ObjectiveTo determine the influence of Spirulina supplementation on the response of bovine chondrocytes to mechanical compression with respect to extracellular matrix dynamics (proteoglycan and collagen) and inflammation [nitric oxide (NO)].MethodsBovine chondrocytes were embedded in agarose constructs and cultured for 14 days in basal media or media supplemented with Spirulina (30 or 90 µg/mL). Constructs were exposed to 10% dynamic compression. DNA content, NO levels, proteoglycan content and release, and collagen synthesis were measured to assess extracellular matrix (ECM) responses.ResultsDNA content did not differ among groups. Spirulina supplementation increased NO levels in constructs and media, with the highest effect observed at 90 µg/mL. Proteoglycan content decreased in Spirulina-treated constructs and declined further after compression, while proteoglycan release increased across all groups. Collagen synthesis and content were elevated by Spirulina, particularly at 90 µg/mL, and further increased following dynamic compression.ConclusionsSpirulina supplementation, particularly at higher concentrations, enhances ECM turnover and increases NO production in chondrocytes under mechanical loading, indicating potential modulation of matrix dynamics that may be beneficial. However, these results are derived from an in vitro model and may not fully represent in vivo physiological conditions.

Background/Objectives: Trochanteric pressure ulcers represent a challenging reconstructive problem due to their depth, frequent infection, and tendency for recurrence. Durable coverage with well-vascularized tissue capable of effective dead-space management is essential for long-term stability. The pedicled musculocutaneous anterolateral thigh (ALT) flap offers substantial soft-tissue volume with reliable regional vascularity. Methods: A retrospective review was performed of consecutive patients with Stage IV trochanteric pressure ulcers who underwent reconstruction using musculocutaneous pedicled island ALT flaps between January 2020 and August 2023. Ulcers were classified according to the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance International Guidelines. Patients with a minimum follow-up of 24 months were included. Demographic characteristics, ulcer etiology, prior flap history, comorbidities, flap dimensions, postoperative complications, and recurrence rates were analyzed. Results: Eight patients (4 males, 4 females; mean age 46.4 years, range 35-63) were included. Six ulcers (75%) were related to prolonged immobilization, and two (25%) developed following entrapment during the 2023 Kahramanmaraş earthquake. All donor sites were closed primarily. Minor recipient-site complications, including seroma and limited suture dehiscence, occurred in two cases. No partial or total flap necrosis was observed. During a mean follow-up of 42.4 months (minimum 24 months), no recurrence occurred. Conclusions: Musculocutaneous pedicled ALT flaps incorporating a substantial portion of the vastus lateralis muscle allowed effective dead-space obliteration and durable soft-tissue coverage in Stage IV trochanteric pressure ulcers. Primary donor-site closure was achievable without major morbidity. These findings support the use of the pedicled ALT flap as a consistent regional option in complex trochanteric defects, including both chronic immobilization-related and acute compression-related cases.

Spinal cord compression secondary to spinal extradural myeloid sarcoma in acute myeloid leukaemia: A case report and literature review

Acute lymphoblastic leukemia (ALL) is a neoplastic proliferation of immature hematopoietic cells, commonly presenting with anaemia, thrombocytopenia, neutropenia, or hepatosplenomegaly. Paraplegia as the initial manifestation is extremely rare. We report a 6-year-old girl presenting with backache and sudden paraplegia. MRI revealed a thoracic epidural mass (D1-D6). Tumor excision and laminectomy were performed, and histopathology confirmed B-cell ALL. This case highlights the importance of considering leukemia in children with acute spinal cord compression.

Severe cervical kyphosis concurrent with neurofibromatosis type 1 (NF-1) and large intraspinal tumors presents a dual challenge of oncological control and biomechanical reconstruction. We report a rare case of a 14-year-old male with NF-1 secondary to C1-C6 cervical spondylolisthesis, cervical retroversion, retrolisthesis of the C3 vertebral body (less than 1/2 of the vertebral diameter), C2 dislocation, atlantoaxial rotational dislocation, and a large intradural tumor, which caused acute spinal cord compression and neurofunctional deficits. An integrated surgical strategy combining microsurgical tumor resection with 3D-printed corrective fusion was implemented. Intraoperatively, gross total resection (GTR) of the tumor was achieved, followed by precise pedicle screw fixation assisted by patient-specific 3D-printed guides. This comprehensive approach prevented further neurological damage, and the patient achieved satisfactory clinical outcomes postoperatively. NF-1 is an autosomal dominant genetic disorder with an incidence of 1/3,000–1/4,000, characterized by diverse manifestations including skin abnormalities, neurological tumors, and musculoskeletal abnormalities. Approximately 50% of cases arise from de novo mutations. Case description A 14-year-old Han male student with no prior medical history was admitted for a 1-year history of a large right neck mass (15 × 9 cm) and 2 months of progressive generalized weakness. Physical examination revealed multiple café-au-lait macules (>30 mm) and a large cervical mass, consistent with NF-1. Neurological assessment showed decreased muscle strength in all limbs (grade 3), indicating incomplete spinal cord injury. Imaging (MRI/CT) demonstrated an intradural-intramedullary tumor extending through the intervertebral foramen, causing severe spinal cord compression and multiplanar instability (C1–C6).The patient was diagnosed with NF-1, severe cervical kyphosis, and an intraspinal tumor. He underwent posterior decompression, microsurgical GTR of the tumor (confirmed as neurofibroma via intraoperative frozen section), and occipitocervicothoracic fusion assisted by 3D-printed guides. The integrated surgery successfully restored spinal stability and decompressed the spinal cord. Conclusion Severe cervical retroversion combined with large NF-1 tumors is rare and technically demanding. A precision-medicine-based model integrating tumor management and digital orthopedic technology is essential for such high-risk cases. Preoperative planning using 3D digital technology enabled precise screw placement, while microsurgical techniques ensured safe and complete tumor resection. This integrated strategy effectively prevented permanent neurological deficits and resulted in satisfactory postoperative outcomes.

Background: Spinal hemangiomas are benign tumors that develop mostly in vertebral bodies but their behavior is uncertain. The thoracic spine is the most frequently affected segment by these lesions, followed by the lumbar and cervical levels. Although the vast majority are asymptomatic, aggressiveness in some cases can cause spinal pain, various neurological compromises or spinal instability. Case Description: We present a case in which a previously asymptomatic male patient suffered a craniocervical trauma that caused a severe compression fracture of C5, which manifested clinically and radiologically as a Brown-Sequard syndrome. Due to intraoperative behavior and surgical findings, the bone fragments and the tissue found within them were histologically analyzed, which confirmed the existence of a capillary hemangioma that considerably involved the vertebral body. The surgical treatment and neurological recovery were adequately evaluated with very good results. Conclusions: Vertebral hemangiomas are considered lesions with a well-defined etiology but an uncertain evolution. The clinical characteristics in the case presented are special due to the development of Brown-Sequard syndrome associated with a severe vertebral fracture that contained a previously undetected vertebral hemangioma that could have influenced the weakening of the fractured vertebral segment. Due to the increasing amount of information about the behavior of these hemangiomas, therapeutic decisions are diverse. Nevertheless, in the case of aggressive hemangiomas, definitive treatment protocols should focus on surgery and total excision of the lesions as a gold standard.

Purpose: To evaluate the clinical and radiologic effects of switching from long-term bisphosphonate therapy to romosozumab in an elderly patient with severe osteoporosis and vertebra plana–type severe osteoporotic vertebral collapse, followed by transition to denosumab maintenance therapy.Methods: An 85-year-old woman with a history of osteoporotic fractures and prolonged intravenous bisphosphonate therapy presented with an acute L2 compression fracture. Conservative management with a body cast was initiated, and romosozumab was introduced as a switching therapy when anabolic treatment was indicated. Thoracolumbar spine radiographs were obtained at presentation and at 1, 3, 7, and 12 months after injury. Computed tomography was performed at presentation and again at 7 and 12 months to assess fracture consolidation. Bone mineral density (BMD) was measured beginning at 18 months after injury and annually thereafter. Functional assessments were recorded throughout a 30-month follow-up period.Results: During romosozumab therapy, the L2 vertebra plana–type severe osteoporotic vertebral collapse showed marked radiologic improvement, characterized by progressive intravertebral bone fill-in and gradual restoration of trabecular continuity without further loss of height. Serial follow-up CT and MRI demonstrated consolidation of the previously cavitated vertebral body, indicating substantial structural recovery rather than simple stabilization. Clinically, the patient experienced steady improvement in pain and ambulatory capacity. After completing six monthly doses of romosozumab, therapy was transitioned to denosumab. L2 bone mineral density improved from a T-score of –1.7 to –0.9, accompanied by gains in femoral BMD. No additional fragility fractures occurred throughout the follow-up period.Conclusions: Switching from long-term bisphosphonate therapy to romosozumab resulted in improved BMD, progressive vertebral bone fill-in, and stabilization without further collapse in this elderly patient with severe osteoporosis. Although not established as a fracture-healing agent, romosozumab may serve as a practical anabolic option in selected cases, with denosumab maintenance ensuring ongoing skeletal protection.

Aim:This study investigated the association between nighttime noise control and melatonin secretion alongside bone repair-related factors in patients with osteoporotic vertebral compression fractures.Methods:A retrospective study was conducted at LiuZhou Municipal Liutie Central Hospital between January 2022 and December 2023. Patients with acute osteoporotic vertebral compression fractures were divided into the following two groups: standard care group (n = 65) and noise control group (n = 72). The noise control group received enhanced acoustic management in specially designed quiet zones, whereas the standard care group was treated in regular hospital wards. Melatonin levels, osteoprotegerin (OPG), cortisol concentrations, receptor activator of nuclear factor-κB ligand (RANKL), RANKL/OPG ratio, Visual Analog Scale (VAS) for pain intensity and Single-Item Sleep Quality Scale (SQS) for sleep quality were measured at baseline and Day 7 of hospitalisation.Results:The noise control group demonstrated significantly elevated melatonin levels compared with the standard care group (P < 0.001). SQS scores were significantly higher in the noise control group than in the standard care group (P < 0.001). Cortisol concentrations were significantly reduced in the noise control group (P < 0.001). Bone metabolism regulation markers showed favourable changes in the noise control group, with significantly decreased RANKL/OPG ratio (P < 0.001), elevated OPG levels (P = 0.005) and reduced soluble RANKL concentrations (P < 0.001). VAS scores demonstrated a significant reduction in the noise control group (P < 0.001).Conclusion:Acoustic environmental modifications were associated with altered melatonin secretion patterns and changes in bone metabolism markers. These findings suggest potential associations between noise control measures and physiological parameters in orthopaedic patient populations.

Advancements in Vertebral Augmentation: Innovations in Biomaterials and Cement Compositions.

Vertebral compression fractures (VCFs) are associated with significant pain and disability. The current standard of care is expectant medical management; however, there is emerging data encouraging the use of early kyphoplasty or vertebroplasty. The goal of this nationwide study was to investigate the outcomes of patients with acute thoracolumbar VCF who undergo very early (inpatient) kyphoplasty compared with those managed medically. This was a retrospective cohort analysis of the Nationwide Readmissions Database from 2016 to 2022. Adult patients admitted nonelectively for thoracolumbar wedge compression fractures were included. Patients were excluded if they had cancer, additional fractures, cord compression, or if they underwent surgery. Those who underwent kyphoplasty or vertebroplasty were 1:1 propensity score matched with those who were managed medically, and Poisson or logistic regression analyses were performed for outcomes. The primary endpoint was discharge to home. Other outcomes included in-hospital death, hospital length of stay (LOS), cost, and major morbidity or mortality after discharge at 180 days. A total of 69,722 patients were included in the study, of whom 53,142 (76.2%) underwent medical management while 16,580 (23.8%) underwent kyphoplasty or vertebroplasty. After propensity score matching, patients who underwent kyphoplasty/vertebroplasty experienced a significantly higher rate of discharge to home (54.3%) compared with medically managed patients (46.2%) (OR 1.38, 95% CI 1.28-1.50; p < 0.001). Compared with medical management, patients who underwent kyphoplasty/vertebroplasty had significantly lower in-hospital death (0.4% vs 0.9%; OR 0.48, 95% CI 0.32-0.74; p < 0.001) but a slightly longer hospital LOS (median 5 vs 4 days; B = 1.23, 95% CI 1.07-1.38; p < 0.001) and higher cost (B = 8.9, 95% CI 8.4-9.3; p < 0.001). There was no significant difference in inpatient adverse events between the medical management and kyphoplasty/vertebroplasty groups (p > 0.05), and, among patients discharged home, inpatient kyphoplasty/vertebroplasty did not lead to differences in delayed morbidity or mortality within 180 days (p > 0.05). Subgroup analysis revealed that women may derive a greater benefit from kyphoplasty/vertebroplasty (OR 1.47, 95% CI 1.35-1.61; p < 0.001) than men (OR 1.19, 95% CI 1.05-1.35; p = 0.009) (interaction p = 0.003). Inpatient kyphoplasty/vertebroplasty is associated with higher odds of home discharge and lower odds of mortality. These findings support the use of very early (inpatient) kyphoplasty/vertebroplasty for those with acute thoracolumbar compression fractures.

Background Context: Vertebral compression fractures are the most common fragility fracture in the world and, with an increasing elderly population, are predicted to comprise a significant portion of spinal health care costs. Although kyphoplasty is accepted as a common treatment option, further details of its procedural aspects are less well established. Purpose: This study aimed to highlight the relationships between age, sex, and spinal levels treated by kyphoplasty and balloon pressure, volume, and cement volume. Study Design: Single Surgeon Observation Study Patient Sample: 77 patients with VCF undergoing kyphoplasty with the author (SRH) between April 2023 to September 2024. Methods: Procedural kyphoplasty measurements of balloon pressure, balloon volume, and cement volume were recorded. The inclusion criteria included patients with known osteoporotic fracture and failure of non-operative management. Only patients with acute or subacute osteoporotic compression fractures were included. Exclusion criteria included previous surgery at the spinal level and VCF due to non-osteoporotic etiology (i.e. trauma or neoplasm). Results: A total of 141 levels were included in this study. There were 77 patients; 61% female, 39% male. 54 thoracic levels were treated with a mean age of 77.0 (females) and 74.7 (males). 87 lumbar levels were treated, with a mean age of 79.3 (females) and 77.9 (males). There was a statistically significant relationship between age (by decade) and region (T vs. L spine) (p=.013). Of the 77 patients, 19% underwent surgery on multiple dates (n=15). Pressure analysis revealed that the mean inflation pressure was 152.5 PSI for thoracic spine levels and 147.5 PSI for lumbar spine levels. This was not statistically significant but there was a significant correlation between age by decade and the mean pressure (p=0.0014). When spinal levels were grouped anatomically (T6-9, T10-L1, L2-5), there was a statistically significant relationship between spinal grouping and pressure (p=0.044). The mean balloon volume was 2.42 cc for the thoracic spine levels and 2.89 cc for the lumbar spine levels. Balloon volume and age by decade were significant, with a (p=0.0137). In addition, statistically significant relationships were identified between balloon volume and level (p=0.014) and between balloon volume and age by decade (p=0.003). However, no statistically significant correlation was found between balloon volume and sex. The mean cement volume was 2.27 cc for the thoracic spine levels and 2.92 cc for the lumbar spine levels. Cement volume demonstrated a significant relationship with spinal level (p&lt;.001). Cement volume analysis revealed a statistically significant relationship between mean cement volume and sex (p = 0.0255, two-way ANOVA). Males required higher cement volumes than females (p&lt;.0001). Cement volume significantly correlated with age by decade (p=0.034). Advanced age requires a higher cement volume. Conclusion: Age, sex, and spinal level can significantly influence procedural components during kyphoplasty for osteoporotic VCF. Both thoracic and lumbar fractures have different procedural requirements, with greater demands on the balloon and cement quantities at the lumbar levels. Variations in sex and age emphasize the importance of personalized surgical planning in the optimization of patient outcomes.

Over a century ago, Charles Sherrington introduced the concept of the brain's unity, emphasizing the collaboration of different sensory and motor functions. This is exemplified by the vestibulo-ocular reflex, which integrates sensory signals to control eye position. Biomedical engineer David Robinson expanded on this by highlighting neural integration over time, balancing sensory differentiation and integration to maintain consistent actions and perceptions. A classic dysfunction of the ocular motor neural integrator is gaze-evoked nystagmus, where the eye position decays towards a neutral position, and it is dependent upon orientation of gaze in orbit. This dysfunction is not limited to gaze holding. Studies have shown that unilateral brainstem lesions affecting the paramedian pontine reticular formation (PPRF) result in the loss of ipsilateral conjugate eye movements. The neural integrator, located in the medial vestibular nucleus (MVN) and nucleus praepositus hypoglossi (NPH), combines all ocular motor signals in their final common pathway. In macaques, acute, reversible lesions in these areas can lead to (reversible) gaze-evoked nystagmus and loss of other eye movements. If the lesions are ipsilateral, they cause unilateral deficits, which are reversible over time. This phenomenon, however, is not exclusive to animal models and can be seen in human patients with acute (reversible) mechanical compression of the neural integrator regions. Here, we report two cases of such deficits, highlighting that reversible focal unilateral neural integrator dysfunction can cause reversible "hemi" ocular motor deficits, affecting pursuit, saccades, and gaze holding in a unidirectional, opposite fashion.

The value of a deep learning image reconstruction algorithm for assessing vertebral compression fractures using dual-energy computed tomography.

Background and Objectives: Acute metastatic cord compression (AMSCC) and femoral impending/pathological fracture negatively impact a patient's quality of life, morbidity and survival, and are considered significant life events. This study aims to compare AMSCC and FMD as distinct yet overlapping metastatic orthopedic emergencies, addressing whether they represent sequential disease stages or distinct patient subpopulations-an analysis critical for prognosis and treatment planning. Materials and Methods: Records of all patients who underwent surgery for a femoral metastatic disease (FMD) over a decade (2004-2015) and patients who were treated for acute metastatic spinal compression (AMSCC) (2007-2017) were retrieved. There were no patients lost to follow-up. Results: The treatment cohorts were similar in terms of age, gender, tumour origin, and the number of spinal metastases. Fifty-four patients were diagnosed with AMSCC. Following treatment, the Frankel muscle grading improved by 0.5 ± 0.8 grades. Two hundred and eighteen patients underwent surgical intervention for FMD. Seventy percent of femoral metastases were located in the femoral neck and trochanteric area. Impending fractures accounted for 52% of the cohort. The FMD cohort, including impending and pathological fractures, was similar to the AMSCC cohort in terms of age and the time interval between cancer diagnosis and surgery (56.7 ± 74.2 vs. 51.6 ± 69.6, respectively, p = 0.646). The Karnofsky functional score was higher for the FMD cohort (63.3 ± 16.2) than for the AMSCC cohort (48.5 ± 19.5; p < 0.001). The mean survival time for the FMD cohort was double that of the AMSCC, at 18.4 ± 23.5 months versus 9.1 ± 13.6 months, respectively (p = 0.006). Conclusions: In conclusion, this study is novel in proposing that FMD and AMSCC are distinct clinical entities, differing in their impact on patient function and, most importantly, on patient survival.

Objectives: Spinal diseases are commonly encountered health problems with a wide spectrum. In addition to degenerative changes, other common spinal pathologies include metastases and compression fractures. Benign tumors like hemangiomas and infections such as spondylodiscitis are also frequently observed. Although magnetic resonance imaging (MRI) is considered the gold standard in diagnostic imaging, the morphological similarities of lesions can pose significant challenges in differential diagnoses. In recent years, the use of artificial intelligence applications in medical imaging has become increasingly widespread. In this study, we aim to detect and classify vertebral body lesions using the YOLO-v8 (You Only Look Once, version 8) deep learning architecture. Materials and Methods: This study included MRI data from 235 patients with vertebral body lesions. The dataset comprised sagittal T1- and T2-weighted sequences. The diagnostic categories consisted of acute compression fractures, metastases, hemangiomas, atypical hemangiomas, and spondylodiscitis. For automated detection and classification of vertebral lesions, the YOLOv8 deep learning model was employed. Following image standardization and data augmentation, a total of 4179 images were generated. The dataset was randomly split into training (80%) and validation (20%) subsets. Additionally, an independent test set was constructed using MRI images from 54 patients who were not included in the training or validation phases to evaluate the model’s performance. Results: In the test, the YOLOv8 model achieved classification accuracies of 0.84 and 0.85 for T1- and T2-weighted MRI sequences, respectively. Among the diagnostic categories, spondylodiscitis had the highest accuracy in the T1 dataset (0.94), while acute compression fractures were most accurately detected in the T2 dataset (0.93). Hemangiomas exhibited the lowest classification accuracy in both modalities (0.73). The F1 scores were calculated as 0.83 for T1-weighted and 0.82 for T2-weighted sequences at optimal confidence thresholds. The model’s mean average precision (mAP) 0.5 values were 0.82 for T1 and 0.86 for T2 datasets, indicating high precision in lesion detection. Conclusions: The YOLO-v8 deep learning model we used demonstrates effective performance in distinguishing vertebral body metastases from different groups of benign pathologies.

Ependymoma is the most common spinal cord tumor in the adult population, but it is, nevertheless, very rare. Most patients have no symptoms or only nonspecific symptoms. Intraspinal anesthesia is the preferred anesthetic technique for obstetric surgery because it has minimal effects on the fetus. Spinal anesthesia causing hemorrhage into spinal tumor have been reported, but very few have been for epidural anesthesia. We describe a case of a 36-year-old female patient who presented with acute paraplegia due to after undergoing a cesarean section under epidural anesthesia. Magnetic resonance imaging suggested the possibility of subdural intratumoral hemorrhage. An emergency laminectomy, at T12-to-L1 level, was performed 39 hours after the cesarean section to decompress the spinal cord. An ependymoma was diagnosed after examination of the pathological specimen. She received physical rehabilitation support after surgery. The patient was left with residual motor and sensory deficits finally. Early identification and early surgery minimize the risk of severe neurological deficit following acute spinal cord compression.

ObjectiveTo investigate whether the unilateral posterosuperior approach PVP is superior to the traditional unilateral transpedicular approach in the treatment of acute osteoporotic vertebral compression fractures (OVCFs).MethodsA retrospective study was conducted on 167 patients with single-segment acute OVCFs admitted to our hospital from September 2019 to March 2022. Patients were divided into two groups according to the type of intraoperative approach used: the unipedicular posterosuperior approach vertebroplasty (UPV) group (n = 85) and the unilateral transpedicular approach vertebroplasty (UTV) group (n = 82). Surgical data, including operation time, blood loss, fluoroscopy frequency, puncture needle crossing the midline during surgery, and bone cement injection volume, were collected. Imaging data, such as vertebral height, distribution of bone cement, and cement leakage, were analyzed. Clinical efficacy indicators, including the Visual analogue scale (VAS) score and Oswestry Disability Index (ODI), were compared. Additionally, the occurrence of vertebral refracture, adjacent vertebral fracture, and postoperative complications were assessed.ResultsBoth groups were followed up for an average of 13.6 months (range: 12–24 months). No statistically significant differences were detected between the UPV and UTV groups in terms of the VAS and ODI scores or the vertebral height. The two groups had similar blood loss rates, fluoroscopy frequencies, and operation times. However, the UPV group presented a greater volume of bone cement injected and a better dispersion pattern of bone cement (10.75 ± 0.48 vs. 7.56 ± 1.86) (P < 0.05). The occurrence of vertebral collapse after surgery was positively correlated with the distribution of bone cement. Cement leakage was observed in 5 patients in the UPV group and 10 patients in the UTV group. The UPV group had 2 cases of adjacent vertebral refracture within six months, whereas the UTV group had 5 cases. One adverse event, pneumothorax, occurred in the UPV group. However, due to the retrospective nature of the study, there was a lack of control over confounding variables such as age, bone mineral density, and comorbidities, which may affect the interpretation of the results.ConclusionsPVP via the unilateral approach effectively relieves back pain in patients with OVCFs. The unilateral posterosuperior approach allows for the injection of a greater volume of bone cement, resulting in a more even distribution within the vertebral body. However, caution should be exercised to avoid excessive lateral puncture points.

Background: Discriminating pathological from osteoporotic vertebral compression ‌a fracture is sometimes challenging.‌Aim: to create scoring system using several MRI signs, trying to correctly ‌differentiate osteoporotic from malignant compression vertebral fractures.‌Patients and method: a prospective case control analytic study was performed in ‌MRI unite of Al-Imamain Al-Kadhemain Medical City/ Baghdad/Iraq, 68 patients (24 ‌male and 44 female) were included, all were presenting with acute back pain and ‌vertebral compression fracture on x ray. MRI was done within 2 months from ‌symptom onset and follow up for at least 4-6 weeks. A 9 MRI signs were evaluated in ‌terms of sensitivity, specificity and accuracy in diagnosis of malignant fractures. A ‌stepwise analysis was used to create a scoring system to differentiate malignant from ‌osteoporotic vertebral compression fractures.‌Results: Malignant vertebral fracture was diagnosed in 13 patients and osteoporotic ‌vertebral fracture 55 patients. All used MRI signs had a variable specificity and ‌sensitivity for diagnosis of malignant fractures but all are statistically significant ‌except one. Mean score for patients with MVF was 3.5 (range of 3-6), while Mean ‌score in patients with OVF was 2.1 (range of 0-4). The optimum score cutoff value ‌was 4 with 61.5% sensitivity, 81.8% specificity, 79.4% accuracy and statistically ‌significant (P-value=0.012) for the discrimination of malignant from osteoporotic ‌vertebral compression fractures.‌Conclusion: Convex posterior vertebral border, asymmetrical diffuse or rounded ‌abnormal bone marrow signal, involvement of the pedicle, and para-vertebral soft ‌tissue mass are highly suggestive MRI sign of malignant fracture. Post contrast ‌enhancement is not a specific sign. Fluid cleft sign is suggestive of osteoporotic ‌fracture. This simple scoring system could be useful tool for the differentiation of ‌malignant and osteoporotic vertebral fractures with the best accurate cutoff value is ‌‌4. ‌Keywords: Magnetic resonance imaging, malignant vertebral compression fracture, ‌Osteoporotic vertebral compression fracture. ‌

Retrospective study. To verify the association between pedicle enhancement (PE) on contrast-enhanced magnetic resonance imaging (MRI) and progressive collapse, and analyze the correlation between the degree of PE and progressive collapse. Osteoporotic compression fracture (OCF) is generally considered a stable fracture, with most patients achieving successful recovery through conservative treatment such as bracing and physical therapy. However, in some cases, progressive collapse occurs, requiring additional treatment or surgery. We enrolled 203patitents and analyzed factors related to progressive collapse. We evaluated the association between PE and progressive collapse and determined the best cult off value of the signal-to-noise ratio of PE (SNR of PE) for predicting progressive collapse. Survival analysis using Kaplan-Meier curve was performed to assess the cumulative risk of positive progressive collapse over time. Presence of PE, SNR of PE, age, body mass index, and segmental kyphosis were significantly correlated with progressive collapse. The optimal cutoff point of SNR of PE was measured at 89.3 with 71.1% and 78.7% sensitivity and specificity, respectively, with an AUC of 0.781. Analysis of cumulative progressive collapse incidence revealed a significant difference between the PE and NPE groups within 1-2 months after OCF, which stabilized after three months. PE is a significant predictor of progressive collapse in OCF within a year, aiding spine surgeons in risk assessment of progressive collapse and management of acute OCF. 3.

Cauda equina syndrome is a symptom complex of significant clinical and medico-legal concern to both primary care physicians and neurosurgeons. Theclinical spectrum of presentation is acause for significant confusion in the primary care and emergency department setting, which, coupled with the high frequency of litigation relating to these cases, results in physician discomfort in the assessment, investigation and triage of patients with lumbar spinal pathology. This paper aims to discuss the clinical spectrum of 'cauda equina syndrome' and relate the signs and symptoms to their underlying anatomical basis, to provide aframework from which primary care physicians and neurosurgeons can triage the urgency of investigation and/or intervention. We recommend that 'cauda equina syndrome' should be better understood asa spectrum of severe radiculopathy relating to acute compression of lumbarand/or sacral nerve roots, which comprises multiple separate indications for investigation and intervention with variable urgency.