Search Results (291)

Background and Objectives: Osteoporotic vertebral compression fractures affect approximately one in four postmenopausal women and carry substantial morbidity, yet established clinical tools such as dual-energy X-ray absorptiometry (DXA) provide only patient-level risk and do not identify which specific vertebra is most likely to fail. Computed tomography (CT) acquired for unrelated indications is the most widely available three-dimensional substrate for opportunistic screening, but published machine learning models for vertebral fracture risk almost universally operate at the patient level. The present study aimed to develop and rigorously validate a per-vertebra prediction pipeline applicable to both routine clinical lumbar-spine CT and opportunistic abdominal CT, both acquired for indications unrelated to osteoporosis screening. Materials and Methods: Two independent retrospective cohorts were assembled from a single academic centre: a routine clinical lumbar-spine CT cohort of 106 patients yielding 478 evaluable vertebrae, and a routine abdominal CT cohort of 126 patients yielding 589 evaluable vertebrae. Vertebral bodies were segmented automatically with TotalSegmentator v2 and the trabecular core isolated by morphological erosion. A panel of 505 quantitative imaging biomarkers compliant with Image Biomarker Standardisation Initiative recommendations was extracted, covering trabecular density, vertebral morphometry, classical texture, trabecular network architecture, sub-endplate vulnerability, low-density topology, radial heterogeneity and adjacent muscle quality. Within-patient feature engineering expanded the input pool to 1293 contextual descriptors. Three model families were evaluated under fully nested leave-one-patient-out cross-validation: ElasticNet logistic regression, a softmax-ranking approximation of conditional logistic regression, and a Two-Stage model combining a patient-level fragility score with a within-patient vertebral outlier score. Patient-level bootstrap resampling (2000 iterations) was used to obtain 95% confidence intervals. Results: On routine clinical lumbar-spine CT the Two-Stage model achieved a per-vertebra AUC of 0.750 (95% CI 0.704 to 0.795), an F1 of 0.549, a within-patient concordance index of 0.693, an expected calibration error of 0.044, and Hit@3 of 0.934. It was the only model evaluated that returned calibrated probabilities; the softmax-ranking and ElasticNet baselines gave expected calibration errors of 0.232 and 0.218 respectively. On opportunistic abdominal CT, the softmax-ranking model gave AUC 0.672 (95% CI 0.615 to 0.727). Selected biomarkers were dominated by regional trabecular density and trabecular network architecture; a stable core of lumbar features entered the model in 100% of cross-validation folds, indicating high reproducibility. The closest prior per-vertebra CT-based predictor in primary, non-surgical patients (Muehlematter and colleagues, 58-patient cohort) reported a per-vertebra AUC of 0.64, which is one of several reference points for the present results. Ten methodological variants and sensitivity analyses, including rank fusion, internal tissue normalisation and additional biomechanical features, did not provide statistically significant gains, indicating that the binding constraint at this sample size is data volume rather than methodology. Conclusions: A two-stage decomposition that separates systemic skeletal fragility from within-patient vertebral outlier status produces well-calibrated per-vertebra fracture-risk estimates from routine clinical lumbar spine CT and was the only model evaluated to do so, which is what permits a per-vertebra output to be reported as an absolute risk rather than as an ordering alone; a within-patient ranking model is preferable for opportunistic abdominal CT. The discrimination advantage of the decomposition over that baseline is numerical and consistent but not statistically established at this sample size, and the work is presented as a transparent and reproducible single-centre benchmark for the still under-developed per-vertebra prediction task. Its clearest near-term value is opportunistic, namely flagging elevated per-vertebra fracture risk on CTs already acquired for unrelated indications without additional radiation, cost or a dedicated densitometric study. External multi-centre validation is the necessary next step. Full article

Background/Objectives: Cervical pedicle screw (CPS) placement provides superior biomechanical stability but remains technically demanding and associated with a risk of screw malposition. While recent advances in imaging and navigation have improved placement accuracy, reliable prediction of malposition remains challenging. The aim of this study was to evaluate whether machine learning (ML) models can predict CPS malposition using structured clinical and anatomical features. Methods: We performed a retrospective analysis of 862 pedicle screws from 168 posterior cervical spine surgeries conducted at our institution between 2018 and 2025. Clinical, procedural, and anatomical variables, including age, sex, body size parameters, surgical indication, vertebral level, pedicle angle, and pedicle width, were evaluated. Pedicle morphology was partially derived from CT-based automated segmentation using TotalSegmentator (v2.13.0), while selected anatomical parameters were manually measured. Supervised ML models, including Random Forest, Balanced Random Forest, XGBoost (v3.2.0), Support Vector Machine, and K-Nearest Neighbor, were trained and compared using Python and scikit-learn to predict inaccurate screw placement. Model performance was evaluated using Area Under the Receiver Operating Characteristic Curve (ROC AUC), F1-score, precision, and recall. Model interpretability was assessed using Shapley Additive Explanations (SHAP). Results: The dataset showed a clinically representative class distribution, with 91.1% of screws classified as acceptable and 8.9% as inaccurate. Across all models, predictive performance was moderate and consistent. Balanced Random Forest achieved the highest discriminative performance (ROC AUC 0.69) and provided the most balanced classification profile, while other models demonstrated comparable overall performance with varying sensitivity to the minority class. SHAP analysis identified anatomical and procedural variables, including pedicle width and angle, as relevant contributors to model output. Feature contributions were distributed across variables, with substantial overlap between outcome groups. Conclusions: ML-based prediction of CPS malposition using clinical and anatomical features demonstrates consistent and interpretable performance. The results highlight that predictive performance is primarily influenced by dataset characteristics, including class distribution and feature overlap, rather than model selection alone. This study provides an important baseline for ML-based CPS prediction and supports future research integrating larger datasets and more detailed anatomical representations to enhance predictive accuracy. Full article

Background: The thoracolumbar junction (TLJ) includes the T11–L2 vertebral segments. It is a pivotal biomechanical transition zone between the rigid thoracic spine and the more mobile lumbar spine. Accurate morphometric data from this region are crucial for understanding human axial biomechanics and supporting forensic investigations. Objective: This study was designed to establish a normative multi-detector computed tomography (MDCT) database of the human thoracolumbar junction (T11–L2) in an adult population. Specifically, the primary objectives were to quantify normal vertebral and pedicle dimensions and to investigate the prevalence of congenital rib anomalies. The ultimate clinical goal is to translate these anatomical metrics into practical guidelines for spinal surgery and tools for forensic sex estimation. Materials and Methods: A retrospective analysis of 517 adults (277 men, 240 women) who received thoracic CT for various clinical indications was conducted. Morphometric parameters, including anterior, middle, and posterior vertebral heights; transverse and sagittal pedicle diameters; pedicle length; and transverse pedicle angle, were systematically measured. Costal variations, including hypoplastic and supernumerary ribs, were carefully recorded. Results: Vertebral and pedicle linear dimensions were generally larger in men than in women. The mean transverse pedicle diameter (TPD) increased progressively from T11 to L2. Significant sexual dimorphism in TPD was observed at the T11, L1, and L2 levels (p < 0.05), whereas both transverse (p = 0.168) and sagittal (p = 0.251) pedicle dimensions remained statistically comparable between sexes exclusively at the T12 transitional segment. The transverse pedicle angle (TPA) showed a consistent, increasing medial trajectory from T11 (~21°) to L2 (~28°) in both sexes, with no significant sex-based difference (p > 0.05). The overall prevalence of congenital rib variations was 18.57%. The most frequent structural anomaly was 12th-rib hypoplasia. Conclusions: This study provides a detailed morphometric baseline for the TLJ in an adult cohort (n = 517) of Turkish adults. The findings show that while absolute pedicle size and volumetric mass are influenced by sexually dimorphic physical geometry, the spatial trajectory and angulation of the pedicles (TPA) are determined by biomechanical principles that are independent of sex. In addition, pronounced sexual dimorphism and a high prevalence of unique costal variations were observed. These factors provide valuable biological markers that serve as reliable radiological fingerprints for forensic anthropologists who estimate sex from skeletal remains and identify unknown individuals. Full article

Background: Show jumping involves repetitive biomechanical loading of the rider’s spine. This study compared lumbar and cervical spine- related disability between amateur and advanced female show jumpers. Methods: This cross-sectional observational study included 353 female show jumping athletes aged 12–25 years. Data were collected using an anonymous online survey distributed during major international equestrian competitions in Poland. Participants were stratified by age (12–17 and 18–25 years) and competitive level (amateur vs. advanced riders) to examine differences in lumbar and cervical spine-related disability. Data were analyzed using non-parametric statistical tests, including the Mann–Whitney U test for continuous variables and the Chi-square test for categorical comparisons, with statistical significance set at p < 0.05. Results: Advanced athletes reported higher ODI scores compared with amateurs, particularly in the younger age group, although this did not reach statistical significance (p = 0.053). No significant differences were observed in the older age group. Similarly, no significant differences were found between amateur and advanced athletes regarding cervical spine-related disability (NDI) in either age group. Advanced athletes in both age groups reported significantly greater weekly training volume and longer training experience. Body mass did not differ between groups. Conclusions: Competitive level is associated with higher training loads, which may contribute to lumbar spine-related disability in younger female show jumpers. Further longitudinal studies are needed to explain the impact of cumulative loading on spinal health and to develop targeted preventive strategies. Full article

The NIOSH Lifting Equation is widely used to evaluate manual material handling tasks by identifying lifting risk through load reduction multipliers based on task geometry. However, while it provides a means of classifying risk, it does not estimate spinal forces and therefore cannot quantify the biomechanical load experienced at the lumbar spine. In contrast, biomechanical simulations can estimate spinal compression with high fidelity, but they require motion capture systems and specialized software that are not practical for most workplace assessments. This study aimed to bridge these approaches by developing a family of mixed-effect statistical models that predict L4/L5 spinal compression forces using the geometric parameters of the NIOSH framework combined with posture-specific biomechanical descriptors at peak-loading poses extracted from digital simulations. Data were aggregated from multiple experimental lifting studies in which standardized NIOSH parameters and corresponding spinal compression forces were obtained through validated digital human modeling. Mixed-effects regression was used to establish the relationship between task geometry, joint posture, load weight, and spinal compression. The resulting predictive equation demonstrated strong agreement with simulation-derived forces and effectively captured the contributions of subject, task and body positioning to the spinal compression force across diverse lifting tasks. Importantly, the variance structure of the model’s coefficients allows the contribution of risk to be attributed either to task-related factors or to subject-specific movement behaviors, reinforcing the safety relevance of the framework. Horizontal reach, vertical hand height, and load magnitude emerged as dominant predictors, with trunk posture providing additional explanatory power. The model offers ergonomists a practical, biomechanics-informed tool that extends the descriptive capacity of the NIOSH framework by enabling direct estimation of spinal compression forces without the need for full biomechanical simulations. Full article

Background: Spinal immobilization during extrication is a key component of trauma care aimed at reducing secondary neurological injury, although conventional techniques such as the Rautek maneuver may induce unintended spinal motion that could increase biomechanical stress on vulnerable structures. Recent developments, including the SNAID^® cervical restraint system, have been designed to improve motion restriction while maintaining operational feasibility in emergency settings. This study aimed to quantitatively compare spinal kinematics during extrication using SNAID^® versus the Rautek maneuver in a simulated environment. Methods: A controlled experimental study was conducted with 15 nursing students performing standardized extrication tasks under both conditions. Four synchronized 9-axis inertial measurement units were placed at the occiput, C7, sternum, and left shoulder to capture kinematic data at 100 Hz. Range of motion (ROM) was calculated for absolute and intersegmental movements, and statistical comparisons were performed using paired non-parametric tests with effect size estimation. Results: The results showed that SNAID^® significantly reduced cervical lateral flexion-extension compared with Rautek (p = 0.013, r_m^b = −0.71), as well as markedly reducing head–trunk relative motion, particularly in sagittal flexion-extension (p < 0.001, r_m^b = −0.99). In contrast, Rautek produced significantly greater shoulder and trunk motion, with the largest effect observed in shoulder lateral displacement (p < 0.001, r_m^b = −0.99). Conclusions: the SNAID^® system demonstrated reduced cervical and intersegmental motion compared with the Rautek maneuver under standardized simulation conditions. These findings indicate differences in biomechanical behavior between both approaches; however, their clinical significance cannot be established from the present study and should not be interpreted as evidence of improved patient outcomes or neurological protection. Full article

Manual lifting is a common occupational activity associated with an increased risk of low back disorders. In this study, 22 participants from UPMC Hamot, organized into 11 pairs, were recruited. A combination of motion capture techniques and an injury assessment tool was used to investigate the relationships among body anthropometrics, three-dimensional trunk and lower-limb kinematics, and lumbar spinal loading. Potential differences in lifting mechanics were observed between male and female participants. Males exhibited greater trunk flexion and higher compressive loading, while females demonstrated greater hip and knee flexion with reduced trunk motion. These findings indicate that spinal loading during lifting is influenced by an interaction between anthropometric characteristics and movement coordination patterns, with variable behavioral trends affecting load distribution across the trunk and lower extremities. The results provide biomechanical insight that may inform the development of bio-ergonomic training techniques aimed at reducing lumbar spine loading and minimizing injury risk in occupational lifting tasks. Full article

Background: Currently, there is a lack of biomechanical studies on traditional dual-growing rods (TDGR) combined with apical osteotomy and short-segment fusion (hybrid technique, HT). This study compared the differences in clinical outcomes and biomechanics between TDGR and HT in the treatment of severe early-onset scoliosis (sEOS) via finite element analysis (FEA) and in vitro biomechanical experiments. Methods: Two scoliotic FEA models and 12 in vitro scoliotic models were created. In the FEA, the initial surgeries for TDGR and HT, two subsequent lengthenings, and up to 12 months of physeal spinal growth were simulated. In the in vitro biomechanical experiments, the initial surgeries were simulated. Correction outcomes, spinal height, and stress were compared between the TDGR and HT groups. Results: (1) FEA: Compared with TDGR, HT achieved better correction (62.4% vs. 36.2%) and a greater increase in spinal height (26.43 mm vs. 12.58 mm) after the initial surgery. During follow-up, HT resulted in better correction maintenance and could better sustain spinal growth than TDGR. HT reduced the stress on the proximal and distal instrumented vertebral bodies, junctional intervertebral discs, and instrumentation compared with TDGR. (2) In vitro biomechanical experiment: After the initial surgery, the mean Cobb angle of the main curve (24.58 ± 2.80° vs. 38.97 ± 3.23°) and AVT (8.87 ± 1.64 mm vs. 13.15 ± 3.58 mm) in the HT group were significantly lower than those in the TDGR group (p < 0.05). The increase in spinal height in the HT group was significantly greater than that in the TDGR group (3.83 ± 0.45 cm vs. 1.85 ± 0.72 cm, p < 0.001). Compared with TDGR, HT significantly decreased rod strain (p < 0.05). Conclusions: Compared with TDGR, HT can significantly improve correction outcomes and maintain spinal growth. Apical anchors can effectively disperse stress on the spine and instrumentation, which may reduce the risk of complications and potentially delay intervertebral disc degeneration, although clinical validation is required. Full article

Tibial spine avulsion injuries represent a distinct pattern of anterior cruciate ligament (ACL) injury in children and adolescents, reflecting the unique anatomical and biomechanical properties of the skeletally immature knee. Unlike midsubstance ACL ruptures, these injuries involve avulsion of the tibial insertion and pose specific diagnostic and therapeutic challenges. Management strategies remain heterogeneous, particularly for partially displaced fractures, with variation in surgical indications, fixation techniques, and rehabilitation protocols. This narrative review provides a structured synthesis of current evidence on the anatomy, biomechanics, clinical presentation, and management of pediatric tibial spine avulsion injuries. Nonoperative and operative approaches are compared, with attention to fixation strategies, complications, physeal considerations, and rehabilitation principles. Return-to-sport (RTS) outcomes are examined, with available evidence suggesting that RTS rates may be comparable between operative and nonoperative management in selected patients, although interpretation is limited by heterogeneous and predominantly retrospective data. Early mobilization appears important for reducing arthrofibrosis risk, while rehabilitation should be individualized. RTS decision-making remains inconsistent, with commonly used criteria largely extrapolated from ACL reconstruction literature and lacking validation in pediatric populations. Multifactorial assessment incorporating functional testing and patient-reported outcomes is increasingly advocated, although evidence for psychological readiness remains limited. Overall, the current literature is characterized by methodological heterogeneity and limited comparative data, restricting definitive conclusions. This review provides a clinically oriented synthesis while highlighting key uncertainties and priorities for future research. Full article

Objective assessment of low back pain (LBP) is challenging due to subtle, task-dependent movement impairments that are poorly captured by existing sensing technologies. Motion Tape (MT), which is a self-adhesive elastic fabric skin strain sensor, enables skin-conforming measurement of localized biomechanical strain during functional movement, but its discriminative utility for LBP remains unclear. We examine this question in a multi-sensor, multi-movement setting and analyze whether MT signals encode discriminative structure that distinguishes individuals with LBP from healthy controls. Using data from 20 participants performing 19 functional movements with six sensors, we evaluate movement-specific classification under a leave-pair-out protocol and examine which movements, sensor placements, and features are most informative. Our analysis reveals that group separation is highly selective: only a small subset of movements, most notably forward flexion, consistently supports accurate classification, while many movements remain at near-chance level. We find that temporal dynamics features help in resolving difficult cases that global strain statistics fail to separate, and that informative signals are spatially localized to the lower lumbar spine. In contrast, pretrained time-series foundation models show negligible sensitivity to participant-level structure in MT signals. Overall, the findings from this exploratory study establish when and how MT sensing can effectively differentiate individuals with LBP from healthy controls, providing a principled foundation for larger-scale validation. Full article

Background: Mechanical complications remain a concern after vertebral body replacement (VBR), especially during rehabilitation. Yet exercise prescription is often guided by body posture or single loading measures. This study characterized mechanical demands during rehabilitation exercises after VBR and examined the effects of posture and postoperative time. Methods: Telemetric in vivo load data from instrumented VBRs in the OrthoLoad database were analyzed. A total of 119 trials across 21 exercises, performed in supine, prone, seated, and standing positions, were collected from five patients over 0.1–63 postoperative months. Mechanical demand was quantified across six biomechanical domains and integrated into a composite SafetyIndex. Posture- and time-related effects were assessed using linear mixed-effects models. Worst-case demand was defined as the 95th percentile of SafetyIndex values. Results: SafetyIndex showed a right-skewed distribution (median 8.5, IQR 3.7–14.1), with marked inter-exercise variability. Composite SafetyIndex did not differ between postures (all p > 0.13). However, posture-dependent effects emerged at the domain level: peak shear ratio was greater in prone than in sitting, standing, and supine positions (all p < 0.05); peak force was greater in standing than prone (p = 0.007 and p = 0.013 in unadjusted and adjusted models); and peak resultant moment was smaller in supine than prone (p = 0.036 and p = 0.046). Postoperative time was positively associated with peak force (β = +0.40 %BW/month, p = 0.042), peak resultant moment (β = +0.025 Nm/month, p < 0.001), and SafetyIndex (β = +0.25/month, p = 0.011), but not peak shear ratio (p = 0.879). Worst-case SafetyIndex_P95 values ranged from 0.6 to 85.0, with stable ranking across percentile thresholds (Spearman’s ρ = 0.995–0.997). Conclusions: Mechanical demand after VBR is task-specific and domain-dependent and cannot be inferred from posture alone. Axial and bending-related components increased over postoperative time, whereas shear-related loading remained task-dependent. Full article

Background: Costal cartilage is the preferred structural material for augmentation rhinoplasty when robust and durable tip support is required. However, conventional full-thickness harvest is associated with significant donor-site morbidity, and commonly employed rigid fixation strategies—such as the septal extension graft—substantially restrict postoperative nasal tip compliance. The present study introduces a novel two-component technique combining a half-harvest costal cartilage procurement method with a pyramidal-shaped columellar strut graft anchored on the floating-tip principle, with the objective of maintaining postoperative nasal tip flexibility while providing structural support following augmentation rhinoplasty. Methods: A retrospective review was performed of consecutive patients who underwent primary or revision augmentation rhinoplasty using the pyramidal costal cartilage columellar strut graft technique by a single surgeon between June 2018 and February 2026. The medial half of the conjoined costal cartilage at the seventh, eighth, or ninth rib was procured via a half-harvest approach, preserving the lateral cortex and perichondrium to minimize donor-site morbidity and potential cartilage regeneration was considered a theoretical benefit. The harvested cartilage was carved into a pyramidal columellar strut and secured to the anterior nasal spine using a floating fixation construct; the inferior base of the strut was rigidly fixed to the nasal septum and anterior nasal spine with a minimum of three PDS 5-0 sutures, while the superior portion remained free to preserve physiologic nasal tip mobility. Adjunctive cap and shield grafts, perichondrial wrapping, and dermal fat grafts were employed as indicated. Primary outcomes included nasal tip projection, postoperative tip mobility, donor-site morbidity, and surgical complication rates. Results: Favorable clinical observations of maintained tip projection were noted throughout follow-up. Manual postoperative examination suggested preservation of tip flexibility in most patients; however, no validated objective mobility assessment tool was available. The revision rate for clinically significant tip deviation was low. No major donor-site adverse events—including pneumothorax or rib fracture—were encountered. Postoperative chest wall pain was minimal and transient, with most patients resuming daily activities within one week of surgery. Conclusions: The pyramidal-shaped costal cartilage columellar strut graft with half-harvest technique is a novel, biomechanically informed, and technically reproducible approach to augmentation rhinoplasty that was developed to address donor-site morbidity and postoperative tip rigidity, two commonly recognized limitations of conventional costal cartilage rhinoplasty: donor-site morbidity and postoperative nasal tip rigidity. Preservation of the lateral cortex and perichondrium during procurement may contribute to reduced postoperative donor-site discomfort, accelerates functional recovery, and may promote endogenous cartilage regeneration over time. The anatomically derived pyramidal strut geometry, combined with floating fixation to the anterior nasal spine, was designed to approximate the native columellar architecture, enabling consistent preservation of physiologic nasal tip mobility. The present series demonstrated a favorable safety profile with a low overall complication rate and an absence of major donor-site adverse events. Prospective studies with validated objective outcome measures are required to confirm these findings, to delineate the optimal patient selection criteria, and to establish evidence-based long-term outcome benchmarks for this technique. Full article

Polework exercise is commonly used in equine training and rehabilitation; however, the influence of pole spacing on locomotor kinematics remains unclear. This study investigated the effects of pole spacing on limb, thoracolumbar and pelvic kinematics in horses walking in-hand. Eleven warmblood horses were assessed during overground walking and over five ground poles set at 85%, 100% and 105% of forelimb step length. Pole spacing did not significantly alter maximum fore- or hindlimb retraction; however, protraction–retraction range of motion (ROM) was reduced at 85% spacing. Forelimb ROM was reduced by 6.5% compared with 100% spacing and by 8.7% compared with 105% spacing, while hindlimb ROM was reduced by 2.9%. Hindlimb protraction was reduced at 85% compared with 100% and 105% spacing (p = 0.022, p = 0.034). Tarsal ROM increased over poles from NP: 38.0 ± 3.6°, poles: 62.1–64.2° (p < 0.001), irrespective of spacing. Walking over poles increased thoracic ROM at T10 from 7.9 ± 1.2° to 9.4–9.6° and at T13 from 8.7 ± 1.3° to 9.4–10.1° (p < 0.001), primarily through increased extension. Shorter spacing (85%) reduced T10 ROM compared with 100% spacing (p = 0.003). Changes in lumbar flexion were smaller, with significant effects observed only at L3 and L5, where maximal flexion increased from 9.6 ± 1.4° to 10.3 ± 1.8° and from 9.2 ± 1.5° to 9.9 ± 1.7°, respectively, at longer pole spacings (p < 0.05). These findings suggest that modest changes in pole spacing result in relatively small alterations in limb and thoracolumbar kinematics during walking. This should be considered when using polework in practice. 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: Cervical osteochondromas invading the vertebral canal are rare but may cause spinal cord compression requiring surgical resection. Conventional open laminectomy may disrupt posterior stabilizing structures and potentially increase the risk of postoperative cervical deformity. This technical note describes a contralateral-structure-preserving endoscopic technique for cervical osteochondroma resection. Methods: A 25-year-old man with multiple hereditary exostosis presented with neck pain, mild numbness, and a positive Lhermitte’s sign. Computed tomography and magnetic resonance imaging revealed a 9 × 6 × 10 mm osteochondroma originating from the base of the C3 spinous process and extending into the vertebral canal with spinal cord compression and cord signal change. Preoperative clinical assessment included a Visual Analog Scale (VAS) for neck pain of 6/10, a modified Japanese Orthopedic Association (mJOA) score of 16/18, a Neck Disability Index (NDI) of 30%, and Nurick grade 1. The lesion was treated using unilateral biportal endoscopic spine surgery through a partial unilateral laminectomy and sublaminar endoscopic corridor, aiming for en bloc resection while preserving the contralateral lamina, posterior ligamentous complex, and posterior tension band. Continuous intraoperative neurophysiological monitoring (SSEP and MEP) was used throughout the procedure. Results: The osteochondroma was completely resected en bloc using a diamond burr and Kerrison rongeur. Histopathological examination confirmed osteochondroma, and negative margins were identified without residual tumor. The patient’s symptoms resolved completely without postoperative complications, and he was discharged on postoperative day 3. At the 18-month clinical and radiological follow-up, the patient remained symptom-free, with VAS improved to 1–2/10, mJOA improved to 18/18, NDI improved to 4%, and Nurick grade improved to 0, with partial regression of the cord signal change and no evidence of tumor recurrence on follow-up imaging. Cervical lordosis was maintained at the immediate postoperative timepoint. Conclusions: Contralateral-structure-preserving endoscopic resection may represent a potential minimally invasive alternative to conventional wide laminectomy or fusion-based approaches in carefully selected cases of benign cervical osteochondroma. Larger comparative studies with long-term follow-up are required to confirm the potential biomechanical and clinical benefits of this approach. Full article