To explore the correlation between the actual age, dental age and cervical vertebral bone age in Uygur children and adolescents in Xinjiang region, and to construct the regression equation and joint prediction model of cervical vertebral bone age for males and females to improve the accuracy of age estimation. This study was conducted in two phases. In the first stage, the data of full mouth surface tomography and skull localization lateral radiographs of 320 Uygur children and adolescents aged 8-15 years were collected. The dental age was inferred by Willems method, and the third and fourth cervical vertebrae were measured by Mito cervical vertebrae osteometry. The cervical spine bone age measurement data of 224 samples (112 males and 112 females) were randomly selected for multiple stepwise regression analysis. The cervical spine bone age prediction equations for males and females were established respectively, and verified with the remaining 96 samples (48 males and 48 females). In the second stage, the cervical spine age of all samples was calculated based on the regression equation constructed in the first stage. Subsequently, Spearman correlation coefficient was used to analyze the correlation between chronological age, dental age and cervical spine bone age, and further multiple regression analysis was performed to evaluate the predictive effect of dental age and cervical spine bone age on chronological age. Finally, all the sample data were collected and combined multiple regression analysis was carried out to construct a comprehensive age prediction model. The cervical spine bone age equation established through multiple stepwise regression analysis was: male cervical spine bone age=-1.189+16.607×H4/D4+9.064×AP3/H3+5.369×H4/AH4(R=0.875); female cervical spine bone age=0.233+7.084×AH4/AP4+26.048×h4/H4+4.650×AH3/PH3(R=0.868). Spearman correlation analysis results showed that the correlation coefficient between chronological age and dental age was r=0.956, the correlation coefficient between chronological age and cervical spine bone age was r=0.871, and the correlation coefficient between dental age and cervical spine bone age was r=0.843, all of which showed significant positive correlation(P＜0.01). The unified regression model constructed by the joint analysis further improved the prediction accuracy, and the R2 of the model was 0.916. The final formula of the combined model was: actual age=-1.064+0.753× tooth age +0.325× cervical bone age. Through joint analysis of dental age and cervical bone age, this study significantly improves the prediction accuracy of actual age, and successfully constructs a unified prediction model suitable for Uyghur children and adolescents aged 8-15 years in Xinjiang region, providing an efficient and reliable tool for age inference in the region.
Bone density can impact treatment decisions for orthopaedic conditions. While ad-hoc intraoperative surgeon assessment of bone quality is common, the accuracy of such evaluation remains unknown. The primary purpose of this study was to determine whether orthopaedic surgeons' intraoperative assessment of bone quality closely correlated with validated measures. In this prospective cross-sectional study, we enrolled adult patients undergoing orthopaedic surgery at a Level-I trauma center. Eligibility required an opportunistic computed tomography (CT) scan of the lumbar spine, glenoid, wrist, pelvis/femur, proximal tibia, or calcaneus. Seven surgeons, blinded to objective measures of bone quality, provided intraoperative bone-quality assessments using a 10-point Likert scale and categorized bone quality as normal, osteopenic, or osteoporotic. Hounsfield units (HUs) were measured on CT using a previously published technique. All images were reviewed by a single orthopaedic surgeon, blinded to intraoperative bone-quality assessments. Of the 229 patients enrolled, 215 had available CT data and were included in the study. The average age of these patients was 44 years (range, 18 to 95 years), with 40.5% being female. Over half of the patients (61%) were Black or African American, while a quarter of the patients (25%) were White. The most common surgical sites included the femur (39 patients, 18.1%), ankle (31, 14.4%), and acetabulum (26, 12.1%). A positive linear relationship between HU and surgeon bone-quality assessments was observed (r = 0.66; p < 0.0001), which was consistent across surgical anatomic sites. Abnormal bone quality was correctly identified by surgeon assessment with 84% sensitivity and 97% specificity. This study demonstrated that surgeons can reliably detect abnormal bone quality through intraoperative assessment across numerous surgical sites. Intraoperative assessments may provide actionable and reliable feedback regarding bone density without additional cost or radiation in cases when opportunistic scans are not available. This information can inform intraoperative decision-making and presents opportunities for bone-health interventions. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
To observe the effect of bone setting manipulation on the lower limb alignment in patients with varus knee osteoarthritis (KOA), and to elucidate the underlying therapeutic mechanism. A total of 100 patients with KOA who received bone-setting manipulation between October 2022 and October 2023 were enrolled. Among them, there were 24 males and 76 females, the age ranged from 47 to 75 years with a mean age of (62.9±8.2) years and a disease course ranging from 0.25 to 20 years . All patients were treated with bone-setting manipulation on spine, hip joint, knee joint, and ankle joint.The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was adopted to evaluate knee joint function. Full-length weight-bearing X-rays of both lower extremities were performed on each patient before treatment and 2 weeks after treatment. The changes in the hip-knee-ankle (HKA) angle of both lower extremities at 2 weeks after treatment compared with those before treatment, as well as the changes in the gap between the HKA angles of both lower extremities before treatment and 2 weeks after treatment, were observed and recorded. A total of 89 patients were followed up at 2 weeks after treatment. The WOMAC score at 2 weeks after treatment was 23.0 (15.0, 31.0), which was lower than the preoperative score of 42.0 (34.3, 49.0), and the difference was statistically significant (P<0.001). There was no statistically significant difference in the HKA angles of the unaffected and affected sides between before treatment and 2 weeks after treatment(P>0.05). However, the absolute value of the HKA angle difference between the unaffected and affected sides at 2 weeks after treatment was 1.8 (0.8, 3.2)°, which was lower than that before treatment 2.1(1.0, 3.5)°, and the difference was statistically significant (P<0.05). Bone-setting manipulation is effective in reducing pain, stiffness, and improving joint function in patients with KOA. The therapeutic mechanism may be due to the correction of the subtle dislocation across the spine, hip, knee, and ankle, thereby reducing bilateral lower limb mechanical axis discrepancies and balancing weight distribution across both knee joints.
Bone homeostasis is maintained through balanced interactions between osteoblasts and osteoclasts, whereas chronic inflammation disrupts this balance by enhancing osteoclast activity and bone loss. This study investigated the protective effects of Cibotii Rhizoma (CR) on inflammatory bone destruction and its underlying mechanisms. In vitro, CR suppressed receptor activator of nuclear factor kappa B ligand (RANKL)-induced osteoclastogenesis in bone marrow-derived monocyte/macrophage (BMM) cultures by downregulating NFATc1, c-Src, and TRAF6, thereby inhibiting osteoclast formation, podosomal actin ring assembly, and cell fusion. In vivo, administration of CR in an LPS-induced bone loss mouse model preserved bone microarchitecture, as confirmed by micro-CT and histological analyses, and significantly reduced osteoclast numbers and calvarial bone erosion. Immunohistochemical staining further revealed decreased RANK and NFATc1 activity in calvarial bone tissue following CR treatment. Collectively, these findings indicate that CR mitigates inflammatory bone loss by targeting RANK signaling to inhibit osteoclastogenesis and bone resorption, highlighting its potential as a therapeutic agent for inflammatory bone diseases.
As cervical total disc arthroplasty progresses, the biomechanics and physiology of cervical facet joints are gaining more attention. Yet, knowledge of their in vivo kinematics and synergistic functions remains limited. Approved by the ethics committee of a tertiary hospital, 20 asymptomatic adults (10 males, 10 females; mean age 34.4 years (SD 9.2)) were recruited with informed consent. Participants underwent cone-beam CT (CBCT) scans in seven functional cervical positions. 3D vertebral models were reconstructed, and local coordinate systems were established for each facet joint. Using 3D-3D registration, segmental motions and displacements were calculated in six degrees of freedom relative to the neutral position. Rotations were described as Cardan angles, and displacements as left-right, anteroposterior, and superoinferior components. Range of motion (ROM) was defined as the absolute difference between end positions and averaged across left and right facet joints. In vivo analysis revealed distinct kinematic characteristics of the cervical facet joints. During flexion-extension, C0-C1 exhibited the greatest ROM (mean 25.6° (SD 5.9°)), whereas C2-C3 and C6-C7 showed relatively restricted motion. The mean total craniocervical (C0-C7) primary ROM was 62.9° (SD 7.6°), with segmental displacements mainly occurring in the anteroposterior direction, particularly at C0-C1. During axial rotation, the C1-C2 joint accounted for approximately 85% of the total motion (mean 51.4° (SD 5.1°)) and demonstrated the largest LR displacement (mean 5.2 mm (SD 4.4)). In lateral bending, the overall ROM was 35.2° (SD 7.7°), with C1-C2 again contributing the most and showing the largest LR displacement (mean 8.7 mm (SD 2.2)). These findings highlight the dominant role of C0-C1 in flexion-extension and C1-C2 in axial rotation and lateral bending, as well as the segment-specific displacement patterns of cervical facet joints. CBCT-based 3D-3D registration enabled precise in vivo assessment of cervical facet joint kinematics. These findings could offer valuable insights into the rehabilitation of facet joint manipulation and provide meaningful prospects for future research.
Psoriasis is a chronic inflammatory skin disease linked to skeletal complications such as osteoporosis and fractures. Whether IL-23 inhibition via risankizumab (RZB) confers different long-term bone and joint outcomes than the conventional systemic agent methotrexate (MTX) remains uncertain. We aimed to compare patient characteristics between psoriatic adults initiating MTX versus RZB and to evaluate fracture and joint arthroplasty outcomes at 90 days, 2 years, and 5 years. We performed a retrospective cohort study using the TriNetX network. Adults ≥18 years with psoriasis initiating RZB (n = 5451) or MTX (n = 54,402) were included; those with prior major fractures or hip, knee, or shoulder arthroplasty were excluded. Propensity score matching (1:1) balanced demographics and comorbidities, yielding 5448 patients per group. Risk ratios (RRs) with 95 % CIs and p-values were calculated. Before matching, RZB initiators were younger, more often male, and had higher prevalences of hypertension and obesity, differences that became negligible after matching. RZB did not differ from MTX in fracture incidence or joint arthroplasty at 90 days or 2 years. At 5 years, RZB was associated with lower risk of shoulder or upper arm fracture (RR 0.491, CI 0.335-0.718), lumbar or pelvis fracture (RR 0.539, CI 0.370-0.787), and hip arthroplasty (RR 0.631, CI 0.437-0.910), with no significant differences in femoral fracture or knee arthroplasty. Among patients who underwent joint replacement, periprosthetic joint infection risk was similar (RR 0.82, CI 0.44-1.52). In this matched cohort, RZB was associated with lower 5-year risk of fractures compared with MTX, without an observed increase in periprosthetic joint infection. IL-23 inhibition, as achieved with RZB, may offer a more favorable long-term skeletal profile and help orthopedic surgeons contextualize skeletal risk in psoriasis.
Along with the growing recognition of sacroiliac joint dysfunction as a contributor to chronic low back pain has come the increase in the utilization of sacroiliac fusion devices. Relative to the various surgical approaches for sacroiliac joint fusion, the posterior intra-articular approach has been described as a potentially less invasive approach that has less proximity to critical neurovascular structures. In this controlled cadaveric study, posterior and posterolateral sacroiliac fixation implants are compared, characterizing each implant's joint stabilization, resistance to fatigue loading, implantation geometry, and positional safety. Pelves were subjected to isolated flexion/extension, lateral bending, axial rotation, and axial compression loads in intact, destabilized, fixed, and postfatigue conditions. Reductions in motion were computed with optical marker tracking. Positional safety was assessed through radiographic measurements from each implant to salient anatomic landmarks. Compared to the posterolateral implant, the novel posterior implant provides improved flexion/extension stability both after fixation (33% vs. 0% motion reduction, p < .01) and after fatigue loading (25% reduction vs. 1% increase, p < .05). The posterior implant reduces device migration after fatigue loading (0.1 mm vs. 0.7 mm, p < .05), removes less bone during placement (955 mm3 vs. 3,248 mm3, p < .001), and is placed further from both the sacral foramina (14.1mm vs. 4.6 mm, p < .01) and the anterior border of the joint (21.3 mm vs. 7 mm, p < .05). No statistically significant differences were found for stability under other loading configurations, surface area available for fusion, or joint width changes. These cadaveric findings suggest biomechanical stability and positional safety advantages for the posterior device. Additional data on patient outcomes, fusion rates, and intraoperative safety is needed to assess clinical performance.
Transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and bone marrow edema syndrome (BMES) are increasingly recognized as manifestations of the same underlying condition. Hallmark features include joint pain, bone marrow edema on MRI, and localized demineralization. However, densitometry data in this context are fragmented and difficult to interpret. This study screened 561 publications and identified 188 patients with quantifiable bone mineral density (BMD) data-Z-, T-scores (for patients under 50), or raw values-obtained during active disease and unaffected by treatment. Mixed-effects modeling and linear regression showed significant BMD reductions in symptomatic hips: marginal mean Z/T-scores of -2.12 (95% CI -2.4 to -1.88, n = 48). In pairwise analyses, symptomatic hips had lower BMD than asymptomatic hips: marginal mean Z/T-score difference -1.2 (95% CI -1.7 to -0.8, n = 16) and raw score difference of -0.173 g/cm2 (21% lower; 95% CI -0.214 to -0.132, n = 19). Despite few reports of back pain, spine BMD was also reduced: mean Z/T-score of -1.83 (95% CI -2.1 to -1.6, n = 65). Among perinatal women, spine BMD reached -2.2 (95% CI -2.6 to -1.8, n = 22). No BMD differences emerged between osteoporosis- and edema-related terminology groups, supporting a shared disease mechanism.
Osteoporosis is a prevalent systemic disease primarily affecting the skeletal system, with the spine being one of the most commonly affected areas. Numerous studies have demonstrated detrimental biomechanical effects of osteoporosis on the lumbar spine. However, its influence on adjacent SIJ remains poorly understood. This study aimed to determine how osteoporosis alters SIJ biomechanics under physiological and vibrational load. A validated, 3D finite element model of the normal lumbopelvic segment (L1-pelvis) was modified to simulate osteoporosis by decreasing bone mechanical properties. Biomechanical responses within the SIJs to both static loading (flexion, extension, lateral bending, rotation) and vibration loading (cyclic axial compression) were analyzed and compared between the normal and osteoporotic conditions. Static analysis revealed that osteoporosis significantly increased SIJ range of motion (ROM) by 20.6%-52.7% and elevated maximum von Mises stress by 30.8%-90.3% compared to the normal condition. Also, forced vibration analysis revealed a 35%-36% increase in stress amplitudes in the osteoporotic model. These alterations correlated with reduced bone stiffness, suggesting compromised joint stability. These findings demonstrate that osteoporosis adversely affects SIJ biomechanics by increasing motion and internal stress, thereby potentially elevating the risks of SIJ instability, degeneration, and subsequent joint dysfunction and pain. This study provides novel insights into the overlooked role of SIJ pathology in osteoporotic patients, emphasizing the need for targeted diagnostic and therapeutic strategies.
Lumbar disc herniation (LDH) is commonly caused by annular disruption resulting from trauma or poor posture, leading to extrusion of nucleus pulposus material and compression of lumbar nerve roots. This condition often presents with radicular pain and sensory disturbances radiating from the lower back to the lower extremities. Although most cases can be managed conservatively, severe or refractory symptoms may require surgical intervention, including conventional discectomy, minimally invasive microscopic discectomy, and endoscopic discectomy. Percutaneous endoscopic lumbar discectomy (PELD) can be performed under local anesthesia; however, the procedure relies heavily on the surgeon's experience and is associated with technical challenges, including positioning difficulty, repeated fluoroscopic confirmation, and increased radiation exposure. The objective of this study was to develop and evaluate a novel percutaneous endoscopic lumbar disc positioning device designed to improve the precision and efficiency of disc positioning during PELD. This study developed a unique percutaneous endoscopic lumbar disc positioning device. The device was realized through the reconstruction and repair of 3D models of the porcine spine and lumbar spine, fabrication of a convex base plate, design of spinal spinous process and disc positioning guiding devices, computer-aided design of a percutaneous endoscopic lumbar disc minimally invasive surgical navigation module, and accuracy testing. Experimental results showed that the device could accurately locate positions on porcine spines and may reduce fluoroscopic dependence in experimental settings. The positioning device provided high precision, supporting minimally invasive surgery by reducing incision size, avoiding damage to surrounding critical blood vessels and nerve tissues, and offering multi-directional surgical instrument guiding paths, facilitating the surgical process. The percutaneous endoscopic lumbar disc positioning device described in this study provides a structured, reproducible approach to intervertebral disc positioning during PELD. This method has the potential to improve procedural efficiency, limit radiation exposure, and support surgical training, particularly for early-career spine surgeons.
Whether memory difficulty is associated with bone mineral density (BMD) is still unclear. We examined the association between memory difficulty and BMD in US adults. This cross-sectional study identified 4383 individuals (2581 [58.9%] males). Memory difficulty data were collected during a face-to-face interview. Femoral neck, total hip, and lumbar spine BMD were measured by a Hologic QDR-4500A fan-beam dual-energy X-ray absorptiometry (DXA); BMD T-scores were calculated using the established method. The average age and body mass index for study participants were 39.5 years (SD = 13.4 years) and 28.6 kg/m2 (SD = 6.6 kg/m2), respectively. In both unadjusted and adjusted models, memory difficulty was associated with decreased femoral neck and total hip BMD T-scores (all P < 0.05), but not with lumbar spine BMD T-scores. These associations were identical for males and females (all P interaction by sex >0.100). The negative association between memory difficulty and hip BMD appeared to be stronger in individuals <50 years old than in those ≥50 years old (P interaction <0.001). Memory difficulty was negatively associated with hip BMD, with stronger associations observed among individuals aged <50 years old.
Bone constitutes a rare site of involvement in hydatid disease, associated with a diagnostic challenge. The present study is an analysis of the clinicopathological features of osseous hydatidosis, emphasizing on its diverse appearance on radiologic imaging. Twenty-one patients with histopathologically confirmed osseous hydatidosis were included. The most involved site was spine (n = 7), followed by pelvis (5), femur (4), and a single case, each in the rib, tibia, ulna, humerus, and talocalcaneal joint, respectively. The radiological differential diagnoses ranged from infections to tumors and tumor-like lesions. The spinal lesions were osteolytic and were diagnosed as tuberculosis, aneurysmal bone cyst, hemangioma, and metastasis, on imaging. The femoral lesions were diagnosed either as fibrous dysplasia or as primary cystic bone lesions. The pelvic lesions mimicked cystic angiomatosis, giant cell tumor, low-grade chondrosarcoma, and tuberculosis. Histopathologic examination revealed characteristic acellular lamellated membranes in all the cases. Following diagnosis, all the patients underwent anti-helmenthic treatment after the histopathological diagnosis. One patient with ankle joint involvement underwent talocalcaneal fusion followed by below-knee amputation and in another patient the affected femoral segment was excised with fibular graft reconstruction. Recurrence was noted in two patients with lesions in the spine and talocalcaneal joint, respectively. This study emphasizes upon the need to consider hydatid disease in the list of differential diagnosis of osteolytic lesions of the bone.
The treatment of complex orthopedic diseases such as osteomyelitis, rheumatoid arthritis, and osteosarcoma is often hindered by the limitations of systemic drug administration, including poor bioavailability, severe side effects, and an inability to address localized pathologies. Liposomes, with their exceptional biocompatibility, structural versatility, and ability to encapsulate diverse therapeutics, have emerged as a cornerstone of nanomedicine. This review provides a function-centric analysis of how liposomes are engineered as intelligent, multi-functional platforms to tackle the specific challenges of the bone microenvironment. We move beyond a simple catalog of applications to critically examine the design strategies that enable liposomes to: (1) penetrate biofilm barriers and eradicate intracellular pathogens in infectious bone diseases; (2) actively target and reprogram inflammatory cells to resolve chronic inflammation in arthritis; (3) provide spatiotemporal control over growth factor and gene delivery for enhanced bone and cartilage regeneration; and (4) enable combinatorial chemo-gene therapies and novel cytotoxic mechanisms for osteosarcoma. By comparing and contrasting these strategies, this review identifies key technological advancements-such as stimuli-responsive release, biomimetic camouflage, and stem-cell fate engineering-that are driving the field forward. We conclude by discussing the persistent challenges for clinical translation and outlining future directions for the next generation of "smart" liposomes that promise to transform the paradigm of orthopedic treatment from symptomatic management to pathology-modifying and regenerative intervention.
To investigate the clinical efficacy and safety of modified bone-disc-bone osteotomy (BDBO) in the treatment of kyphosis caused by old thoracolumbar vertebral fractures. A retrospective analysis was performed on 22 consecutive patients (mean age 65.1 ± 5.9 years) who underwent posterior-only modified BDBO combined with internal fixation and fusion between September 2020 and December 2023. Radiological parameters, including global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), were measured on standing full-spine lateral X-rays. Clinical outcomes were evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire. All indicators were assessed preoperatively, on the 5th postoperative day, and at the final follow-up (minimum 24 months, mean 25.45 ± 2.24 months). Surgical data and complications were also recorded. Modified BDBO significantly corrected global kyphosis. For GK, the preoperative mean value was 45.32 ± 10.76°, which decreased to 10.51 ± 4.08° on the 5th postoperative day (significant difference, t = 15.82, p < 0.001) and 11.15 ± 4.25° at the final follow-up (compared with preoperative: t = 15.4, p < 0.001; compared with 5th postoperative day: t = - 10.88, p = 0.031). For TK, the preoperative mean value of 40.21 ± 11.24° significantly decreased to 24.5 ± 2.17° on the 5th postoperative day (t = 8.1, p < 0.001) and 24.82 ± 2.31° at the final follow-up (t = 8.01, p < 0.001), with a slight difference between the 5th postoperative day and final follow-up (t = - 6.25, p = 0.049). For LL, it decreased from 47.62 ± 14.74° preoperatively to 42.73 ± 6.58° on the 5th postoperative day (t = 2.79, p = 0.011) and 39.59 ± 7.18° at the final follow-up (t = 4.92, p = 0.006), with continuous adjustment between the 5th postoperative day and final follow-up (t = 23.1, p = 0.010). For SVA (a marker of spinal balance), the preoperative mean value of 37.95 ± 8.02 mm drastically decreased to 12.11 ± 3.92 mm on the 5th postoperative day (t = 29.06, p < 0.001) and 13.39 ± 4.07 mm at the final follow-up (t = 28.36, p < 0.001), with no significant drift. PI, PT, and SS also showed significant improvements and remained stable. No major neurological injury occurred. One patient had a superficial wound infection cured before discharge, and one had a pulmonary infection resolved with anti-infection treatment. All patients achieved solid fusion without internal fixation failure or pseudarthrosis. SRS-22 scores in Function (3.0 ± 0.3 vs. 3.8 ± 0.2, p < 0.001), Appearance (2.8 ± 0.2 vs. 4.0 ± 0.2, p< 0.001), and Pain (2.8 ± 0.2 vs. 3.6 ± 0.1, p < 0.001) domains improved significantly, with a mean satisfaction score of 4.1 ± 0.23. Modified BDBO is an effective and relatively safe surgical technique for kyphosis secondary to old thoracolumbar vertebral fractures. It provides powerful sagittal correction, sustains improved spinal alignment, and enhances patient-reported pain relief and function.
Sacroiliac joint (SIJ) disorders are among the most common causes of chronic low back pain. Imaging-guided SIJ injections are widely used as an early diagnostic tool, with corticosteroid often added to provide a therapeutic component. Evidence of factors predicting the therapeutic outcome of these injections remains scarce. To evaluate the effect of SIJ osteoarthritis and other potentially relevant demographic, imaging, and procedural factors on the patient-reported therapeutic outcome of imaging-guided SIJ injection. This retrospective single-center study included 101 patients who underwent specialist-referred imaging-guided SIJ injection between 2010 and 2023. Medical records and procedural reports were reviewed to collect relevant patient information, and associated SIJ MRIs and CT scans were reanalyzed for osteoarthritis, sacroiliitis, and bone marrow edema by an experienced musculoskeletal radiologist. The association of demographic, imaging, and procedural factors with the therapeutic injection outcome was assessed using logistic regression modeling. Of 101 patients who underwent an imaging-guided SIJ injection, 72 (71.3%) met the inclusion criteria. The mean age was 52.2 (SD 14.2) years, and 30 patients (41.7%) achieved a positive therapeutic response. Increasing age was significantly associated with a lower likelihood of a positive outcome, with the probability decreasing on average by 9.4% for each additional year of age (OR 0.91 [95% CI 0.84-0.99]). Neither SIJ osteoarthritis grade nor other demographic, imaging, or procedural factors showed a significant association with injection outcome. Increasing age was significantly associated with a lower likelihood of achieving a positive therapeutic SIJ injection outcome, while SIJ osteoarthritis grade showed no association.
Adolescent Idiopathic Scoliosis (AIS) is the most common form of spinal deformity among adolescents. To explore its etiology of progression and scoliosis-modifying drugs, chondrocytic senescence was confirmed in AIS facet joint cartilage by analyzing clinical specimen. Furthermore, through 4D/480 label-free proteomics analysis, we identified an exosome-mediated positive feedback loop during scoliosis progression, which driving the elevation of cholesterol flow between spinal cartilage and vertebra. To further investigate the pathological significance of the loop in vivo, high-cholesterol flow was reconstructed in C57BL/6 J mice by injecting with recombinant adeno-associated virus rAAV9-Runx2-HMGCR. Our results confirmed the important role of the positive feedback loop in the development of scoliosis. Meanwhile, Avasimibe or/and Corylin were used to delay the scoliosis progression by targeting the key exosomal proteins APOB (Apolipoprotein B-100) or/and HSP90β (Heat Shock Protein 90-beta). This research extends the etiology of scoliosis progression and provides an alternative perspective for scoliosis non-surgical treatment.
To describe the anatomic landmarks and demonstrate the method used to collect goniometric measurements of dog and cat joints. Dogs and cats evaluated for joint and bone problems, as shown in the video. A goniometer is used to measure flexion and extension to detect joint disease and monitor response to therapy and disease progression. The dog or cat is placed in lateral recumbency. A hinged plastic goniometer with 2 arms adapted to the pet size is used. The proximal arm is stationary. The distal arm moves with the limb segment. To place the goniometer consistently, the long axis of the stationary and moving arms of the goniometer are aligned with specific anatomic landmarks palpable from the skin surface. For the forelimb, the landmarks include the spine of the scapula, greater tubercle, caudal aspect of the humeral head, lateral epicondyle, craniocaudal midpoint of the distal aspect of the antebrachium, and dorsal aspect of the metacarpals. For the hind limb, the landmarks include the tuber sacrale and ischiadicum, greater trochanter, patella, lateral fabella, tibial tubercle, fibular head, lateral malleolus, and dorsal aspect of the metatarsals. Measurements are collected in full flexion and extension. Goniometry enables the collection of objective and repeatable measurements of joint motion in dog limbs. Goniometry is a safe and convenient method to measure flexion and extension of normal and abnormal joints that has been validated in healthy Labrador Retrievers and cats.
An intraosseous pneumatocyst is a gas-containing cystic bone lesion that is not associated with infection or bone necrosis due to vertebral compression fracture. The most common sites are the pelvis and spine, but it is reported rarely in other sites. To our knowledge, only two cases of intraosseous pneumatocyst in the scapula have been reported. Herein, we report two cases of intraosseous pneumatocyst of the scapula, in a 41-year-old woman and a 51-year-old man. Neither patient had shoulder symptoms, and the lesions were found incidentally during imaging studies. Plain X-rays revealed cystic lesions with sclerotic rims, located from the scapular neck to the glenoid, adjacent to the shoulder joint. Plain X-rays of the 51-year-old male patient showed osteoarthritis of the shoulder, including joint space narrowing and osteophyte formation. CT was used for diagnosis in both cases. The patients remained pain-free throughout the follow-up period (10 years and 6 months, respectively). Their lesion sizes were unchanged, and radiolucency was reduced at the final follow-up. The shoulder joint has the largest range of motion in the human body; thus, the vacuum phenomenon may occur when the shoulder is elevated or externally rotated. We speculate that gas was produced in an intraosseous ganglion or subchondral cyst, the likely pre-existing lesions, after the vacuum phenomenon occurred in the shoulder joints of these patients.
Transient osteoporosis of pregnancy (TOP) is a rare condition that typically presents during the third trimester as unexplained lower limb joint pain, most commonly involving the hip. We report an uncommon case of TOP affecting both ankles and provide a literature review of previously reported cases involving the ankle. A 31-year-old Japanese woman developed bilateral ankle pain in the second trimester of pregnancy without any history of trauma. She presented to the orthopedic outpatient clinic in the postpartum period, and her radiographs revealed bilateral diffuse osteopenia, which brought her to our rheumatologic department. Additional radiographic evaluation of the spine and hips showed no evidence of osteopenia. Magnetic resonance imaging of the right ankle, which was obtained for worsening pain, demonstrated bone marrow edema. Blood tests, which evaluated inflammatory markers and alkaline phosphatase, and a musculoskeletal ultrasound were unremarkable. The patient's symptoms gradually resolved with conservative management, including vitamin D supplementation, intermittent use of nonsteroidal anti-inflammatory drugs, and rest. At three months postpartum, radiographs showed partial improvement of osteopenia, whereas MRI still demonstrated bone marrow edema. Follow-up radiographs at eight months demonstrated resolution of the patient's osteopenia, which was consistent with a diagnosis of TOP. We also reviewed previously reported cases of TOP affecting the ankles, identifying eight cases in total. Clinicians should consider the possibility of TOP in pregnant or postpartum women presenting with unexplained joint pain in the lower limbs, including the ankles, even when the pain appears during the second trimester of pregnancy. TOP carries a risk of fracture, making timely and appropriate conservative management essential. Although based on a single case, these findings may indicate that radiographs could reflect recovery earlier than MRI, and may be useful as a follow-up imaging modality in TOP affecting the ankles.