Search Results (327)

Objective: The objective of this study was to examine the association between baseline psychological distress, joint hypermobility, body mass index (BMI), and physical activity with Quality of Life (QoL) in adolescents with Idiopathic Scoliosis (AIS) 12 months on. Design: This is a prospective longitudinal study. Adolescents (10–18 years) with AIS were recruited. At baseline (n = 69), participants completed questionnaires covering demographics, psychological distress (Depression, Anxiety and Stress Scale, DASS-21), physical activity (International Physical Activity Questionnaire, IPAQ), and QoL (SRS-22r). Clinical assessments included joint hypermobility and BMI measurement. After 12 months, participants (n = 49) completed the SRS-22r to re-evaluate QoL. Factors associated with QoL were explored using bivariate and multiple linear regression analyses. Results: Multiple linear regression models assessing factors associated with QoL 12 months after baseline measurements explained 53.3% of variance in SRS-22 scores (p < 0.001), with an adjusted R² of 44.6%. Among baseline explanatory variables, thoracolumbar/lumbar Cobb angle contributed most significantly (β = 0.476, p < 0.05), followed by BMI (β = 0.342, p < 0.05) and DASS-Stress scores (β = −0.309, p < 0.05). Conclusions: Cobb angle, BMI, and stress emerged as important factors associated with QoL, highlighting the importance of addressing both clinical and psychosocial factors in AIS care. Full article

Background: Adjacent segment disease (ASD) after spinal fusion is well described in degenerative cohorts, but its radiographic and clinical behavior after acute traumatic thoracolumbar fracture fusion remains incompletely defined. This study evaluated whether ASD after traumatic fusion represents an imaging finding alone or a clinically relevant recovery-limiting event. Methods: This retrospective study included 98 patients who underwent posterior instrumented thoracolumbar/lumbar fusion for acute traumatic vertebral fractures. Because urgent surgery precluded meaningful preoperative disability assessment, the 1-month postoperative Oswestry Disability Index (ODI) was used as an early post-treatment functional reference point. Radiographic ASD was defined by new or progressive adjacent-level disc degeneration, disc-space narrowing, translation, angular instability, or junctional kyphosis, whereas clinical ASD was defined strictly as revision-confirmed symptomatic adjacent pathology. Results: Radiographic ASD occurred in 54 patients (55.1%), whereas revision-confirmed clinical ASD occurred in 11 patients (11.2%). Proximal and distal involvement were observed in 39.8% and 36.7% of patients, respectively. ODI improved from 42.5 ± 15.4 at 1 month to 27.0 ± 10.9 at final follow-up. Radiographic ASD alone was not associated with worse functional recovery. In contrast, revision-confirmed clinical ASD identified patients with markedly reduced ODI improvement (4.4 ± 2.8 vs. 16.9 ± 17.0; p = 0.007), and no patient with revision-confirmed clinical ASD achieved the ODI minimum clinically important difference. Conclusions: ASD after traumatic fusion should be interpreted as a clinically stratified phenomenon: frequently radiographic, but clinically relevant primarily when revision-confirmed and associated with reduced ODI-based recovery. Full article

Background: Osteoporotic vertebral compression fractures (OVCFs) are the most prevalent manifestation of osteoporotic skeletal disease, associated with severe pain, functional decline, and elevated risk of subsequent fractures. Conservative management remains the first-line approach for stable fractures, yet pain control is often suboptimal, and vertebral collapse progresses in up to 37% of patients. Bio-activated orthosilicic acid combined with vitamins D3 and K2 (BioSi-DK) may support fracture healing through complementary mechanisms acting on osteoblast differentiation, collagen synthesis, osteocalcin carboxylation, and mineralization, but its clinical efficacy in OVCFs has not previously been investigated. Methods: A retrospective, multi-center comparative cohort study was conducted in patients aged >50 years with DXA-confirmed osteoporosis and acute thoracolumbar OVCFs (AO Spine OF1-OF2) managed conservatively. Patients receiving BioSi-DK supplementation (two capsules daily for two months, then one capsule daily for four months) in addition to standard conservative treatment were compared with controls receiving conservative treatment alone. Propensity score matching (1:1, sex-exact constraint, caliper 0.3 SD) was applied across twelve pre-specified baseline covariates. The primary outcome was pain intensity at six months, assessed by numerical rating scale (NRS). Secondary outcomes included NRS change, analgesic use, Patient Global Impression of Change (PGIC), requirement for vertebral augmentation (kyphoplasty), MRI marrow edema score (MES), and Genant grade change. Results: After propensity score matching, 38 patients (19 per group) with balanced baseline characteristics were analyzed (mean age 71.2 ± 6.5 years; 89.5% female; mean T-score −2.61 ± 0.32; mean baseline NRS 8.26 ± 0.95). The BioSi-DK group achieved a significantly lower post-treatment NRS score compared with controls (2.05 ± 2.17 vs. 3.84 ± 2.83; p = 0.015; Cohen’s d = −0.71) and a significantly greater mean NRS reduction (−6.21 ± 1.90 vs. −4.42 ± 2.12 points; p = 0.005; d = −0.89). Analgesic discontinuation was more frequent in the BioSi-DK group (68.4% vs. 36.8%; p = 0.068). Kyphoplasty was required in 5.3% of BioSi-DK patients versus 21.1% of controls (p = 0.340; OR = 0.21), and vertebral compression grade remained stable in 100% of supplemented patients versus 84% of controls. At two months, MES improvement by at least one category was more frequently observed in the BioSi-DK group than in controls, suggesting an earlier edema resolution effect; at six months, MES distribution was comparable between groups (p = 0.620). Conclusions: BioSi-DK supplementation as an adjunct to conservative management was associated with a statistically significant and clinically large reduction in pain at six months, with favorable trends in analgesic burden, kyphoplasty requirement, and edema resolution. The safety profile was excellent. These findings support the conduct of prospective, randomized, placebo-controlled trials to confirm BioSi-DK as an effective adjunct therapy for OVCFs. Full article

Antimicrobial resistance (AMR) is a global threat to both human and animal health. Carbapenems are last-resort antimicrobials used to treat severe infections with multidrug-resistant Gram-negative nosocomial pathogens in humans. Therefore, the dissemination of carbapenemase-producing Enterobacterales (CPE) has emerged as a major concern worldwide. Although carbapenems are not routinely used in veterinary medicine, CPE, including OXA-48-like-producing Escherichia coli, are increasingly being reported in companion animals. We document the first report of E. coli-harbouring bla_OXA-484 isolated from a urine sample from a dog with a history of chronic thoracolumbar myelopathy. Using a combined Oxford Nanopore (ONT) long-reads and Illumina short-reads sequencing approach, the isolate was characterized and an IncF plasmid containing bla_OXA-484 was reconstructed. The isolate belonged to sequence type (ST)167, which is an emerging high-risk clone frequently reported among human clinical isolates. The bla_OXA-484 gene was harboured in a composite transposon bracketed by IS26 identical to that of bla_OXA-484 carried on an IncX plasmid pOXA-484-JS316 from a human clinical E. coli ST410 from Germany. The isolation of the epidemic clone ST167 harbouring bla_OXA-484 from a canine infection raises the hypothesis of a transmission event between humans and companion animals. Full article

Background: Arthrogryposis consists of a heterogeneous group of congenital disorders characterized by multiple joint contractures. Distal arthrogryposes (DAs) are often caused by pathogenic variants in fast-twitch muscle protein genes, including MYH3, nosologically linked to DA2A and DA2B. Methods: We evaluated two siblings with features suggestive of arthrogryposis through detailed clinical examination, radiographic imaging, audiological assessment, and targeted next-generation sequencing (NGS) for skeletal dysplasias and an arthrogryposis panel, including MYH3. Variants were confirmed by Sanger sequencing, and segregation analysis was performed in available relatives. Results: Both patients harbored three heterozygous MYH3 variants: two maternally inherited in cis (c.749G>A and c.787G>T) and one paternally inherited in trans (c.4130_4138del), currently classified as variants of uncertain significance (VUS) and likely pathogenic, respectively. The female patient presented with a short neck, hand contractures, cubitus valgus, a widened internipple distance, and severe thoracolumbar scoliosis. The male sibling showed craniofacial dysmorphisms, more extensive musculoskeletal anomalies, and moderate-to-severe sensorineural hearing loss. The segregation analysis suggests an MYH3 autosomal recessive inheritance pattern. Conclusions: This report broadens the phenotypic spectrum of MYH3-related disorders, suggesting potential involvement in atypical DA phenotypes resembling DA4 (scoliosis) and DA6 (hearing loss), for which causative genes remain unknown. Comprehensive molecular testing and segregation analysis are essential to clarify genotype–phenotype correlations in congenital contracture syndromes. Full article

Background/Objectives: Ankylosing Spinal Disorders (ASDs) encompass a heterogeneous group of rheumatic diseases characterized by progressive ankylosis of the axial skeleton, including Ankylosing Spondylitis (AS), Diffuse Idiopathic Skeletal Hyperostosis (DISH), and Non-Radiographic Axial Spondyloarthritis (nr-AxSpA). Spinal ankylosis profoundly alters the biomechanical properties of the vertebral column, transforming it into a rigid long-bone equivalent and dramatically increasing fracture risk even after low-energy trauma. Once a fracture occurs, the long lever arm created by the ankylosed segments generates enormous mechanical stress at the fracture site, making surgical stabilization mandatory in the vast majority of cases. Long posterior instrumentation is the treatment of choice; however, no consensus exists regarding the optimal number of instrumented levels. The aim of this study is to clinically and radiologically evaluate long posterior instrumentation in the 3 + 3 (3 proximal and 3 caudal screws), 3 + 2 (3 proximal and 2 caudal screws), or 2 + 2 (2 proximal and 2 caudal screws) configuration for the treatment of traumatic ASD thoracolumbar vertebral fractures, in terms of implant failure, infection rate, and mortality. Methods: Between 2018 and 2023, 65 consecutive patients with ASD-related thoracolumbar vertebral fractures were treated at our institution. After applying pre-defined inclusion and exclusion criteria, 37 patients were enrolled. Patients were retrospectively divided into three groups according to the posterior arthrodesis configuration (notation indicates number of instrumented vertebral levels proximal + distal to the fracture: 3 + 3, 3 + 2, or 2 + 2). Radiological outcomes were assessed for loosening, screw cut-out, and implant breakage. Infection and mortality rates within 3 months from surgery were evaluated as secondary endpoints. Statistical analysis was performed using the Fisher exact test (significance set at p < 0.05). Results: Thirty-seven patients (28 males and 9 females; mean age 77 ± 7.3 years) were included, with a mean follow-up of 30 ± 5.3 months. Instrumentation configurations were as follows: 23 (3 + 3), 5 (3 + 2), and 9 (2 + 2). Three implant failures (8.1%) and four infections (10.8%) were recorded. Eleven patients died within 3 months of surgery. A statistically significant difference was found between instrumentation length and mechanical complications (p = 0.0468), while no significant difference was observed for infection (p = 1) or mortality rate (p = 0.137). Conclusions: In this exploratory retrospective cohort, the 3 + 3 configuration was associated with the lowest observed rate of implant failure in ASD thoracolumbar fractures, suggesting a potential mechanical advantage over shorter constructs that warrants confirmation in larger prospective studies. No significant correlation was found between instrumentation length and infection rate or early mortality. Prospective, multicentre studies with larger cohorts are warranted to establish definitive guidelines for instrumentation length in this challenging patient population. Full article

Background: Myelomeningocele (MMC) is a severe neural tube defect resulting from primary neurulation failure. Despite advanced multidisciplinary paradigms, long-term morbidity remains substantial. Population-based longitudinal data from small European cohorts are scarce. This study evaluates long-term clinical and functional outcomes within a complete national cohort in Slovenia. Methods: A retrospective cohort study was conducted on all children born with MMC in Slovenia between 2007 and 2023. Patients were managed via a centralized, standardized multidisciplinary program. Phenotypic severity was stratified by anatomical lesion levels, and outcomes were assessed using standardized functional measures. Results: Over an 18-year period, 32 children were treated (prevalence: ~1 per 10,000 live births; mean follow-up: 13.2 years). All underwent anatomical closure within 24 h of birth. Hydrocephalus developed in 71.8% (n = 23), with 65.6% requiring ventriculoperitoneal shunting. Independent ambulation was achieved by 28.1%, while 46.8% were wheelchair-dependent and paraplegic. Neurogenic bladder dysfunction occurred in 87.5%. Subgroup analysis demonstrated that thoracolumbar lesions were significantly associated with lower ambulation rates and higher shunt dependency compared to lumbosacral lesions (p < 0.05). Long-term survival was 96.9%. Conclusions: This study represents the first comprehensive national analysis of myelomeningocele outcomes in Slovenia. Despite the relatively small number of patients, complete national coverage and centralized multidisciplinary management provide a unique overview of long-term outcomes. The findings demonstrate that outcomes achieved within the Slovenian healthcare system are comparable to those reported internationally, thereby establishing an important national benchmark for future evaluation of preventive measures and evolving treatment strategies. Full article

Background: The aim of the present retrospective observational study is to compare the required doses of propofol (PPF) for anaesthesia induction in dogs presented with intervertebral disc disease (IVDD)-related thoracolumbar or cervical myelopathy. Methods: The anaesthetic records of dogs with either cervical- or thoracolumbar-related myelopathy anaesthetised for diagnostic or surgical procedures from September 2021 to July 2023 were evaluated. Inclusion criteria were premedication with the same dose of dexmedetomidine (DEX) (180 μg m⁻²), and induction with PPF. The sedation score (SS), Glasgow Composite Measure Pain Scale-Short Form (GCMPS-SF) results and the total PPF dose required for intubation were collected. Data were analysed with the Shapiro–Wilk test, independent samples t-test and Spearman’s rho test. A value of p < 0.05 was considered statistically significant. Results: Fifty-five records were included in the study, 27 dogs with cervical and 28 with thoracolumbar myelopathy due to IVDD. Statistically significant higher doses of PPF were required in the dogs with cervical (mean 3.2 mg kg⁻¹, ±SD 1.25 mg kg⁻¹) than with thoracolumbar (mean 1.9 mg kg⁻¹, ±SD 0.65 mg kg⁻¹) myelopathy (t-test, p < 0.001). The SS in the dogs with cervical–cervicothoracic myelopathy (CCTM) (median 6, ±min 2 max 10) also differed from the SS of the dogs with thoracolumbar myelopathy (TLM) (median 7.5, min 2 max 12) (t-test, p = 0.02). Sedation score and the dose of PPF were significantly negatively correlated (Spearman’s rho −0.311, p = 0.021). Sedation score and GCMPS-SF were also significantly negatively correlated (Spearman’s rho −0.363, p = 0.007). However, no statistically significant negative correlation was found between PPF dose and GCMPS-SF score (Spearman’s rho = 0.248, p = 0.068). Conclusions: Our findings should be considered when planning anaesthetic protocols in patients suffering from IVVD-related myelopathy in order to optimize safety in these patients. 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: There is no consensus on whether it is possible to preserve implant retention during deep surgical site infections (SSIs), and there is no widely accepted treatment protocol to date for these patients. The aim of this study is to evaluate the efficacy of the debridement, antibiotics, and implant retention (DAIR) protocol in patients who were treated for degenerative thoracolumbar spinal disorder using spinal instrumentation. Methods: This retrospective study describes the 24-month outcomes of deep SSI that developed in 25 of 720 patients (3.5%) who underwent surgery for thoracolumbar degenerative spinal disorders (disc disease, spinal stenosis, and scoliosis) and were treated according to the DAIR protocol. Results: Of these 25 patients, 18 developed early infection (<1 month), 3 developed delayed infection (1–3 months), and 4 developed late-onset deep infection (>3 months). Staphylococcus aureus was isolated in 56% of the patients. The DAIR protocol was successful in 22 (88%) of the patients, while it failed in 3 (12%). Surgical implants were removed in 25% of patients with late-onset SSI, and only 11.1% with early onset and 0% with delayed SSI. All patients who failed DAIR were smokers. A significant association was found between the Charlson Comorbidity Index and the number of surgical interventions (p = 0.022). Conclusions: In this small retrospective cohort, the DAIR protocol appeared to be a feasible treatment option for deep SSI, particularly in early infections. Implant removal may be considered when infection persists after repeat DAIR or when implant loosening is observed. Full article

Thoracolumbar stump ribs are one of the essential indicators of thoracolumbar transitional vertebrae or enumeration anomalies. While some studies manually assess these anomalies and describe the ribs qualitatively, this study aims to automate thoracolumbar stump rib detection and analyze their morphology quantitatively. To this end, we train a high-resolution deep learning model for rib segmentation using nnUNet and achieve significant improvements over existing models (Dice score 0.997 vs. 0.779, p-value < 0.01). In addition, we employ a novel iterative algorithm and piecewise linear interpolation to estimate rib length, achieving a success rate of 98.2%. When analyzing morphological features, we show that stump ribs articulate more posteriorly at the vertebrae ($-19.2\pm 3.8$ vs. $-13.8\pm 2.5$ mm, p-value < 0.01), are thinner ($260.6\pm 103.4$ vs. $563.6\pm 127.1$${\mathrm{mm}}^2$, p-value < 0.01), and are oriented more downwards and sideways within the first centimeters in contrast to full-length ribs. We show that with partially visible ribs, these features can achieve an F1-score of 0.84 and an AUC of 0.98 in differentiating stump ribs from regular ones. We publish the model weights and masks for public use. 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

(1) Background: Intervertebral Disc Disease (IVDD) represents one of the most frequently encountered neurological disorders in canine patients and often necessitates surgical decompression by means of hemilaminectomy. Objective methods for evaluating postoperative inflammatory response and tissue healing remain limited. This study aimed to evaluate temporal changes in local cutaneous temperature and thermal patterns in dogs undergoing hemilaminectomy for thoracolumbar intervertebral disc extrusion using Infrared Thermography; (2) Methods: Fifteen dogs diagnosed with Hansen type I thoracolumbar intervertebral disc extrusion were included. Diagnosis was established through neurological examination and computed tomography. Thermographic assessment of the thoracolumbar region (T11–L3) was performed preoperatively (Day 0), 24 h postoperatively (Day 1), and 7 days after surgery (Day 7) using an FLIR E50 thermal camera. Mean cutaneous temperature and thermal distribution patterns were analyzed. Statistical evaluation was performed using Repeated Measures ANOVA and the Friedman test; (3) Results: Significant temporal differences in local cutaneous temperature were identified between the evaluated time points (p < 0.001). Thermographic assessment demonstrated progressive modifications in thermal distribution throughout the postoperative period. No postoperative complications, including seroma formation, wound dehiscence, or fistula development, were observed; (4) Conclusions: Infrared thermography enabled identification of significant postoperative thermal changes following hemilaminectomy and may represent a useful complementary non-invasive method for postoperative monitoring of tissue healing in dogs. 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

Spinal arachnoid diverticulum is a fluid-filled dilation within the subarachnoid space that can result in compressive myelopathy, prompting investigation into optimal surgical management and outcomes. This retrospective study reviewed clinical records of dogs treated surgically between January 2021 and July 2025, including 11 cases that met the criteria of chronic progressive para- or tetraparesis, MRI-confirmed diagnosis, and use of a standardized surgical technique. All dogs underwent dorsal laminectomy followed by durotomy, durectomy, and microsurgical dissection of adhesions performed by the same surgeon, with optical magnification and specialized instruments to ensure consistency. The condition was more common in males, with French Bulldogs overrepresented (n = 6); lesions were thoracolumbar in small breeds and cervical in the single large-breed dog. Short-term outcomes, assessed one month postoperatively, showed neurological improvement in all but one dog. These findings suggest that the described microsurgical approach is feasible and associated with favorable short-term neurological recovery in most cases. However, the absence of long-term follow-up limits definitive conclusions, and further studies are needed to evaluate sustained outcomes. Full article