Search Results (134)

Intraosseous hemangiomas (IH) are rare intrabony lesions that represent less than 1% of intraosseous tumors. IH are mostly seen in the axial skeleton and skull. Most commonly, the frontal bone, zygomatic, sphenoid, maxilla, ethmoid, and lacrimal bone can manifest IH. Currently, IH is classified as a developmental condition of endothelial origin. According to WHO, the five histological types of IH are cavernous, capillary, epithelioid, histiocytoid, and sclerosing. IH of the zygoma is an extremely rare condition with female predominance. A systematic review recently estimated that there were 78 cases published in the literature until 2023. The lesion is usually asymptomatic and presents with a gradually deteriorating deformity of the malar area, and the patient might be able to recall a history of trauma. Numbness due to involvement of the infraorbital nerve might also be present; however, atypical skin and bone sensations might also occur. Other symptoms include painful swelling, bone asymmetry, skin irritation, sinus pressure, paresthesia, diplopia, enophthalmos, or atypical neuralgia. A bony lesion with a trabecular pattern in a radiating formation (sunburst pattern) or a multilocal lytic lesion pattern created by the multiple cavernous spaces (honeycomb pattern) is commonly observed during radiologic evaluation. We present a rare case of IH of the zygoma in a 65-year-old generally healthy woman. A cyst-like bone tumor was revealed from the CT scan, which made preoperative biopsy of the lesion problematic. A careful radiological diagnostic differentiation of the lesion should always be conducted in such cases to outline a safe surgical plan and possible alternatives if needed. The patient underwent total tumor resection in the operating room, and the defect was reconstructed with the use of a titanium mesh and a synthetic hydroxyapatite bone graft based on a 3D surgical guide printed model. Full article

Background/Objectives: Diagnosis of Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) currently lacks objective biomarkers. Therefore, this retrospective study aimed to investigate differences in glucose metabolism in the axial musculoskeletal system in PSPS-T2 patients by means of [¹⁸F]FDG PET-CT imaging. Methods: Nine PSPS-T2 patients (five females, four males; mean age of 53 ± 4.82 years) and nine age- and gender-matched healthy controls (five females, four males; mean age of 53 ± 3.91 years) were included. For each participant, 24 regions of interest (ROIs) were manually drawn, including areas of the vertebral endplates, the intervertebral discs, and the psoas muscles. For each ROI, the mean standardized uptake values (SUVs) were assessed. Group differences were evaluated using repeated measures ANOVA with Bonferroni-adjusted post-hoc pairwise comparisons. Additionally, Pearson correlation analyses examined associations between SUV_mean values and the Numerical Rating Scale (NRS) pain scores. Results: Results demonstrated significantly higher SUV_mean values in healthy controls compared to PSPS-T2 patients, particularly at the superior endplates of L4 and S1, the intervertebral discs at L4-L5 and L5-S1, and the posterior endplates of L4 and L5. Although PSPS-T2 patients exhibited higher SUV_mean values than controls in the psoas muscle, these differences were not statistically significant. Additionally, no significant correlations were found between SUV_mean values and NRS pain scores, suggesting that metabolic activity alone does not directly reflect pain severity. Conclusions: Despite the limited sample size of this pilot study, the metabolic fingerprint of the axial musculoskeletal system was shown to be distinctly different in PSPS-T2 patients compared to healthy controls. This could lead to an improved understanding of PSPS-T2 pathophysiology and might open new doors for better diagnosis and treatment strategies. Full article

Transdermal microneedle systems have received great attention due to their minimally invasive way of delivering biomolecules through the skin with reduced pain. However, designing high-strength separable microneedles, which enable easy skin penetration and easy patch detachment, is challenging. Here, we present a Parametric Rule-based Intelligent System (PRISM), which generates the design of and analyzes high-strength separable microneedles. The PRISM platform integrates parametric 3D modeling, geometry-based structural analysis, and high-resolution micro-3D printing for the creation of high-strength separable microneedles. We fabricated prototype microneedle arrays via microscale stereolithographic printing (pµSL) and demonstrated separation of microneedle tips in a skin-mimicking phantom sample. Mechanical testing showed that the suggested design achieved 2.13 ± 0.51 N axial resistance and 73.92 ± 34.77 mN shear fracture force; this surpasses that of conventional designs. Finally, an experiment using a skin-mimicking artificial phantom sample confirmed that only the PRISM-designed separable microneedles could have been inserted and separated at the target depth, whereas conventional designs failed to detach. This approach addresses the development of microneedle systems, which achieve both robust skin phantom penetration and reliable separable delivery, presenting an efficient development tool in transdermal drug delivery technology. Full article

Background: Juvenile spondyloarthritis (JSpA) is a heterogeneous group of diseases. An international consensus group developed the axial juvenile SpA (AxJSpA) classification criteria for this purpose, defining a homogeneous group of patients diagnosed with jSpA and experiencing axial symptoms before the age of 18 years. Aim: To validate this new set of criteria in our pediatric SpA patients. Methods: This study was held in the Hacettepe University Department of Pediatric Rheumatology. Juvenile SpA patients suspected of axial disease diagnosed and followed at the same center between 2005 and 2024 were included. Patients who had other etiologies for axial symptoms, including chronic nonbacterial osteomyelitis, mechanical back pain–overuse injuries, amplified pain/growing pains, and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) served as the control group. Results: In total, 123 JSpA patients and 74 controls were included in this study. The sensitivity/specificity of the new criteria were 61%/77% with an area under curve value of 0.75 (95% CI: 0.68–0.83) in our cohort. Among different criteria sets, European Spondyloarthropathy Study Group (ESSG) criteria were the most sensitive (sensitivity/specificity 91%/68%), and ASAS peripheral criteria (Assessment of SpondyloArthritis International Society) were the most specific (sensitivity/specificity 67%/84%) in our cohort when compared to ASAS axial criteria (sensitivity/specificity 74%/65%), ILAR (International League of Associations for Rheumatology) (sensitivity/specificity 85%/81%), and ILAR + SI (sacroiliitis) (sensitivity/specificity 67%/74%) criteria. Conclusions: The area under the curve of the new AxJSpA criteria was similar to that of the original report; however, both sensitivity and specificity were lower in our cohort, possibly due to factors like earlier disease presentation and a lower prevalence of chronic structural changes on MRI. Full article

Objective: Psoriatic arthritis (PsA) is a heterogeneous, chronic inflammatory disease that primarily affects the joints and skin, presenting with variable clinical outcomes. This review explores sex-related differences in PsA, emphasizing clinical implications, radiological manifestations, comorbidities, and tailored treatments. By examining these sex-based differences, the review aims to provide insights into how clinicians can adjust treatment strategies to better meet the distinct needs of male and female patients. Methods: A systematic review was conducted across national registries, interventional and observational studies, and meta-analyses including adults (≥18 years) diagnosed with PsA. The review focused on comparing clinical and radiological features, comorbidities, and treatment outcomes between sexes. A comprehensive literature search was performed in PubMed, the Cochrane Library, and Embase on 12 January 2025, with a final update on 4 April 2025. Results: Out of 80 records identified, 26 studies met the inclusion criteria. Women more frequently presented peripheral arthritis, reported higher pain levels, and exhibited greater functional impairment. In contrast, men showed a higher prevalence of axial involvement, radiographic progression, and more severe skin disease. Overall, treatment responses were less favorable in women, particularly with tumor necrosis factor inhibitors (TNFi), as reflected by lower rates of achieving low disease activity and reduced treatment persistence. In terms of comorbidities, data on cardiovascular risk factors were inconsistent across sexes, while depression and fibromyalgia were more frequently reported in women. Conclusions: Marked sex differences exist in the clinical profile, therapeutic response, and comorbidity patterns of PsA patients. Recognizing and addressing these disparities is crucial for tailoring personalized treatment strategies and optimizing patient outcomes. Full article

Background/Objectives: Spine mobility is essential for overall health and daily functioning. Accurate assessment of spinal mobility is necessary for diagnosing and managing orthopedic, neurological, and rheumatological disorders, particularly in patients experiencing lower back and thoracic pain. The present study evaluates the effectiveness of traditional clinical tests in comparison to the innovative photogrammetric 3D posture assessment for evaluating spinal mobility. Methods: A total of 20 patients from a medical clinic underwent tests to measure lumbar and thoracic spine mobility, including flexion, lateral incline, and axial rotation, using both conventional and 3D posture assessment methods. Results: We found strong correlations between investigated methods, which recommends photogrammetry as a reliable and effective tool for assessing posture in clinical practice. Furthermore, 3D posture assessment offers a faster approach (clinical evaluation: 2:59 ± 0.22 min vs. photogrammetry: 1:03 ± 0.01 min) and a more practical method for assessing spinal mobility, thereby enhancing the patient experience and providing clinicians with objective data for treatment planning. Conclusions: The study highlights the value of modern technologies in clinical assessment and therapeutic intervention, encouraging therapists to integrate photogrammetric methods into their daily practice to improve patient outcomes. Full article

Background and Objectives: The objective of our study was to describe the biopsychosocial profile of individuals diagnosed with axial spondyloarthritis (AxSpA) and to analyze how their clinical characteristics interact with disease activity. Materials and Methods: An observational study was conducted, involving 28 participants diagnosed with AxSpA. We evaluated clinical outcomes (perceived pain, range of motion [RoM], pressure pain threshold [PPT], and proprioceptive acuity), psychosocial outcomes (the Pain Catastrophizing Scale [PCS], Tampa Scale of Kinesiophobia [TSK-11], and the Fear-Avoidance Beliefs Questionnaire [FABQ]), and AxSpA-specific indices (the Bath Ankylosing Spondylitis Metrology Index [BASMI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]). Data were analyzed using Spearman’s correlation coefficients and simple and multiple linear regression models. Results: Cervical and lumbar RoM values were reduced compared to established normative values for the general population. Significant associations were found between perceived pain, pain catastrophizing, and FABQ scores with both BASDAI and BASFI (p < 0.05). The interaction between perceived pain and pain catastrophizing (p < 0.001) accounted for 45.7% of the variance in BASDAI, while the interaction between perceived pain and FABQ (p < 0.001) explained 52.1% of the variance in BASDAI. Conclusions: The biopsychosocial profile of patients with AxSpA is characterized by moderate-intensity perceived pain and reduced cervical and lumbar mobility. The observed associations between BASDAI, pain catastrophizing, and fear-avoidance beliefs underscore the influence of psychosocial factors on disease progression. Full article

Background and Objectives: This study compares the biomechanical performance of a new-generation implant designed for patella fracture fixation with the traditional tension band method. Its goal is to assess fracture fixation’s stability and the new implant’s potential advantages in reducing complications such as skin irritation, pain, and implant failure. Materials and Methods: In this experimental study, 20 calf patellae were divided into two groups. The first group was treated with the traditional tension band method, while the second group received the new-generation implant, designed using finite element analysis (FEA) for optimization. Both groups underwent biomechanical testing with axial forces at a 45° flexion angle to simulate real-life load conditions. The maximum forces at which mechanical insufficiency occurred were recorded. Data were analyzed using SPSS for statistical comparison. Results: Finite element analysis revealed that the new-generation implant provided better fracture line stability than the tension band method under applied forces. In the biomechanical tests, the maximum force at which mechanical insufficiency occurred was significantly higher in the new-generation implant group (1130 ± 222 N) compared to the tension band method group (680.5 ± 185.4 N), with a statistically significant difference (p = 0.008). The new implant demonstrated superior fixation, with better resistance to distraction forces. Conclusions: The new-generation implant offers enhanced biomechanical stability compared to the traditional tension band method, particularly regarding fixation strength under applied forces. This study supports the potential of the new implant to improve fixation stability and reduce common complications associated with patella fracture surgeries. Further testing in more extensive human cadaver studies is recommended to confirm these findings and assess long-term clinical outcomes. Full article

Background: Carpal tunnel syndrome (CTS) is a common neuropathy caused by compression of the median nerve (MN) within the carpal tunnel, which causes pain, paresthesia, or altered sensation. While a small carpal tunnel area is considered a risk factor for CTS, varying carpal tunnel dimensions in CTS patients have been obtained via axial computed tomography and magnetic resonance imaging (MRI). Methods: In this retrospective study, MR images from 49 CTS patients and 38 healthy controls were analyzed to investigate differences in the carpal tunnel area and carpal boundaries between the groups and to explore the relationships of these parameters with CTS severity. Results: Our findings revealed that compared with the controls, CTS patients presented significantly larger cross-sectional areas (CSAs) of the MN and carpal tunnel and increased MN flattening ratios. The CSAs of the MN showed moderate positive correlations with severity (r = 0.395, p < 0.001), symptom score (r = 0.354, p < 0.001), and disability score (r = 0.300, p < 0.001), while the carpal tunnel area showed weaker but significant correlations with severity (r = 0.268, p = 0.002), symptom score (r = 0.173, p = 0.026), and disability score (r = 0.183, p = 0.018). The ratios of the MN CSA to those of the carpal tunnel, the interior carpal boundary (ICB), the exterior carpal boundary (ECB), and the wrist were disproportionately greater in the CTS patients. Among them, both the MN-to-ICB and MN-to-ECB ratios had fair to good diagnostic values (area under the curve = 0.725 and 0.794, respectively). Conclusions: These results highlight the utility of MRI-derived CSA measurements and ratios in identifying pathophysiological changes in CTS patients, particularly crowding of the MN inside the carpal tunnel. Further studies are recommended to refine MRI-based diagnostic protocols for CTS. Full article

Background: Axial involvement in psoriatic arthritis (axPsA) presents clinical and radiological differences from ankylosing spondylitis (AS), which may influence the therapeutic response. While Guselkumab has demonstrated efficacy in peripheral PsA, its role in axPsA is less well established, particularly in real-world settings. Objective: To evaluate the positive effects of Guselkumab therapy in patients with psoriatic arthritis (PsA), 58.6% of whom have axial involvement, in a 12-month, single-center, longitudinal, prospective observational cohort study conducted in a real-life setting. Methods: A cohort of 99 patients with PsA, including 58 with axial involvement (axPsA), was treated with Guselkumab for 12 months. Treatment efficacy was assessed by evaluating the reduction in mBASDAI, ASDAS, DAPSA, VAS Pain, LEI, and HAQ scores. The Friedman test was used to analyze whether the overall changes from baseline to 12 months were statistically significant. Patients with axial involvement were assessed by MRI, with scores measured at baseline (t₀), after 6 months (t₆), and after 12 months (t₁₂) of therapy. Statistical evaluation was conducted using the Friedman test, followed by pairwise comparisons of values obtained at different follow-up time points using the Wilcoxon signed-rank test. Additionally, the drug’s retention rate was examined using a Kaplan–Meier curve. Results: After 12 months of therapy, a statistically significant reduction was observed in all clinimetric parameters. Patients with axial involvement were also evaluated by MRI at baseline, after 6 months, and after 12 months of therapy. MRI images showed a reduction in bone marrow edema and a decrease in signal intensity, indicating a significant reduction in inflammation and confirming the drug’s efficacy. Retention rate values demonstrate that Guselkumab is well tolerated and effective in the long term for the majority of patients. Conclusions: This 12-month real-world study of 99 PsA patients confirms the efficacy of Guselkumab in reducing disease activity in both peripheral and axial forms. The findings align with previous RWE and clinical trials (DISCOVER-1 and -2), supporting its clinical utility in PsA and axPsA, with high treatment retention. Full article

Background/Objectives: Functional spinal instability from multifidus dysfunction has been proposed as a mechanism for chronic postsurgical pain. Prior studies reported structural impairments in the lumbar multifidus in patients with chronic low back pain, including a reduced cross-sectional area, muscle thickness, and increased fat infiltration. This preliminary report examined the prevalence of multifidus fat infiltration after Spinal Cord Stimulation (SCS), an established pain management technique. It also assessed inter-rater reliability in evaluating fat infiltration using MRI. Methods: The medical imaging data from four patients with Persistent Spinal Pain Syndrome Type II (PSPS II) treated with SCS were collected. Two independent operators performed the manual segmentation of the multifidus muscle on axial MRI images of the lumbar spine. The fat-to-muscle ratio was quantified and rated using a four-point classification system, categorizing multifidus fat infiltration as normal, mild, moderate, or severe. To assess the reliability of the manual segmentations, inter-rater reliability was determined. Results: The median fat-to-muscle ratio at the levels L2–L3 was 46.12 (Q1–Q3: 44.88–47.35). At the levels L3–L4, L4–L5, and L5–S1, the median values were 50.45 (Q1–Q3: 45.57–52.98), 52.11 (Q1–Q3: 48.81–52.80), and 52.84 (Q1–Q3: 49.09–56.39), respectively. An ICC value of one (95% CI from 0.999 to 1, p < 0.001) was found for inter-rater agreement on the muscle volume of the multifidus muscle. Conclusions: All the patients had moderate-to-severe fat infiltration of the multifidus muscle at each lumbar spinal level. Although time-consuming, the manual segmentation of the multifidus muscle in patients treated with SCS was feasible and yielded excellent inter-rater reliability when determining muscle volume. Future endeavors should focus on the automation of segmentation and classification. Full article

Background and Objectives: Spondylarthritis is a complex group of inflammatory diseases closely associated with the HLA-B27 antigen. However, the role of non-HLA-B27 alleles in the disease’s pathogenesis has gained significant scholarly attention in recent years. Case presentation: This case study presents a 49-year-old male with a history of progressive inflammatory back pain, characterized by morning stiffness and restricted spinal mobility developed over several years. Initially presenting with non-specific symptoms, the patient eventually experienced persistent axial pain and deteriorating functional limitations, which required further evaluation. Radiographic imaging supported the diagnosis of ankylosing spondylitis (AS) by identifying bilateral sacroiliitis. HLA genotyping revealed a negative result for HLA-B27 but positive results for HLA-B13 and HLA-B37. This finding serves as a foundation for exploring alternative genetic factors contributing to spondylarthritis (SpA). HLA-B13 and HLA-B37 exhibit structural and functional similarities to HLA-B27, particularly in their peptide-binding grooves. This resemblance may lead to overlapping peptide repertoires and increased T cell cross-reactivity. Moreover, these alleles belong to overlapping cross-reactive groups (CREGs) and share the Bw4 epitope. This suggests that they may contribute to disease pathogenesis via similar mechanisms, such as molecular mimicry and the dysregulation of natural killer (NK) cell interactions, as observed in HLA-B27. Conclusions: This case emphasizes the necessity of expanding diagnostic criteria to incorporate non-HLA-B27 markers, particularly for patients who are HLA-B27-negative. Enhancing our understanding of the roles of alternative genetic markers can improve diagnostic accuracy, enable personalized treatment approaches, and enhance outcomes for the diverse SpA patient population. Full article

Background: This study aims to evaluate how surgical timing and the radiological characteristics of fragment blocks can affect the effectiveness of ligamentotaxis, in restoring the spinal canal area, and local kyphosis in adults with traumatic thoracolumbar A3 burst fractures without neurological impairment treated with percutaneous short-segment fixation. Methods: A retrospective observational study was conducted between January 2016 and December 2022 on neurologically intact adult patients with a single A3 thoracolumbar fracture. Data collected included demographics, injury mechanism, fracture level, and clinical and surgical details. Radiological assessments included spinal canal area, local kyphotic angle, anterior and posterior vertebral heights, and fragment block measurements. Results: Out of 101 treated patients, 9 met the criteria with a mean age of 52.22 years. Most fractures were at L1 (88.89%). All patients had moderate-to-severe pain (NRS 6.22 ± 1.09) at baseline. Five patients (55.55%) underwent surgery within 72 h, with a mean surgical time of 109.22 min. SCA and LKA values improved significantly in all patients post-surgery. Early surgical intervention (<72 h) correlated with greater improvements in spinal canal area (p = 0.016) and local kyphotic angle (p = 0.004). A significant association was found between spinal canal area improvement and the percentage ratio of fragment height to “normal” vertebral height (rho = 0.682; p = 0.043). Conclusions: Early (<72 h) short-segment percutaneous fixation is recommended for adults with high functional demands and moderate-to-severe axial pain due to single traumatic A3N0M0 thoracolumbar fracture. This “upfront” approach is associated with enhanced indirect decompression and better local kyphotic angle restoration. Considering the fragment morphology could also be important in surgical planning. Full article

We present an ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography/computed tomography (PET/CT) scan of a 27 y/o patient with long-standing significant B symptoms, diffuse bone pain, increased inflammation parameters, and polydipsia revealing multiple FDG-avid osteolytic lesions of the axial skeleton including a vertebra plana of T7 and paraosseous soft tissue lesions. A CT-guided biopsy confirmed the diagnosis of Langerhans cell histiocytosis (LCH). This case highlights the importance of considering LCH in young patients with vertebral collapse and underscores the role of PET/CT imaging in establishing an accurate diagnosis. Full article

Chronic low back pain has traditionally been thought to stem from intervertebral disc degeneration. However, emerging evidence over the last few decades has revealed other contributing sources. One such etiology of chronic non-radiating axial low back pain has been attributed to vertebral end plate disruption and degeneration, leading to basivertebral nerve-mediated nociception. These degenerative events, described as Modic changes on MRI, provide a means of diagnosis and offer personalized treatment options, like minimally invasive radiofrequency ablation, to help address this source of low back pain. This review focuses on recent advancements, rationale, efficacy, and safety profile intraosseous basivertebral nerve ablation in the treatment of vertebrogenic back pain, and discusses current knowledge gaps that may help guide future research in the field. Full article