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.
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.
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.
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.
Osteoarticular tuberculosis infection in spine, hip, and knee is the most common bone and joint extrapulmonary tuberculosis (EPTB), accounting for 10-15% of all EPTB cases. The urgent need for new treatment strategies arises from the severe clinical consequences of delayed or misdiagnosed osteoarticular TB infections, compounded by the inadequacies of current antibiotic therapies. Local antibiotic delivery approaches using advanced biomimetic biomaterials as a carrier system provide an efficient alternative. Herein, we develop an injectable, biocompatible nanohydroxyapatite-based carrier system (Nanocement; NC), compositionally similar to natural bone mineral, to deliver two first-line anti-tuberculosis antibiotics, isoniazid and rifampicin locally. The NC carrier was characterised for physicochemical properties, in vitro biocompatibility and anti-mycobacterial activities using a virulent H37Rv strain of Mycobacterium tuberculosis. The antibiotic-loaded NC was finally implanted in the spine and tibia TB infection model developed in guinea pigs for 8 weeks, using oral antibiotic therapy as a control. The results showed that the antibiotic carrier system has enormous potential to provide an promising alternative to oral antibiotic therapy or could be more beneficial if combined with an oral regime. During the surgical debridement, an irregular dead space is created that require local infection control and support for early bone healing, rather than immediate structural restoration. As an injectable cement, NC is optimized to conform to these cavities, deliver sustained local anti-tubercular therapy, and provide an osteoconductive microenvironment that supports gradual bone regeneration. While its intrinsic mechanical properties may limit its use in large, critical defects requiring structural support, NC can be effectively applied in combination with fixation devices or secondary grafting strategies. STATEMENT OF SIGNIFICANCE: Osteoarticular tuberculosis remains a debilitating global health challenge, where delayed diagnosis and limited efficacy of systemic antibiotics often result in irreversible skeletal damage. This study explores the potential of an indigenously developed injectable nanohydroxyapatite-based "Nanocement" that locally co-delivers isoniazid and rifampicin while simultaneously acting as an osteoconductive bone filler. By directly targeting infectious bone lesions, this biomimetic carrier achieves potent and sustained anti-mycobacterial activity against virulent M. tuberculosis in vivo, while promoting bone healing in infectious lesions. This dual-action strategy offers a transformative alternative to conventional oral regimens and highlights a clinically translatable approach for treating complex bone infections.
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.
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.
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.
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.
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.
Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by extensive ossification of the spinal ligaments and entheses, resulting in a rigid spine that behaves biomechanically like a long bone. Although spinal fractures and dislocations after minor trauma are well recognized in ankylosed spines, non-traumatic spontaneous instability is rare. We report a rare case of spontaneous L4/L5 dislocation in a young patient with severe obesity and DISH. A 40-year-old man presented with progressive low back pain, bilateral lower extremity weakness, and bladder-bowel dysfunction. He had initially been treated at another hospital for septic shock due to urinary tract infection, but his neurological deficits persisted after improvement of the infection. On transfer to our institution, he was 168 cm tall, weighed 132 kg, and had a body mass index of 46.7 kg/m2. Neurological examination showed severe bilateral lower extremity weakness and sensory disturbance below the L1 level. Computed tomography demonstrated extensive thoracolumbar ankylosis consistent with DISH, with the L4/L5 segment representing the only remaining mobile level. An L5 superior articular process fracture, facet joint separation, and spontaneous L4/L5 dislocation were identified. Magnetic resonance imaging showed cauda equina compression at L4/L5. Because the lesion was considered highly unstable, staged circumferential reconstruction was performed. Initial percutaneous posterior fixation from L2 to S1 was carried out in the lateral decubitus position to avoid aggravation of the dislocation that might have occurred in the prone position. Pelvic fixation with S2 alar-iliac screws was then added in a second stage after repositioning the patient prone, because screw insertion was technically difficult in the lateral position. Anterior lumbar interbody fusion at L4/L5 with iliac bone grafting was subsequently performed. At six months postoperatively, low back pain had improved, and local stability was maintained, although severe motor deficits and bladder-bowel dysfunction persisted. In this patient, severe obesity and extensive ankylosis likely concentrated chronic mechanical stress at the L4/L5 segment, which functioned as the last mobile segment. This resulted in progressive failure culminating in spontaneous dislocation. Clinicians should recognize that, even without trauma, the last mobile segment in DISH may fail catastrophically. In such cases, rigid circumferential stabilization with long-segment fixation should be considered.
Osteoid osteoma (OO) is a benign osteogenic tumor that most commonly affects long bones, accounting for 2-3% of primary bone tumors. Spinal involvement is relatively rare, representing 6-20% of cases, with the lumbar spine being the most frequently affected region. Typical spinal OO presents with painful scoliosis and nocturnal pain relieved by non-steroidal anti-inflammatory drugs (NSAIDs). However, atypical presentations may occur when lesions are located adjacent to neural structures, leading to radicular symptoms and poor NSAID response. This case report describes an unusual presentation of OO in the L4 superior articular process, manifesting with back and leg pain, minimal NSAID responsiveness, and nerve root irritation. A 17-year-old male presented with a 6-month history of back and leg pain, fluctuating between 3/10 and 7/10 in severity, with associated numbness in the L3 dermatome. Examination revealed painful paraspinal palpation and a positive straight leg raise on the right side, without motor weakness or reflex abnormalities. Magnetic resonance imaging demonstrated non-specific inflammatory changes, whereas computed tomography (CT) confirmed a 9 × 9 mm nidus in the right superior articular process of L4. Given the lesion's proximity to neural structures, radiofrequency ablation was deemed unsafe, and surgical excision was performed. The patient underwent open resection of the nidus with preservation of the inferior facet joint. Immediate post-operative resolution of leg pain was noted, and at 3-month follow-up, the patient reported complete resolution of both back and leg pain, with no recurrence of symptoms. This case highlights an atypical presentation of spinal OO, characterized by radicular symptoms and poor NSAID response due to nerve root inflammation. It underscores the importance of considering OO in the differential diagnosis of adolescent back and leg pain, even in the absence of classic features. CT imaging remains essential for definitive diagnosis, and surgical excision provides safe and effective treatment when minimally invasive options are contraindicated by lesion proximity to neural structures.
Recent studies highlight the crucial role of the paraspinal musculature (PM), particularly the multifidus (MF), in spinal health and patient outcomes. However, factors associated with PM atrophy and their relative importance remain unclear. To address this gap, we analyzed factors linked to PM atrophy in patients undergoing lumbar fusion using machine learning, aiming to clarify the multifactorial mechanisms underlying this condition. Fatty infiltration (FI) of the lumbar MF was measured as a proxy for muscular atrophy in patients undergoing lumbar spinal fusion. Two machine learning models, logistic regression and extreme gradient boosting (XGBoost), were trained to predict severe FI (> 50%) of the MF. Model performance was evaluated on unseen test data using receiver operating characteristic (ROC) analysis and Brier score, and predictor importance was assessed via SHAP (SHapley Additive exPlanations). The study included 316 patients, primarily treated due to lumbar spinal stenosis. Both machine learning models effectively predicted severe MF atrophy, with an area under the curve (AUC) of 0.83 (95% CI 0.74–0.83) for the logistic regression and 0.88 (95% CI 0.81–0.88) for the XGBoost. In the logistic regression model, only sex, age, and facet joint degeneration were significant predictors. The XGBoost model identified the same top three variables, while the lumbar endplate score and bone mineral density ranked higher than in logistic regression. This study introduces a novel framework for analyzing factors influencing PM atrophy, highlighting the intricate interplay between demographic variables like age and sex and facet joint degeneration. By applying modern machine learning techniques, we improved predictive accuracy and identified endplate and bone changes as strongly associated factors, offering valuable insights into the mechanisms shaping muscle health in lumbar conditions.
Osteoporotic fracture healing is frequently complicated by elevated levels of reactive oxygen species and disrupted bone homeostasis. Biodegradable magnesium alloys are promising orthopedic implants, but rapid degradation in oxidative, acidic osteoporotic microenvironments limits their clinical application. In this study, we develop a reactive oxygen species-responsive hydrogel coating of tannic acid and gelatin methacryloyl on magnesium implants via a metal-phenolic network. We show that this firmly adhering coating significantly decelerates magnesium degradation while scavenging reactive oxygen species on demand. In osteoporotic rat models, we demonstrate that coated implants effectively reduce oxidative stress and facilitate bone healing. Mechanistically, single-cell transcriptomics reveals that the coating activates the nuclear factor erythroid 2-related factor 2 signaling pathway in bone marrow mesenchymal stromal cells and bone marrow-derived macrophages, enhancing osteogenesis while inhibiting osteoclastogenesis. Consequently, this multifunctional coating provides corrosion protection and a targeted therapeutic approach to enhance osteoporotic fracture healing under oxidative stress.
Determine the effect of mechanical and intrinsic (demographic and anthropometric) variables on anteroposterior shear stiffness in cervical functional spinal units (FSUs), and provide response corridors for computer model validation. Thirty-nine human FSUs were loaded non-destructively in statically rotationally unconstrained pure shear up to 200N, in anterior and posterior directions, at rates of 1, 10, and 100 mm/s. Due to the inherent non-linear behavior, the resulting stiffness response was analyzed as bilinear (lower Phase I and higher Phase II). The effect of mechanical (direction and rate) and intrinsic (age, sex, anteroposterior endplate dimension, disc and facet joint degeneration, bone volume fraction) factors on stiffness were evaluated using a linear mixed models approach. In Phase I, specimens were 67% stiffer in anterior shear than posterior (p < 0.001), and 25% less stiff at 100 mm/s than at 1 and 10 mm/s (p < 0.001) across both directions. In Phase II, specimens were 42% stiffer in anterior shear than posterior (p < 0.001) and displacement rate was positively correlated with stiffness (p < 0.001). Males were 8% stiffer than females on average (p = 0.001), although a significant interaction between sex and direction (p = 0.008) showed that this was more prominent in the anterior direction, where males were 12% stiffer. Disc degeneration was positively correlated with stiffness (p = 0.003). The unique data measured in this study provides improved understanding of lower cervical spine shear response and provide critical data for validating computational models of the spine.
Adjacent segment retrolisthesis is a common yet frequently overlooked complication after lumbar fusion, which may lead to reoperation. However, its risk factors, particularly those related to preoperative degenerative status and intraoperative variables, remain poorly understood. Therefore, this study aimed to elucidate the risk factors that contribute to the development of retrolisthesis in the adjacent segment following transforaminal lumbar interbody fusion (TLIF). We retrospectively reviewed 473 patients who underwent lower lumbar fusion for degenerative diseases from June 2017 to September 2022, with a minimum follow-up of 2 years. Seventy patients who developed radiographic retrolisthesis postoperatively were included in the RR group, and 18 patients with symptoms were classified into the symptomatic retrolisthesis (SR) group. Using a 1:2 ratio, 140 patients without retrolisthesis were matched as the non-retrolisthesis (NR) group. Preoperative MRI was used to assess fat infiltration and cross-sectional area of the erector spinae, multifidus, and psoas muscles, as well as total endplate score and disc degeneration. CT was used to evaluate facet degeneration and pedicle screw-related facet joint violation. Independent sample t-tests and chi-square tests were used for group comparisons, and multivariate logistic regression analysis was performed to identify independent risk factors. Baseline age, sex, and bone mineral density were comparable between groups. Multivariate analysis showed that higher preoperative total endplate score (OR 2.086, 95% CI 1.496-2.907, p < 0.001), greater paraspinal muscle fat infiltration (OR 1.117, 95% CI 1.046-1.192, p = 0.001), facet degeneration (OR 2.838, 95% CI 1.762-4.570, p < 0.001), and postoperative facet violation (OR 1.911, 95% CI 1.330-2.746, p = 0.001) were independent risk factors for RR. Predictors of SR included total endplate score (OR 3.506, p = 0.002), fat infiltration of paraspinal muscles (OR 1.230, p = 0.008), facet degeneration (OR 8.940, p = 0.002), and postoperative facet violation (OR 2.873, p = 0.024). Preoperative degeneration of adjacent endplates, facet joints, and paraspinal muscles, together with postoperative facet joint violation, appears to be significantly associated with the development of retrolisthesis. Patients with retrolisthesis often present with persistent or severe low back pain after lumbar fusion, resulting in impaired quality of life.
Pathological osteolysis, driven by excessive osteoclast activity, is a hallmark of Rheumatoid Arthritis (RA) and osteoporosis. Current therapies target inflammation but fail to prevent bone erosion, highlighting the demand for dual-action agents. Although Tripterygium wilfordii has shown therapeutic efficacy in RA, its clinical application is restricted by toxicity. Consequently, identifying novel bioactive monomers with favorable safety and deciphering their targets remains a critical need. Through network pharmacology, we identified Friedelin as a core bioactive monomer of Tripterygium wilfordii. Its anti-osteoclastogenic efficacy was evaluated in vitro and validated in vivo using collagen-induced arthritis (CIA) and ovariectomized (OVX) mouse models. To elucidate direct targets and molecular mechanisms, we integrated RNA-seq, cellular thermal shift assay (CETSA), surface plasmon resonance (SPR), and molecular docking. Friedelin potently suppresses RANKL-induced osteoclast differentiation throughout the full course of induction in vitro. Mechanistically, Friedelin directly targets both p105(NF-κB1) and STAT3 exerting sequential pharmacological effects. During the early phase of differentiation, its binding to p105 inhibits ubiquitination-dependent processing, thereby aborting NF-κB signaling initiation. Subsequently, in the late phase, its interaction with STAT3 disrupts the STAT3/NFATc1 transcriptional and STAT3/LDHB metabolic axes, leading to impaired osteoclastogenesis. In vivo, Friedelin exhibited superior efficacy to Methotrexate (MTX) in alleviating bone erosion in CIA mice and effectively prevented bone loss in OVX mice. Friedelin acts as a potent dual-phase inhibitor of osteoclastogenesis by sequentially blocking p105 dependent signaling initiation and STAT3 mediated transcriptional regulation. This study highlights Friedelin as a promising therapeutic candidate for inflammatory and metabolic bone diseases.