Search Results (362)

Background/Objectives: Thoracic trauma remains a leading cause of trauma-related illness and death. Despite advances in imaging, ventilation strategies, and surgical fixation, its management remains a topic of debate, with varying practices across hospitals. Current Gaps: Although surgical stabilization of rib fractures (SSRF) has shown a mortality benefit in cases of flail chest and in elderly patients, its indications for non-flail cases remain uncertain. Analgesia strategies are evolving, and epidural remains the gold standard; however, it is limited by contraindications. In contrast, regional blocks, such as the erector spinae plane block (ESPB) and serratus anterior plane block (SAPB), are emerging as safer alternatives to opioid and thoracic epidural analgesia (TEA). Artificial intelligence (AI) is transforming imaging interpretation and risk stratification; however, its integration into daily trauma care is still in its early stages of development. Perspective: This article examines the integration of surgical innovation, regional anesthesia, and AI-powered diagnostics as integral components of future thoracic trauma care. We emphasize the importance of standardized surgical criteria, multimodal pain management approaches, and AI-assisted decision-making tools. Conclusions: Thoracic trauma care is shifting toward a personalized, multidisciplinary, and technology-enhanced approach. Incorporating evidence-based SSRF, advanced pain management techniques, and AI-supported imaging can help reduce mortality, enhance recovery, and optimize resource utilization. Full article

Background/Objectives: Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft tissue sarcoma with high rates of local recurrence and distant metastasis. Primary spinal involvement is exceedingly uncommon and often misdiagnosed due to radiological and histopathological resemblance to more frequent spinal tumors. The objective of this study is to present a rare case of thoracic spinal SEF and to contextualize it within the available literature. Methods: We describe the case of a 37-year-old woman presenting with progressive back pain and dysesthesia. MRI demonstrated a heterogeneously enhancing mass at the left T10–T11 neural foramen, initially interpreted as a common nerve sheath tumor. Gross total resection (GTR) was achieved, and histopathological analysis revealed a SEF. Clinical course, adjuvant therapies, and outcomes were evaluated, together with a review of previously reported spinal SEF cases. Results: Despite GTR followed by adjuvant chemotherapy, local recurrence occurred 18 months later. The patient underwent subtotal resection (STR) with adjuvant proton therapy. At 18-month follow-up after the second procedure, she remained neurologically stable and disease-free. The literature review confirmed the rarity of spinal SEF, its frequent misdiagnosis, and the absence of standardized therapeutic protocols. Conclusions: Spinal SEF is a rare malignancy that can mimic benign spinal tumors, delaying diagnosis. Its management relies on multidisciplinary assessment, individualized therapy, and long-term follow-up. This report increases awareness of spinal SEF and provides additional evidence to support clinical decision-making in rare spinal tumors. Full article

A butterfly vertebra is an uncommon but clinically and radiologically significant pathology. The etiological factor of this pathology is a congenital defect in the formation of the vertebral body during embryogenesis, resulting in a cleft within the vertebral body that, in an X-ray, resembles the shape of a butterfly. Butterfly vertebrae are most often found in the thoracic and lumbar spine and more rarely in the sacral region. The clinical manifestations of this condition do not differ from the symptoms of other diseases, and it may also be asymptomatic. Only the recognition of its characteristic radiologic signs allows for accurate and timely diagnosis, as well as differentiation from other pathological processes such as fractures, metastases, and inflammation. In these cases, magnetic resonance imaging is the first-choice method. An important aspect in recognizing this pathology is its correlation with other congenital syndromes, even in cases of a single vertebral defect. We present 2 cases with an isolated S1 butterfly vertebra. The first is a 47-year-old male who presented to the hospital with complaints of chronic pain in the lower back and sacral region, more pronounced on the right side. The second is of a 39-year-old male who also presented to the hospital with chronic pain. All diagnostic modalities for this pathology have been used to demonstrate high-quality pictures, including X-ray, computed tomography (CT), and magnetic resonance imaging (MRI). Full article

Background and Clinical Significance: Effective postoperative pain management is crucial in patients undergoing extensive thoracoabdominal surgery, such as esophageal reconstruction, where both thoracic and abdominal incisions are involved. In such cases, a single epidural catheter may not provide sufficient analgesic coverage. Dual epidural analgesia (DEA) offers a potential solution, allowing segmental, targeted pain control while minimizing systemic opioid exposure. Case Presentation: A 64-year-old male underwent esophageal reconstruction using a combined thoracoabdominal approach. Two epidural catheters were placed at Th5/6 and Th11/12 levels. Intraoperatively, segmental bupivacaine boluses and multimodal non-opioid intravenous analgesia were administered. Postoperatively, continuous epidural bupivacaine infusion was maintained, supplemented with morphine boluses when the numeric rating scale (NRS) was ≥5. Mean NRS scores were 2 at rest and 5 on movement on postoperative day 1 (POD1); 1 and 4 on POD2; and 3 and 5 on POD3. Total epidural morphine consumption was 36 mg over 340 h, and the 24-h bupivacaine dose was 180 mg (2.77 mg/kg/24 h). No complications were observed. Conclusions: Dual epidural analgesia provided effective, opioid-sparing multimodal pain control in complex thoracoabdominal surgery. This case highlights DEA as a safe and feasible approach when single-catheter coverage is inadequate, supporting enhanced recovery and reduced opioid use after esophageal reconstruction. Full article

Background/Objectives: Malignant pleural effusion is a common and distressing complication of advanced cancer, often resulting in severe symptoms such as dyspnoea, which significantly impacts patients’ quality of life. This study evaluates the effectiveness and safety of talc slurry pleurodesis as a palliative treatment for recurrent malignant pleural effusion and examines predictive factors for pleurodesis success and survival. Methods: A single-centre cohort study was conducted at the Thoracic Surgery Department of the University Clinical Centre of Kosovo between April 2022 and March 2024. The study included adult patients with recurrent and symptomatic malignant pleural effusion who met specific inclusion criteria for performing pleurodesis. Patients were followed prospectively with routine clinical evaluations until the conclusion of the study on 9 September 2024. Descriptive and inferential statistics were employed to evaluate the success of pleurodesis and its associated outcomes. Results: The study shows a success rate of 84.6% at 30 days post-procedure, with 57.6% achieving complete success and 42.4% partial success. Talc slurry pleurodesis was associated with minimal complications, with chest pain and fever being the most common adverse effects. The most significant predictors of survival post-pleurodesis identified were the Karnofsky Performance Status score and serum neutrophil-to-lymphocyte ratio. Patients with higher Karnofsky Performance Status scores and lower neutrophil-to-lymphocyte ratios had improved survival outcomes. Conclusions: This study suggests that talc slurry pleurodesis is an effective and safe option for managing malignant pleural effusions in patients with low-performance status, offering symptom relief and potentially extending survival in certain patients. Further research is required to refine predictive models for treatment success. Full article

Aim: To evaluate the effectiveness and economic impact of early Incisional Negative Pressure Wound Therapy (iNPWT) in promoting surgical wound healing in pediatric patients undergoing abdominal and thoracic surgery. Background: Surgical wound complications, such as dehiscence and infection, are frequent in pediatric patients, especially in high-risk cases. Although iNPWT is increasingly used in surgical care, evidence supporting its efficacy in pediatric populations remains limited. Methods: This single-center, retrospective observational study analyzed 49 pediatric patients who underwent abdominal or thoracic surgery between January and December 2023. Patients received either intraoperative iNPWT (early application) or standard dressings. The outcomes assessed included time to complete wound healing, incidence of complications, pain levels, and healthcare costs. Results: Patients treated with early iNPWT showed significantly faster wound healing and fewer complications—particularly dehiscence and infections—compared to those receiving standard dressing. Pain perception did not significantly differ between groups. Although the initial costs of iNPWT were higher, overall costs were lower due to fewer complications and shorter hospital stays. Conclusions: Early iNPWT is a clinically effective and cost-efficient intervention for pediatric surgical patients at high risk of wound complications. However, limitations related to the retrospective design and small sample size suggest that prospective multicenter studies are needed to confirm these findings and support the development of standardized pediatric protocols. Full article

Acromegaly is associated with a higher risk of certain malignancies, but not hematological neoplasia, although multiple myeloma (MM) was found in very limited cases. We aim to present such a case, adding a particular presentation with co-occurrence of a plasmocytoma. A 52-year-old male with acromegaly confirmed at 46 (MRI: pituitary macroadenoma of 12 × 11 × 10 mm) underwent hypophysectomy followed by 3 years of octreotide LAR then lanreotide depot. After another 6 months, he experienced a rapidly growing, painful lump in the right lateral thoracic area confirmed by CT as a 9-cm osteolytic lesion at the third rib. Core biopsy revealed plasmocytoma of the bone and medullary biopsy confirmed MM. Plasmacytoma was managed with 10 radiotherapy sessions, with favorable outcome and mass resorption; MM was managed with a VRD regimen, followed by autologous hematopoietic stem-cell transplantation. Six months after sFLC normalization and plasmacytoma resorption, complete remission was reported. In the meantime, lanreotide was continued, with complete acromegaly control. To conclude, what started as a rather typical scenario for an otherwise rare condition, as is acromegaly in the general population (but not so rare for endocrinologists), turned into an unexpected and more severe outcome. Noting this exceptional association, we pinpoint that further research is needed for understanding the dual acromegaly–MM relationship. Full article

We present the findings of a case showing an improvement in severe, chronic mid-back pain (MBP) and disability following sagittal correction of the thoracic spine using Chiropractic BioPhysics^® (CBP^®) spinal rehabilitation with a nine-month long-term follow-up. A 40-year-old female had suffered for years and was referred for spinal rehabilitation by her physicians and physical therapist to treat her severe, chronic MBP. The symptoms had not improved despite several months of physical therapy, traditional chiropractic spinal manipulation, and pain management trigger point injections. The pain was reported as severe and rated as 8/10 at worst on the numerical rating scale. The pain was severe enough to interfere with her normal activities including martial arts training. Postural analysis revealed increased thoracic flexion and spine hyperkyphosis. Lateral thoracic radiography showed a previously undiagnosed wedged vertebral body at T6. Mensuration of the radiograph found an increase in overall posterior tangent angulation from T3–T10 measuring 66.2°. Negative sagittal balance measured from a vertical of T3 above T10 was −16.3 mm. Treatment included Chiropractic Biophysics^® (CBP^®) orthopedic rehabilitation protocols including postural and radiographic based Mirror Image^® (MI^®) exercises, spinal manipulation, and traction. The patient was treated in-office 37 times over the course of 3 months and all initial subjective and objective outcomes were re-assessed. It was reported that the initial average pain of 8/10 for the mid-back had nearly resolved and was rated as 2/10. All ADLs were reported as pain free, including intense exercise and martial arts. Post-treatment radiography was taken following a 24 h “rest-period” and found reduction in the overall hyperkyphosis from T3–T10 now measured 45.2°. Due to the presence of the wedge vertebra, it was recommended that the patient continue home traction and exercises, and long-term follow-up was assessed at 9 months including a repeat of all initial examinations, for subjective and objective outcomes. Thoracic kyphosis was maintained at 47.7° and VAS was 0/10 at 9-month follow-up and symptoms remained nearly resolved. Full article

Background/Objectives: We report a prospective series of five patients with symptomatic cervicothoracic spinal cord tethering from prior surgical interventions for acquired and congenital spinal pathologies. Each patient demonstrated incidental radiographic evidence of a low-lying conus or a fatty/thickened filum terminale (FT), suggesting concomitant symptomatic conus tethering as a potential contributor. Therefore, all underwent single-stage “tandem detethering”, consisting of microsurgical release of the cervicothoracic pathology followed by FT resection. Methods: Patients’ charts were reviewed for preoperative presentation, imaging, intraoperative findings, surgical details, FT pathology, and six-month outcomes. Results: Preoperative tethering occurred at sites of prior interventions: (i) thoracic arachnoid cyst decompression after Chiari surgery, (ii) cervical lipomyelomeningocele repair, (iii) thoracic ependymoma resection, (iv) syringosubarachnoid shunt placement, and (v) laminectomies for recurrent syrinx. Lumbar MRI demonstrated a low-lying conus in two patients and a fatty/thickened FT in four patients. Intraoperatively, all patients exhibited an abnormal FT (tight, fat-infiltrated, thickened, or dysplastic). No intraoperative complications or neuromonitoring abnormalities were observed. At six months, all patients demonstrated improvement in motor, sensory, pain, and urinary/bowel symptoms. Complications included two pseudomeningoceles requiring repair and one case of recurrent cauda tethering following FT resection. Conclusions: In patients with symptomatic cervicothoracic tethering, a concomitant low-lying conus or pathological FT may contribute to symptomatology by perpetuating biomechanical stress and, if not surgically addressed, may limit neurological recovery. This concept provides a rationale for considering tandem detethering under such circumstances. Full article

Background: Primary spinal gliomas are rare in the pediatric population. Separately, FGFR1 genomic aberrations are also uncommon in spinal cord tumors. We report a case of a previously well adolescent who presented with progressive symptoms secondary to an intramedullary tumor with unique radiological and molecular characteristics. Case Presentation: A previously well 17-year-old male presented with worsening mid-back pain associated with lower limb long-tract signs. Magnetic resonance imaging (MRI) of his neuro-axis reported a long-segment intramedullary lesion with enhancing foci and a multi-septate syrinx containing hemorrhagic components from C4 to T12. The largest enhancement focus was centered at T7. Additional MRI sequences observed no intracranial involvement or vascular anomaly. He underwent an emergent laminoplasty and excision of the thoracic lesion. Intraoperative findings demonstrated a soft, grayish intramedullary tumor associated with extensive hematomyelia that had multiple septations. Active fenestration of the latter revealed blood products in various stages of resolution. Postoperatively, the patient recovered well, with neurological improvement. Final histology reported a circumscribed low-grade glial neoplasm. Further molecular interrogation via next-generation sequencing panels showed FGFR1 p.K656E and V561M alterations. The unique features of this case are presented and discussed in corroboration with a focused literature review. Conclusions: We highlight an interesting case of an intramedullary tumor with unusual radiological and pathological findings. Emphasis is on the importance of tissue sampling in corroboration with genomic investigations to guide clinical management. Full article

Objectives: The aim of this systematic review was to evaluate the effectiveness of thoracic manual therapy with or without exercise for improving clinical outcomes (pain, disability, range of motion (ROM), quality of life (QoL) and satisfaction) in patients with subacromial pain syndrome (SPS). Methods: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) involving thoracic manual therapy with or without thoracic exercise for patients with SPS were included. Databases searched included PubMed, PEDro, Cochrane Library, and Web of Science up to April 2025. The methodological quality was evaluated with the PEDro scale. Results: Seven RCTs involving 393 patients were included. Interventions ranged from thoracic manipulation alone to combinations with exercises. Better outcomes were reported for every clinical outcome evaluated: pain, disability, ROM, QoL and satisfaction. However, methodological heterogeneity and variability in follow-up durations limited result generalizability. Conclusions: Thoracic manual therapy applied in isolation or with exercise was reported to have positive effects in reducing pain and disability in patients with SPS, especially in the short term. These findings support the inclusion of thoracic interventions as complementary strategies in shoulder rehabilitation programs. Future high-quality trials with long-term follow-up are needed to confirm and standardize these approaches. Full article

Background/Objectives: This case represents the successful treatment of cervical spine injury from high-speed rear-impact motor vehicle collision and abnormal cervical kyphosis with left arm radiculopathy, utilizing conservative spine care rehabilitation methods. This patient was treated with a multimodal treatment approach integrating a cervical spine extension traction protocol. Subject and Methods: A 50-year-old male with a history of motor vehicle collision presented with left arm radiculopathy, as well as cervical and upper thoracic spine pain. Notably the cervical spine presented with kyphotic deformity. The patient presented, after a being struck during a rear-end motor vehicle collision, with neck, upper back, and left arm radiculopathy. Prescription medication and traditional chiropractic care proved ineffective for substantive symptom and quality-of-life improvement. Treatment frequency was three times per week for eight weeks using the Chiropractic Biophysics^® protocol of mirror image (MI^®) postural exercise, spinal adjustment, and cervical spinal traction. On completion of in-office care, the patient was treated monthly, performed home care at least three times per week, and was re-examined at one year. Results: Final examination after eight weeks of care showed significant improvement in cervical lordosis (21.8 degrees), resulting in reduced cervical kyphosis. The patient completed outcome indices before, during, and 12 months after cessation of active care, all indicating improvement. Conclusions: This case report demonstrates both subjective and objective improvement in cervical spine kyphosis and attendant symptoms. The successful treatment of chronic pain, peripheral weakness, and radiculopathy with long-term follow-up using CBP care is documented as well. The treatment was designed to improve sagittal balance and reduce radiographic abnormalities evincing spinal misalignment. Administration of subjective, objective, and health-related quality-of-life outcome indices during, following, and 12 months post-treatment are suggestive of long-term efficacy of Chiropractic BioPhysics^® (CBP) treatment methods. Larger studies are needed to substantiate this given the limitations of a case report. Full article

Background: First rib stress fractures (FRSFs) are exceptionally rare in skeletally immature athletes and are frequently overlooked because their symptoms mimic more common scapular conditions such as scapular dyskinesis or thoracic outlet syndrome. Early and accurate identification is critical to avoid delayed union, prolonged disability, and misdirected management. Case Presentation: We report a 12-year-old elite baseball pitcher with progressive scapular winging and audible snapping during pitching. Unlike typical posterior-type fractures near the costotransverse joint, imaging revealed a cortical discontinuity precisely at the serratus anterior enthesis, consistent with repetitive traction enthesopathy. High-resolution musculoskeletal ultrasound (MSK-US) identified cortical disruption with periosteal edema, and dynamic ultrasound reproduced the patient’s snapping and pain in real time, establishing a direct clinical–imaging correlation. Conservative three-phase rehabilitation (scapular stabilization, serratus anterior activation, and structured return-to-throwing) led to complete union and pain-free return to sport within 12 weeks. Discussion: This case highlights the superior diagnostic efficacy of MSK-US for FRSFs in adolescents. The posterior scanning approach facilitated bilateral comparison and growth plate assessment. Dynamic examination provided a functional correlation beyond static imaging, identifying a novel snapping mechanism. This underscores the value of MSK-US in visualizing not just anatomy but also pathophysiology. Conclusions: This is among the youngest documented cases of first rib stress fracture diagnosed with dynamic ultrasound. Its novelty lies in the following: (1) occurrence at the serratus anterior enthesis, (2) reproduction of snapping during provocative maneuvers, and (3) expansion of the etiological spectrum of scapular dyskinesis to include rib pathology. Dynamic ultrasound should be considered a frontline modality for adolescent throwers with unexplained periscapular pain. Full article

Background and Objectives: Thoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control following major abdominal surgery. Bilateral rectus sheath block (RSB) is a promising alternative regional technique. This study aimed to compare the efficacy of RSB and TEA in managing early postoperative pain and enhancing recovery after open gastrectomy. Materials and Methods: Between October 2021 and December 2024, 70 patients scheduled for elective open gastrectomy were randomized into two groups: Group A (RSB with continuous bupivacaine infusion) and Group B (TEA with 10 mg bupivacaine plus 1 µg/mL fentanyl). Primary outcomes included opioid consumption within 72 h postoperatively and pain intensity measured using the visual analog scale (VAS). Statistical analysis was conducted using the Mann–Whitney U test, Friedman’s ANOVA with Bonferroni correction, and Chi-square or Fisher’s exact test for categorical variables. Results: A total of 64 patients were finally included (30 in RSB, 34 in TEA). VAS scores in the RSB group were significantly lower at 24 and 48 h postoperatively compared to baseline (p < 0.001). Between-group comparisons showed consistently lower pain scores in the RSB group at all measured time points. At 48 h, 94% of patients in the TEA group required rescue analgesia, compared to only 17% in the RSB group. Additionally, the RSB group had a significantly shorter postoperative hospital stay (mean 6 vs. 9 days) and demonstrated earlier return of bowel function. Conclusions: RSB is a safe and effective alternative to TEA for analgesia after open gastrectomy. It significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and enhances early recovery. Bilateral rectus sheath block with continuous bupivacaine infusion significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and facilitates early recovery. Full article

Background/Objectives: Back pain is increasingly prevalent during childhood and adolescence, often predicting adult spinal disorders. This study aimed to describe sex-specific anthropometric and “Postural Fitness” characteristics in school-aged children and adolescents and to introduce a standardized, field-based assessment protocol for early screening of postural and functional deficits. Methods: This cross-sectional study included a total of 494 students (8–17 years; 50% girls) from 14 schools in Murcia (Spain). Exclusion criteria included diagnosed spinal pathology or major physical injury, lack of signed informed consent, absence on the testing day, and incomplete Postural Fitness assessment. The “Postural Fitness” protocol included assessments of sagittal spinal alignment (inclinometer), hip range of motion (ROM) (inclinometer with an extendable telescopic arm), pelvic tilt (goniometer with a spirit level system), and trunk muscle endurance (chronometer). Tests were conducted in physical education sessions by trained sports scientists. Results: Significant sex-based differences were observed. Boys exhibited greater thoracic kyphosis (40.3 ± 9.6° vs. 36.7 ± 9.2°), reduced hip ROM (passive hip extension (PHE): 16.8 ± 8.1°, passive hip flexion with knee extension (PHFKE): 68.9 ± 8.6°), and more posterior pelvic tilt (104.9 ± 8.4° vs. 99.7 ± 8.1°), whereas girls demonstrated increased lumbar lordosis (35.7 ± 8.6° vs. 31.5 ± 8.5°), greater hip ROM (PHE: 18.5 ± 9°, PHFKE: 77.9 ± 13°), and superior trunk extensor endurance (123.2 ± 74.7 s vs. 106.2 ± 69.8 s). Lateral trunk muscle endurance was higher in boys (48.7 ± 31 s vs. 41.4 ± 24.9 s). Conclusions: The “Postural Fitness” protocol proved feasible in school settings and revealed key sex-based disparities in spinal and neuromuscular profiles. These findings highlight the need for individualized, sex-specific screening and preventive programs to enhance back health during growth. Implementing this protocol may support early identification of modifiable risk factors linked to spinal dysfunction and pain in youth. Full article