Search Results (444)

Background: Oxygen–ozone (O₂–O₃) therapy is a minimally invasive treatment for discogenic lumbar pain. Although rare, spinal infections—specifically spondylodiscitis—have been reported following intradiscal injections. To date, Lactobacillus iners has not been described as a causative agent in this context. Case Presentation: A 55-year-old immunocompetent woman presented with progressive lumbosciatica and elevated inflammatory markers three months after intradiscal O₂–O₃ therapy. MRI revealed L4–L5 spondylodiscitis with paravertebral involvement. Surgical biopsy confirmed L. iners as the pathogen. She underwent decompression and received targeted intravenous antibiotics, achieving full clinical and radiological recovery. Methods: A systematic literature review was performed using PubMed, MEDLINE, and Scopus to identify reports of spondylodiscitis following oxygen–ozone therapy. Six cases were included based on predefined inclusion criteria. Results: The 8 identified cases involved a range of pathogens, including Staphylococcus aureus, Streptococcus beta-haemolyticus, Escherichia coli, Achromobacter xylosoxidans, Mycobacterium abscessus, and Streptococcus intermedius, and one culture-negative infection. Clinical presentations varied from radiculopathy to sepsis. Management strategies encompassed both conservative (antibiotics alone) and surgical approaches, depending on neurological status and abscess formation. Outcomes were favorable in all cases except one fatality. Conclusions: This report is the first to describe L. iners spondylodiscitis in an immunocompetent patient following O₂–O₃ therapy. Clinicians should vigilantly evaluate post-infiltration spinal infections, maintain a low threshold for imaging and biopsy, and implement pathogen-targeted antibiotic regimens, with surgical intervention as needed. Full article

Duropathies represent a spectrum of disorders associated with spinal dural tears and cerebrospinal fluid (CSF) leaks. Diagnosis and treatment is often complicated by overlapping clinical manifestations. This review aims to synthesize current literature on duropathies, focusing on their clinical, neuroradiological, and pathophysiological features. A comprehensive literature review was conducted, analyzing various conditions classified as duropathies, including spontaneous intracranial hypotension (SIH), superficial siderosis (SS), spinal cord herniation, and, as added issue, arachnoid webs. The review emphasized the importance of imaging techniques such as MRI and CT myelography in diagnosing these conditions. Duropathies can arise from congenital anomalies, trauma, and degenerative changes, with SIH being characterized by orthostatic headaches and neurological deficits. Imaging typically reveals specific patterns, such as a widened dorsal subarachnoid space and ventral displacement of the spinal cord. Syringomyelia was frequently associated with arachnoid webs, and complications like SS and bibrachial amyotrophy were noted in patients with persistent ventral spinal CSF leaks. The unifying concept of duropathies is proposed, emphasizing the need for timely intervention to mitigate long-term neurological consequences. Enhanced diagnostic strategies are crucial for improving patient outcomes, and a multidisciplinary approach is recommended for the management of these complex disorders. Further research is warranted to clarify the pathophysiological mechanisms underlying duropathies and to establish standardized treatment protocols. Full article

Background: Although magnetic resonance imaging (MRI) provides excellent soft-tissue contrast for most spinal evaluations, computed tomography (CT) is still always required for preoperative planning to assess osseous anatomy and determine surgical device size, increasing the radiation exposure and workflow complexity. CT-like images enable visualization of precise bone morphology without ionizing radiation. In addition, these images often provide CT myelography-like contrasts, allowing the simultaneous depiction of the spinal canal area (SCA). This study aimed to evaluate whether CT-like images provide measurement accuracy equivalent to conventional CT and MRI for pedicle screw planning and spinal canal area assessment. Methods: We retrospectively analyzed paired lumbar CT and MRI datasets obtained within ≤1 month in 51 patients. Pedicle width and length were measured on CT and CT-like images, whereas SCA was measured on T2 weighed-images and CT-like images. A total of 224 vertebrae were analyzed. Annotated images were independently evaluated by two readers in a randomized order. Inter-modality agreement was assessed using intraclass correlation coefficients (ICCs) and a Bland–Altman analysis. Results: CT-like images demonstrated an excellent agreement with CT for pedicle measurements (ICCs: 0.968–0.985 for width; 0.922–0.966 for length). Mean differences were ≤0.1 mm for pedicle width and approximately 1 mm for pedicle length, which are unlikely to affect screw selection. The agreement with T2WI for SCA was good to excellent (ICCs: 0.766–0.945). Conclusions: CT-like images provide comparable performance for quantitative pedicle assessment and show high agreement for SCA evaluation, supporting comprehensive preoperative assessment with a single MRI examination. Full article

Multiple Sclerosis (MS) and Myelitis are serious inflammatory spinal cord disorders with overlapping clinical symptoms and radiological characteristics, making accurate differentiation challenging yet clinically essential. Early and precise diagnosis is critical for guiding treatment strategies and improving patient outcomes. In this study, we propose KhayyamNet, a novel hybrid deep learning architecture designed to fuse complementary local and global representations for the accurate diagnosis of MS and Myelitis using spinal MRI. To improve robustness and generalization capability, a comprehensive preprocessing strategy including data augmentation and intensity normalization is also applied to reduce noise and address data variability. The proposed architecture combines three complementary deep learning models for feature extraction composed of Xception for high-level semantic features, Convolutional Neural Networks (CNNs) for fine-grained local patterns, and Vision Transformers (ViTs) for global contextual representations via attention mechanisms. Extracted features are then fused and refined using the Minimum Redundancy Maximum Relevance (MRMR) algorithm to eliminate redundancy and retain the most informative signals. Finally, a Random Forest (RF) classifier utilizes the optimized feature set to achieve accurate and robust differentiation between MS, Myelitis, and control spinal MRIs. Experimental results demonstrate that KhayyamNet outperforms existing methods by achieving an average classification accuracy of $98.15\pm 0.80\%$. This framework demonstrates promising performance for the automated analysis of spinal MRIs and shows potential to assist in the differentiation of MS and Myelitis. While these findings highlight the potential of KhayyamNet for automated MRI interpretation, its evaluation is limited to a single-center dataset, and further validation on external multi-center data is required. Full article

Recombinant human bone morphogenic protein-2 (rhBMP-2) use in spinal fusion is limited by dose-dependent complications. Peptide amphiphile (PA) supramolecular polymers presenting a BMP-2–binding epitope have previously been developed to reduce the rhBMP-2 dose required for successful fusion. We evaluated PA implant biodegradation and tissue clearance in a rat posterolateral spinal fusion model as a prerequisite to clinical safety studies. Twenty-three female Sprague–Dawley rats underwent L4–L5 fusion with gadolinium (Gd)-labeled PA implants. Longitudinal magnetic resonance imaging (MRI) was performed up to 13 weeks postoperatively, while the spine and filter organs were harvested for inductively coupled plasma mass spectrometry (ICP-MS) quantification of Gd at multiple time points. Gd concentration at the fusion site decreased from 71% of maximum to 19.5% at 13 weeks, and MRI showed a complete loss of Gd signal enhancement by 8 weeks. In peripheral organs, peak Gd accumulation was 3% in the liver at 4 weeks, declining to 1.4% at 13 weeks, while Gd remained below 0.05% in the spleen, lung, and blood at all time points. These data indicate PA implant localization, with robust degradation and clearance and minimal off-target accumulation, supporting its translational potential for spinal fusion applications. Full article

Background/Objectives: Magnetic Resonance Imaging (MRI) is frequently used to evaluate back pain and other spinal indications in the pediatric population. However, the diagnostic value in the pediatric population remains unclear. This study aimed to determine the prevalence of spinal abnormalities detected by MRI in children and adolescents and to identify factors associated with MRI findings of added diagnostic value. Methods: A retrospective two-centre cohort study was conducted among 229 patients aged 0–16 years who underwent spinal MRI at two hospitals. MRI findings were classified into five categories: (1) no finding; (2) spinal incidental finding; (3) confirmed diagnosis with no additional information; (4) confirmed diagnosis/severity with additional information; and (5) new diagnosis. In categories 4 and 5, there was an added value of the MRI scan. Patients with and without added MRI findings were compared regarding age, gender, presence of night pain, exercise-dependent pain, sharp pain localization, trauma, neurological abnormalities, and symptom duration. Results: The prevalence of MRI abnormalities related to the patient’s complaints was 19.2%. When the ‘added value of MRI’ group is compared to the ‘no added value of MRI group’, neurological abnormalities (p = 0.009) and shorter symptom duration (p = 0.002) were statistically associated with abnormal MRI findings. Stratified analysis showed that MRIs provided added diagnostic value more frequently in patients with clinical indications other than chronic back pain. Most abnormalities were located in the lumbar spine, with spondylolysis/spondylolisthesis and discopathy as the most common findings. Conclusions: Although spinal MRIs frequently detected abnormalities, only a small proportion of MRIs revealed findings that provided added diagnostic or therapeutic value. This highlights the importance of developing clear criteria for spinal MRI use in children and adolescents to minimize unnecessary imaging, limit patient burden, and optimize healthcare resources. Full article

Background: Macrophages play a key role in clearing Borrelia burgdorferi infection and express somatostatin receptor subtype 2 (SSTR2), a potential imaging target. This study investigates immune activation in neuroborreliosis (NB) and assesses the diagnostic value of ⁶⁴Cu-DOTATATE positron emission tomography/computed tomography (PET/CT) alongside magnetic resonance imaging (MRI). Methods: Prospective cohort study (2024–2025) enrolling patients with suspected NB from four Danish hospitals. NB was defined by the following ≥2 criteria: neurological symptoms, cerebrospinal fluid (CSF) pleocytosis, and intrathecal B. burgdorferi-specific antibodies; patients not meeting these criteria served as controls. Results: The study included 20 participants: 15 NB patients (75%) and 5 controls (25%). PET/CT was performed after a median of 9.5 days of antibiotic treatment. Symmetric ⁶⁴Cu-DOTATATE uptake in dorsal root and paravertebral ganglia was observed in 10 of 15 patients, with cervical involvement in 8 and lumbosacral in 9. All of them had symptoms that corresponded to the anatomical distribution of the uptake. No controls had lumbosacral involvement (p = 0.04). One control with erythema migrans and systemic symptoms showed cervical ganglia uptake. MRI showed cranial or spinal nerve enhancement in five patients. Only one patient had focal PET uptake matching MRI findings and clinical facial palsy. Conclusions: Symmetric ⁶⁴Cu-DOTATATE ganglionic uptake in NB patients may reflect immune activation or altered ganglionic physiology. One patient had focal ⁶⁴Cu-DOTATATE uptake corresponding with palsy and MRI and ⁶⁴Cu-DOTATATE PET/CT did not contribute additional diagnostic value beyond standard clinical evaluation. Full article

Background and Clinical Significance: We report a rare case of a 66-year-old male with malignant non-germinal center-type large B-cell lymphoma involving the thoracic epidural, cauda equina, and filum terminal simultaneously. Case Presentation: The patient complained of back pain, rapid progressive numbness, and motor palsy in both legs in one month. Neurological examination revealed grade 2 muscle power in both lower limbs, hypesthesia below the T8 dermatome, and bladder and bowel dysfunctions. Magnetic resonance imaging (MRI) with contrast showed a well-defined extradural lesion extending from the T7 to T9 level, with severe spinal cord compression. Additionally, it revealed enlargement of the cauda equina occupying the extradural space from the L1-S1 level. The lesion appeared isointense on T1, mildly hyperintense on T2-weighted images, and exhibited homogeneous enhancement on post-contrast images. To relieve the patient’s spinal cord compression as soon as possible and allow the patient to recover quickly after surgery, we performed unilateral biportal endoscopy (UBE) to completely remove the T7-9 epidural lesion. The immunohistochemical assessment confirmed a histological diagnosis of diffuse large B-cell lymphoma, a non-germinal center type. The patient received radiotherapy to the thoracic and lumbosacral areas (50 Gy) and chemotherapy with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) after surgery. Follow-up positron emission tomography (PET) scan and MRI performed 4 months after surgery revealed complete remission of the lesion. The patient was able to walk using a walker after therapy. Conclusions: UBE is a favorable option for selected patients requiring immediate chemotherapy or radiotherapy owing to its reduced tissue trauma compared to traditional open surgery. Full article

Background/Objectives: Degenerative cervical myelopathy (DCM) may result from posture-dependent spinal cord compromise not detectable on neutral imaging. Dynamic MRI can uncover clinically relevant mechanisms underlying otherwise unexplained myelopathy and guide management. This report illustrates a dynamic cervical myelopathy phenotype revealed by flexion–extension imaging and its impact on surgical decision-making. Methods: A 49-year-old man presented with progressive bilateral upper-limb paresthesias, intrinsic hand atrophy, and distal weakness. Neutral cervical MRI, standard radiographs, and flexion–extension MRI were performed to investigate a suspected dynamic etiology, including differentiation from Hirayama disease. Surgical treatment consisted of anterior cervical discectomy and fusion (ACDF), with clinical and radiological follow-up. Results: Neutral MRI showed intramedullary T2 hyperintensity from C4 to C6 without static canal stenosis or frank compression, while radiographs demonstrated segmental kyphosis without instability. Flexion MRI revealed reproducible spinal cord contact with a small cranially located osteophyte at C5–C6, concordant with the myelopathic signal. ACDF at C4–C6 led to clinical improvement. One year later, recurrent symptoms from adjacent-segment pathology (C3–C4 myelopathic signal and C6–C7 foraminal disc herniation) required a second ACDF, resulting in durable neurological stability. Conclusions: This case demonstrates flexion-dependent cord–osteophyte conflict causing cervical myelomalacia in the absence of static stenosis. Dynamic MRI resolved a clinical–radiological mismatch and directly informed surgical planning. Recognition of dynamic myelopathy phenotypes and vigilance for adjacent-segment disease after fusion are essential for optimizing outcomes. Full article

A 78-year-old woman with a history of rheumatoid arthritis (treated with methotrexate) developed disturbed consciousness, emesis, and intestinal perforation. Initial labs revealed hyperammonemia (189 μg/dL) and hypertonic dehydration. Despite ammonia normalization, her neurological status improved only slightly, necessitating additional tests. Cerebrospinal fluid analysis showed no pleocytosis but positive oligoclonal bands and markedly elevated myelin basic protein (>500 pg/mL). Serum autoimmune markers were negative, including anti-aquaporin-4 (AQP4), anti-myelin oligodendrocyte glycoprotein (MOG), and anti-glial fibrillary acidic protein (GFAP) antibodies. MRI revealed T2/DWI-hyperintense lesions in the left parietal lobe and cerebellum. Crucially, extensive T2/DWI-hyperintense lesions with diffusion restriction spanned the white matter from the medulla oblongata to the lumbar spinal cord. Axial spinal DWI demonstrated diffuse hyperintensity throughout the entire white matter, accompanied by gray matter atrophy. Subsequent metabolic screening revealed low folate and hypocupremia (34 μg/dL) as well as urinary orotic acid and low serum citrulline, suggesting late-onset ornithine transcarbamylase (OTC) deficiency. Given the clinical context, this was interpreted as a metabolic breakdown rather than an established genetic diagnosis. This case is characterized by a long, diffusion-restricted lesion from the brainstem to the spinal cord that does not correspond to vascular territories. She experienced sudden death. We hypothesize that an underlying metabolic disorder, nutritional deficiencies and drug-induced neurotoxicity contributed to lesion formation. Full article

Background: Osteoporosis (OP) is characterized by reduced bone mineral density and increased fracture risk. Many spinal surgery patients have undiagnosed OP due to the lack of preoperative screening, leading to postoperative complications. Magnetic resonance imaging (MRI), a routine, non-invasive tool for spinal assessment, offers potential for opportunistic OP detection. This study aimed to develop deep learning models to identify OP using lumbar MRI. Methods: We retrospectively enrolled 218 patients (≥50 years) who underwent both lumbar MRI and dual-energy X-ray absorptiometry (DXA). After segmentation of vertebral bodies from T1- and T2-weighted MRI images, 738 images per sequence were extracted. Separate convolutional neural network (CNN) models were trained for each sequence. Model performance was evaluated using receiver operating characteristic curves and area under the curve (AUC). Results: Among tested classifiers, EfficientNet b4 showed the best performance. For the T1-weighted model, it achieved an AUC of 82%, with a sensitivity of 85% and specificity of 79%. For the T2-weighted model, the AUC was 83%, with a sensitivity of 86% and specificity of 80%. These results were superior to those of InceptionResNet v2 and ResNet-50 for both sequences. Conclusions: The AI models provided reliable OP classification without additional imaging or radiation. AI-based analysis of standard lumbar MRI sequences can accurately identify OP. These models may assist in early detection of undiagnosed OP in surgical candidates, enabling timely treatment and perioperative strategies to improve outcomes and reduce healthcare burden. Full article

Background/Objectives: In patients with spinal cord injury (SCI), quality of life (QoL) is increasingly recognized as an important indicator of their ability to sustain both the rehabilitation process and post-rehabilitation community reintegration, and it plays a crucial role in prognosis. The primary purpose of this study was to identify the demographic and clinical correlates of different QoL domains as perceived by patients hospitalized after SCI. Methods: We conducted a cross-sectional study on a single day in the units of the Montecatone Rehabilitation Institute (MRI), the largest Italian center for intensive rehabilitation of individuals with SCI. We administered the World Health Organization Quality of Life–Short Version (WHOQOL-BREF), which consists of 26 items rated on a five-point Likert scale. Study participants included 88 adults with SCI; a total of 74% were male, with a mean age of 53.3 years (SD = 15.05). The lesion was traumatic in 74% of cases and complete in 59%. Physical health showed a weak negative association with age (r = −0.213, p = 0.05), whereas social QoL demonstrated a significant positive association with age (r = 0.215, p = 0.046). Psychological QoL was significantly lower in females compared with males (46.9 vs. 55.1, p < 0.05) and in patients living alone compared with those not living alone (46.1 vs. 54.6, p < 0.05). Conclusions: Clinicians should consider routine assessment of QoL to personalize post-discharge therapeutic plans and to implement targeted interventions aimed at improving outcomes in patients with SCI. Full article

Background: Spondylolysis is a stress fracture of the pars interarticularis, most common in adolescents and athletes involved in sports requiring repetitive spinal loading, extension, and rotation. The condition is often underdiagnosed due to delays in presentation and diagnosis, particularly among non-orthopedic providers. Aims: This review aims to summarize the current understanding of spondylolysis, focusing on its etiology, diagnosis, management strategies, and identify gaps in research for future exploration. Methods: A structured literature search was conducted in PubMed to identify studies relevant to pediatric and adolescent spondylolysis, spondylosis, and spondylolisthesis, particularly in the context of athletic injuries. The initial search yielded 143 citations. Applying filters for English language publications within the past five years reduced this to 125 citations. Limiting to populations that were aged 18 years and under returned 50 studies. After screening the titles and abstracts, 12 non-specific or irrelevant articles (including letters to the editor) were excluded, leaving a final dataset of 38 articles for detailed review. In addition, foundational and landmark studies outside this window were included to provide historical and conceptual context, bringing the total evidence base to 50 papers. Findings: Spondylolysis most commonly affects the L5 vertebra, with a higher incidence in male athletes. Conservative treatments like physical therapy and bracing are effective, especially when initiated early. However, the efficacy of bracing remains debated, with limited evidence on long-term clinical benefits. Surgical intervention is considered for severe or non-responsive cases. Diagnostic methods, including CT and MRI, are preferred, with emerging techniques like ultrasound showing potential for non-ionizing, cost-effective, early detection. Implications: Early diagnosis and treatment are crucial for preventing progression to spondylolisthesis. While conservative treatments often yield favorable outcomes, more research is needed to compare the effectiveness of bracing and pharmacological interventions. Future studies should focus on long-term outcomes, cost-effective, non-ionizing diagnostic methods, and the role of emerging therapies like regenerative medicine. A multi-disciplinary approach is vital for optimal patient care, particularly in young athletes. Full article

Spine stereotactic radiotherapy and radiosurgery (SSRS) techniques, encompassing both fractionated stereotactic treatments and single-fraction radiosurgery, are widely used for the management of spinal metastases due to their ability to deliver highly conformal radiation while limiting dose to adjacent critical structures. Clinical outcomes following SSRS, including durable local control and acceptable toxicity, have been reported previously in multiple institutional series. In this manuscript, we describe the clinical workflow used to deliver SSRS at a high-volume academic center, with emphasis on the medical physics processes that support routine clinical practice. Key elements of the workflow include patient selection, treatment region-specific immobilization, CT and MRI-based simulation, treatment planning, patient-specific quality assurance, and image-guided treatment delivery. Rather than presenting new outcome data, this work provides a descriptive overview of how established SSRS techniques are integrated into day-to-day clinical care. Full article

Background/Objectives: Holocord astrocytomas are exceptionally rare intramedullary tumors, especially in adults, and often present with extensive longitudinal growth. Because only a small number of cases have been described, management strategies remain insufficiently defined. This report presents an adult patient treated with a staged surgical approach and provides an updated review of the literature. Methods: A 31-year-old male presented with progressive paraparesis, sensory deficits, and sphincter dysfunction. MRI demonstrated an intramedullary tumor extending from T3 to the conus medullaris. The patient underwent a planned two-stage resection with intraoperative neurophysiological monitoring. Histopathological and DNA-methylation analyses were performed. Additionally, a systematic review of previously reported holocord astrocytoma cases was conducted. Results: The two-stage surgical strategy enabled extensive debulking across multiple spinal segments while preserving neurological function. The patient demonstrated marked postoperative improvement, including restoration of sphincter control, improved motor function, and better mobility. Histopathological analyses confirmed a high-grade astrocytoma with piloid features. The literature review identified 28 previously reported cases, including only 5 in adults. Reported neurological outcomes across adult cases are variable, reflecting the heterogeneity and rarity of this tumor entity. Conclusions: Holocord astrocytomas in adults are extremely rare and pose particular diagnostic and therapeutic challenges. This case demonstrates that a carefully planned, staged surgical approach can achieve meaningful neurological recovery, even in patients presenting with severe preoperative deficits. The report expands the limited body of evidence available for adult holocord astrocytomas and may support future management strategies. Full article