Search Results (2,283)

Background/Objectives: Traditional Mongolian Rhythmical Vibration Therapy (RVT) is a manual intervention utilizing low-frequency mechanical oscillations, yet its biomechanical effects lack objective quantification. The present study aimed to evaluate the impact of manual RVT on paraspinal muscle stiffness and its long-term sustainability on the quality of life (QoL) in patients with chronic low back pain (LBP). Methods: To evaluate treatment mechanisms and long-term sustainability, this investigation utilized an acute comparative framework (n = 60) alongside a three-year longitudinal observational study design (n = 60) using consecutive convenience sampling. To assess biomechanical efficacy, paraspinal stiffness was measured via mytonometry, contrasting manual RVT against mechanical percussive vibration. Additionally, the long-term sustainability of outcomes was evaluated where clinical efficacy was quantified using the Roland-Morris Disability Questionnaire (RMQ) and the WHOQoL instrument, supported by a post-treatment metered walking regimen (Terrenkur). Within- and between-group changes were analyzed using paired and independent t-tests. Results: A Manual RVT yielded statistically significant and greater reduction in paraspinal muscle stiffness compared to mechanical vibration (p < 0.05). Immediate clinical outcomes revealed significant reductions in RMQ scores, which dropped from 13.33 ± 2.046 to 3. 40 ± 1.522 (p < 0.001, Cohen’s d = 4.20). At the three-year follow-up, participants maintained significantly high quality of life scores across physical, psychological, and social domains (p < 0.001, effect sizes d > 0.80). Conclusions: Manual RVT is associated with reduced paraspinal muscle stiffness in chronic LBP patients. The integration of this manual therapy with a Terrenkur maintenance regimen appears to support the maintenance of functional and quality of life improvements over a three-year period. However, given the observational design of the study, these outcomes must be interpreted cautiously, and randomized controlled trials are required to establish absolute therapeutic efficacy. Full article

Muscle cramps are among the most common acute complications of hemodialysis (HD), often occurring even in the absence of electrolyte disturbances. Most cramps are painful and may cause patients to fear future dialysis sessions. We hypothesized that susceptibility to muscle cramps may be related to impaired skeletal muscle myokine secretion. No significant differences in pre-dialysis myokine levels were observed between patients with and without muscle cramps (myostatin 36.2 vs. 86.9 (p = 0.09), fibronectin type III domain-containing protein 5 (FNDC5) 0.6 vs. 0.6 (p = 0.61), interleukin-6 (IL-6) 2.4 vs. 2.0 (p = 0.4). However, after adjustment for lean tissue mass (LTM) and lean tissue index (LTI), myostatin levels were significantly lower in patients with cramps (0.80 [0.35–1.84] vs. 1.49 [0.45–6.31], respectively, (p = 0.048) for LTM, and 2.26 [1.04–4.06] vs. 3.89 [1.52–19.47], respectively, (p = 0.04) for LTI). In multivariable logistic regression analysis, log2-transformed myostatin concentration was independently and inversely associated with muscle cramps after adjustment for dialysis vintage, body mass index (BMI), and extracellular water. No association was found between muscle cramps and ultrafiltration volume or serum sodium and potassium levels. The study included 67 hemodialysis patients (HD patients), of whom 39 experienced repeated muscle cramps during dialysis. Muscle cramps were defined as painful involuntary muscle contractions lasting more than one minute during or shortly after a dialysis session. Plasma levels of myokines—myostatin, FNDC5, and IL-6—were assessed. Pre-dialysis myostatin, but not FNDC5 or IL-6, was independently associated with the occurrence of intradialytic muscle cramps. Further studies are needed to confirm its clinical utility. Full article

Great toe strength (GTS) is critical for gait, balance, and mobility, yet reliable assessment methods are lacking. This scoping review aims to evaluate and synthesize the direct methods of GTS assessment and their corresponding measurement protocols to guide clinical and research applications. Following the Joanna Briggs Institute methodology, five databases were searched: PubMed, CINAHL, Embase, Web of Science, and IEEE Xplore. All publications on or before 16 December 2024 were included in this review. Studies were included if they quantified isolated great toe strength in human participants using direct measurement tools with non-normalized force outcomes, while exclusion criteria included non-human models, indirect assessments (e.g., electromyography), and multi-digit or dynamic tasks. Following the initial screening of the results, the information from the included articles were extracted into Excel for analyses and synthesis. Two independent reviewers screened titles/abstracts and full texts using Covidence. Conflicts were resolved via consensus or consultation with a third reviewer. We identified 55 studies involving 2821 participants that met our inclusion criteria. Four types of direct GTS assessment methods were identified: dynamometry (56%), manual muscle testing (11%), force transducers (13%), and load cells/strain gauges (18%). Dynamometry was the most common but showed variable reliability due to non-standardized protocols. Healthy individuals exhibited higher GTS (95.01 N) than those with conditions like hallux injury (6.1 N), though plantar fasciitis/plantar heel pain populations showed unexpectedly high GTS (133.27 N). No clear age-related GTS trend emerged, likely due to methodological variability. Less than 11% of studies measured extension strength, highlighting a critical research gap. This review emphasizes the need for standardized protocols to enhance GTS assessment reliability and clinical utility. Full article

Background/Objectives: Low back pain (LBP) is a leading cause of disability worldwide and is influenced by multiple biological and functional factors. While pain intensity is a well-established determinant of disability, the contribution of body composition and relative skeletal muscle mass remains insufficiently understood. This study aimed to investigate the associations between body composition parameters, Muscle-to-Weight Ratio (MWR), pain intensity, and functional disability in patients with LBP and to explore sex-related differences in these variables. Methods: A cross-sectional observational study was conducted in 98 adults with chronic non-specific LBP recruited from a rehabilitation department in Romania. Anthropometric and body composition measurements were obtained using bioelectrical impedance analysis (BIA). Pain intensity was assessed using the Visual Analogue Scale (VAS), and functional disability was evaluated using the Roland–Morris Disability Questionnaire (RMDQ). The MWR was calculated as skeletal muscle mass divided by body weight and expressed as a percentage. Sex comparisons, correlation analyses, and multiple linear regression analyses were performed. Results: The mean age of participants was 61.9 ± 10.0 years, and 53.1% were female. Female participants reported significantly higher pain intensity than males (60.5 ± 31.0 vs. 44.2 ± 35.5; p = 0.021) and demonstrated a different distribution of disability severity categories compared with males (Fisher–Freeman–Halton exact p = 0.021). Pain intensity showed the strongest positive correlation with disability (r = 0.56, p < 0.001), whereas MWR was negatively correlated with disability (r = −0.34, p = 0.001). In multivariable regression analysis, pain intensity (β = 0.49, p < 0.001), age (β = 0.22, p = 0.013), and MWR (β = −0.27, p = 0.018) remained significantly associated with disability after adjustment for sex and body fat percentage. The model explained 43.2% of the variance in RMDQ scores (R² = 0.432). Conclusions: Pain intensity, age, and MWR were significantly associated with functional disability in patients with chronic non-specific LBP. Lower MWR values were associated with greater disability after adjustment for age, sex, body fat percentage, and pain intensity. These findings suggest that assessment of body composition and MWR may provide additional information when evaluating patients with chronic non-specific low back pain. However, the cross-sectional design precludes conclusions regarding causality. Full article

Background/Objectives: Iliopsoas-related groin pain (IRGP) occurs in native hips and following hip surgery. However, diagnosis is challenging due to symptom overlap with other hip pathologies and limited imaging accuracy. Treatment ranges from conservative management to surgery. This systematic review evaluates the diagnostic accuracy of clinical tests and the effectiveness of conservative and surgical treatments for IRGP. Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO. A comprehensive search of PubMed, Embase, and Web of Science was performed from database inception to 13 March 2026. Diagnostic accuracy studies evaluating clinical tests for IRGP against reference standards and therapeutic intervention studies assessing treatment effectiveness in individuals with IRGP were included. Risk of bias was assessed using QUADAS-3 for diagnostic studies and the MINORS tool for treatment studies. Due to heterogeneity in populations, interventions, outcomes, and study design, a narrative synthesis was performed. Results: Three diagnostic accuracy studies and 71 treatment studies were included. All three diagnostic studies used an image-guided injection as reference standard and were at high risk of bias. The hip–external rotation–flexion–ceiling (HEC) test showed the highest diagnostic accuracy (sensitivity 94%, specificity 88%), together with resisted seated hip flexion. However, all three diagnostic studies were at high risk of bias, so these estimates should be regarded as preliminary. Supine provocation tests showed high sensitivity but poor specificity. Conservative management achieved high success rates in idiopathic and athletic populations (77–100%) but lower and more variable effectiveness after total hip arthroplasty (THA) (16–50%). Image-guided injections produced short-term improvement in 50–70% of patients, with limited long-term effectiveness in mechanically driven cases after THA. In native hips, four matched comparative cohort studies indicated that arthroscopic iliopsoas release provided no clear benefit beyond treatment of concomitant intra-articular pathology and was associated with measurable iliopsoas atrophy and loss of hip flexion strength. After THA, both iliopsoas tenotomy and acetabular component revision improved pain and function, with outcomes strongly dependent on implant position and patient selection. Methodological quality of the treatment studies was generally low to moderate (MINORS 5–14/16 for non-comparative and 14–21/24 for comparative studies), while all three diagnostic studies were at high risk of bias on QUADAS-3. Conclusions: Current evidence highlights substantial diagnostic and therapeutic uncertainty in IRGP. Clinical tests lack sufficient standalone accuracy and should at least include the HEC test and resisted seated hip flexion. Treatment outcomes depend strongly on the underlying etiology, and the lack of an accurate diagnostic reference standard further complicates their interpretation. High-quality diagnostic studies and comparative intervention trials are needed to support evidence-based clinical pathways. Registration: PROSPERO CRD42025644593. Full article

Volumetric muscle loss (VML) constitutes a significant clinical challenge, defined by the irreversible loss of skeletal muscle tissue and resulting in persistent functional deficits due to fibrosis, chronic inflammation, and insufficient endogenous regeneration. Existing clinical interventions, such as autologous grafting and free functional muscle transfer, are constrained by donor-site morbidity including infection, pain, suboptimal vascularization, and limited functional integration. Although tissue engineering has advanced considerably, no FDA-approved regenerative therapies currently exist for VML, underscoring a substantial translational gap. This review provides a systems-level synthesis of skeletal muscle repair through integrating fundamental biological processes, such as inflammation, satellite-cell activation, myogenesis, angiogenesis, and neuromuscular junction formation, with recent advances in biomaterials, scaffold engineering, and biofabrication technologies. The analysis addresses how critical scaffold design parameters, including alignment, porosity, stiffness, degradation kinetics, and bioactivity, influence cellular responses and tissue integration. Additionally, emerging strategies such as 3D bioprinting, nanofiber-based architectures, stem cell and exosome therapies, and bio-functional stimulation are evaluated inside a unified mechanobiological framework. This analysis is further extended to the regulatory setting, with emphasis on how scaffold composition, mechanism of action, and degree of biological integration affect classification pathways governed by the U.S. Food and Drug Administration. Most advanced VML therapies are anticipated to be regulated as combination products, which will require rigorous preclinical validation, standardized manufacturing processes, and carefully designed clinical studies. By integrating biological principles, engineering design, and regulatory considerations, this review highlights key opportunities, remaining challenges, and future priorities for the clinical translation of next-generation regenerative strategies for VML. Full article

Introduction: Stiff-Person Syndrome (SPS) is a rare autoimmune neurological disorder characterized by progressive muscle rigidity and painful spasms, primarily affecting axial and proximal musculature. Its diagnosis can be challenging due to clinical overlap with other neurological conditions such as spasticity, dystonia, or functional movement disorders. The detection of antibodies against glutamic acid decarboxylase (anti-GAD) is a key biomarker that supports diagnosis. Methods: Two clinical cases of patients with manifestations consistent with classic SPS are described, and were evaluated in a specialized neurology service. Both patients underwent detailed clinical assessment, complementary studies, and serum testing for anti-GAD antibodies. Results: Both patients presented with progressive rigidity and fluctuating muscle spasms, predominantly involving axial musculature. After an extensive diagnostic workup, elevated anti-GAD antibody titers were documented in both cases, confirming the diagnosis of classic SPS. Treatment with medications enhancing GABAergic neurotransmission was associated with significant clinical improvement, evidenced by reduced rigidity and the decreased frequency of spasms. Conclusions: These cases highlight the importance of considering SPS in the differential diagnosis of progressive rigidity syndromes. Identification of anti-GAD antibodies is essential for diagnostic confirmation, and treatment that aims to enhance GABAergic neurotransmission can significantly improve symptoms and patient functionality. Full article

Background: Spasticity resulting from a stroke usually develops within a few weeks or months of the incident and occurs in approximately 43 percent of patients. Recently, noninvasive radial shockwave therapy has been gaining increasing attention as a treatment for spastic muscles, leading to a decline in muscle tone. This study aims to evaluate the effectiveness of rESWT in reducing muscle tone and improving hand function in stroke patients with upper-limb spasticity. Methods: We conducted a study involving 62 stroke patients with upper-limb spasticity (MAS ≥ 2). The ESWT group received four sessions of radial shockwave therapy applied to the wrist flexor muscles (flexor carpi radialis, flexor carpi ulnaris, palmaris longus, pronator teres, pronator quadratus, and flexor digitorum superficialis) at 6-day intervals (3500 pulses, 8 Hz, 2.5 bar), combined with standard rehabilitation during hospitalization. The non-ESWT group followed a standard rehabilitation program. Assessments were performed using the following scales: FMA-UE, ADL, MAS, radiocarpal joint extension range of motion, and VAS. Measurements were obtained at three time points: before the intervention, one week after the first intervention, and one week after the fourth intervention. Results: The ESWT group showed improvements in upper-limb motor function (FMA-UE, p < 0.0001) and functional independence (ADL, p < 0.0001). They also experienced an increase in radiocarpal joint range of motion (ROM, p > 0.0001) and a reduction in spasticity (MAS, p < 0.0001). Conclusions: The intervention involving four ESWT sessions combined with conventional rehabilitation results in improved hand motor function, reduced spasticity, increased extension of the radiocarpal joint, and increased functional independence. Improvements in upper-limb function and reductions in spasticity may occur independently of changes in pain perception. Full article

Background/Objectives: Although the etiology and pathomechanism of temporomandibular joint osteoarthritis (TMJ OA) and rheumatoid arthritis (RA) are different, they can both lead to serious structural and functional changes in the masticatory system. This study aimed to assess and compare the prevalence and characteristics of functional changes in the masticatory system in RA and OA TMJ patients. Materials and Methods: This cross-sectional study included 40 RA patients meeting the 2010 ACR/EULAR criteria and 40 TMJ OA patients. Research diagnostic criteria for TMD (RDC/TMD) were used to assess functional changes. Results: Orofacial pain was a predominant TMD reported in 80% of RA patients and in 67.5% of OA TMJ patients. There was no difference in the orofacial pain intensity and degree of somatization between RA and OA TMJ patients (p = 0.114). Orofacial pain duration was statistically longer in OA TMJ patients than in RA patients (p = 0.003). The ranges of mandibular movement were limited but without any statistically significant differences between the groups compared for maximum active opening (p = 0.349) and maximum passive opening (p = 0.461). Patients with RA presented with more muscles affected with pain. The most painful muscles were the medial pterygoid muscles and the anterior belly of the digastric muscle for the right side (p = 0.006) and for the left side (p = 0.004), and the tendon of the temporal muscle (p = 0.011) and (p = 0.004). The pain intensity of these muscles was statistically higher in RA patients in comparison to OA TMJ patients. Predominant TMJ sounds were slight crepitations in both RA and OA TMJ patients, mainly during laterotrusion in OA (p = 0.000). Conclusions: Laterotrusion was the key movement differentiating TMD manifestations between the two groups. Early functional diagnosis of the temporomandibular joint and an interdisciplinary therapeutic approach, combining treatment of the underlying disease with therapy of the masticatory system disorders, are crucial to limit the progression of changes and improve masticatory function. Full article

Background: Congenital thoracic kyphoscoliosis caused by vertebral malformations is a challenging condition that may progress during skeletal growth, leading to spinal imbalance, pain, cosmetic deformity, and neurological compromise. Conventional correction often requires extensive anterior, posterior, or combined approaches associated with substantial surgical morbidity. We describe a single-position surgical technique combining a lateral retropleural asymmetric vertebral resection with percutaneous posterior instrumentation performed entirely in the lateral decubitus position. Methods: A 15-year-old boy with progressive congenital thoracic kyphoscoliosis secondary to a T10 butterfly vertebra underwent surgical correction after failure of conservative treatment. The procedure was performed entirely in the left lateral decubitus position under multimodal intraoperative neurophysiological monitoring. Bilateral percutaneous pedicle screws were inserted from T7 to L1 under fluoroscopic guidance without repositioning the patient. A muscle-sparing lateral retropleural approach was then used to perform T10 asymmetric vertebral column resection, anterior column reconstruction with an expandable cage, and definitive deformity correction using posterior rod compression. The technical rationale, operative workflow, and reconstruction strategy are described. Results: The procedure was completed without intraoperative neurological deterioration or the need for patient repositioning. Postoperative imaging demonstrated satisfactory restoration of coronal and sagittal alignment, appropriate implant positioning, and spinal canal decompression. The patient experienced marked improvement in pain, shoulder balance, rib hump deformity, and overall posture while maintaining normal neurological function. The main thoracic curve improved from 32° to 6°, thoracic kyphosis from 78° to 63°, VAS from 5 to 0, ODI from 42 to 5, and SRS-22R from 3.85 to 4.85. Solid fusion was confirmed at 3 years. A postoperative pneumothorax, attributed to pleural violation during exposure, represented the only complication and resolved completely following pleural drainage. At 36-month follow-up, radiographs and computed tomography confirmed maintenance of deformity correction, stable instrumentation, and solid anterior and posterior fusion without implant failure or loss of correction. Conclusions: Single-position lateral retropleural asymmetric vertebral resection combined with percutaneous pedicle screw fixation is a technically feasible option for selected patients with congenital thoracic kyphoscoliosis. Avoiding intraoperative repositioning while combining anterior reconstruction and posterior stabilization through a reduced-access retropleural approach may simplify the surgical workflow and minimize soft-tissue disruption without compromising deformity correction. Further clinical experience is required to establish its reproducibility and comparative advantages. Full article

Background/Objectives: Pressure pain thresholds (PPTs) are widely used to quantify hyperalgesia in tension-type headache (TTH). However, previous diagnostic accuracy research has mainly focused on muscular or segmental sites, while the discriminative performance of PPTs measured over peripheral nerves remains largely unexplored. This study primarily aimed to compare PPTs measured across nerve-related and muscular anatomical sites between women with frequent episodic TTH and headache-free controls. As a secondary exploratory objective, site-specific ROC analyses were performed to examine within-sample discrimination and derive sample-specific exploratory cut-offs. Methods: A cross-sectional exploratory study with a case–control sampling design evaluated 31 women with frequent episodic TTH (mean age: 19.6 ± 4.3 years) and 32 headache-free women (mean age: 22.1 ± 4.9 years). The groups differed significantly in age (p = 0.039). PPTs were recorded over peripheral nerves (greater occipital, median, ulnar, radial, tibial, common fibular), muscles (temporalis, tibialis anterior), 2nd–3rd interdigital hand space and the C5/C6 zygapophyseal joints. Results: Women with TTH showed lower PPTs than controls across all evaluated locations. However, after adjustment for age and Holm correction across the 20 anatomical sites, only the right greater occipital nerve remained statistically significant (p = 0.043). The right greater occipital nerve also yielded the highest area under the curve (AUC = 0.706; 95% CI 0.576–0.836) and was the only location whose AUC remained significantly different from 0.50 after correction for multiple testing (p = 0.040). Its sample-derived exploratory cut-off of 1.75 kg/cm² showed low sensitivity (0.419; 95% CI 0.245–0.609) but high specificity (0.969; 95% CI 0.838–0.999). Although the corresponding LR+ was 13.419, its confidence interval was extremely wide (95% CI 1.866–96.525), indicating substantial imprecision. The LR− was 0.599 (95% CI 0.442–0.814). Overall, the operating characteristics varied considerably across locations and should be interpreted as exploratory. Conclusions: Women with frequent episodic TTH showed generally lower PPTs across nerve and muscle locations. However, after adjustment for age and multiple testing, the between-group difference was statistically supported only at the right greater occipital nerve. Although this location showed the highest AUC and high specificity at the sample-derived cut-off, its low sensitivity and the considerable imprecision of the LR+ estimate limit its interpretation. These findings reflect discrimination between selected participants with established TTH and headache-free controls, and should not be interpreted as evidence of clinical differential-diagnostic accuracy. Full article

Background/Objectives: This study aimed to assess nerve conduction studies (NCS) parameters of the median nerve and abductor pollicis brevis (APB) muscle activity in patients with cervical spondylosis. Additionally, we evaluated longitudinal changes in these parameters at six months following a multimodal rehabilitation treatment. Methods: This quasiexperimental, nonrandomized study included 41 patients with cervical spondylosis and 25 healthy controls. Median nerve conduction studies and semiquantitative surface electromyography (sEMG) of the APB muscle were assessed using a two-channel Neuro-MEP-Micro system (version 2009, Neurosoft Ltd.). The evaluations were performed at baseline in both groups and repeated after six months in the patient group. Pain intensity was assessed using the Visual Analog Scale (VAS). Results: Compared with controls, patients showed reduced compound muscle action potential (CMAP) amplitude (Cohen’s d = 1.53–1.83), slower motor conduction velocity (r = 0.91–0.95), and impaired sEMG amplitude and recruitment pattern of the APB muscle (all adjusted p < 0.001). After application of multimodal rehabilitation treatment, VAS scores decreased significantly (adjusted p < 0.001), and favorable changes in NCS and sEMG parameters were observed, with moderate to large effect sizes (Cohen’s d = 0.56–0.82; r = 0.52–0.86; all adjusted p ≤ 0.006). CMAP amplitude correlated positively with sEMG amplitude and recruitment pattern (ρ = 0.483–0.632, all adjusted p ≤ 0.001). Conclusions: Multimodal rehabilitation treatment may be associated with clinical and electrophysiological improvements, suggesting the complementary value of NCS and sEMG for the evaluation and follow-up of patients with cervical spondylosis. However, because of the nonrandomized uncontrolled design and the absence of longitudinal follow-up in controls, causal treatment effects cannot be inferred. Full article

Aim: The relationship between lumbar intervertebral disc degeneration and paraspinal muscle degeneration remains controversial. Although previous studies have reported associations between disc degeneration and muscle atrophy and fatty infiltration, the effect of age on this relationship has not been sufficiently clarified. This study aimed to investigate the associations that cumulative and L4–L5 level-specific disc degeneration have with paraspinal muscle morphology, and to determine whether these associations persisted after adjustment for age. Materials and Methods: This retrospective cross-sectional study included 84 patients who underwent lumbar magnetic resonance imaging (MRI) for low back pain. Disc degeneration was evaluated at all lumbar levels according to the Pfirrmann classification, and the Total Pfirrmann Score was calculated. Relative functional cross-sectional area (rFCSA) and fatty infiltration (FI) measurements of the multifidus, erector spinae, and psoas muscles at the L4–L5 level were performed using ImageJ software. The relationships between variables were examined using Spearman correlation analysis. Multiple linear regression analysis was performed to investigate independent predictors. Age-controlled partial correlation analyses were also performed to evaluate the potential confounding effect of age. Results: Of the 84 patients included in the study, 48 (57.1%) were female and 36 (42.9%) were male, with a mean age of 42.3 ± 8.4 years. The mean Total Pfirrmann Score was 14.3 ± 3.8. A moderate positive correlation was found between age and the Total Pfirrmann Score (rho = 0.519; p < 0.001). Significant positive correlations were observed between the Total Pfirrmann Score and multifidus fatty infiltration (rho = 0.316; p = 0.003) and erector spinae fatty infiltration (rho = 0.300; p = 0.006). A weak negative correlation was detected between psoas rFCSA and the Total Pfirrmann Score (rho = −0.247; p = 0.023). Multifidus and erector spinae rFCSA were not significantly associated with the Total Pfirrmann Score (p = 0.094 and p = 0.095, respectively). At the L4–L5 level, higher Pfirrmann grade was associated with lower multifidus rFCSA (rho = −0.233; p = 0.033) and lower psoas rFCSA (rho = −0.319; p = 0.003), whereas the inverse association with erector spinae rFCSA was borderline (rho = −0.215; p = 0.050). Multiple linear regression analysis showed that age was the only statistically significant predictor of the Total Pfirrmann Score in the multivariable model (p < 0.001). After adjustment for age, the associations of multifidus FI (r = 0.193; p = 0.079) and erector spinae FI (r = 0.194; p = 0.078) with the Total Pfirrmann Score did not reach statistical significance. In the age-adjusted L4–L5 analysis, only the inverse association between Pfirrmann grade and psoas rFCSA remained statistically significant (r = −0.232; p = 0.034). Conclusions: Greater cumulative lumbar disc degeneration was associated with increased fatty infiltration of the multifidus and erector spinae muscles and lower psoas rFCSA, whereas multifidus and erector spinae rFCSA were not associated with the Total Pfirrmann Score. At L4–L5, greater disc degeneration was associated with lower multifidus and psoas rFCSA, while the association with erector spinae rFCSA was borderline. After adjustment for age, the associations of multifidus and erector spinae fatty infiltration with cumulative disc degeneration were attenuated and did not reach statistical significance; however, a weak independent association cannot be excluded. Full article

An 8-year-old intact male German Shorthaired Pointer presented as a referral for a one-week history of unilateral ocular discharge of the left eye and progressive temporalis muscle atrophy. Severe temporalis muscle wasting was appreciated, with periorbital asymmetry. Computed tomography showed aggressive and extensive multifocal bone lysis, primarily on the left rostral aspect of the skull, affecting the cribriform plate, frontal bone, ethmoid bone, zygomatic bone, and maxilla, with marked left temporal muscle atrophy and near-complete collapse and destruction of the left frontal sinus. Bone biopsy revealed osteoblastic osteosarcoma of the skull. Aside from the physical examination abnormalities, the patient did not exhibit pain, lethargy or anorexia at home or while in hospital. This case is notable for the unusual presentation, clinical manifestation and location of osteoblastic osteosarcoma in dogs. The survival time of 132 days was calculated starting from the date of confirmed histopathologic diagnosis, or 159 days from the date of the computed tomography scan. Full article

Introduction: Uterine leiomyosarcoma (uLMS) is a rare, highly aggressive malignancy arising from the smooth muscle tissue of the uterine wall. It typically presents with abnormal vaginal bleeding, pelvic pain, or a pelvic mass. In rare instances, symptoms may result from local invasion or metastasis. We report a case of uLMS initially diagnosed following colonic perforation due to direct tumor invasion, accompanied by a comprehensive narrative review of the literature on the incidental identification of uterine sarcomas during emergency general surgery to further emphasize the diagnostic challenges, treatment approaches, and need for individualized care in these complex cases. Case Presentation: A 45-year-old woman presented to the Emergency Department with acute abdominal pain of several hours’ duration, in the absence of other associated symptoms. An emergency exploratory laparotomy was performed, revealing feculent peritonitis secondary to sigmoid colon rupture, resulting from local invasion by a large uterine mass. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was undertaken, followed by en bloc resection of the sigmoid colon, appendectomy and construction of a terminal colostomy. Her postoperative course was uneventful, and she was discharged on postoperative day eight. Histopathological examination of the specimen revealed a high-grade uterine leiomyosarcoma. Following evaluation by a multidisciplinary oncology board, the patient received adjuvant chemotherapy. Methods and Results: A narrative review of the literature was performed to identify cases of uterine sarcomas incidentally diagnosed during emergency surgery performed by general surgeons. Including the present case, six cases were identified. Most patients presented with acute abdomen mimicking gastrointestinal pathology, with diagnosis established intraoperatively or postoperatively. Definitive surgical management was achieved during the initial emergency procedure in all cases. Conclusion: Although exceptionally rare, uterine sarcoma should be considered in the differential diagnosis of acute abdomen in female patients undergoing emergency surgery. Awareness of this atypical presentation, the appropriate diagnostic approach, real-time intraoperative adaptability, and individualized multidisciplinary management are essential for ensuring appropriate surgical management and optimizing patient care. Full article