Search Results (445)

Background: Congenital abdominal wall defects (CAWDs), primarily gastroschisis and omphalocele, result from disturbances in early embryonic folding and midgut development and are routinely detected during prenatal ultrasound screening. Despite advances in prenatal imaging, considerable heterogeneity in clinical presentation, severity, and outcomes necessitates structured risk stratification to optimize prenatal and perinatal management. Objectives: We aimed to present a series of prenatally diagnosed congenital abdominal wall defects and integrate current evidence into a clinically applicable, risk-adapted framework for prenatal assessment and perinatal management. Materials and Methods: Three pathological cases of CAWDs diagnosed between 2025 and 2026 were retrospectively analyzed. Two additional first-trimester ultrasound examinations demonstrating physiological midgut herniation were included as illustrative examples of an important differential diagnosis during early pregnancy. Prenatal assessment included systematic evaluation of bowel dilatation, bowel wall thickness, liver herniation, and associated structural anomalies. Established risk stratification systems—including the distinction between simple and complex gastroschisis and the classification of omphalocele according to defect size and associated anomalies—were applied. A narrative review of the literature was performed to contextualize the clinical findings and support the development of a practical ultrasound-based diagnostic and management algorithm. Results: The pathological cases illustrated the broad clinical spectrum of CAWDs, ranging from isolated omphalocele to lethal body stalk anomaly, while the illustrative examples emphasized the importance of distinguishing physiological midgut herniation from pathological abdominal wall defects during the first trimester. Prenatal risk stratification based on ultrasound findings may inform surveillance strategies, delivery planning, and parental counseling. In particular, associated anomalies and liver herniation in omphalocele, as well as progressive bowel abnormalities in gastroschisis, were identified as key determinants of prognosis and clinical management. Based on the literature review and the illustrative institutional cases, an educational ultrasound-based diagnostic and management framework was proposed to summarize the current evidence and support a structured diagnostic approach. Conclusions: Congenital abdominal wall defects should be considered a spectrum of disorders with varying embryological origins, clinical manifestations, and prognostic implications. A standardized prenatal assessment combined with risk-adapted management can improve prognostic accuracy, optimize perinatal planning, and support informed parental counseling. Implementation of structured diagnostic frameworks may enhance clinical decision making and improve outcomes in affected pregnancies. Full article

Background and Clinical Significance: Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract and an uncommon cause of small bowel obstruction in adults, in which the diverticulum or a band arising from it typically constricts the adjacent bowel. Entrapment of the diverticulum itself within a pre-existing fibrous band is exceedingly rare; Case Presentation: A 42-year-old man with no previous abdominal surgery presented with colicky abdominal pain, distension and bilious vomiting. Contrast-enhanced computed tomography demonstrated small bowel loops dilated to 35.4 mm with a pelvic transition point of undetermined cause. At emergency laparotomy, a fibrous ileo-mesenteric band delimited a constricting orifice through which the Meckel’s diverticulum had herniated and become strangulated at its base, with secondary obstruction and ischemia of the adjacent ileum. Division of the band restored perfusion; the bowel remained viable and stapled diverticulectomy was performed without segmental resection. The patient recovered without complications. In most reported cases of Meckel’s diverticulum causing small bowel obstruction, the diverticulum or a band arising from it constricts the adjacent bowel. In this case the mechanism is reversed: the diverticulum was the entrapped structure itself, herniating through and strangulating within the orifice of a pre-existing ileo-mesenteric fibrous band. This configuration is exceptionally rare; Conclusions: Meckel’s diverticulum should be considered among the possible causes of small bowel obstruction in adults with no history of abdominal surgery. Recognition of this unusual anatomical configuration may facilitate intraoperative identification and appropriate assessment of bowel viability. Full article

Introduction: delayed abdominal closure following congenital diaphragmatic hernia (CDH) repair is required in patients with large defects in whom primary fascial closure would risk abdominal compartment syndrome. Several strategies have been described, but most require prolonged time to definitive closure. We present a novel technique based on a Gore-Tex^® abdominal patch with dynamic traction under intra-abdominal pressure monitoring. Methods: retrospective observational study of 41 neonates undergoing CDH repair at a tertiary referral center (2015–2023). Patients were divided into primary closure (n = 27) and delayed dynamic abdominal wall closure (DDAC) (n = 14) groups. Baseline characteristics, surgical outcomes, and mortality were compared between groups using Fisher’s exact test and the Wilcoxon rank-sum test. Results: patients requiring DDAC had more severe baseline disease, including lower O/E LHR (26.30 [21.40–31.00] vs. 42.00 [34.00–46.00], p < 0.001), higher rates of liver herniation (13/14 vs. 4/27, p < 0.001), more advanced defect type (p < 0.001) and greater need of ECMO (9/14 vs. 3/27, p < 0.001). Definitive fascial closure was achieved at a median of 6 days. In-hospital mortality after diaphragmatic repair was 19.5% (8/41), with 7 deaths occurring in the DDAC group. Mortality was strongly associated with the gradient of disease severity across prenatal and anatomical markers, although an independent contribution of the abdominal closure strategy cannot be excluded. Conclusions: DDAC achieves early definitive fascial closure and appears technically feasible in CDH patients unsuitable for primary closure. Higher mortality in this group was strongly associated with baseline disease severity, though its independent relationship with the closure technique remains to be established. Full article

Background/Objectives: Low back pain (LBP) is highly prevalent among dentists, although the relationship between lumbar magnetic resonance imaging (MRI) findings and symptoms remains unclear. This study aimed to identify lumbar MRI-derived structural profiles in actively practicing dentists and to examine their relationship with LBP, pain-related disability, demographic characteristics, occupational factors, and individual MRI findings. Methods: A cross-sectional observational study was conducted in 57 actively practicing dentists. Demographic, occupational, and clinical data were collected, and lumbar MRI examinations were performed using standardized protocols. MRI findings included disc bulging, disc herniation, annular fissure, Modic changes, osteophytes, facet joint degeneration, and spinal canal stenosis. Cluster analysis was used to identify MRI-derived structural profiles. Associations between profiles, LBP, disability, demographic characteristics, occupational factors, and individual MRI findings were assessed using chi-square tests and correspondence analysis. Results: Two distinct MRI-derived structural profiles were identified: a disc–facet degenerative profile (n = 38) and a non-osseous degeneration profile (n = 19). Disc bulging (100% vs. 52.6%, p < 0.001), facet joint degeneration (94.7% vs. 10.5%, p < 0.001), and osteophytes (23.7% vs. 0%, p = 0.022) significantly contributed to profile differentiation, whereas disc herniation, Modic changes, and annular fissure did not. Neither MRI-derived profile was associated with the presence of LBP or pain-related disability (p > 0.05). Younger dentists were more frequently classified within the disc–facet degenerative profile with LBP, whereas older dentists with similar structural findings were more commonly classified within the same profile without LBP (p = 0.007). No significant associations were observed between MRI-derived profiles and occupational characteristics. Conclusions: Two distinct lumbar MRI-derived structural profiles were identified in dentists, but neither was associated with LBP or pain-related disability. Age appeared to influence the clinical expression of the disc–facet degenerative profile, suggesting that lumbar MRI findings should be interpreted within a broader, age-sensitive clinical context rather than as isolated determinants of symptoms. Full article

Background: Lumbar radicular pain, commonly referred to as sciatica, is a prevalent musculoskeletal condition that negatively impacts patients’ quality of life. Evidence regarding the use of foot orthoses in patients with sciatica secondary to lumbar disc herniation remains limited. Objectives: To determine the influence of custom-made foot orthoses on health-related quality of life and perceived pain in patients with chronic radicular pain secondary to non-traumatic lumbar or lumbosacral disc herniation. Methods: A randomized, controlled, double-blind clinical trial was conducted. Fifty-two patients (mean age: 46.12 ± 9.37 years; 53.8% men, 46.2% women) were allocated to either a customized functional foot orthoses group or a cushioning flat insole group. Pain, foot-related disability, low back disability, and health-related quality of life were assessed at baseline and after three months using the 11-point Numeric Pain Rating Scale (NPRS), Manchester Foot Pain and Disability Index (MFPDI), Oswestry Disability Index (ODI), and Short Form-12 (SF-12) questionnaire. Results: No statistically significant differences were observed between treatment groups in foot pain ($p=0.821$), lower-limb pain ($p=0.244$), low back pain ($p=0.497$), low back disability ($p=0.684$), or physical quality of life ($p=0.069$) after follow-up. However, participants treated with customized functional foot orthoses showed significant intragroup improvements in foot function (MFPDI-Function: $p=0.046$; MFPDI-Total: $p=0.033$) and in the physical component of health-related quality of life (SF-12 Physical: $p=0.031$), whereas no significant changes were observed in the cushioning insole group ($p>0.05$). Conclusions: Customized functional foot orthoses may improve foot function and physical health-related quality of life in patients with chronic radicular pain secondary to lumbar or lumbosacral disc herniation. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings. Full article

Background: Recurrent lumbar disc herniation (rLDH) significantly impairs outcomes following percutaneous endoscopic lumbar discectomy (PELD). Accurate individualized risk prediction remains challenging. This study aimed to develop and compare multiple machine learning models for predicting rLDH within two years post-surgery. Methods: A retrospective cohort of 1483 patients undergoing single-level PELD was analyzed. The primary outcome was symptomatic, magnetic resonance imaging-confirmed rLDH requiring reintervention. Candidate predictors included demographic, surgical, and radiographic parameters. The dataset was stratified by outcome and randomly split into training (70%, n = 1038) and validation (30%, n = 445) sets. Feature selection utilized univariate screening (p < 0.2) and least absolute shrinkage and selection operator regression. Six machine learning algorithms were trained and optimized via grid search. Performance was evaluated using the area under the receiver operating characteristic curve (AUC), F1-score, Brier score, calibration and decision curve analysis (DCA). Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: The overall recurrence rate was 4.25% (63/1483). Logistic regression achieved the optimal F1-score (0.286), while light Gradient Boosting Machine (LightGBM) demonstrated superior discrimination (AUC = 0.768). DCA indicated clinical utility primarily at low threshold probabilities (<10%). SHAP analysis identified increased sagittal range of motion as the strongest risk factor, followed by reduced facet orientation, advanced age, type II Modic changes, and Michigan State University zone C. Conclusions: This study presents an exploratory, internally validated machine learning framework for rLDH risk stratification. While LightGBM demonstrated moderate discriminative ability, model sensitivity was constrained by the inherent rarity of recurrence events, precluding its use as a definitive standalone screening tool. Notably, clinical utility was restricted to low threshold probabilities (<10%), supporting a focused role in identifying high-risk subgroups for intensified preoperative counseling and postoperative monitoring. Beyond elucidating key radiological and demographic risk factors, our findings underscore that rigorous external prospective validation and probability calibration are indispensable before any future clinical deployment. Full article

Background and Objectives: The aim of this study was to use a modified lateral lumbar approach developed by the authors for single-level lumbar decompression and interbody fusion using intervertebral implants. Materials and Methods: A total of 38 patients with single-level L1–L5 degenerative disc disease who underwent lumbar interbody fusion were included in this study. The procedure was performed using the modified lateral lumbar surgical approach. Clinical outcomes included the assessment of functional status using the Karnofsky Performance Scale and Oswestry Disability Index (ODI), quality of life using the EuroQol Visual Analogue Scale (EQ-VAS), and pain intensity using Visual Analogue Scale (VAS). Preoperative and postoperative radiographic parameters assessed on magnetic resonance imaging (MRI) were compared. Results: Significant improvement in functional status, quality of life, and pain reduction was observed in all patients. Radiographic outcomes also improved significantly. Mean disc height increased from 8.2 mm preoperatively to 12.2 mm postoperatively (p < 0.05). The cross-sectional area of the spinal canal increased significantly following surgery. Furthermore, a reduction in disc herniation width and enlargement of the intervertebral foramina were observed. No neurovascular complications occurred, and endplate injury with cage subsidence was noted in 5% of patients. Conclusions: Lateral lumbar discectomy and interbody fusion increase spinal canal area, enlarge the neuroforamina, and restore intervertebral disc height. Most patients experienced substantial functional improvement and pain reduction. No neurological or vascular complications were observed, which may be due to the modified approach. The confirmation of this hypothesis requires further research and a longer follow-up period. Full article

In spinal pathology, lumbar disc herniation (LDH) is typically contrasted with lumbar spinal stenosis (LSS) based on either its pathophysiology (structural compression vs. dynamic/vascular/degenerative changes) or its clinical presentation (acute radiculopathy vs. chronic claudication). We compared the ligamentum flavum (LF) tissue, primary LF cells, and serum cytokine profiles using human cytokine antibody arrays and Western blotting between patients with LDH (n = 17) and LSS (n = 23). LF specimens underwent hematoxylin–eosin, Masson’s trichrome, and immunohistochemical staining. Compared with LSS, LDH specimens showed relatively preserved LF architecture and higher tissue levels of IL-7, IL-10, eotaxin-3, HGF, and TGF-β2, suggesting an earlier immune-regulatory and reparative phase. In contrast, LSS specimens showed fragmented elastic fibers, increased collagen accumulation, and significantly elevated OPG in primary LF cell cultures. Serum cytokine profiles did not differ significantly between groups. These findings suggest that LDH-associated LF changes may involve immunoregulatory and repair-related cytokine expression, whereas LSS represents a more fibrotic, OPG-enriched remodeling phenotype. TGF-β2, eotaxin-3, and the RANKL/OPG pathway merit further evaluation as stage-specific biomarkers. Full article

Background and Importance: Congenital encephalocele refers to the protrusion of CNS tissue through a skull defect. As a rare neural tube malformation, clinical evidence is particularly limited for large encephaloceles, and management is subject to ongoing discussions. Clinical Presentation: A 3-month-old boy presented with a left hemisphere herniation above the level of the Sylvian fissure into a congenital parietal encephalocele. No focal deficits were appreciated. We hypothesized that early prenatal damage due to protruding brain tissue may have resulted in unihemispheric motor control of both body sides. As such, surgical repair guided by intraoperative electrophysiology and plastic reconstruction was scheduled. Intraoperatively, bilateral and symmetric extremity response upon transcranial electric stimulation of the contra-lesional right hemisphere was detected, whereas no responses from direct cortical and subcortical stimulation of the herniated brain parenchyma were elicited. Complete resection of the herniated supra-insular hemisphere was provided, and no ischemic changes or new deficits occurred. At 24-month follow-up, the patient showed voluntary movements with both upper extremities and voluntary grasping with his left (non-paretic) hand, no mirror movements, no signs of spasticity, good eye contact, and could speak several words. Conclusions: Safe resection with excellent outcome can be provided even for large encephaloceles. Intraoperative electrophysiological findings aid in identifying the absence of cortico-spinal projections and appear helpful to avoid post-operative deficits. Full article

Objective: To evaluate the feasibility and short-term outcomes of a modified percutaneous endoscopic interlaminar discectomy (PEID) trajectory via the inferolateral margin of the L5 pedicle projection for central disc herniation at L5/S1. Methods: From June 2023 to July 2025, a consecutive cohort of 70 patients diagnosed with L5/S1 lumbar disc herniation (LDH) undergoing modified projection PEID was enrolled. Based on preoperative MRI (magnetic resonance imaging) evaluation of herniation types, they were divided into a central herniation group (n = 32) and a non-central herniation group (n = 38). Clinical outcomes and radiographic parameters were subsequently compared between the groups. Results: Seventy patients were included (38 non-central and 32 central). Baseline characteristics were comparable between the two groups except for a higher prevalence of bilateral symptoms in the central herniation group (p = 0.036). The central herniation group exhibited significantly shorter operative time (p = 0.027), reduced intraoperative blood loss (p = 0.047), and lower haemoglobin drop (p = 0.033). Multivariable linear regression confirmed that central herniation was independently associated with improved surgical efficiency. Both groups demonstrated significant postoperative improvements in VAS (Visual Analogue Scale) and JOA (Japanese Orthopaedic Association) scores. Although the non-central herniation group showed a higher JOA score on postoperative day 1 (p = 0.047), no significant differences were observed at 3 months or the final follow-up. The modified MacNab satisfaction rates were comparable (p = 0.411), with a similarly low complication rate in both groups. Conclusions: The modified PEID trajectory via the inferolateral margin of the L5 pedicle projection is feasible for central L5/S1 disc herniation and is associated with reduced operative time and decreased intraoperative blood loss. Full article

Acute parastomal hernia containing the stomach with subsequent mechanical gastric outlet obstruction is an exceedingly rare phenomenon given the anatomical fixation of the stomach. Herein, we present the case of an 81-year-old female with a history of a Hartmann’s procedure who developed acute vomiting. She was found to have herniation of the stomach into the parastomal hernia sac with tight angulation of the gastroduodenal junction and, therefore, gastric outlet obstruction. Following decompression with a nasogastric tube, we report an open approach with circumstomal mesh for acute emergent repair. Full article

Background/Objectives: Upward-migrated lumbar disc herniation (LDH) presents technical challenges during the transforaminal endoscopic approach, particularly when fragments migrate cranially and medially beyond the usual working corridor. This study was based on the hypothesis that surgical difficulty is influenced by both vertical migration height and medial location. We aimed to describe key surgical steps for accessing these difficult lesions and to propose a coronal MRI-based modification of existing migration grading to support preoperative localization and surgical planning. Methods: This retrospective observational cohort study included 66 patients who underwent transforaminal endoscopic lumbar discectomy for upward-migrated LDH. Sagittal MRI-based migration grading was modified on coronal MRI using two reference lines: the inferior pedicle line for vertical grades 1–3 and the inner pedicle line for horizontal grades L and M. Cases with grade 2 or 3 plus grade M were defined as involving the high axillar space (HAS). Patients were divided into non-HAS and HAS groups. Key surgical steps included superior articular process flattening, detachment of the superior extraforaminal ligament, and cranial rotation with oblique tilting of the endoscope. Results: Thirty-five cases (53.0%) involved the HAS. Grade 2 was the most common vertical grade (65.2%), and grade M accounted for 56.1% of cases. Despite more demanding anatomical characteristics, the HAS group achieved early clinical outcomes comparable to those of the non-HAS group, with excellent or good outcomes in 85.7% and 93.6% of patients. Conclusions: Standardized key surgical steps, including SAP flattening, detachment of the superior extraforaminal ligament, and cranial rotation with oblique tilting of the endoscope, may facilitate access to upward-migrated LDH involving the HAS while maintaining favorable early clinical outcomes. The proposed coronal MRI-based modified migration grading may help assess the vertical and medial extent of upward-migrated LDH and support preoperative planning for these technically demanding cases. Full article

Background and Clinical Significance: Proximal hamstring tendinopathy can occur not only in athletes but also in nonathletes when daily activities impose repetitive tensile or compressive loading at the ischial tuberosity. Because symptoms often resemble piriformis syndrome or lumbar pathology, diagnosis may be delayed; Case Presentation: A woman in her twenties developed buttock pain during desk work. Lumbar MRI was normal, and piriformis blocks provided only temporary relief. Localized tenderness at the ischial tuberosity, pain provocation during sitting, and positive provocation tests suggested proximal hamstring tendinopathy. Ultrasound showed a mildly hypoechoic area at the tendon insertion without definite thickening or tear. Ultrasound-guided injection of levobupivacaine and dexamethasone produced immediate but temporary relief. She continued receiving injections every two weeks, combined with stretching, hip-lift strengthening, and reduced sitting. After 18 injections, her pain improved from a numerical rating scale score of 10 to 0–1; Conclusions: This case demonstrates that proximal hamstring tendinopathy can develop in nonathletes due to lifestyle-related mechanical loading. Characteristic clinical findings and ultrasound evaluation are essential for diagnosis, and ultrasound-guided injection combined with exercise and activity modification provided sustained symptom improvement. Full article

Chronic pain is increasingly understood as a multidimensional condition in which, in a substantial subgroup of patients, a protective symptom can evolve into a persistent maladaptive disorder of the nervous system, while in others it may remain closely tied to ongoing mechanical or structural factors. Central sensitization (CS) represents a key mechanism underlying this transition, characterized by enhanced neural responsiveness and impaired endogenous pain inhibition, leading to a dissociation between pain and tissue pathology. The aim of this narrative review is to critically discuss current evidence on CS as a mechanism-based explanation for persistent pain, using lumbar disk herniation (LDH) as a clinical model of the radiological-clinical mismatch, and to discuss its direct implications for identifying sensitized phenotypes, multimodal assessment, and rehabilitation strategies. A total of 77 sources published between 2006 and 2026 were synthesized. These reviewed sources demonstrate that identification of the sensitized phenotype requires a multimodal assessment approach combining self-report measures, such as the Central Sensitization Inventory (CSI), with psychophysical methods including quantitative sensory testing (QST) and conditioned pain modulation (CPM). Cognitive-emotional factors are also critical, as postoperative kinesiophobia affects approximately 38.3% of LDH patients and is associated with increased pain intensity and reduced self-efficacy. Management strategies reported in these publications focus on mechanism-based interventions, particularly pain neuroscience education (PNE) and graded, time-contingent exercise, which aim to modify pain-related cognitions and restore endogenous inhibitory processes. These approaches may be supported by adjunctive therapies, including dry needling (DN), electro-dry needling (EDN), centrally acting pharmacological agents (e.g., serotonin–norepinephrine reuptake inhibitors [SNRIs] and gabapentinoids), and psychologically informed treatments such as cognitive behavioral therapy (CBT). While surgical decompression may reduce CS-related symptoms, preoperative sensitization does not necessarily predict poorer outcomes, highlighting the interaction between peripheral and central mechanisms. Adopting a sensitization-informed perspective may encourage a broader integration of contemporary pain models alongside traditional structural views in lumbar disc herniation clinical care. Full article

Background and Objectives: In degenerative spine disease, compensatory mechanisms are activated to maintain upright posture, extending beyond the spine to involve the pelvis, lower limbs, and feet. These adaptations may be accompanied by differences in foot alignment, which could be associated with sagittal balance. The aim of this study is to investigate the relationship between foot alignment and spinal posture in patients with degenerative spine disease and evaluate whether foot deformities are associated with sagittal imbalance in degenerative spine disease. Materials and Methods: We retrospectively reviewed 98 patients with degenerative spine disease who underwent preoperative standing EOS imaging between 2017 and 2025 at a single academic spine centre. Meary’s angle, talocalcaneal angle, and calcaneal pitch were measured on lateral EOS images to classify feet as flat, normal, or cavus. Spinopelvic parameters were extracted from EOS and conventional radiographs. Differences in spinal parameters across foot groups were compared using ANOVA, and linear regression evaluated associations between sagittal vertical axis (SVA) and foot angles. Results: Among spinopelvic parameters, only SVA significantly differed between foot groups, with flatfoot patients showing greater forward imbalance (p = 0.035). Regression analysis demonstrated an inverse relationship between SVA and both talocalcaneal angle (p = 0.003) and calcaneal pitch (p = 0.034), suggesting that greater forward trunk inclination was associated with flatter feet. Degenerative scoliosis patients demonstrated a bimodal pattern with more flat and cavus feet (p = 0.006), while herniated disc patients more often exhibited flatfoot (p = 0.031). Conclusions: Foot posture abnormalities, particularly flatfoot, are associated with sagittal spinal imbalance, suggesting foot posture may be associated with global alignment and could reflect distal postural adaptations. Full article