Search Results (729)

Background: Vertebrogenic low back pain (LBP) is a distinct subtype of chronic LBP (cLBP) arising from nociceptive sensitization of the basivertebral nerve (BVN) within pathologically altered vertebral endplates. Modic type 1 and type 2 changes on MRI are primary imaging biomarkers for patient selection. Basivertebral nerve ablation (BVNA), a minimally invasive intraosseous radiofrequency procedure, has emerged as a targeted treatment for this condition. This narrative review aims to synthesize current evidence on the pathophysiology of vertebrogenic LBP, patient selection criteria, procedural outcomes, safety profile, and cost-effectiveness of BVNA. Methods: We conducted this narrative review of the literature, encompassing randomized controlled trials (including the SMART and INTRACEPT studies), prospective registries, and real-world cohort studies evaluating BVNA for vertebrogenic LBP. Clinical and imaging-based selection criteria, procedural techniques, outcome measures, adverse events, opioid utilization, and healthcare utilization data were examined. Results: Evidence demonstrates consistent and durable reductions in pain and disability following BVNA, with a favorable safety profile. Complication rates are low, with vertebral compression fracture and procedure-related radicular pain reported as the most frequent adverse events. BVNA is associated with reduced opioid consumption and decreased overall healthcare utilization. Moreover, emerging data suggest efficacy beyond originally defined inclusion criteria, including cases of osteoporosis, multilevel Modic changes, adult spinal deformity, and complex comorbid presentations. Conclusions: BVNA represents an effective and safe treatment option within the multimodal management of vertebrogenic LBP. Current evidence supports a gradual expansion of procedural indications, with implications for healthcare resource optimization and opioid stewardship. Full article

Intervertebral disc disease remains the most common spinal pathology in dogs and is characterized by degeneration of the intervertebral disc, primarily through chondroid metaplasia of the nucleus pulposus. Current histological grading systems for disc degeneration do not include inflammation, despite its potential relevance in clinical presentation through extradural swelling and compression. In this retrospective study, surgically removed disc extrusion material from 74 dogs was histologically processed and evaluated using a semi-quantitative grading system for disc degeneration and inflammation. A high prevalence of chondroid metaplasia was observed, frequently accompanied by inflammatory infiltrates, hemorrhage, and necrosis. A significant positive correlation (correlation coefficient = 0.636, p < 0.001) was found between the degree of degeneration and the intensity of inflammation. Notably, thoracolumbar extrusions exhibited significantly higher inflammatory scores than cervical cases. In Dachshunds, more severe neurological deficits were associated with lower histological degeneration scores, indicating that neurological severity depends on multiple interacting factors that may differ between breeds. No significant associations were identified with age, sex, breed, body weight, neurological localization, or lesion severity in other groups. These findings suggest that inflammation is an active component in the pathophysiology of intervertebral disc disease. Incorporating inflammatory grading into histological grading systems could refine functional outcome predictions and guide therapeutic decisions. Full article

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/Objectives: Although the Spinal Instability Neoplastic Score (SINS) is widely used to estimate spinal metastases fracture risk and guide decisions on stabilisation procedures, prior studies have demonstrated mixed results. Patients with the same score exhibit clinically heterogeneous outcomes, with some SINS criteria correlating less well with the estimated fracture risk than others. There are also barriers to implementation such as the time burden required for manual calculation and interobserver variability associated with qualitative morphological criteria. SINS also lacks sensitivity for detecting latent structural compromise in treatment-naive patients and those susceptible to the iatrogenic effects of stereotactic body radiation therapy. This review aims to evaluate emerging imaging, biomechanical, and microstructural markers with the potential to improve fracture risk stratification and prognostication for spinal oncology patients. Methods: We synthesise evidence across three innovative frontiers: (1) biomechanical modelling, including CT-derived finite element analysis and failure-load pattern models; (2) radiomics, utilizing radiomics features from radiological imaging to develop a predictive model; and (3) microstructural MRI biomarkers, exploring the translatability of the Vertebral Bone Quality score, fat fraction, and paraspinal muscle atrophy from osteoporosis to the metastatic spine. Results: Emerging biomechanical, radiomic and microstructural imaging markers show potential in addressing some limitations of traditional SINS criteria for fracture risk stratification across the spinal oncology treatment continuum, from initial diagnosis to post-radiation surveillance, thereby facilitating more precise risk assessment. However, current evidence remains largely retrospective and heterogeneous, and further validation is required before clinical adoption. Conclusions: We propose a framework that shifts the paradigm from conventional morphological scoring toward a multiparametric assessment of spinal stability. Full article

Background/Objectives: The relationship between cervical central canal and neural foraminal dimensions remains undefined. This study examined correlations between these structures in a young adult CT cohort screened to exclude apparent cervical spinal pathology. Methods: We retrospectively reviewed computed tomography images of 1000 patients aged 18 to 35 years screened to exclude apparent cervical spinal pathology. Central canal dimensions included anteroposterior diameter, interpedicular distance, and cross-sectional area. Neural foraminal dimensions included axial width, craniocaudal height, and area. Pearson correlation tests were used to assess associations between the central canal and neural foraminal dimensions. Results: Neural foraminal area showed the most consistent associations with interpedicular distance bilaterally, though these relationships were modest-to-moderate in magnitude. Axial width and craniocaudal height exhibited no consistent correlations with central canal dimensions. No strong correlations were observed between any combination of central canal and neural foraminal dimensions at any disc level. Conclusions: In this young adult CT cohort without apparent cervical spinal pathology, cervical central canal and neural foraminal dimensions demonstrated no strong correlations across levels. These findings suggest that central canal dimensions should not be used as a surrogate for neural foraminal dimensions in quantitative morphometric assessment. Full article

Objective: To describe the surgical technique and early clinical outcomes of prone-transpsoas single-position corpectomy (PTP-corpectomy) for the management of complex thoracolumbar spinal pathology. Background: PTP-corpectomy is an emerging technique for providing simultaneous lateral and posterior spinal access without patient repositioning. The previous literature describes the PTP approach for interbody fusions; however, evaluation of its use for corpectomy is limited. This case series reports our experience with the PTP-corpectomy procedure at our institution. Methods: We retrospectively reviewed seven patients who underwent PTP-corpectomy surgery for complex spinal pathologies, including severe kyphoscoliosis, traumatic burst fractures, and revision in 2022–2025. Collected variables included demographics, comorbidities, surgical history, perioperative details, radiographic imaging, and clinical outcomes. Results: All seven patients successfully underwent PTP-corpectomy. The average operative time was 460.6 ± 147.1 min, and the estimated blood loss (EBL) was 892.9 ± 898.3 mL. Average length of stay (LOS) postoperatively was 6.7 ± 3.0 days. One case required revision of a preexisting construct and complex wound closure with plastic surgery, which had significantly increased operative time and blood loss (767 min, 2700 mL). Excluding this complicated case, the average time was 409 ± 63.7 min, and EBL was 591.7 ± 454.3 mL. All seven patients maintained clinical stability postoperatively, demonstrating improvements in pain and functional status at latest follow-up. Follow-up time ranged from 41 to 375 days. Conclusions: Our experience adds to the limited body of evidence that the PTP approach is well suited for corpectomy procedures, and that it is feasible, safe, and effective at improving clinical outcomes for complex spinal pathologies. This series adds to the limited case volume describing this technique in the current literature. Future studies with larger patient populations are warranted to further validate these findings. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Background/Objectives: A considerable number of patients with malignant spinal cord compression (MSCC) and a longer expected lifespan do not receive upfront surgery but radiation therapy alone. These patients were suggested to benefit from radiation programs with total doses > 30 Gy in terms of better local progression-free survival (LPFS). A previous study compared such regimens, namely 15 × 2.633 Gy over three weeks (34 patients, prospective cohort) and 20 × 2.0 Gy over four weeks (239 patients, control), using a propensity score-adjusted approach. Both regimens were associated with similar rates of overall survival (OS) and LPFS. However, follow-up was limited to 12 months. For long-term survivors, a longer period of follow-up would be desirable. Therefore, the present study was initiated. Methods: Retrospective collection of additional data enabled us to provide OS- and LPFS-rates at 36 months following radiation therapy. Results: In the prospective cohort, 36-month rates of OS and LPFS were 27.0% and 89.7%, respectively. After application of the propensity score-adjusted Cox regression model, 36-month OS-rates (HR 1.454; 95% CI 0.748–2.828; p = 0.270) and LPFS-rates (HR 0.311; 95% CI 0.041–2.352; p = 0.258) appeared not considerably different. Late radiation myelopathy and pathologic vertebral fractures were not identified. Conclusions: The results of the current study suggest that the role of 15 × 2.633 Gy should be further investigated in selected patients with MSCC, particularly when considering its shorter overall treatment time in comparison to 20 × 2.0 Gy. Overall, our findings are hypothesis-generating rather than confirmatory. Full article

Spinal cord injury (SCI) is associated with respiratory dysfunction, chronic inflammation, and oxidative stress, and can increase pulmonary tissue stress during exercise. Thus, hydrogen peroxide (H₂O₂) and nitrite (NO₂⁻) concentrations in exhaled breath condensate (EBC) were compared during an official wheelchair rugby match. 14 males and two females with SCI (33.3 ± 6.5 years), anthropometry, baseline spirometry, and the International Wheelchair Rugby Federation classification (IWRF) were recorded. Playing time (23.6 ± 7.49 min), Borg scale (4.3 ± 1.64), and [H₂O₂] EBC and [NO₂⁻] EBC were determined before and 20 min after the match. In the total sample, [H₂O₂] EBC and [NO₂⁻] EBC increased post-match (p = 0.0042 and p = 0.031, respectively). When segmented according to IWRF classification, the highest functional capacity, H group (>1.5 points; n = 11) increased its [H₂O₂] EBC per exercise (p = 0.0029) and showed a trend for [NO₂⁻] EBC (p = 0.09), while the lowest classification, L group (≤1.5 points; n = 5) showed a higher baseline concentration in both EBC markers with no changes per exercise. Baseline IWRF classification was inversely correlated with [H₂O₂] EBC, while body mass index (BMI) was positively associated with [NO₂⁻] EBC. In conclusion, in the sample analyzed, a short period of moderate intensity during a wheelchair rugby match increases H₂O₂ and NO₂⁻ in the airway with a potentially greater effect in SCI athletes with better functional capacity; it remains to be determined whether this phenomenon corresponds to a physiological or pathological process. Full article

Oligodendrocytes (OLs) are specialized glial cells essential for the formation and maintenance of the myelin sheath within the central nervous system (CNS). Historically, OLs were considered a functionally homogeneous population. However, the advent and widespread application of single-cell and single-nucleus RNA sequencing (scRNA-seq/snRNA-seq) technologies since 2015 have revealed substantial transcriptional heterogeneity, varying according to developmental stage, anatomical region, and disease state. In this review, we synthesized current advances in the understanding of OL heterogeneity. Nine OL cell classes have been identified in the mouse somatosensory cortex and hippocampal CA1 region, later expanding to 13 distinct subpopulations across ten CNS regions. Furthermore, we characterized disease-associated oligodendrocytes (DAOs)/disease-associated oligodendrocyte lineages (DOLs), identified in various neurological diseases, including multiple sclerosis (MS), Alzheimer’s disease (AD), and spinal cord injury, focusing on their molecular markers, spatial distribution, and pathophysiological roles. We summarized key transcriptional regulatory networks underlying DAO induction, including the signal transducer and activator of transcription (STAT)/interferon regulatory factor (IRF) family, the Yin Yang 1 (YY1)/nuclear factor kappa B (NF-κB) axis, and the SOX9/SOX10 regulatory system. The utility of region-specific brain analyses using spatial transcriptomics (ST) in conjunction with these approaches was also discussed. Finally, we compiled the implications of patient stratification according to white matter glial response patterns derived from large-scale snRNA-seq analyses of patients with progressive MS. Our synthesis shows that oligodendrocytes consist of multiple distinct subtypes that vary across development, brain regions, and disease conditions. In pathological states, they adopt specific disease-associated programs that reflect context-dependent responses and may influence disease progression and repair. This work provides a framework for understanding how oligodendrocyte diversity contributes to neurological disease and may support the development of targeted remyelination therapies. Full article

Background/Objectives: Spontaneous intracranial hypotension (SIH) is a rare pathology that arises in the context of a known or suspected cerebral spinal fluid (CSF) leak. A key symptom of SIH is an orthostatic headache; however, additional neurological complications are common. This case study not only highlights the co-existence of Menière’s disease and SIH but describes a subsequent complication of benign paroxysmal positional vertigo (BPPV) and management thereof. Case Description: The patient is a 61-year-old female who presented to the emergency department due to an intractable headache, right sided weakness and aphasia. CT/MRI revealed a subdural hematoma overlying the left cerebral hemisphere measuring up to 8 mm with 4 mm left to right midline shift. Fluoro-guided total spine myelogram, cisternogram, and lumbar epidural blood patch were performed for suspected SIH. As headache, right sided weakness and aphasia resolved, the patient began reporting onset of constant “spinning” dizziness, tinnitus and aural fullness mimicking symptoms of a Menière’s attack. The vestibular examination was consistent with compensated bilateral Menière’s disease (left > right) and right horizontal canalithiasis BPPV. The patient was treated with Gufoni and Lempert maneuvers with complete resolution of positional dizziness and associated nystagmus along with improved balance and gait. Discussion/Conclusions: This case study highlights the importance of multidisciplinary assessment in complex neurological cases and specifically recommends that patients with Menière’s disease accompanied by intractable headaches undergo extended neuroradiological examination of the brain to exclude underlying spontaneous intracranial hypotension syndrome. Full article

Objective: To evaluate the feasibility and early outcomes of a curvature-guided strategy that guides dual-branch revascularization during Zone 1 Thoracic Endovascular Aortic Repair (TEVAR) based on whether the aortic pathology is predominantly located on the greater or lesser curvature of the arch. Methods: In this retrospective, descriptive study (February 2023–June 2024), 43 consecutive patients were included under a predefined anatomical protocol. Of these, 3 patients (7.0%) were lost to follow-up and were included in the analysis of baseline characteristics and perioperative outcomes. The remaining 40 patients constituted the per-protocol follow-up cohort. Pathologies predominantly on the aortic arch’s greater curvature (n = 21) were managed with a Castor single-branched stent-graft for the left subclavian artery (LSA) and a left common carotid artery (LCCA) chimney stent. Those on the lesser curvature (n = 22) received a physician-modified endograft (PMEG). The primary outcome was technical success; secondary outcomes included safety, branch patency, and reintervention. Results: The overall technical success rate was 97.7% (100% in the Castor-chimney cohort [21/21] vs. 95.5% in the PMEG cohort [21/22]). No perioperative stroke, spinal cord ischemia, or retrograde type A dissection occurred in either cohort. Two type II endoleaks were observed: one intraoperative in the Castor-chimney cohort and one during follow-up in the PMEG cohort. Among the 40 patients (20 per cohort) who completed a median follow-up of 22.5 months, freedom from aortic-related reintervention was 95% (38/40), with one reintervention occurring in each cohort. Branch patency was 100% (20/20) in the PMEG cohort, whereas it was 95% (one asymptomatic LSA occlusion) in the Castor-chimney cohort. Conclusions: The implementation of a curvature-guided protocol, which rationally matches endograft techniques to arch anatomy, suggests acceptable early safety and efficacy for complex Zone 1 TEVAR. This anatomy-driven framework offers a potential personalized approach to dual-branch revascularization and warrants prospective validation. Full article

Mesenchymal stromal cells (MSCs) are multipotent cells characterized by their regenerative capacity and strong immunomodulatory properties. In recent years, MSC-based therapy has attracted significant attention as a potential treatment for a wide range of immune-mediated and degenerative diseases. The therapeutic effects of MSCs are primarily mediated through paracrine signaling and secretion of cytokines that regulate immune responses and promote tissue repair. This review focuses on five key cytokines involved in MSC immunomodulation: interleukin-6 (IL-6), interleukin-10 (IL-10), transforming growth factor-beta (TGF-β), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β). These cytokines interact within a complex signaling network that allows MSCs to suppress excessive inflammation and restore immune balance. The role of MSC therapy is examined in several clinically relevant conditions, including systemic lupus erythematosus, systemic sclerosis, ischemic stroke, spinal cord injury, diabetes mellitus, and female infertility. Across these diseases, MSCs demonstrate the ability to inhibit pro-inflammatory immune cell activity, promote regulatory immune phenotypes, reduce oxidative stress, and stimulate regeneration through the secretion of growth factors and extracellular vesicles. Despite promising experimental and early clinical findings, several limitations remain, including variability in MSC sources, limited cell survival after transplantation, and the need for optimized dosing strategies. Overall, MSC therapy represents a multifunctional therapeutic approach combining immunomodulation, anti-inflammatory activity, and regenerative support. Further research is required to better understand cytokine interactions, improve standardization of MSC-based treatments, and enhance clinical efficacy across diverse pathological conditions. Full article

Background/Objectives: Lumbosacral transitional vertebrae (LSTV) are associated with alterations in spinal anatomy and biomechanics that may complicate localization of symptomatic nerve root pathology. However, the relationship between anatomically defined nerve root compression on magnetic resonance imaging (MRI) and electrophysiologically identified radiculopathy on electromyography (EMG) remains insufficiently characterized. This study aimed to evaluate concordance between MRI-identified nerve root compression and EMG-identified radiculopathy and to investigate whether transitional morphology influences this relationship. Methods: A retrospective analysis was performed in patients with LSTV who underwent both MRI and needle EMG for single-level lumbosacral radiculopathy. Transitional vertebrae were classified as lumbarization or sacralization and further categorized as complete or partial. Concordance between the anatomical level of nerve root compression and the electrophysiological level of radiculopathy was assessed. Clinical and radiographic variables potentially associated with discordance were analyzed. Results: Twenty-nine patients were included. Concordance between MRI-defined nerve root compression and EMG-identified radiculopathy was observed in 27.6% of cases, whereas 72.4% demonstrated discordance. The degree of transitional morphology significantly influenced concordance patterns, with complete transitional vertebrae showing a higher rate of discordance compared with partial transitions. Conclusions: In this exploratory cohort, patients with LSTV showed a high rate of anatomical–functional discordance between MRI and EMG findings. Complete transitional morphology is associated with increased discordance, suggesting altered functional expression of nerve root pathology. These findings suggest that anatomical and electrophysiological assessments may provide complementary information during diagnostic evaluation in selected patients with LSTV. Full article

Spinal infections in general, and infectious spondylodiscitis in particular, are increasingly diagnosed in the Western world, in recent decades. This rise in incidence is associated with an ageing population and with an increased availability of accurate diagnostic modalities. Even so, due to the non-specific nature of clinical manifestations, and of the implicated blood and serum markers, there is a risk of underdiagnosis or misdiagnosis of the disease in its initial stages. Ionizing radiation methods, such as plain radiography (X-ray) and computed tomography (CT), are also not reliable in the early stages of the diseases, and the golden standard of imagistic diagnosis, magnetic resonance imaging (MRI), is not always available or requested. Still, MRI remains the most reliable method in most cases where there is a need for differential diagnosis with other pathologies, namely Andersson lesions, destructive spondyloarthropathy, erosive osteochondritis, micro-crystalline spondylitis, Modic 1 lesion, Charcot spinal arthropathy, osteoporotic fractures, SAPHO syndrome with spinal involvement, and Schmorl’s nodes. Infectious spondylodiscitis is caused by bacteria, and, less frequently, by fungi. Rare cases of parasitic causes have also been reported in the literature. Infectious spondylodiscitis of bacterial causes may be pyogenic, more frequently caused by Staphylococcus spp. or Streptococcus spp., or granulomatous, usually caused by Mycobacterium tuberculosis complex (MTBC) or from classical brucellosis. In all these cases, therapy may be conservative, with antibiotics, or surgical, when the former fails or in patients with significant spinal instability or other neurological manifestations. There are various surgical approaches, each with its own drawbacks, and usually used according to the preference of the attending physician. Even in cases of surgical treatment, antibiotic administration is prolonged, and it is important for a proper scheme to be selected based on antimicrobial susceptibility testing. However, given that in many cases, the causative agent cannot be identified, empirical treatment must be initiated. Finally, newer approaches, including the incorporation of antimicrobial substances, may offer better solutions for improving treatment and rehabilitation outcomes. Full article