short Form-36 v. 2.0 (SF-36) were used. Results: The Polish version of KOS-ADLS in subjects after ACL rupture demonstrated excellent internal consistency (Cronbach’s alpha for KOS-ADLS- total = 0.91), and test–retest reliability using the intraclass correlation coefficient (ICC-total = 0.98). The standard error of measurement (SEM) value was 0.81 and the minimal detectable change (MDC) was 2.23 for KOS-ADLS-total. The validity analysis showed a moderate and low correlation between KOS-ADLS and different domains of SF-36 from r = 0.354 between KOS-ADLS activity and the physical component scale (PCS) of SF-36: to r = 0.206 between KOS-ADLS activity and the mental component scale (MCS) of SF-36. Conclusions: The Polish version of KOS-ADLS turned out to be a reliable, valid and responsive self-reported outcome measure, allowing for the self-assessment of symptoms and function related to the knee joint impairment after ACL reconstruction. Therefore, the scale can be applied in clinical practice and research. Full article

Anterior decompression and fusion (ADF) using the floating method for cervical ossification of the posterior longitudinal ligament (OPLL) is an ideal surgical technique, but it has a specific risk of insufficient decompression caused by the impingement of residual ossification. Augmented reality (AR) support is a novel technology that enables the superimposition of images onto the view of a surgical field. AR technology was applied to ADF for cervical OPLL to facilitate intraoperative anatomical orientation and OPLL identification. In total, 14 patients with cervical OPLL underwent ADF with microscopic AR support. The outline of the OPLL and the bilateral vertebral arteries was marked after intraoperative CT, and the reconstructed 3D image data were transferred and linked to the microscope. The AR microscopic view enabled us to visualize the ossification outline, which could not be seen directly in the surgical field, and allowed sufficient decompression of the ossification. Neurological disturbances were improved in all patients. No cases of serious complications, such as major intraoperative bleeding or reoperation due to the postoperative impingement of the floating OPLL, were registered. To our knowledge, this is the first report of the introduction of microscopic AR into ADF using the floating method for cervical OPLL with favorable clinical results. Full article

We prospectively investigated the postoperative dysphagia in cervical posterior longitudinal ligament ossification (C-OPLL) and cervical spondylotic myelopathy (CSM) to identify the risk factors of each disease and the incidence. A series of 55 cases with C-OPLL: 13 anterior decompression with fusion (ADF), 16 posterior decompression with fusion (PDF), and 26 laminoplasty (LAMP), and a series of 123 cases with CSM: 61 ADF, 5 PDF, and 57 LAMP, were included. Vertebral level, number of segments, approach, and with or without fusion, and pre and postoperative values of Bazaz dysphagia score, C2-7 lordotic angle (∠C2-7), cervical range of motion, O-C2 lordotic angle, cervical Japanese Orthopedic Association score, and visual analog scale for neck pain were investigated. New dysphagia was defined as an increase in the Bazaz dysphagia score by one grade or more than one year after surgery. New dysphagia occurred in 12 cases with C-OPLL; 6 with ADF (46.2%), 4 with PDF (25%), 2 with LAMP (7.7%), and in 19 cases with CSM; 15 with ADF (24.6%), 1 with PDF (20%), and 3 with LAMP (1.8%). There was no significant difference in the incidence between the two diseases. Multivariate analysis demonstrated that increased ∠C2-7 was a risk factor for both diseases. Full article