In 4059 postmenopausal women, spine-hip discordance was common (41.3%) and associated with heterogeneous fracture risk. Hip-only screening missed 680 vertebral fractures. Major hip-lower discordance showed the highest fracture burden. Each 1-SD increase in T-score offset independently increased hip fracture odds by 28%. To evaluate the prevalence and clinical significance of spine-hip T-score discordance in a large cohort of postmenopausal Asian women and to determine whether a standardized discordance metric provides incremental fracture risk information beyond hip bone mineral density (BMD) alone. We conducted a retrospective cross-sectional study of 4059 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) at a tertiary referral hospital. Participants were classified according to spine-hip diagnostic concordance as concordant, minor discordance (a one-category difference, spine lower or hip lower), or major discordance (a two-category difference, spine lower or hip lower). Three osteoporosis classification strategies (hip-only, spine-only, and combined dual-site DXA) were compared for detection of prevalent fractures. Multivariable logistic regression models were used to evaluate whether the T-score offset (lumbar spine T-score minus hip T-score) provided incremental predictive information beyond hip BMD. Diagnostic discordance was present in 41.3% of participants, including 39.1% with minor discordance and 2.2% with major discordance. The spine-lower pattern was approximately twice as common as the hip-lower pattern (25.7% vs. 13.4%). Women with major discordance (hip lower) demonstrated the highest prevalence of vertebral fracture (60.0%) and hip fracture (28.6%), exceeding rates observed in the concordant osteoporosis group (53.0% and 16.6%, respectively). Hip-only classification missed 680 prevalent vertebral fractures and showed a sensitivity of 45.1%. For hip fracture detection, hip-only screening demonstrated the highest overall discrimination (AUC 0.701), whereas combined dual-site classification provided the greatest sensitivity (73.0%). Consistent with recent evidence that hip BMD is the dominant densitometric predictor of hip fracture, hip BMD remained the strongest single predictor in our cohort. Importantly, after adjustment for age, body mass index, and hip BMD, each 1-standard deviation increase in T-score offset was independently associated with a 28% higher odds of hip fracture (adjusted OR 1.28; 95% CI 1.09-1.51; P = 0.003), indicating statistically significant incremental predictive information beyond absolute hip BMD alone. Spine-hip T-score discordance was common in this clinical DXA cohort and was associated with clinically meaningful heterogeneity in fracture burden. Major discordance (hip lower) identified a high-risk phenotype that may be obscured by relatively preserved lumbar spine BMD. Although hip BMD remained the strongest single predictor of hip fracture, the standardized T-score offset may provide complementary information regarding skeletal heterogeneity, although prospective validation is required.
To examine sociodemographic, clinical, and healthcare-related factors associated with preoperative health-related quality of life (HRQoL) among patients undergoing surgery for degenerative lumbar spine conditions in a multi-ethnic Asian population. This cross-sectional study used baseline data from the Spine PROM Surgery Registry, including 1194 patients scheduled for surgery within a Singapore healthcare cluster between 2017 and 2022. HRQoL was measured using the EQ-5D-3L, with utility scores crosswalked to the EQ-5D-5L index using the van Hout crosswalk. Hierarchical linear regression assessed factors associated with HRQoL across three blocks: sociodemographic, clinical, and healthcare/lifestyle. Multivariable logistic regression identified factors associated with reporting problems within each EQ-5D dimension. Mean age was 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities problems (84.3%) were most commonly reported. Lower EQ-5D scores were independently associated with non-outpatient presentation (β = -0.37), non-Chinese ethnicity (e.g., Malay: β = -0.10), secondary education (β = -0.15), and accident/trauma history (β = -0.11). Dimension-level analyses showed secondary education was associated with higher odds of problems in mobility (OR = 2.72), self-care (OR = 1.87), usual activities (OR = 1.80), and anxiety/depression (OR = 1.97). Non-outpatient presentation was associated with markedly higher odds of self-care problems (OR = 2.98). Patients awaiting lumbar spine surgery appear to have impaired preoperative HRQoL. Although the modest explained variance limits robust risk prediction, preoperative profiles may still help inform clinical discussions and shared decision-making. Non-outpatient presentation may help identify patients who could benefit from enhanced preoperative support, although this requires prospective validation. Differences by ethnicity and education suggest opportunities for culturally tailored counselling. EQ-5D dimension profiles may indicate targets for prehabilitation and provide Singapore-based benchmark data for a lumbar spine surgery cohort for patient-centred care, service benchmarking, and health technology assessment. Low back pain is a common reason why people lose the ability to work, move, and take part in daily life. Many patients with long-lasting back problems eventually need surgery, but their quality of life before surgery can vary widely. Understanding how patients feel and function before surgery is important for planning care, setting expectations, and deciding who may need extra support. This study looked at how good or poor quality of life is in patients waiting for surgery for degenerative lumbar spine conditions, and which personal, social, and clinical factors are linked to worse quality of life. We studied over 1100 patients in Singapore using a standard health questionnaire that measures mobility, self-care, daily activities, pain, and mental wellbeing. This allowed us to examine both overall quality of life and specific problem areas. We found that patients had substantial problems before surgery, especially with pain and daily activities. Quality of life did not differ by diagnosis, but was worse in patients who entered care through emergency or inpatient routes, and in some ethnic and educational groups. These findings suggest that identifying patients with poorer preoperative quality of life may help clinicians tailor support and plan care before surgery.
Usually, complete burst fractures of the thoracolumbar spine responsible for neurological deficit are managed with posterior open long-segment fixation, laminectomy, and second-stage anterior corpectomy. Although SpineJack expansion kyphoplasty allows for one-stage posterior-only restoration of the anterior and middle columns of the spine, to date, it has not been employed for complete burst fracture with neurological deficit. Review of all cases of AO Spine A4 thoracolumbar complete burst fractures with neurological deficit treated by a single senior spine surgeon at Sainte-Anne Military Teaching Hospital using the same surgical procedure-SpineJack expansion kyphoplasty, posterior pedicle screw fixation, and posterior decompression-between November 2023 and October 2025. There were five patients with a mean age of 42.6 ± 16.8 years. Levels involved were T12, L1, L2, and L3 (patients 1-4), and combined L2L3 in a last severe trauma case (patient 5). Neurological deficit was classified as American Spinal Injury Association (ASIA) C in four cases, and ASIA B in patient 5. Mean preoperative loss of vertebral body height was 54 ± 10.3% and regional kyphosis 22.8 ± 4.4 degrees. Mean postoperative length of stay was 16.2 ± 24.6 days, and 5.3 ± 2.5 days excluding patient 5. Patients 1 to 4 returned to work after a mean delay of 3.3 ± 0.5 months. At the 1-year follow-up, the mean visual analog scale score was 2.8 ± 0.5, the mean Oswestry Disability Index was 7.6 ± 5.2, the mean segmental kyphosis was 4.2 ± 6.9 degrees, and the mean loss of vertebral body height was 11.2 ± 8.9%. SpineJack expansion kyphoplasty combined with short-segment monoaxial pedicle screw fixation and laminectomy is a possible one-stage surgical treatment option for complete burst fracture of the thoracolumbar spine with neurological deficit.
Retrospective cohort study. This study aimed to evaluate the extent of racial and ethnic disparities in perioperative outcomes after posterior cervical spine surgeries. Although racial disparities have been studied in the context of anterior cervical spine surgery, limited literature exists on outcomes after posterior cervical spine procedures. Using 2006-2023 National Surgical Quality Improvement Program database, we conducted a study of patients who underwent posterior cervical fusion or cervical laminoplasty. Patients were stratified by race [White, Black or African American (B/AA), Asian, Native Hawaiian or Pacific Islander (NH/PI), American Indian or Alaska Native (AI/AN)] and Hispanic ethnicity. The primary outcome was the incidence of postoperative complications within 30 days. Secondary outcomes included hospital length of stay and discharge disposition. A total of 19,994 patients were included in the study. The majority were White (n=14,276, 71.3%), followed by B/AA (n=3473, 17.4%), Asian (n=822, 4.1%), AI/AN (n=218, 1.1%), NH/PI (n=114, 0.6%), and Hispanic (n=1091, 5.5%). After adjusting for covariates, B/AA race was independently correlated with higher risk of experiencing at least one major complication (OR: 1.264, P=0.005), a medical complication (OR: 1.234, P=0.007), cardiac arrest (OR: 2.631, P=0.001), pulmonary embolism (OR: 1.88, P=0.001), extended hospital stay (OR: 1.921, P<0.001), and non-home discharge (OR: 1.801, P<0.001). NH/PI race was independently correlated with higher odds of prolonged hospitalization (OR: 2.396, P<0.001), as was Hispanic ethnicity (OR: 1.309, P=0.001). Racial and ethnic minority patients were significantly more likely to experience unfavorable outcomes within 30 days after posterior cervical spine surgery, underscoring the need for interdisciplinary approaches to address inequities in surgical care. Level III.
Asian rhinoplasty frequently requires robust structural support to counteract a thick skin envelope. However, relying solely on septal cartilage often leads to graft depletion after preserving a safety L-strut. This study quantifies the volumetric sufficiency of the composite bony-cartilaginous unit to address this limitation while ensuring skull base safety. A retrospective computed tomography analysis was performed on 116 Asian adults (60 men, 56 women). A standardized harvest template was virtually executed, assuming the preservation of a 10-mm L-strut. Total septal area, harvestable cartilage, and the composite bony-cartilaginous unit (cartilage, perpendicular plate of the ethmoid, and vomer) were quantified using defined anatomical landmarks. The harvestable septal cartilage averaged 461.5 mm2, which was significantly smaller in women than in men (p < 0.001). Expanding the harvest to include the bony septum yielded a composite area of 992.0 mm2, representing a 2.21-fold increase in graft availability. Radiographic analysis established critical safety landmarks: the mean skull base angle was 123.6°, the distance from the anterior nasal spine to the cribriform plate was 48.9 mm, and the distance to the anterior sphenoid wall was 54.3 mm. Septal cartilage is an inherently scarce resource in Asian rhinoplasty, particularly in females. Harvesting the septum as a bony-cartilaginous unit safely and reliably doubles the graft supply. With precise osteotomy trajectories, this composite graft eliminates the need for distant donor site morbidity, serving as an optimal local reserve. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Osteochondromas (OCs) are the most common benign bone tumors, but rarely arise in the lumbar spine. Due to their infrequency, understanding of their clinical presentation, management, and outcomes is limited, with most available data derived from case reports and small series. This systematic review aims to synthesize the literature on nonsyndromic lumbar spine OCs and to present an illustrative institutional case. A systematic search was conducted in PubMed, Embase, Web of Science, and Scopus from database inception to April 2024, following PRISMA 2020 guidelines. Studies reporting clinical cases or series of nonsyndromic lumbar spine OCs with sufficient details on presentation, tumor characteristics, management, and outcomes were included. The risk of bias was evaluated using the Joanna Briggs Institute tools for case reports and case series. Data extraction encompassed demographics, clinical characteristics, tumor features, operative management, and postoperative outcomes. A total of 39 studies encompassing 56 patients were included. The mean age was 42 years; 59% were male. Most lesions originated from the inferior articular process (43%) and commonly affected L4 and L5. The mean lesion size was 29.7 ± 22.2 mm, with significantly smaller lesions in patients with radiculopathy than those with low back pain or palpable mass ( p  = 0.00034). Radiculopathy (50%) and low back pain (25%) were the most frequent presentations ( p  < 0.001). The majority (80%) underwent posterior surgical excision without instrumentation, with en bloc resection performed in 78.5%. Complete symptomatic improvement was observed in 94% of patients, and recurrence was rare. Lumbar spine OCs most frequently arise from the inferior articular process and often produce radiculopathy due to intracanalicular growth. Surgical excision-especially en bloc resection-yields excellent outcomes and a low recurrence rate. Conservative treatment may be considered in selected asymptomatic patients. Early recognition and individualized management are essential for optimal outcomes.
To evaluate the patient-reported outcome measures (PROMs) of hip arthroscopy (HA) in patients with concomitant low back pain and lumbar spine pathology (LSP) compared with those without back concerns at a minimum of 5 year follow-up and determine the prevalence of low back pain (LBP) and LSP in Asian patients with femoroacetabular impingement syndrome (FAIS). Patients with FAIS, who underwent primary HA for FAIS with labral repair by a single surgeon between July 2017 and October 2019 with minimum 5-year follow-up, were identified. Patients were placed into 3 groups based on presence of preoperative LBP and LSP. These groups included: group LBP (with LBP), group Both (with LBP and LSP), and group None (neither diagnosis). The presence of concomitant LSP was identified using preoperative imaging with a pathologic lumbar spine diagnosis. All patients included in the study were asked to complete the Harris Hip Score (HHS) and Visual Analog Scale (VAS). All patients enrolled in the study were asked to fill out this survey preoperatively, at 3 months postoperatively, and latest follow-up. Satisfaction ratings were collected. Patient-reported outcomes (PROs) were compared between groups, postoperative with preoperative, along with revision arthroscopy, and conversion to total hip arthroplasty (THA). The groups were similar in age (46.2 ± 14.4 years, 46.0 ± 15.5 vs 43.9 ± 13.8, P = .16), sex (55.4% female, 58.2% vs 55.4%,P = .91), and body mass index (23.4 ± 2.2 kg/m2, 23.6 ± 2.5 vs 23.1 ± 2.2, P = .93). Comparing HHS and VAS between groups, no significant differences were observed preoperatively and at 5-year follow-up (P ≥ 0.057). Postoperative PROs significantly improved compared with preoperative PROs in all groups at 5-year follow-up (P < .0001). The LBP, Both, and None groups showed comparable rates of any patient acceptable symptomatic state (PASS) (89.1%, 88.1% vs 90.1%, P = .86) at 5-year follow-up. No significant differences in the rates of revision or THA conversion were identified between groups (P = .45). The prevalence of LBP and LSP was 28.9% and 11.5% in the cohort, respectively. The patients with LBP and/or LSP undergoing HA achieved comparable PROs, achievement of PASS, and reoperation-free survivorship to patients with isolated FAIS at minimum 5-year follow-up. The prevalence of LBP and LSP was 28.9% and 11.5% in Asian patients with FAIS, respectively. Level III, retrospective therapeutic comparative case series.
Never-smoker non-small cell lung cancer (NSCLC) represents a distinct molecular subtype enriched for actionable driver mutations, including ERBB2 (HER2) exon 20 insertions, which occur in approximately 2-4% of cases and are more common in women and individuals of Asian ancestry. We report a 75-year-old never-smoking, asymptomatic Asian-American woman with incidentally discovered stage IV (cT1cN0M1a) lung adenocarcinoma. Imaging demonstrated innumerable bilateral solid, part-solid, ground-glass, and cavitary pulmonary nodules, with the largest measuring 29 × 25 mm, without nodal or distant metastases. Lung biopsy confirmed TTF-1 and Napsin A-positive adenocarcinoma, and genomic profiling identified an ERBB2 (HER2) exon 20 insertion mutation (p.A775_G776insYVMA; VAF 3.9%). She enrolled in a clinical trial of the selective HER2 tyrosine kinase inhibitor zongertinib (60 mg twice daily) in February 2025 and tolerated therapy well, with mild diarrhea, lactose intolerance, brittle nails, and intermittent muscle cramps. Serial imaging demonstrated an early partial response by RECIST 1.1 at six weeks, followed by sustained radiographic stability with cavitary changes consistent with treatment effect. As of January 2026, she has maintained lung-confined disease control for over 11 months without extrapulmonary progression and remains fully functional without symptoms. This case highlights the clinical benefit and tolerability of selective HER2-targeted therapy in HER2-mutant NSCLC and adds to emerging evidence supporting consideration of risk-based lung cancer screening strategies in high-risk never-smoking populations.
Neurenteric cysts are rare, benign congenital lesions of endodermal origin that primarily affect the spinal cord. Their clinical and radiological presentations can vary significantly, especially in pediatric patients, complicating diagnosis and management. We report two pediatric cases of spinal neurenteric cysts and review the relevant literature. An 11-month-old infant presented with progressive lower limb weakness. Magnetic resonance imaging (MRI) revealed a nonenhancing intradural cystic lesion at the thoracic level. A 14-year-old female reported neck pain and upper limb paresthesia; cervical spine MRI showed a well-demarcated T2-hyperintense cystic lesion. Both patients underwent complete surgical excision. Histopathology confirmed neurenteric cysts, showing pseudostratified or columnar epithelium with interspersed goblet cells. Postoperative recovery was uneventful, with no recurrence at 6-month and 1-year follow-up, respectively. These cases underscore the variability in presentation and spinal level involvement of neurenteric cysts in children. MRI plays a central role in preoperative assessment, though definitive diagnosis relies on histopathology. Complete surgical excision remains the treatment of choice, offering favorable outcomes with low recurrence risk. The age extremes and differing anatomical locations in our cases reflect the broad clinical spectrum seen in pediatric patients. Spinal neurenteric cysts should be considered in children with unexplained spinal cord-related symptoms. Early imaging, accurate histological diagnosis, and total surgical excision are critical for optimal outcomes. Increased clinical awareness and case reporting will aid in improving recognition and management of this rare spinal lesion.
Background/Objectives: Proton pump inhibitors (PPIs) are widely used for the treatment of acid-related disorders. However, there are concerns that PPI use may be associated with an increased risk of osteoporosis and fractures. This study aimed to investigate the association between PPI use and the risk of osteoporosis and fractures using national data. Methods: Two nested case-control studies using Korean National Health Insurance Service-Health Screening Cohort (514,866 participants, 2002-2019). Study I: 68,719 osteoporosis patients matched 1:1 with 68,719 controls by age, sex, income, region. Study II: 72,456 fracture patients matched 1:1 with 72,456 controls, stratified by fracture site (distal radius [n = 25,882], hip [n = 7753], spine [n = 38,821]). PPI use defined as prescription 1-year preceding index date: current users (≤30 days) and exposed group (31-365 days). Associations were analyzed using propensity score overlap-weighted logistic regression. Results: For osteoporosis, current PPI use showed odds ratio (OR) = 37.4 (95% confidence interval [CI] 33.3-42.1, p < 0.001); exposed group OR = 2.62 (95% CI 2.32-2.96, p < 0.001). Duration-dependent relationship observed: <30 days OR = 8.67, 30-180 days OR = 29.9, ≥180 days OR = 25.0. For fractures, current use associated with distal radius (OR = 37.4, 95% CI 28.8-48.7), hip (OR = 20.3, 95% CI 13.7-30.3), and spine (OR = 29.8, 95% CI 23.7-37.4). However, the exposed group showed no significant associations (distal radius OR = 1.24 p = 0.125; hip OR = 1.34 p = 0.174; spine OR = 1.26 p = 0.057). Conclusions: Current PPI use is strongly associated with increased odds of osteoporosis and fracture in the Asian population, with prominent duration-response relationship. Past PPI exposure showed no significant fracture risk. Healthcare providers should carefully assess bone health risks and consider lowest effective PPI doses.
The cervical spine is a complex, dynamic structure characterized by an expansive range of motion and biological priority for maintaining horizontal gaze. Unlike the rigid thoracolumbar segments, the cervical spine often develops compensatory hyperlordosis in response to global sagittal malalignment. However, aggressive surgical correction of the thoracolumbar axis can paradoxically reduce this compensation, potentially inducing iatrogenic kyphosis. This review synthesizes these dynamics through a "top-down driver" framework, shifting away from traditional pelvic-centric models. By analyzing longitudinal data from asymptomatic Asian cohorts and surgical registries, we evaluated the interplay between C2 slope, T1 slope (T1S), T1S cervical lordosis (T1S-CL), chin brow vertical angle, and integrated measures, such as the cervical-thoracolumbar pelvic angle (CTPA) and TPA. To restore economic balance, the surgeon must move beyond segmental correction and manage the integrated hierarchy of the spinal axis. Master regulators (C2 slope and T1S) dictate the primary axis, whereas secondary responders (T1S-CL mismatch and CTPA) represent the "biomechanical tax" paid by the body. Ultimately, recognizing the cervical spine as the "top-down driver" is essential for successful deformity management. Utilizing the proposed five-step clinical algorithm could allow surgeons to prioritize master regulators, such as C2 slope and T1S-CL mismatch, ensuring more physiologically harmonious global restoration.
Ossification of the ligamentum flavum (OLF) is a well-recognised cause of thoracic myelopathy in East Asian countries like Japan and China. T10 and T11 are the most frequently involved segments in the thoracic spine. Initial clinical features are numbness in lower limbs, loss of vibration, and proprioception, as severity increases spastic paraparesis ensues. In this study, the authors retrospectively analysed the clinical outcomes after decompressive laminectomy for thoracic myelopathy due to OLF at the thoracic spine. This was a retrospective study conducted in the Department of Orthopaedics, in the author's tertiary institute, using medical records from January 2020 to May 2023, after obtaining informed consent from patients and institutional ethics committee approval. Fourteen cases diagnosed with thoracic myelopathy meeting the inclusion criteria and underwent decompressive laminectomy, with at least one year of follow-up, were considered in the study. Demographic data, detailed history of patient's symptoms and duration of symptoms, preoperative and postoperative neurological status, in the form of Japanese Orthopaedic Association (JOA) score, Hirabayashi recovery rate, and Visual Analogue Scale (VAS) score for pain or numbness, were evaluated. Mean operation time was 75.71 ± 28.58 min, and mean blood loss was 166.42 ± 44.99 mL. The mean preoperative JOA score was 4.71 ± 1.43 points which significantly improved to 7.50 ± 2.06 points postoperatively (P < 0.001). The mean Hirabayashi recovery rate was 48.25% (range 12.5-80%). The surgical outcome was excellent in three patients, good in five patients, fair in five patients, and unchanged in one patient. Decompressive laminectomy is a safe and effective treatment for thoracic myelopathy due to OLF, which provides satisfactory clinical outcomes improvement.
Background and objective It remains unclear whether atlas hypoplasia is causative of symptomatic cervical canal stenosis or represents an independent and unrelated finding. There have been few dedicated studies describing atlas hypoplasia, and the existing literature has focused almost entirely on Asian populations. Therefore, the aims of the current study were threefold. First, we aimed to characterize the differences in cervical foraminal sagittal measurements by race and sex. Second, we evaluated the impact of age on cervical sagittal diameter and assessed the relationship between atlas hypoplasia and subaxial canal stenosis. Finally, we investigated the relationship between dens size and canal stenosis. Methods This was a single-institution retrospective cohort study approved by the Institutional Review Board at the University of Rochester School of Medicine and Dentistry. An overarching patient cohort was created by selecting patients with a Current Procedural Terminology (CPT) code of 72125-7 (CT of the cervical spine) and an International Classification of Diseases, 9th Edition (ICD-9) code 723.0 (cervical myelopathy) between January 1, 2014, and December 31, 2014. A total of 851 patients fulfilled the inclusion criteria. Variables collected included demographic and radiographic data. The inner sagittal diameters (ISD) at every cervical spine level, including the atlas, were measured. The prevalence of atlas hypoplasia was compared by age group. The correlation between each ISD was calculated. Among cases of atlas hypoplasia, the proportion of patients with subaxial canal stenosis was investigated. Results A total of 851 patients were included in the analysis. The mean ISD of the atlas was 31.4 ± 2.2 mm, and we defined atlas hypoplasia as an atlas ISD ≤ 27.0 mm. The mean space available for the cord (SAC) of the atlas was 19.0 ± 2.0 mm (range: 12.8-27.1). There was no significant difference in either the ISD of the atlas or the prevalence of atlas hypoplasia between the age groups. Pearson's correlation analysis showed that the ISD of the atlas had a strong correlation with the SAC of the atlas (r = 0.86, p < 0.01); a moderate correlation with both the sagittal diameter of the dens (coefficient = 0.48, p < 0.01) and the ISD of C2 (r = 0.59, p < 0.01) to C3 (r = 0.44, p < 0.01); and a weak correlation with the ISD of C4 (r = 0.37, p < 0.01), C5 (r = 0.38, p < 0.01), C6 (r = 0.36, p < 0.01), and C7 (r = 0.37, p < 0.01). A sub-cohort analysis of the 17 cases of atlas hypoplasia revealed that the mean ISD of the atlas was 26.3 ± 0.7 mm, and the mean SAC of the atlas was 14.5 ± 0.8 mm within this cohort. Regarding the rate of canal stenosis, the atlantal SAC was less than 14 mm in 17.6% of the cases, and the ISD of C2 to C7 was < 12 mm in 0%, 35.3%, 41.2%, 64.7%, 52.9%, and 47.1% of the cases, respectively. Conclusions The prevalence of atlas hypoplasia was not correlated with older age, which differs from subaxial developmental canal stenosis. Furthermore, although there was no strong correlation between the ISD of the atlas and each subaxial ISD, cases with atlas hypoplasia often involved subaxial canal stenosis.
Sauropod dinosaur remains comprise the majority of the Mesozoic vertebrate fossil record in Thailand. However, they are rare and fragmentary in the Aptian-Albian (Lower Cretaceous) Khok Kruat Formation, the stratigraphically youngest fossil-bearing Mesozoic Thai stratigraphic unit. Based on a partial postcranial skeleton, we present the first diagnostic sauropod specimen from this formation, which represents a new somphospondylan titanosauriform, Nagatitan chaiyaphumensis n. gen. n. sp. Nagatitan is diagnosed by two autapomorphies and a unique character combination, including the presence of two distinct hyposphene-hypantrum morphologies within the middle-posterior dorsal vertebrae. Phylogenetic analyses under maximum parsimony, using a data matrix containing 153 taxa and 570 characters, produce well-resolved topologies that place Nagatitan within the somphospondylan clade Euhelopodidae. Nagatitan does not form an endemic subclade with the approximately contemporaneous Southeast Asian euhelopodids Phuwiangosaurus and Tangvayosaurus, with a suite of anatomical features distinguishing these taxa. We estimate a body mass of 25-28 tonnes for Nagatitan, and suggest it was part of a broader middle Cretaceous body size increase in Asian titanosauriforms, facilitated by rising temperatures and expanded suitable habitat. The discovery of Nagatitan expands the known diversity of Southeast Asian sauropods and improves our understanding of titanosauriform biogeography within the region.
Systemic lupus erythematosus (SLE) is a complex autoimmune disease in which patients have a significantly increased risk of developing osteoporosis (OP) and osteopenia. Despite numerous studies, the global burden of SLE-related OP, its regional distribution patterns and its major risk factors remain poorly quantified and subject to controversy due to heterogeneity in sample sizes, diagnostic criteria and methodologies. To address these gaps in the evidence, we conducted a systematic assessment of the prevalence and risk factors for OP and osteopenia in patients with SLE. We conducted a systematic review and meta-analysis. We performed a comprehensive search of Chinese and English databases, including PubMed, Embase, the Cochrane Library, Web of Science, CNKI and WANFANG, up to 26 September 2025. We included observational studies that met the diagnostic criteria for SLE and reported the prevalence of OP or reduced bone mass, as well as associated risk factors. Two reviewers independently conducted literature screening, data extraction and quality assessment. Statistical analysis was performed using Stata 12.0 software; random-effects or fixed-effects models were employed to pool prevalence rates and odds ratios, and subgroup analysis, meta-regression and sensitivity analysis were used to explore sources of heterogeneity. A total of 59 studies were included. Meta-analysis revealed an overall prevalence of osteoporosis in SLE patients of 16.70% (95% CI: 14.2%, 19.3%) and a prevalence of osteopenia of 39.50% (95% CI: 35.5%, 43.5%). Site-specific analysis indicated that the lumbar spine was the site with the highest prevalence of osteoporosis (10.0%), whilst the femoral neck was the site most commonly affected by osteopenia (44.1%). Subgroup analysis identified several high-risk populations; the prevalence of osteoporosis in postmenopausal women (34.0%) was significantly higher than in premenopausal women (11.6%). Risk factor analysis indicated that advanced age (>50 years, OR = 21.92), long-term glucocorticoid use (OR = 1.63) and prolonged duration of SLE (OR = 1.05) were significant risk factors for OP. Glucocorticoid dosage was positively correlated with risk, with a significant increase in risk observed at daily doses >10 mg. Patients with SLE are at high risk of osteoporosis and osteopenia; postmenopausal women, Asian patients and those on long-term glucocorticoid therapy should be prioritized for screening and intervention. This study has revealed site-specific patterns of skeletal involvement and quantified the impact of key risk factors. In clinical practice, priority should be given to combined bone density monitoring, focusing on the lumbar spine and femoral neck, in high-risk populations. Furthermore, risk-stratified, proactive bone health management strategies should be implemented, with the aim of shifting the focus from 'treating fractures' to 'preventing fractures', thereby improving long-term patient outcomes. https://inplasy.com/inplasy-2025-12-0043/, identifier INPLASY2025120043.
Rachiphagus is a rare congenital anomaly in which conjoined twins are fused at the midline of the vertebral column region. When one twin is malformed, the condition is referred to as a parasitic twin. The term "parasitic twin" also encompasses cases involving extra limbs or limb-like structures. Despite ongoing research, the underlying causes of this condition remain unknown. This is a systematic review of the literature with a case report. A literature search was done in English language in PubMed and Semantic-Scholar from 1952 to 2023. All articles and cases with excess leg or mass which were attached at the back of the spine were reviewed and analysed. A total of 65 cases with rachipagus anomaly were included in this study. Females 37 (56.9%) were affected more than males 28 (43.1%). The lower limbs were in 41 (63.1%) cases, followed by rudimental limbs and mass were in 15 (23.1%) cases, upper limbs were in 8 (12.3%) cases and rudimental upper and low limbs were in 1 (1.5%) case. In majority of cases, accessory limb or mass were attached at lumbosacral region, 27 (41.5%), followed by 12 (18.5%) cases at lumbar region, 7 (10.8%) were at thoracolumbar region, 5 (7.7%) were at sacral and other regions. More than half of the cases 34 (52%) were in Asian countries, followed by 24 (37%) cases in Africa. Rachipagus parasitic twin is congenital abnormalities that develops during embryogenesis and exists at birth with structural deformities of the spine and additional limb or limb like mass. This article presents a novel rachipagus case and systematically reviews the relevant literature.
Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity encountered in paediatric orthopaedic practice, and surgical correction with posterior pedicle-screw constructs has become the reference standard for curves progressing beyond conservative thresholds. The axial translational technique (ATT) relies on sequential derotation and translation of the deformed spine toward a pre-contoured rod, avoiding the forceful segmental manoeuvres that characterise older cantilever and direct-rotation methods. Data describing this technique from South Asian centres remain limited. We conducted a single-centre, prospective quasi-experimental study at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, between September 2021 and March 2024. Adolescents aged 10-18 years with a confirmed diagnosis of AIS and a major Cobb angle greater than 45° were consecutively enrolled. All patients underwent posterior instrumentation and fusion using the ATT with polyaxial pedicle screws and a pre-bent 5.5 mm titanium rod. The primary outcomes were the change in the main-curve Cobb angle and thoracic kyphotic angle from baseline to 12 months post-operatively. Secondary outcomes were standing height, visual analogue scale (VAS) pain score, the Scoliosis Research Society-22 (SRS-22) questionnaire, and functional grading by Modified Macnab criteria. Paired t-tests and chi-square tests were used as appropriate; a two-sided P-value of less than .05 was considered statistically significant. Fifteen patients were analysed (mean age 14.13 ± 2.06 years; 60.0% female). Mid-thoracic curves predominated (53.3%), and Lenke type 1 was the most frequent pattern (53.3%). The mean Cobb angle was corrected from 59 ± 7° to 10 ± 2° (mean absolute correction 48.8 ± 5.83°, 83% correction; P < .001). Thoracic kyphosis improved from 9 ± 2° to 34.2 ± 3.43° (P < .001), representing restoration toward the physiological range. The VAS score fell from 5.73 ± 0.77 to 1.40 ± 0.48 at 12 months (P < .001), and standing height increased by a mean of 3 cm (P < .001). All SRS-22 domains improved significantly (P < .001). Functional outcome by Modified Macnab criteria was Excellent in 9 patients (60.0%), Good in 4 (26.7%), and Fair in 2 (13.3%); no patient was graded Poor. Nine screws in three patients (20.0%) were radiographically misplaced on post-operative computed tomography without clinical sequelae; three patients (20.0%) developed superficial wound infection that resolved with oral antibiotics. The ATT with pedicle-screw-and-rod instrumentation produced substantial three-dimensional correction of AIS with a favourable safety profile and meaningful gains in pain, appearance, and health-related quality of life at one year. These findings support its use as a reproducible correction strategy in resource-constrained tertiary centres.
Patients with nasopharyngeal cancer and following head/neck radiotherapy often experience a difficult airway during subsequent surgical treatment. Pre-operative airway examination usually reveals certain degrees of radiation-induced fibrosis over the neck, trismus, a higher Mallampati class, and an upper lip bite test grade. Available pre-operative transnasal videoendoscopic and radiological imaging findings might show vulnerable mucous membrane irregularities and anatomical abnormalities over the nasopharynx and larynx, and edematous or distorted epiglottis and vocal cords. Along with aforementioned adverse impacts, the need for mounting devices, such as halo-vest stabilization, would further restrict patients' cervical spines mobility and lead to more difficult endotracheal intubation. Both non-technical and technical skills, and various intubating tools/devices have been discussed in an evidence-based approach. Among them, videolaryngoscopy with/without flexible video-endoscopy is advocated for such difficult airway scenarios. In this short communication, we present our successful experience in applying StyleTubation (video intubating stylet technique) in such a difficult airway scenario (nasopharyngeal carcinoma patient, severe post-radiation fibrosis over the neck, mounted a halo-vest stabilization device, undergoing cervical spine surgery).