Search Results (320)

Introduction: Haglund’s deformity, characterized by bony enlargement at the back of the heel, often coincides with Achilles tendon pathology due to impingement on the retrocalcaneal bursa and tendon insertion. Surgical management of Haglund’s deformity with a preexisting Achilles tendon rupture is complex, and understanding the outcomes of this subset of patients is essential for optimizing treatment strategies. Methods: This retrospective study reviewed patients undergoing open surgical management for Haglund’s syndrome between January 2015 and December 2023. Patients with chronic degenerative changes secondary to Haglund’s deformity and a preoperative Achilles tendon rupture were compared to those without. Data on demographics, surgical techniques, weightbearing protocols, and complications were collected. Univariate analysis was performed using χ² or Fisher’s exact test for categorical variables, and the T-test or Wilcoxon rank-sum test for continuous and ordinal variables, with normality assessed via the Shapiro–Wilk test. Results: Four hundred and three patients were included, with 13 having a preoperative Achilles tendon rupture. There was a higher incidence of preoperative ruptures among males. Surgical repair techniques and postoperative weightbearing protocols varied, though were not randomized. Complications included persistent pain, wound breakdown, infection, plantar flexion weakness, and revision surgery. While patients with Haglund’s deformity and a preoperative Achilles tendon rupture demonstrated a trend toward higher complication rates, including postoperative rupture and wound breakdown, these differences were not statistically significant in our analysis. Conclusions: A cautious approach is warranted in managing these patients, with careful consideration of surgical planning and postoperative rehabilitation. While our findings provide valuable insights into managing patients with Haglund’s deformity and preoperative Achilles tendon rupture, the retrospective design, limited sample size of the rupture group, and short duration of follow-up restrict generalizability and the strength of the conclusions by limiting the power of the analysis and underestimating the incidence of long-term complications. Therefore, the results of this study should be interpreted with caution. Further studies with larger patient cohorts, validated functional outcome measures, and comparable follow-up durations between groups are needed to confirm these results and optimize treatment approaches. Full article

Endometriosis is a benign and often underdiagnosed condition that affects women of reproductive age, typically between 18 and 45 years. It can cause infertility and pain, including radicular pain and low back pain (LBP). The aim of this case report is to emphasize the importance of making a differential diagnosis when facing LBP and radicular symptoms. We report the case of a 17-year-old female patient, R.A., presented with a significant LBP (NPRS 8/10) radiating from her lumbar spine to her right buttock and occasionally to both legs, accompanied by weakness. She revealed exacerbation of pain during menstruation, despite being under hormonal contraceptive treatment. After three physiotherapy sessions that included education, manual therapy and exercise, the patient’s pain persisted so her physiotherapist recommended an evaluation in the emergency department, where standard radiography did not reveal any significant findings. Physiotherapy continued until the fifth session, when the patient agreed to undergo evaluation at a specialized endometriosis centre. Further investigations revealed endometriotic tissue on the uterosacral ligament, leading to hormonal therapy adjustment, with which pain gradually decreased to a manageable level (NPRS 2/10). This case report highlights the importance of an early differential diagnosis in patients with LBP, as endometriosis can present not only in older women but also in younger patients, including those already on oral contraceptives. Therefore, to mitigate the risk of pattern recognition bias, clinicians must maintain a high index of suspicion for endometriosis, even in atypical or unlikely clinical presentations. Full article

Background and Clinical Significance: Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. Case Presentation: A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. Conclusions: Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates. Full article

Background and Objectives: In the present study, distinct subgroups of older adults with chronic low back pain (LBP) were identified using cluster analysis based on the five dimensions of the EQ-5D-5L. Using detailed profiles of how chronic LBP affects various facets of health-related quality of life (HRQoL), differences in frailty levels across these subgroups were investigated in this study. Materials and Methods: This retrospective study included patients ≥ 60 years of age who visited the pain clinic at a tertiary hospital between March 2022 and February 2023. HRQoL was assessed using the EQ-5D-5L, and frailty was evaluated via the Frailty Phenotype Questionnaire. Hierarchical cluster analysis using the WARD method with squared Euclidean distance was conducted on the EQ-5D-5L dimensions to identify subgroups. Differences in frailty, demographics, and clinical data across clusters were analyzed. Results: Among 837 older adults with chronic LBP, four distinct clusters were identified based on a cluster analysis of the EQ-5D-5L dimensions. Cluster 1 exhibited high levels of pain/discomfort and anxiety/depression, and cluster 2 had severe mobility limitations and pain/discomfort but low anxiety/depression. Cluster 3 showed balanced scores across all dimensions, and cluster 4 had severe pain/discomfort but good mobility. Significant differences were observed among the clusters in pain intensity, EQ Visual Analogue Scale (EQ-VAS) and EQ-5D-5L index scores, and frailty status. Cluster 1 had the highest pain scores and lowest EQ-VAS, and frailty was most prevalent in cluster 2 (28.5%) and least in cluster 4 (13.3%). Conclusions: The results of the present study emphasize the complexity of chronic LBP in older adults by identifying distinct clusters. Cluster analysis identified four unique profiles, with significant frailty differences across the clusters. These findings emphasize the importance of personalized management strategies tailored to specific patient profiles to enhance treatment effectiveness and improve frailty status. Full article

Background: Scheuermann’s kyphosis (SK) is characterized by anterior wedging of >5 degrees at three or more contiguous vertebrae associated with severe back pain and cosmetic disfigurement. Different surgical interventions have been applied for SK correction, but the optimal operational treatment remains controversial. Objectives: The aim of our study is to analyze all the current indications for the surgical correction of SK, as well as to describe the instrumentation methods and techniques in order to detect the ideal operational management and accompanied complications. Methods: This comprehensive review investigates the up-to-date surgical indications and approaches for SK, the current trends, and the associated postoperative functional outcomes. A detailed search of PubMed, Web of Science and Google Scholar databases in English literature was performed for articles during the last 20 years. Additional criteria were peer-reviewed original studies that provided the type of interventions for SK and the clinical outcomes. Results: Thirty studies that met our induction criteria were analyzed. The up-to-date surgical indications such as back pain, failure of conservative treatment, progression of deformity, and neurological complications were described. Anterior (AO) and posterior-only (PO), and combined anterior–posterior (AP) approaches and instrumentation techniques were outlined. The most common side effects of the above interventions were hardware failure, loss of correction and Proximal Junctional Kyphosis. Contrariwise, in PO, reduced blood loss and operational duration was noted. Conclusions: Although the published studies reported contradictory results of the effectiveness of the various techniques applied for SK treatment, the PO fusion was correlated with a decreased rate of complications that resulted in its current increase in popularity. Full article

Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD compared to conservative therapy as an early treatment alternative. Methods: This retrospective observational study compared PLDD to conservative treatment in adult patients with contained LDH. All patients underwent 3 months of standard conservative therapy. Those who remained dissatisfied according to the Visual Analog Scale (VAS) and/or Macnab criteria were then treated with PLDD. We analyzed outcomes from both treatment phases using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results: 121 patients underwent outpatient evaluation for LDH and received an average of 90 days of conservative therapy. Of these 103 patients, dissatisfied with the outcomes of conservative treatment, subsequently underwent PLDD. Following conservative treatment, the average VAS score reduction was 4.1%. Six months after PLDD, the VAS scores demonstrated a significant reduction, with an average decrease of 30% (p < 0.0001). In terms of functional outcomes assessed by the Macnab criteria, 39.8% of patients treated with PLDD achieved ‘Excellent’ or ‘Good’ outcomes, compared to only 11.4% after conservative treatment. Conclusions: PLDD appears to be a viable alternative to conservative therapy for this subgroup of patients with contained LDH. It may be beneficial to propose PLDD early in the therapeutic regimen to accelerate short term clinical improvement. Further studies are required to evaluate the long term efficacy of this treatment approach. 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/Objectives: Total hip arthroplasty (THA) is a widely performed procedure to alleviate pain and improve function in patients with hip disorders. However, leg length discrepancy (LLD) remains a prevalent complication. LLD can cause gait disturbances, back pain, postural imbalance, and patient dissatisfaction, along with significant medico-legal implications. This review examines the evaluation, management, and medico-legal aspects of LLD. Methods: The review analyzed literature on the prevalence, evaluation methods, and management strategies for LLD in THA. Radiographic and clinical assessment tools were considered, alongside factors such as pelvic obliquity and pre-existing conditions. The importance of preoperative planning, intraoperative techniques (including computer-assisted methods), and comprehensive documentation was evaluated to address both clinical and legal challenges. Results: The review shows that leg length discrepancy (LLD) following total hip arthroplasty (THA) occurs in 3% to 30% of cases, with mean values ranging from 3 to 17 mm. LLD may result from anatomical or procedural factors, and effective evaluation requires both radiographic imaging and clinical assessment. Preoperative planning plays a critical role in accurately assessing anatomical parameters and selecting appropriate prosthetic components to preserve or restore limb length symmetry. Advanced intraoperative techniques, including computer-assisted surgery, help reduce LLD incidence. While some complications may be unavoidable, proper documentation and patient communication, particularly regarding informed consent, are essential to mitigate medico-legal risks Conclusions: LLD after THA requires a multidimensional approach incorporating clinical, radiological, biomechanical, and legal considerations. Effective preoperative and intraoperative strategies, combined with robust communication and documentation, are essential to minimize LLD and its associated risks. A focus on precision and patient-centered care can improve outcomes and reduce litigation. Full article

Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well-defined treatment strategy: a series of five patients diagnosed with SAC and submitted to neurosurgical treatment was retrospectively analyzed. Objectives: SACs represent 1–2% of all spinal neoplasms; they can be extradural, intradural, or intramedullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neurosurgical management in patients with SACs treated at our institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and December 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (three males, two females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging indicated that most cysts were at the thoracic level. Surgical interventions primarily involved cyst resection and adhesiolysis. Post-operative outcomes showed overall improvement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (ASIA) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences. Full article

Background: Infected aortic aneurysms pose significant therapeutic challenges, given the fragility of infected aneurysmal tissue. Mycotic aneurysms caused by Streptococcus agalactiae are rare and may progress in the absence of classical systemic infection signs. Here, we discuss the surgical management of an unusual presentation of a mycotic aneurysm and its rapid progression with no incremental changes in the patient’s symptoms. Case: A 72-year-old woman presented with subacute general deterioration and back pain. A general workup revealed a mycotic aneurysm of the aortic arch, at the level of the brachiocephalic artery. Initial CT showed a 7 × 5.5 mm pseudoaneurysm that enlarged to 41 × 26 mm within three weeks, despite clinical improvement of her presenting symptoms on antibiotics. Given that the lesion progressed, a staged procedure, consisting of a left carotid–subclavian bypass followed by proximal arch repair, was undertaken with success. Intra-operatively, a completely thrombosed innominate vein was found compressing—and likely tamponading—the pseudoaneurysm, a phenomenon that may have prevented catastrophic rupture. A Dacron graft was sewn end-to-end to the distal ascending aorta; the posterior half of this distal anastomosis incorporated the rim of the innominate artery defect to create a single hemostatic suture line. Conclusions: This case demonstrates a benign initial presentation can degenerate into a catastrophic pseudoaneurysm and how rapidly progressive thoracic infected aneurysms can develop. Heightened clinical acumen is required for accurate diagnosis. Close follow-up is also suggested based on the rapid progression experienced by our patient. Serial imaging, rather than symptomatic or laboratory response alone, should guide the timing of intervention. Full article

Background: Low back pain (LBP) in older mothers is a prevalent and multifaceted condition influenced by a range of biopsychosocial factors. As the trend of late motherhood increases globally, it is essential to understand how LBP affects this population from a biopsychosocial perspective. Objective: This systematic review aims to examine the biopsychosocial determinants of LBP in older mothers by synthesizing findings from quantitative studies published between January 2010 and May 2024. Specifically, it explores the biological, psychological, and social factors contributing to LBP in this population and how it affects their daily lives and well-being. Methods: A comprehensive literature search was conducted across PubMed, PsychInfo, Web of Science, EMBASE, DARE, and the Cochrane Library. Studies were screened for eligibility based on predefined criteria. Five quantitative studies with a combined sample of 118,964 participants were included. The methodological quality was assessed, and data were extracted for analysis. Results: All five studies addressed biological aspects of LBP, including pelvic girdle pain, hemorrhoids, and varicose veins. Three studies also explored psychological factors such as depression and stress. Two studies incorporated social dimensions, including inadequate support systems, occupational burdens, and healthcare access barriers. Age and parity were consistently reported as exacerbating physical and psychological symptoms. Conclusions: This review highlights the importance of considering biopsychosocial factors when managing LBP in older mothers. Tailored interventions, such as exercise programs, family support, and workplace accommodations, are essential for improving outcomes. Further research using longitudinal studies is needed to explore these factors in greater depth. Full article

For the past two decades, the consideration of spinopelvic parameters, sagittal balance, and spine shape has gained importance in the diagnosis and optimal surgical management of painful adult spinal deformity. These principles are used with increasing frequency in the surgical planning and treatment of degenerative mechanical lower back pain. Several parameters exist to analyze both global and regional spinal balance. Chronic lower back pain due to degenerative disc disease, degenerative spondylolisthesis, or adult spinal deformity can be surgically managed in a multitude of ways ranging from simple decompression to multilevel arthrodesis with or without corrective osteotomies, depending on the presumed etiology of the pain, surgical planning, and the surgical goal. In surgical candidates, preoperative evaluation of spinopelvic parameters is paramount, as increasing evidence shows that restoration of the shape of the spine while respecting these parameters improves patient-reported outcome measures (PROMs), decreases re-operation rates, and reduces mechanical complications such as proximal junctional kyphosis/failure (PJK/PJF), distal junctional kyphosis/failure (DJK/DJF), adjacent segment disease (ASD), and rod fracture. This review provides a conceptual analysis of spinopelvic alignment, global and regional sagittal balance, and the restoration of the spine’s shape in relation to patient outcomes during surgical treatment of degenerative spine disorders. Full article

Background and Objective: This observational study aimed to evaluate the clinical efficacy of combined oxygen–ozone (O₂-O₃) therapy under CT guidance with the oral administration of alpha-lipoic acid (ALA), palmitoylethanolamine (PEA), and myrrh in elderly patients suffering from chronic low back pain (LBP). Given the rising prevalence of degenerative spinal diseases in older adults, this study addresses the need for effective, minimally invasive treatment options. Methods: A total of 276 patients aged 65 to 92 years, with chronic unilateral or bilateral LBP, underwent CT-guided paravertebral infiltrations with an O₂-O₃ gas mixture. This treatment was complemented with a 30-day regimen of ALA (800 mg/day), PEA (600 mg/day), and myrrh (200 mg/day). Clinical outcomes were assessed at one month and one year post-treatment using the Visual Analog Scale (VAS) and the modified McNab method. Results: At one month, 32.94% of patients reported an excellent improvement, with the mean VAS score dropping from 8.17 to 2.81. At the one-year follow-up, 68.15% cumulatively experienced positive outcomes, with 17.78% reporting the complete resolution of pain. In this occasion, the mean VAS score was 3.57. Conclusions: The study demonstrates that the combination of oxygen–ozone therapy and oral ALA, PEA, and myrrh is a promising alternative for managing chronic low back pain in the elderly, leading to significant pain reduction and improved quality of life. Findings emphasize the need for further research to validate these results and explore the long-term benefits. Full article

Background: Musculoskeletal trauma involving the lower extremities is an unfortunately prevalent injury pattern in contemporary warfare, and the secondary health conditions (SHCs) associated with these injuries remain largely unexplored. Methods: U.S. Service members (SMs) with combat-related lower extremity injuries between 2004 and 2014 were categorized into primary amputation (PA), limb salvage (LS), and non-threatened limb trauma (NTLT) cohorts. The LS cohort was further divided into those with secondary amputation (LS-SA) and those without (LS-NA). The prevalence and incidence of 12 SHCs were analyzed across cohorts to test the hypotheses that (1) the prevalence of deleterious SHCs would differ among SMs with PA, LS, or NTLT, and (2) LS-SA would exhibit a greater prevalence of SHCs compared to LS-NA. Results: The prevalence of SHCs varied significantly across cohorts. Mental health disorders, nonspecific pain, and movement abnormalities were more prevalent in the PA cohort, while osteoarthritis, internal derangement of the knee, joint pain, and late-effect musculoskeletal injury were more prevalent in the LS cohort, specifically in the LS-SA subpopulation. The LS cohort had a higher prevalence of several SHCs than the NTLT cohort. Osteoarthritis incidence increased over time in all cohorts except NTLT, while unspecified back disorders decreased. Notable incidence differences were observed for late-effect musculoskeletal injury and other soft tissue disorders. Conclusions: This study characterizes SHCs associated with combat-related extremity trauma, emphasizing the need for tailored interventions and follow-up care based on specific injury management. Future research should explore underlying mechanisms and evaluate targeted interventions to minimize SHCs’ impact on patient outcomes. Full article

Introduction and case report: Angiosarcomas, rare soft tissue malignancies originating from endothelial cells, represent only 1–2% of all soft tissue sarcomas. Primary pleural angiosarcoma (PPA) is exceptionally rare, with only 43 reported cases since 1943. There are many diagnostic and therapeutic challenges due to the rarity of these tumors. We present the case of a 72-year-old man presenting with back pain, dyspnea and anemia. Conventional imaging revealed bilateral pleural effusion and a thickened parietal pleura, while contrast chest MR was able to identify pleural sites of contrast enhancement. Left chest tube placement evidenced a hemothorax, and the cytology result was negative. A thoracoscopic approach was chosen, allowing us to perform different parietal pleural biopsies. Radiological and pathological features led to the diagnosis of epithelioid PPA. Despite pleural drainage and blood transfusions, the patient died only 4 days after diagnosis. Objectives: To present a literature review, evaluating the disease epidemiology and the clinical, diagnostic and therapeutic features of PPA. Methods: We reviewed cases of PPA in the literature (1954–2024) by searching the PubMed database for the terms “pleural angiosarcoma” and “pleura + angiosarcoma”. Results: We found a total of 47 cases that were described between 1987 and 2024 with sufficient data to be included in our review. PPA was found to be a challenging diagnosis, found mostly in older Caucasian males. The cytology is mostly indeterminant, and an endoscopic approach is usually needed. Radical surgery is the most common treatment option, and chemotherapy and radiation therapy are also often used. However, the prognosis is poor. Conclusions: PPA is very rare, and complex cases such as this one showcase the importance of innovative approaches like MRI and emphasize the significance of multidisciplinary collaboration for optimal patient management. Bilateral spontaneous hemothorax, as seen in this case, is uncommon and poses additional challenges in disease management. Further research to advance the diagnostic capabilities and treatment efficacy is needed. Full article