Cellular senescence is a persistent state of irreversible growth arrest that occurs when cells encounter various stress signals. It is marked by elevated expression of cell cycle inhibitors, dysregulated gene transcription, and secretion of the senescence-associated secretory phenotype (SASP). These senescent features may exert both detrimental and beneficial effects on tissue homeostasis and systemic physiological integrity. In this review, the relevant pathological processes are categorized into three tissue types: skeletal muscle, bone, and cartilaginous tissue. We systematically delineate the mechanisms of cellular senescence underlying seven musculoskeletal diseases, including skeletal muscle injury and regeneration, sarcopenia, osteoporosis, fracture, osteonecrosis of the femoral head (ONFH), osteoarthritis (OA), and intervertebral disc degeneration (IDD), with a particular focus on the heterogeneity of senescent cells across distinct musculoskeletal diseases. On this basis, we further elaborated on relevant mechanisms and senescence-related targets, and analyzed senescence heterogeneity in diverse musculoskeletal tissues, senescence identification and integrated diagnostic approaches. Moreover, we discussed convergent pathways, the dual roles of senescent cells, and the critical evaluation of disease-specific versus common therapeutic vulnerabilities.
Soft tissue sarcomas (STS) of the foot are rare, accounting for 2-5% of musculoskeletal sarcomas, and are often associated with higher amputation rates due to limited soft tissue coverage, complex anatomy, and the functional demands of weight-bearing. We report the case of a 70-year-old woman with a myxoinflammatory fibroblastic sarcoma involving the 2nd-4th metatarsals. Limb salvage surgery was performed, consisting of en bloc resection with preservation of the metatarso-phalangeal joints, skeletal fixation with titanium plates, tendon reconstruction using tensor fascia lata, and soft-tissue coverage with an anterolateral thigh free flap. Intraoperative, interstitial brachytherapy catheters were placed, enabling 36 Gy/9 fractions safely without wound or flap complications. At 6 months, the patient was disease-free and ambulatory without disability. This case demonstrates that with multidisciplinary planning, complex reconstruction and adjuvant brachytherapy can achieve durable local control and preserve function in selected patients with foot sarcoma.
Work-related musculoskeletal (MSK) pain is frequent in surgeons, but factors associated with it are not well studied. Repeat surveys were sent to general and subspecialty surgeons in the evening of their operating room (OR) days in one month. Age, sex, BMI, weekly exercise, NASA Task Load Index (NASA-TLX: a composite measure of workload), and pain scores were collected. Operating room case length and approach were collected from a registry. All variables were analyzed for their independent association with mean pain score changes in 12 body regions (with 95% CI). There were 29 surgeons who performed a total of 537 operative cases on 228 OR days. Increases in NASA-TLX by 100 were associated with increased pain in neck +0.23 (0.10-0.35), hands/fingers +0.22 (0.11-0.33), upper back +0.22 (0.10-0.34), lower back +0.31 (0.18-0.44), buttocks +0.07 (0.02-0.13), hips +0.10 (0.03-0.18), legs +0.14 (0.06-0.21), and feet +0.15 (0.05-0.24). Longer total case length increased pain in neck and upper back (+0.15 and +0.13 for every increase in 4 hours, respectively). An OR day with higher proportion of robotic time was associated with increased pain in wrists +0.32 (0.10-0.54) and lower back +0.36 (0.02-0.70). Higher proportion of lap/endo time was associated with increased pain in upper back +0.33 (0.08-0.58). Workload was the strongest contributor to musculoskeletal pain during operating days, with associations seen across most body regions. Case length and approach contributed to pain in a smaller number of regions. Targeted ergonomic strategies may reduce the burden of MSK pain among surgeons.
As client experience becomes an established quality domain in veterinary care, owner appraisals of postoperative recovery may influence downstream behavioral intentions. In feline medicine, postoperative recovery in daily life is commonly inferred from owner observations using structured owner-reported outcome measures, where patients cannot self-report. To examine how client experience (CE), modeled as a reflective-reflective higher order construct, relates to owner-perceived postoperative functional recovery and how CE and owner-reported outcomes (ORO) predict client loyalty (CL) and recommendation likelihood (RL), including ORO's mediating role. Owners of cats who underwent orthopedic surgery at an Indonesian feline referral clinic completed a cross-sectional online questionnaire (N = 153). ORO was assessed using the 9-item Feline Musculoskeletal Pain Index short form (FMPI-sf) as an owner-reported proxy of postoperative function and comfort (not a direct measure of radiographic healing). The data were analyzed using partial least squares structural equation modeling in SmartPLS 4, applying a disjoint two-stage approach for the CE higher-order construct and bootstrapping for inference. CE positively predicted ORO (β = 0.677, p < 0.001) and had direct effects on CL (β = 0.486, p < 0.001) and RL (β = 0.709, p < 0.001). ORO predicted CL (β = 0.451, p < 0.001) but not RL (β = 0.144, p = 0.089). ORO partially mediated the effect of CE on CL (β = 0.305, p < 0.001), whereas it did not mediate RL (β = 0.097, p = 0.118). The model explained substantial variance in ORO (R2 = 0.458), CL (R2 = 0.737), and RL (R2 = 0.662). In feline orthopedic pathways, perioperative communication, empathy, pain management guidance, and shared decision-making are clinically relevant care-process targets associated with stronger owner-perceived recovery and higher continuity intentions. Recommendation intention appeared to be primarily experience-driven rather than recovery-driven. The findings should be interpreted in light of the cross-sectional, single-clinic design and the use of FMPI-sf as a postoperative proxy measure.
Since antiquity, the human body has inspired architecture both aesthetically and structurally. Vitruvius introduced proportion as a principle of harmony, whereas Leonardo da Vinci and Michelangelo studied anatomy to enrich artistic and architectural concepts. Their dissections and analyses of muscles, joints, and bones influenced ideas of stability, flexibility, and dynamic structures. Later, architects such as Gaudí, Eiffel, Le Corbusier, Parent, and Calatrava integrated biomimicry and biomechanical principles into their works, translating skeletal and muscular systems into innovative forms. Gaudí's Casa Batlló and Sagrada Família evoke bones and tendons, whereas Eiffel's Tower mirrors femoral trabeculae. Le Corbusier's Modulor system formalised body-based proportions, and Calatrava explicitly referenced the spine and rib cage in his buildings. Beyond symbolism, modern 'healing architecture' demonstrates how spatial design impacts health and recovery. By bridging architecture and medicine, particularly rheumatology, biomimetic approaches highlight the musculoskeletal system as a lasting model for functional, inclusive, and therapeutic spaces.
Distal humeral fractures in elderly patients are difficult to treat due to poor bone quality and high complication rates. Total elbow arthroplasty (TEA) is an alternative for non-reconstructable fractures. This study aimed to evaluate long-term outcomes and implant survival of elderly subjects treated with linked TEA for acute distal humeral fractures. A retrospective study was conducted on data from patients who underwent TEA between January 2017 and December 2024 with fractures unsuitable for open reduction and internal fixation (ORIF). Clinical (range of motion, visual analogue scale, Mayo Elbow Performance Score, the Quick Disabilities of the Arm, Shoulder, and Hand score, and the American Shoulder and Elbow Surgeons score) and radiographic outcomes, complications, and implant survival were analysed. Thirty-seven patients (mean age 80.4 ± 5.1 years) were followed for a mean of 107 ± 54 months. TEA permitted achievement of a good ROM (flexion 130 ± 8.16°; extension 19.8 ± 11.4°), and functional outcomes (VAS 3.3 ± 1.3, MEPS 83.5 ± 7.3, DASH 54 ± 4.4, ASES 78 ± 12.9) at the final follow-up. Revision rate was 11%, and 5-year implant survival was 94.2%. Comorbidities did not significantly influence clinical outcomes. TEA provides reliable long-term function and pain relief with acceptable complication rates in elderly patients with complex distal humeral fractures, supporting its use as a primary treatment in selected cases.
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To analyze epidemiologic trends, injury prevalence, and mechanisms of injury associated with rock climbing. The National Electronic Injury Surveillance System, a public emergency department database, was queried for rock climbing-related injuries from 2014 to 2023. Data extracted included demographics, anatomic region injured, diagnosis, mechanism of injury, and disposition. Patients were stratified into 4 age groups: pediatric (≲18 years), young adult (19-39 years), middle-aged adult (40-64 years), and geriatric (≳65 years). Mechanisms of injury were categorized and analyzed by fall height where applicable. A total of 1346 cases of rock climbing-related injuries were identified after exclusion criteria. Fractures (30.2%) and sprains/strains (20.2%) were the most common diagnoses. The majority of injuries resulted from falls (61.2%), with fracture incidence increasing with fall height. Pediatric and young adult climbers sustained more upper extremity injuries, while geriatric climbers had a higher proportion of lower extremity injuries. In this study, we found that younger climbers experienced more upper extremity injuries, while older adults more commonly sustained lower extremity injuries. In addition, male rock climbers experienced higher proportions of shoulder injuries compared with female rock climbers. These findings illustrate the potential need for age- and sex-specific injury prevention strategies to guide safe participation in this growing sport. Level IV, retrospective epidemiological case series.
Management of advanced hemorrhoidal disease in patients with Marfan syndrome (MFS) who require lifelong anticoagulation is clinically complex because perioperative care must balance prosthetic valve thrombosis against postoperative anorectal bleeding. We report the case of a 33-year-old male with MFS, status post-aortic dissection repair (Sun's procedure and Bentall operation) on continuous warfarin therapy, who presented with persistent Grade III circumferential mixed hemorrhoids that had not responded adequately to prior conservative outpatient management. Physical examination confirmed characteristic MFS musculoskeletal signs and severe hemorrhoidal prolapse. A structured multidisciplinary team (MDT) pathway involving colorectal surgery, cardiovascular medicine, vascular surgery, anesthesia, pharmacy, and nutrition was used to individualize perioperative management. After cardiology consultation, and based on the patient's high thromboembolic risk, preoperative warfarin interruption was shortened to 3 days with enoxaparin bridging, and the INR decreased to 1.01 on the day before surgery. Rubber band ligation was avoided because of concern for delayed bleeding after sloughing in an anticoagulated patient. Because the disease involved circumferential mixed hemorrhoids with a prominent external component and prolapse, repeated sclerotherapy alone was considered unlikely to provide adequate definitive control. The patient therefore underwent external dissection and internal ligation combined with liquid polidocanol injection sclerotherapy, with minimal intraoperative blood loss. Postoperatively, a 25-day inpatient observation period enabled close INR titration during warfarin reinitiation, controlled bowel management, staged low-residue enteral nutrition, avoidance of rectal suppositories, and direct monitoring for delayed bleeding. Following minor self-limiting hematochezia, the patient was discharged with an INR of 1.8 as a pragmatic compromise between bleeding and thrombotic risks. At 41 months of follow-up, the wounds remained well healed, with no recurrent prolapse or severe hemorrhagic complications. This case suggests that surgical intervention for advanced hemorrhoids in anticoagulated MFS patients may be feasible when embedded within a structured, individualized multidisciplinary pathway. The anticoagulation, nutritional, and inpatient-monitoring strategies described here should be interpreted as patient-specific measures requiring further validation.
Perioperatively used, topically administered tranexamic acid (TXA) has attracted increasing interest in plastic surgery, and several studies have compared the effectiveness and safety of topical and intravenous (IV) administration. Topical TXA has been reported to have an equal or superior effect in reducing postoperative bleeding and transfusion requirements, with no increase in reported adverse events. Although prophylactic topical TXA is believed to result in cost savings, cost-effectiveness analyses concerning the use of TXA in breast surgery have not yet been reported. This single-center, retrospective cohort study calculated the costs for all patients who underwent reduction mammaplasty between 2019 and 2021 at Jorvi Hospital, Finland. We compared postoperative complications and total healthcare costs associated with surgery between two groups: patients who received topical TXA perioperatively (TXA group) and patients who did not receive TXA (non-TXA group). Total costs were analyzed, including both the intraoperative and postoperative periods. All costs were calculated in euros, based on the 2020 Helsinki University Hospital (HUS) rates. In 328 breast reduction surgeries, the leading postoperative costs were caused by reoperations, and additional ward stays due to complications. The cost of TXA irrigation itself was negligible compared with the other expenses. The median postoperative costs were €414 in the non-TXA group and €335 in the TXA group, and the mean postoperative costs were €874 in the non-TXA group and €453 in the TXA group (p = 0.002). In the non-TXA group, 11 patients (6.1%) underwent reoperation for hematoma and four (2.2%) for other wound-healing complications. In contrast, in the TXA group only one (0.7%) patient required reoperation for hematoma and one (0.7%) for wound-healing complications. This study demonstrates that the application of this low-cost drug may reduce the overall costs associated with reduction mammaplasty.
To quantify contributions of health- and employment-related risk factors to high annual sickness absence (HASA) among a population-based cohort of older workers in England. Prospective cohort study. 24 general practices geographically dispersed across England. Men and women initially aged 50-64 years recruited as part of the Health and Employment After Fifty study. HASA, defined as a total of more than 20 days sickness absence over a 12-month interval. 4726 men and women were analysed, providing data on 15 333 12-month follow-up intervals. HASA was reported in 1003 (6.5%) follow-up intervals. In adjusted models, the aspects of health with the largest population-attributable fractions (PAFs) % were disabling musculoskeletal pain (25.4, 95% CI 21.2 to 29.3) and depression (11.3, 95% CI 6.1 to 16.2). Among long-term determinants of health, high body mass index had the greatest impact (PAF% 18.2, 95% CI 8.9 to 26.5). After allowance for health, high physical demands of work (PAF% 22.8) and eligibility for more generous sick pay (PAF% 25.8) made substantial contributions. Strategies to minimise avoidable sickness absence at older ages should prioritise: reversal of recent increases in disabling mental illness; encouragement of continued activity in workers with non-specific musculoskeletal pain, supported by modification of occupational tasks if needed; timely surgery for disabling osteoarthritis; reducing obesity; and increasing opportunities for placement in work that is less demanding physically. Further research is needed to clarify the impacts of generous sick pay on patterns of sickness absence.
Continuous local antibiotics perfusion (CLAP) involves placing a bone marrow needle and a double-lumen tube in the infected area, through which an antibiotic at an appropriate concentration is continuously administered. CLAP has shown good outcomes in patients with bone and soft tissue infections. However, the use of CLAP for late infection after total knee arthroplasty (TKA) is rarely reported. We addressed the gap in the treatment of prosthetic joint infection (PJI) using intra-joint antibiotics perfusion (iJAP) combined with debridement, antibiotics, and implant retention (DAIR) to treat patients with PJI. This case series study included seven patients who received iJAP combined with DAIR for the treatment of late infection. Continuous passive motion (CPM) was administered immediately after surgery. The diagnosis of late infection was based on the Musculoskeletal Infection Society criteria. Clinical outcomes including success rate and range of motion at 2 years after iJAP were investigated. In all cases, the infection was eradicated with the implants retained. The success rate of the first iJAP with DAIR was 100%, and the average range of motion was 111.9° at 1 year postoperatively. iJAP for late infection after primary TKA resulted in good outcomes, and the range of motion was similar to that reported in previous studies. CPM use immediately after surgery prevented short-circuiting of perfusion and contributed to a good postoperative motion. iJAP with DAIR may be a useful treatment for late infection after TKA.
Suzetrigine (Journavx; VX-548), the first selective NaV1.8 voltage-gated sodium channel inhibitor approved by the FDA on 30 January 2025, represents a novel non-opioid option for moderate-to-severe acute pain. Given its recent market entry and unique peripheral mechanism, comprehensive post-marketing safety surveillance is essential. This study aimed to identify and characterize adverse event signals associated with suzetrigine in the FDA Adverse Event Reporting System (FAERS) using advanced disproportionality and comparator-referenced empirical Bayes (EB) methods, with external triangulation against published literature and WHO VigiBase data. We analyzed FAERS reports through the first 8 months post-approval. Disproportionality metrics (ROR, PRR, IC) were supplemented by a comparator-referenced EB profiling approach that incorporated suzetrigine, acetaminophen, ibuprofen, and background "other drugs," generating 3,000 posterior draws per preferred term (PT). Signals with EB q05 > 2 and no comparator overlap were classified as suzetrigine-unique. High-priority PTs were triangulated with Phase II/III trial data, systematic reviews, case reports, and VigiBase report counts (February 2026). Of 19 prioritized PTs, 14 were suzetrigine-unique. Dominant clusters included sensory disturbances (paresthesia, burning sensation, skin burning sensation, hypoaesthesia; EB q05 11.43-31.16), musculoskeletal events (muscle spasms EB q05 31.15), and cutaneous reactions (pruritus, rash). These signals were mechanistically consistent with peripheral NaV1.8 blockade of nociceptors and pruriceptors. Literature and VigiBase data corroborated neurological/sensory and musculoskeletal signals; psychiatric signals (euphoric mood, abnormal dreams) lacked external support and were deprioritized. This real-world pharmacovigilance analysis identifies a distinct safety signature for suzetrigine, with neurological and sensory disturbances (e.g., paresthesia, burning sensation, skin burning sensation, hypoaesthesia) emerging as prominent signals not fully characterized in pre-approval trials, whereas musculoskeletal and cutaneous events largely align with labeled reactions. These hypothesis-generating findings highlight the need for focused post-marketing surveillance on neurological/sensory preferred terms through prospective cohort studies and Phase IV trials to quantify incidence, identify risk factors, and optimize risk-minimization strategies for this promising non-opioid analgesic.
To describe the short- and intermediate-term outcomes of tibial plateau leveling osteotomy (TPLO) in cats. Electronic medical records of cats with cranial cruciate ligament tears treated with TPLO at nine hospitals between January 2015 and November 2024 were reviewed. Cats were included if they had a TPLO procedure and excluded if they had concurrent ipsilateral orthopedic procedures or underwent additional concurrent procedures other than simultaneous contralateral stifle surgery. Physical and radiographic examination metrics, including bone healing scores, were used to assess short-term outcomes (<6 months). Owner responses to Feline Musculoskeletal and Pain Index (FMPI) surveys were used to assess intermediate-term outcomes (<12 months). Thirty-two stifles were operated on in 28 cats. Complications occurred in 9/32 stifles, and they were categorized as eight minor and one major complications. The median (range) pre- and postoperative lameness grades were 3 (1-5) and 0 (0-2) out of 5, respectively. Cranial tibial thrust was neutralized in 28/32 stifles; the remaining four stifles did not have information about stifle stability. The median 10-point radiographic bone healing score after 8 weeks was 8. The median FMPI score decreased from 16 to 4 with a median reduction of 14 (maximum score: 36). TPLO was associated with neutralization of cranial tibial thrust in cats and may be a viable treatment option.
Background Although interest in health disparities has expanded across medicine, the extent to which race and other social determinants of health are represented in orthopaedic research is unclear. Orthopaedics has traditionally emphasized biomechanical and procedural outcomes rather than structural or social drivers of inequity. This study maps how race and other determinants-gender, socioeconomic status, geography, and insurance-are represented within U.S. orthopaedic surgery journals. Methods A scoping review was performed following PRISMA-ScR guidelines. Searches in PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, and Web of Science (2014-2024) identified orthopaedic publications addressing health disparities. Eligible articles analysed or reported variables such as race, ethnicity, sex/gender, socioeconomic status, geography, or insurance. Two reviewers independently screened and charted data. Results Among more than 180,000 articles across sixty-nine orthopaedic journals, 333 (<0.5 per cent) met inclusion criteria. Race/ethnicity appeared most frequently (94 per cent), followed by sex/gender (77 per cent), insurance (39 per cent), socioeconomic status (29 per cent), and geography (24 per cent). Nearly half of the included articles were published in 2022 or later. Of race-related articles, 58 per cent included race only as a demographic descriptor, while 42 per cent analysed race as a primary focus. Conclusion Despite recent growth, health disparities remain minimally represented in orthopaedic literature, with most studies using race descriptively rather than examining structural inequity. Greater engagement with social determinants is needed to advance equitable musculoskeletal care and uphold core bioethical principles.
Obesity is a significant public health issue that has been increasingly linked to various musculoskeletal disorders, including intervertebral disk degeneration (IVDD). The interplay between metabolic dysfunction, chronic inflammation, and biomechanical stress suggests a multifactorial link between obesity and IVDD, warranting further investigation. This review aims to explore the pathophysiological mechanisms through which obesity contributes to IVDD and discuss this relationship's clinical implications. Obesity induces an occurrence of minor chronic inflammation and metabolic abnormalities, which can exacerbate degenerative changes in the intervertebral disks. Pro-inflammatory cytokines (TNF-α and IL-6) secreted by visceral adipose tissue can promote disk degeneration by enhancing catabolic processes and inhibiting anabolic repair mechanisms within the disk matrix. Additionally, mechanical loading due to excess body weight increases stress on the spinal structures, accelerating wear and tear of the intervertebral disks. This review summarizes current research findings on the biochemical and biomechanical pathways linking obesity to IVDD. We examine evidence from epidemiological studies, clinical trials, and animal models that highlight the multifaceted impact of obesity on spinal health. Furthermore, we discuss the implications of these findings for clinical practice, emphasizing the importance of weight management in preventing and treating IVDD. Interventions such as lifestyle modifications, dietary changes, and bariatric surgery are evaluated for their effectiveness in mitigating the adverse effects of obesity on the spine. The review also addresses the potential for targeted pharmacological therapies that modulate inflammatory pathways and mechanical stress responses. Understanding the association between obesity and IVDD is crucial when establishing all-encompassing management approaches for those who are impacted by the growing global prevalence of obesity. By elucidating the pathophysiological underpinnings and clinical consequences of obesity-induced IVDD, this review aims to inform future research directions and clinical guidelines, ultimately improving patient outcomes in this growing population.
To address the limited recognition of structural causes of lower-limb pain and the lack of real-world data on entheseal pathology, we evaluated ultrasound-detected entheseal and tendinous abnormalities in an unselected outpatient population, highlighting the underuse of musculoskeletal ultrasound (MSK US) in early diagnostic assessment despite the frequent misclassification of these conditions as nonspecific soft-tissue or degenerative disorders. We conducted a retrospective analysis of 667 consecutive adults undergoing standardized MSK US for lower-limb pain in a general ambulatory orthopedic clinic. Fourteen predefined entheseal and tendinous sites across the hip, knee, and ankle-foot regions were evaluated using Outcome Measures in Rheumatology criteria. Prevalence, anatomical distribution, bilaterality, and clinical predictors were assessed using descriptive statistics and multivariable logistic regression. Ultrasound-confirmed enthesopathy or tendinopathy was present in 152 of 667 patients (22.8%). Lesions most frequently involved the gluteus medius tendon and plantar fascia (5.5% each, n=37), followed by the semimembranosus (2.8%, n=19), patellar (2.6%, n=17), and Achilles tendons (4.2%, n=28). Abnormalities were predominantly unilateral (<10% bilateral). Increasing age was the only independent predictor of entheseal pathology (adjusted OR 1.26 per 10-year increase; 95% CI, 1.08-1.47). Sex, body mass index, diabetes, and rheumatologic disease were not relatively associated with pathology. Entheseal and tendinous abnormalities are common among symptomatic adults in everyday outpatient practice. Systematic integration of MSK US as a first-line assessment tool could improve diagnostic precision and enable targeted management strategies. These findings provide population-relevant evidence to inform musculoskeletal care pathways and health system decision-making.
Congenital muscular torticollis (CMT) is a common pediatric musculoskeletal condition resulting from unilateral contracture of the sternocleidomastoid muscle. When conservative treatment fails, surgical intervention is required. Traditional open approaches leave visible cervical scars, prompting the need for minimally invasive alternatives. This study evaluates the clinical outcomes of an innovative endoscopic sub-platysmal release technique for CMT in children. We retrospectively analyzed pediatric patients (<10 years) with CMT who underwent endoscopic release via a sub-platysmal approach under general anesthesia after failed at least 6 months of conservative therapy. The procedure utilized a 2.7-mm endoscope and radiofrequency ablation with gravity-fed hemostatic irrigation. Outcomes were assessed using the Cheng and Tang scoring system, including neck rotation deficiency, lateral bending deficiency, craniofacial asymmetry, and head tilt. Operative time, blood loss, and complications were recorded. Minimum follow-up was 30 months. A total of 44 patients (28 males, 16 females; mean age 3.88 ± 2.15 years) operated between January 2019 and December 2023 were analyzed. The cohort had a mean follow-up of 49.3 ± 8.2 months. Mean operative time was 35.2 ± 6.4 min, and mean blood loss was 4.5 ± 1.2 mL. At final follow-up, the median neck rotation deficiency significantly improved from 26.5° (IQR, 23.1°-29.4°) preoperatively to 3.0° (IQR, 2.5°-4.1°) (P < 0.001), and lateral bending deficiency improved from 18.2° (IQR, 15.8°-20.5°) to 2.5° (IQR, 2.0°-3.3°) (P < 0.001). According to Cheng and Tang scoring, 42 patients (95.4%) achieved excellent or good outcomes, with earlier intervention demonstrating significantly higher clinical scores. No intraoperative or postoperative complications were observed. This endoscopic sub-platysmal approach is a safe and effective minimally invasive technique for pediatric CMT, offering excellent functional recovery, minimal blood loss, superior cosmetic outcomes, and a remarkable safety profile. It represents a valuable addition to the surgical armamentarium for pediatric musculoskeletal disorders.
Spinal metastases from malignant tumors represent an increasingly relevant clinical problem due to improved systemic therapies, prolonged survival, and the growing prevalence of long-term survivors with metastatic disease. The spine is not only a central biomechanical component of the musculoskeletal system, but also protects the spinal cord and spinal nerves. Accordingly, the treatment of spinal metastases is complex and must always be embedded within an overarching oncological treatment concept. This review summarizes epidemiological and pathophysiological principles and presents contemporary indications and operative strategies for spinal metastases. The central goals of surgery are histological diagnosis, decompression of neural structures, restoration or preservation of mechanical stability, pain relief, and maintenance of neurological function and quality of life. Surgical decision-making should be interdisciplinary and should consider not only imaging findings and neurological status, but also tumor biology, radiosensitivity, systemic treatment options, prognosis, patient preference, and rehabilitation potential. Modern surgical treatment of spinal metastases has undergone a paradigm shift: maximal tumor resection is no longer routinely the primary objective; instead, the focus has shifted toward function-preserving, low-morbidity interventions embedded within a multimodal treatment strategy. Concepts such as NOMS, SINS, and the Bilsky grading system support structured decision-making. Minimally invasive procedures, percutaneous instrumentation, navigation, intraoperative three-dimensional imaging, modern implant materials, and increasingly AI-based prognostic models allow a patient-specific calibration of surgical invasiveness. The overall aim is to preserve neurological function and quality of life, control local tumor progression, and minimize treatment-delaying morbidity. HINTERGRUND: Die spinale Metastasierung maligner Tumorerkrankungen stellt aufgrund verbesserter systemischer Therapien, längerer Überlebenszeiten und einer steigenden Prävalenz von Langzeitüberlebenden ein zunehmend relevantes klinisches Problem dar. Die Wirbelsäule ist dabei nicht nur zentrales biomechanisches Element des Bewegungsapparats, sondern schützt zugleich Rückenmark und Spinalnerven. Entsprechend komplex ist die Behandlung spinaler Metastasen und muss stets in ein übergeordnetes onkologisches Gesamtkonzept eingebettet werden. Diese Übersichtsarbeit fasst epidemiologische und pathophysiologische Grundlagen zusammen und stellt moderne Indikationen sowie operative Strategien bei spinalen Metastasen dar. Zentrale Operationsziele sind die histologische Diagnosesicherung, die Dekompression neuraler Strukturen, die Wiederherstellung oder Erhaltung der mechanischen Stabilität, die Schmerzlinderung sowie der Erhalt neurologischer Funktion und Lebensqualität. Die Entscheidung zur Operation sollte interdisziplinär erfolgen und neben Bildgebung und neurologischem Status auch Tumorbiologie, Strahlensensitivität, systemische Therapiesituation, Prognose, Patientenwunsch und Rehabilitationsfähigkeit berücksichtigen. Die moderne chirurgische Behandlung spinaler Metastasen hat einen Paradigmenwechsel erfahren: Im Vordergrund steht nicht mehr regelhaft die maximale Tumorresektion, sondern eine funktionserhaltende, morbiditätsarme und multimodal eingebettete Intervention. Konzepte wie NOMS, SINS und die Bilsky-Graduierung unterstützen dabei die strukturierte Entscheidungsfindung. Minimalinvasive Verfahren, perkutane Instrumentierungen, Navigation, intraoperative 3‑D-Bildgebung, moderne Implantatmaterialien und zunehmend KI-basierte Prognosemodelle ermöglichen eine patientenspezifische Abstufung der Invasivität. Ziel ist es, neurologische Funktion und Lebensqualität zu erhalten, lokale Tumorprogression zu kontrollieren und therapieverzögernde Morbidität möglichst gering zu halten.