Search Results (126)

Background: Endoscopic spine surgery (ESS) is an established minimally invasive approach for degenerative spinal conditions. Advances in instrumentation and visualization have expanded its application to spinal tumor resection. This review synthesizes reported clinical outcomes and technical considerations of ESS for primary spinal tumors. Methods: PubMed was queried from 2000 to 2025 for studies reporting endoscopic resection of primary spinal tumors. Studies involving metastatic disease or non-resective interventions were excluded. Data were descriptively analyzed given heterogeneity and limited sample size. Results: Eleven patients across seven studies were included (mean age = 50.3 years). Pathologies comprised schwannoma (n = 5), meningioma (n = 3), osteoid osteoma (n = 2), and Ewing sarcoma (n = 1). Seven tumors were intradural extramedullary (63.6%) and four were extradural (36.4%); no intramedullary lesions were included. Of the seven intradural cases, one was performed via uniportal full-endoscopic technique, one via biportal endoscopy, and five via tubular retractor-assisted endoscopy. Across all eleven patients, gross total resection was achieved in 90.9% of cases. Gross total resection was achieved in 100% of cases in which it was the operative intent (10/10); the remaining case was a planned biopsy of recurrent Ewing sarcoma. One transient postoperative lower extremity weakness was reported; no cerebrospinal fluid leaks, reoperations, or perioperative deaths occurred. No recurrences were observed across a mean follow-up of 21.9 months (range 4–48 months), though this duration may be insufficient to assess long-term recurrence for slow-growing tumors such as meningioma and schwannoma. Conclusions: ESS of primary spinal tumors appears feasible and safe in carefully selected cases, particularly for small, well-circumscribed lesions in favorable anatomical locations. Intradural resection introduced distinct technical challenges, including irrigation management and dural closure, which influence platform selection. These findings are limited by small sample size, short follow-up, and likely publication bias. ESS should be considered an emerging minimally invasive option rather than a replacement for established microsurgical approaches. Prospective comparative studies are needed to better define its role in spinal oncology. Full article

Background and Clinical Significance: Osteoblastomas are rare, benign but locally aggressive bone tumors with a predilection for the posterior elements of the spine. Their clinical, radiological and histopathological presentation often overlaps with that of osteoid osteomas, leading to diagnostic and therapeutic challenges—particularly in atypical locations such as the anterior thoracic spine. Case Presentation: We report two cases of young female patients (aged 35 and 30 years) presenting with persistent thoracic back pain unresponsive to NSAIDs. In the first case, imaging revealed a lesion at the right T7 pedicle initially attributed to osteoid osteoma; CT-guided thermoablation was declined due to proximity to neural structures. At this stage, we chose percutaneous transpedicular ablation by drilling through the centrum of the lesion (Nidus) surgically. After this transpedicular resection with initial symptom improvement, the patient developed recurrence with lesion progression into both anterior and posterior columns, requiring a second, open, surgical intervention. In the second case, a lesion at the left T11 pedicle and transverse process was identified directly as osteoblastoma due to size and radiological morphology; initial biopsy was non-diagnostic due to specimen fragmentation. In both cases, histopathology was inconclusive or misleading, while clinical and radiological features—including NSAID unresponsiveness, lesion size, and anatomical extent—favored osteoblastoma. Both patients underwent surgical resection via posterior costotransversectomy, partial hemivertebrectomy, expandable cage placement, and posterior instrumentation (T5–T8 and T10–T12, respectively). The postoperative courses were complicated by thoracic events—hemothorax in the first case and pulmonary embolism in the second—both of which were managed successfully. At follow-up, both patients were neurologically intact and pain-free. Conclusions: These cases emphasize the diagnostic overlap between osteoid osteoma and osteoblastoma and highlight the importance of clinical and radiographic correlation when histopathology is inconclusive. A posterior-only approach with costotransversectomy may be a valid strategy in selected cases of thoracic spinal tumors, although specific complications such as hemothorax must be considered. Full article

This study explores the potential utilization of bioactive glasses using different dopant ions and ketoprofen for both tissue ingrowth and local drug delivery. Four different compositions of vitreous powders were synthesized by the sol–gel combined with the emulsion method, in the presence of the ionic surfactant cetyltrimethylammonium bromide (CTAB), differing by dopant ions: SiO₂- P₂O₅-CaO-(ZnO-MgO). This study investigates the chemical–mineralogical, morphological, and structural characteristics, as well as the biological properties of vitreous materials obtained. X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR) data analysis confirmed the vitreous nature; scanning electron microscopy (SEM) micrographs correlate with the results of physical absorption with N₂, and the compositions used for the synthesis of the powders all showed for the samples with MgO lower porosity. Biological testing demonstrated biocompatible behavior towards osteoblast cells, (MG-63 type), inducing a slight acceleration of the mineralization phenomenon in the osteoid of the cells compared to the negative control, with cell viability for all the samples higher than 50%. Preliminary release analyses performed by UV–Visible spectroscopy showed a characteristic controlled release profile with prospects for a potential drug delivery system. The zinc–magnesium co-doped sample exhibits optimal performance in both osteogenic promotion and drug delivery, presenting potential for integrated bone repair and local drug administration. This study concludes that the synthesized bioglass exhibits promising characteristics for potential applications in tissue engineering with local drug delivery. Full article

Mesoporous bioactive glass (MBG) has been extensively studied in bone regeneration due to its excellent bioactivity and osteoconductive properties. Here, we prepared amino-modified MBG (MBG-NH₂) adsorbed osteopontin (OPN) to form MBG-NH₂/OPN composites, enabling the sustained release of OPN and enhancing osteoblast differentiation and mineralization capacity. Interestingly, we observed that MBG-NH₂ promotes the formation of osteoid deposits and calcium deposition in vitro. Furthermore, we also found that MBG-NH₂/OPN significantly enhances cell adhesion, differentiation, and mineralization. Consistent with these observations, we found the expression of the osteoblast-specific marker gene increased, including bone morphogenetic protein 2 (Bmp2) and Collagen I. Intriguingly, we also found that MBG-NH₂/OPN promotes osteoblast differentiation and mineralization through activating the extracellular regulated protein kinases1/2 (Erk1/2) signaling pathway. We concluded that MBG-NH₂/OPN enhances osteoblast differentiation and mineralization through the Erk1/2 pathway. These findings indicate that MBG-NH₂/OPN is a new potential biomaterial for bone regeneration. Full article

Bone regeneration in critical-size defects requires biomaterials that provide both structural support and appropriate osteoinductive cues. Natural nacre contains an organic matrix rich in acidic macromolecules with reported osteogenic activity; however, its in vivo regenerative potential remains insufficiently explored. This study evaluated the bone regenerative capacity of nacre-derived materials alone and combined with oxidized porous silicon microparticles (pSi-MP), a bioactive material known to release silicic acid and support mineralized tissue formation. Critical-size defects were created in four caudal vertebrae of Wistar rats and filled with nacre, pSi-MP, a nacre–pSi composite, or left empty. After 60 days, bone formation was assessed using micro-computed tomography and non-decalcified histology. Empty defects failed to regenerate, whereas nacre and pSi-MP individually promoted partial mineralized tissue deposition. The nacre–pSi composite produced the most extensive repair, showing near-complete defect bridging, higher bone mineral density, and seamless integration of particles within newly formed bone. No inflammation or adverse reactions were observed, and osteoid deposition occurred directly on material surfaces. These findings demonstrate that nacre-derived materials exert intrinsic osteogenic effects in vivo and that combining nacre with porous silicon yields a synergistic response that significantly enhances bone regeneration. The composite represents a promising candidate for future bone repair strategies. Full article

This study investigates the effect of three-dimensional (3D) bioprinted collagen (Col) scaffolds (2% w/v collagen) loaded with autologous bone marrow stromal cells (BMSCs) and enriched with bone morphogenetic protein-2 (BMP-2) and hydroxyapatite-based particles (HAPPs) on bone regeneration in calvarial defects in rabbits. Three implant formulations, Col-(BMP-2) (at a concentration of 80 ng/mL), Col-HAPP (1% w/v) and a mixture of the two—Col-(BMP-2)-HAPP (40 ng/mL final concentration and 0.5% HAPP), were compared with a control group C-Per containing only periosteum to assess the influence of material structure, biochemical signals and cell component on osteogenesis. Histological analysis and quantitative computed tomography (CT) imaging parameters (HU values and residual defect diameter) showed significant differences between the groups, highlighting the role of combined strategies for optimal bone repair. The control group demonstrated the weakest regeneration, expressed by minimal lamellar bone and the largest residual defect. Col-(BMP-2) stimulated moderate osteoinduction with active osteoblasts but without a fully organised lamellar structure. Col-HAΡΡ provided more advanced regeneration, with histologically observed thick osteoid lamellae, early calcification, and structured lamellar architecture, emphasising the osteoconductive role of HAΡΡs. The strongest regeneration was reported with Col-(BMP-2)-HAΡΡ, where the synergy between BMP-2, HAΡΡs and BMSCs resulted in formed osteons, well-developed cancellous bone and minimal residual defects. The established negative correlation between bone density and residual calvarial defects emphasises the relationship between mineralisation and the degree of defect filling. The new data presented demonstrate that the combination of the abovementioned structural, biochemical and cellular factors in 3D bioprinted scaffolds offers a promising strategy for osteoregeneration of complex bone defects. Full article

Primary spinal osseous tumors are relatively rare, comprising ~5–10% of spinal bone neoplasms, whereas metastases account for the vast majority of spinal lesions. Patients commonly present with insidious back pain, sometimes with a focal mass, and constitutional symptoms are uncommon early in the disease course. As clinical features are often nonspecific and may overlap with degenerative, infectious, and metastatic disease, imaging plays an important role in lesion identification, characterization, and treatment planning. Computed tomography helps to define osseous architecture and matrix characteristics. Magnetic resonance imaging can assess marrow involvement, soft tissue extension, neural compression and intra-canal disease, and tumor vascularity. Together, advanced imaging modalities guide further workup, optimize biopsy planning, inform prognostic assessment and therapeutic decision-making, and anticipate mechanical instability or neural compromise. This narrative pictorial review synthesizes radiographic, CT, and MRI appearances of primary spinal tumors across major histologic lineages (e.g., osteogenic, chondrogenic, notochordal, vascular), illustrated with representative cases. We correlate imaging with clinical presentation to distinguish typical from atypical variants and highlight mimics and pitfalls with implications for diagnostic interpretation and management. Full article

Background: Osteoid osteoma (OO) is a benign osteogenic tumor that causes severe pain despite its small size. Minimally invasive image-guided thermal ablation has replaced surgery as the treatment of choice. While radiofrequency ablation (RFA) is considered the gold standard, microwave ablation (MWA) offers faster and more homogeneous heating, though comparative evidence remains limited. Methods: We retrospectively analyzed 53 patients with OO treated with RFA (n = 27) or MWA (n = 26) between 2014 and 2023. All procedures were CT-guided. Technical success, clinical success, recurrence, complications, and prognostic factors—including the nidus diameter and eccentricity index—were evaluated over a minimum 24-month follow-up period. Results: Technical success was achieved in all cases. Overall clinical success was 94.3% (96.2% MWA vs. 92.6% RFA, p = 1.000). Two recurrences (4%) occurred, unrelated to device type. One major complication (1.9%, third-degree skin burn after MWA) was noted. Median nidus diameter was 7 mm; lesions ≥10 mm were significantly linked to failure (p = 0.009). Logistic regression identified nidus size as the strongest outcome predictor, with the eccentricity index showing a borderline effect. Conclusions: Both RFA and MWA are safe and effective for OO, with comparable outcomes and low recurrence rates. Treatment selection should prioritize lesion-specific factors—particularly nidus size ≥ 10 mm and geometry—rather than device type. Lesion size (≥10 mm) and geometry—not ablation modality—were the principal determinants of treatment success. Individualized modality selection based on these features may optimize outcomes. Full article

Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)—a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone (PTH)-driven bone resorption while bone formation continues, leading to intensive mineral deposition (mainly calcium) into chronically demineralized bone. Clinically, HBS ranges from asymptomatic biochemical disturbances to life-threatening hypocalcemia with tetany, seizures, and/or cardiac arrhythmias. This illustrative review synthesizes current knowledge of HBS pathogenesis and management in the context of SHPT. We detail how the high-turnover bone remodeling state of SHPT (osteitis fibrosa cystica) creates an expansive unmineralized osteoid pool that avidly mineralizes post-PTX. We also explore molecular mechanisms (e.g., RANKL/OPG dysregulation, Wnt/β-catenin activation, osteocyte-driven signals, and calcium-sensing receptor effects) that underpin this process. Key preoperative risk factors for HBS include very elevated PTH and alkaline phosphatase levels, large skeletal calcium deficits, younger patient age, and total PTX. We outline the typical postoperative course of HBS, phased from immediate acute hypocalcemia to a nadir and gradual recovery. Prevention and management strategies are emphasized, centered on vigilant monitoring and aggressive calcium and calcitriol supplementation, with preoperative optimization (e.g., vitamin D loading, calcimimetics) to mitigate severity. By enhancing risk stratification and perioperative care, clinicians can improve outcomes and safely navigate patients through this challenging complication of endocrine surgery. Full article

Background: Phosphaturic mesenchymal tumours secreting fibroblast growth factor 23 (hereinafter referred to as FGF23+ PMT) are rare neoplasms that can cause hypophosphataemic osteomalacia, owing to excessive FGF23 production. Mast cells (MCs) play a key role in tumour biology by modulating proliferative activity of atypical cells, resistance to innate and acquired immunity, angiogenesis, and metastatic behaviour. However, MCs associated with FGF23+ PMT have not previously been investigated. This study, to our knowledge, is the first to characterise features of the tumour microenvironment through spatial phenotyping of the immune and stromal landscape, together with histotopographic mapping of intercellular MC interactions with other subcellular populations in FGF23+ PMT. Methods: Histochemical staining (haematoxylin and eosin, toluidine blue, Giemsa solution, picro-Mallory protocol, silver impregnation), as well as monoplex and multiplex immunohistochemical staining with spatial phenotyping, were performed to detect atypical FGF23-secreting cells, immune cells (CD3, CD4, CD8, CD14, CD20, CD38, CD68, or CD163), stromal components (CD31, α-SMA, or vimentin), and specific MC proteases (tryptase, chymase, or carboxypeptidase A3). Bioinformatics analysis using artificial intelligence technologies was applied for spatial profiling of MC interactions with tumour, immunocompetent, and stromal cells in the tumour microenvironment. Results: Bioinformatic analysis of the entire tumour histological section, comprising over 70,000 cells stained using monoplex and multiplex immunohistochemical protocols, enabled identification of more than half of the cell population. The most abundant were CD14+ (30.7%), CD163+ (23.2%), and CD31+ (17.9%) cells. Tumour-associated MCs accounted for 0.7% of the total pool of immunopositive cells and included both mucosal and connective tissue subpopulations, predominantly of the tryptase + chymase-CPA3-specific protease phenotype. This pattern reflected combined multidirectional morphogenetic processes in the patient’s FGF23+ PMT. More than 50% of MCs were colocalized with neighbouring cells of the tumour microenvironment within 20 μm, most frequently with monocytes (CD14+CD68+), M2 macrophages (CD68+CD163+), and endothelial cells (CD31+). In contrast, colocalization with atypical FGF23-secreting cells was rare, indicating minimal direct effects on tumour cell activity. Interaction with T lymphocytes, including CD8+, was also infrequent, excluding their activation and the development of antitumour effects. Mapping of MC histotopography validated the hypothesis of their inductive role in monocyte differentiation into M2 macrophages and probable polarisation of macrophages from M1 into M2, thereby contributing to slow tumour growth. MCs were further involved in extracellular matrix remodelling and participated in the formation of pro-osteogenic niches within the FGF23+ PMT microenvironment, leading to pathological osteoid development. Conclusions: This study demonstrated active MC participation in the evolution of the FGF23+ PMT microenvironment. The findings may be applied in translational medicine to develop novel algorithms for personalised therapy in patients with FGF23-secreting tumours, offering an alternative when surgical removal of the tumour is not feasible. Full article

Objectives: This case series and focused literature review address the diagnostic challenges and management strategies for patients presenting with atraumatic, isolated swelling, and stiffness of a single finger’s proximal interphalangeal (PIP) joint. The dual emphasis is on synthesizing the lessons learned from our case series and providing a structured framework for clinical reasoning, including imaging, biopsy, and laboratory assessment. Non-traumatic causes of finger swelling may include rheumatological disease, atypical infection, tumor, or metabolic conditions. Routine evaluation includes history, examination, and radiographs. Additional evaluation may include ultrasound, inflammatory screening labs, magnetic resonance imaging (MRI) and computed tomography (CT). Despite these efforts, a diagnosis may still be elusive. The objective of this study is to provide a useful clinical differential diagnosis and provide lessons learned from this unique group of patients. Methods: Starting in February 2017, patients with isolated unilateral PIP swelling were followed. Clinical information was collected, including history, examination, and laboratory and imaging studies. Patients were followed until a specific diagnosis was obtained. In addition to the series of patients, a focused literature review is given to present additional unusual causes of atraumatic isolated PIP swelling that were not found in this series. Results: There were five cases that met the criteria. This includes two cases ultimately diagnosed with psoriatic arthritis, and one case each of osteoid osteoma, gout and palindromic rheumatoid arthritis. Conclusions: The single most effective test that helped to reach the final diagnosis in this series was the CT scan. Full article

Background: Our previous study demonstrated that miR-140-3p induced osteocalcin expression in osteoblastic MC3T3-E1 cells. In this study, we investigated the direct effects of miR-140-3p on bone turnover in senescence-accelerated mice. Methods: In order to evaluate the effects of miR-140-3p, we formulated lipid nanoparticles (LNPs) containing miR-140-3p (100 μg/mL), with or without flotillin-2 (Flo2), a microvesicle marker excreted by osteoblasts. LNP was administered into the right tibia of the P6 strain of senescence-accelerated mice (SAMP6). Four-week-old SAMP6 males were divided into three groups: control, LNP, and LNP + Flo2. LNPs were administered five times, once every three days. No gait abnormalities were observed in any group. Two days after the last administration of LNPs, blood and urine samples were collected to measure bone turnover markers and blood chemistry and to perform urinalysis. Bone histomorphometry was performed on the left femur, contralateral to the administration site. The pancreas was removed for insulin staining of the Langerhans islets. Results: The LNP + Flo2 group showed greater bone volume, trabecular thickness, and osteoid thickness in bone histomorphometry. Carboxylated osteocalcin, a bone formation marker, was also higher in the LNP + Flo2 group, indicating that LNP + Flo2 activated osteoblastic function. Insulin levels in the islets of Langerhans did not differ across the groups, consistent with under-carboxylated osteocalcin levels. Conclusions: LNP + Flo2 effectively improved bone metabolism. Full article

Aberrant Rho-associated kinase function could be associated with increased bone fragility. Since cigarette smoke (CS) exposure promotes the increase in bone fragility due to changes in bone tissue components, this study aimed to investigate how CS exposure could modulate the Rho kinase-associated bone structural changes. Mice were assigned to four groups: control; smoke; control with Rho kinase inhibitor administration; and smoke with a Rho kinase inhibitor. Bone samples were obtained to assess bone histomorphometry analysis, type I collagen composition, and MEPE expression in trabeculae. We observed that CS exposure induced decreased trabecular and osteoid thickness. A concomitant increase in the osteoclastic and erosion surfaces and a decrease in the mineralization surface were observed. Additionally, CS exposure decreased the type I collagen and MEPE expression. Rho kinase inhibitor administration recovered the bone mineralization and the collagen type I deposition. Conclusions: CS exposure increases Rho kinase activity in bone cells, leading to structural changes. The administration of a Rho GTPases inhibitor partially reverses these effects, likely due to the recovery in osteoblast activity. Full article

Osteoid osteoma is a benign tumor of the bone, which tends to occur in diaphysis or metaphysis of the long bones. The lesion is generally intraosseous with vague clinical symptoms, hence given the name great mimicker. When located subperiosteally and juxta-articulary, atypical clinical presentation and radiographs may lead to a delayed or missed diagnosis. Performing surgery with a misdiagnosis carries the risk of incomplete resection of the lesion and recurrence. We report the case of a 15-year-old male with a subperiosteal osteoid osteoma of the talus, who was misdiagnosed with pigmented villonodular synovitis (PVNS) and operated through anterior ankle arthrotomy. A nodular lesion, 1 cm in diameter, with a hard rubber consistency, was removed from the dorsal aspect of the talar neck. The pathologic specimens were consistent with subperiosteal osteoid osteoma. The patient’s symptoms resolved rapidly in the early postoperative period. The patient remained asymptomatic at the 20-month follow-up and the control magnetic resonance imaging revealed no signs of recurrence. Atypical radiographs and clinical presentation of juxta-articular subperiosteal osteoid osteomas cause misdiagnosis, delay in diagnosis, incomplete resection, and recurrence. It is important to keep in mind “juxta-articular subperiosteal osteoid osteoma” in the differential diagnosis of cases with suspected pigmented villonodular synovitis. Full article