Anterior Osteophytes Research Articles

Association between quadriceps fat pad edema and patellofemoral osteoarthritis: a quantitative Q-Dixon-based magnetic resonance imaging (MRI) analysis.

Anterior knee pain (AKP) is a common symptom of patellofemoral osteoarthritis (PFOA). There is limited prospective evidence supporting the relationships between patellofemoral maltracking parameters, AKP, and PFOA. Thus, this prospective cross-sectional study aimed to determine the association between quadriceps fat pad (QFP) edema and patellofemoral maltracking in patients with chronic AKP and to evaluate the feasibility and diagnostic performance of a PFOA assessment using fat fraction (FF) and T2* based on Q-Dixon. This was a cross-sectional study with prospective data collection. Patients with chronic AKP were recruited from an orthopedic outpatient magnetic resonance imaging (MRI) waiting room at Shanghai Tongren Hospital between November 1, 2022, and April, 30, 2023. Exclusion criteria included age of <18 years, knee trauma, major internal derangement, prior surgery/arthroscopy, pre-existing joint diseases, and contraindications to MRI. MRI was performed using a 3.0-T instrument, and patellofemoral maltracking parameters were measured. Patellofemoral feature-relevant items, including patellar cartilage defects, patellar bone marrow lesions (BMLs), patellar osteophytes, anterior femoral osteophytes, Hoffa synovitis, and synovitis-effusion, from the semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) were measured. The Anterior Knee Pain Scale (AKPS) was used to assess pain and function. FF/T2* measurement differences between groups and their associations with maltracking metrics, osteoarthritis grading based on the Iwano grading system, MOAKS, and AKPS, were investigated. Based on Iwano grading, the participants were categorized as having no-PFOA (n=40), mild PFOA (n=40), and advanced PFOA (n=40). Chi-squared and one-way analysis of variance were used to assess potential differences between the groups. Spearman's correlation test was used to analyze the correlation between the morphological parameters, AKPS, Iwano grade, MOAKS, and MRI quantitative values. Receiver operating characteristic (ROC) curves assessed the area under the curve (AUC), sensitivity, and specificity of quantitative values for distinguishing PFOA from no-PFOA. Among the 120 included patients, those in the mild (86.2±8.5) and advanced (83.9±9.5) PFOA groups had significantly lower AKPS scores than those in the no-PFOA group (88.8±7.3) (P=0.03). The mean FF and T2* values of the QFP were significantly higher in the no-PFOA group than those in the mild and advanced PFOA groups (P<0.001 for FF and P=0.02 for T2*). Quantitative data on the QFP and patellofemoral maltracking parameters showed no association. FF (r=-0.686, P<0.001) and T2* (r=-0.314, P=0.008) showed a negative correlation with the Iwano grade. The AUCs for PFOA diagnosis were 0.906 [95% confidence interval (CI), 0.853-0.960] (FF) and 0.744 (95% CI, 0.657-0.831) (T2*). QFP FF and T2* were not associated with patellofemoral maltracking parameters but with increased PFOA in patients with AKP, suggesting that QFP abnormalities play a role in PFOA. Therefore, a quantitative QFP assessment (FF and T2*) based on Q-Dixon technology could be a convenient and reliable new imaging biomarker for PFOA severity during clinical diagnosis, treatment, and follow-up.

Quantitative analysis and stochastic modeling of osteophyte formation and growth process on human vertebrae based on radiographs: a follow-up study

Osteophytes are frequently observed in elderly people and most commonly appear at the anterior edge of the cervical and lumbar vertebrae body. The anterior osteophytes keep developing and will lead to neck/back pain over time. In clinical practice, the accurate measurement of the anterior osteophyte length and the understanding of the temporal progression of anterior osteophyte growth are of vital importance to clinicians for effective treatment planning. This study proposes a new measuring method using the osteophyte ratio index to quantify anterior osteophyte length based on lateral radiographs. Moreover, we develop a continuous stochastic degradation model with time-related functions to characterize the anterior osteophyte formation and growth process on cervical and lumbar vertebrae over time. Follow-up data of anterior osteophytes up to 9 years are obtained for measurement and model validation. The agreement test indicates excellent reproducibility for our measuring method. The proposed model accurately fits the osteophyte growth paths. The model predicts the mean time to onset of pain and obtained survival function of the degenerative vertebrae. This research opens the door to future quantification and mathematical modeling of the anterior osteophyte growth on human cervical and lumbar vertebrae. The measured follow-up data is shared for future studies.

Prevalence, Features, and Predictive Factors of Spontaneous Spinal Arthrodesis in Posttraumatic Thoracolumbar Kyphosis

ObjectiveSpontaneous spinal arthrodesis (SSA) is a phenomenon of spontaneous fusion, and SSA is not rare in post-traumatic thoracolumbar kyphosis (PTK). However, few reports have focused on SSA in patients with PTK. The objective of this study was to investigate the prevalence, features and predictive factors of SSA in PTK patients. MethodsIn this retrospective study, 70 patients with PTK were included. Data on the clinical and radiological parameters were obtained and evaluated. According to whether there was SSA or not, patients were divided into SSA group (n=45) or non-SSA group (n=25). A binary logistic regression analysis was used to identify the predictive factors for SSA. ResultsThe incidence of SSA in PTK was 64%. Among 45 PTK cases with SSA, SSA could be present as a solid bridging anterior osteophyte along the vertebral bodies in 11 cases, posterior contiguous bony growth through the facet joints bilaterally in 13 cases, bony formation in both anterior and posterior elements in 18 cases, and direct contiguous bony formation from injured vertebral body to adjacent one in 3 cases. Patients with longer disease duration, larger local Cobb angle and anterior wall height loss ratio (AWHL) of injured vertebral body, and less kyphosis flexibility index were significantly more likely to develop SSA. The parameter of AWHL remained significant in binary logistic regression analysis. ConclusionsSSA in PTK was common, and SSA sign could be present as various patterns, which might have implications for surgical decisions. AWHL was the independent predictor for SSA.

Traction Spurs in the Lumbar Spine: A Historical Overview and Future Perspectives.

Numerous studies have explored the connection between lumbar osteophytes, their pathophysiology, and instability since Macnab's 1971 report on traction spurs as an indicator of lumbar instability. This study provides a narrative historical overview of traction spurs, a classic finding that suggests lumbar instability. It summarizes the causes of anterior lumbar vertebral osteophytes, the relationship between traction spurs and lumbar spinal instability, and the clinical significance of traction spurs. Vertebral osteophytes are grouped into two categories, namely, traction spurs or claw spurs, which represent different stages of the same pathological process. Traction spurs are indicative of instability and occur in the early stage of disc degeneration, characterized by temporary dysfunction or instability. Traction spur formation following fusion surgery can predict union or nonunion, and it serves as an indicator of preoperative and postoperative segmental instability. The relationship between traction spurs and radiographic instability, as well as their association with imaging findings such as CT and MRI, has been clarified. Additionally, finite element analysis and mechanical testing have been used to investigate the significance of traction spurs. However, further research is needed to verify that traction spurs are an accurate indicator of pre- and postoperative lumbar instability.

Intramedullary Spinal Cord Abscess Due to Traumatic Esophageal Perforation Associated with Cervicothoracic Anterior Osteophytes: A Case Report

Intramedullary Spinal Cord Abscess Due to Traumatic Esophageal Perforation Associated with Cervicothoracic Anterior Osteophytes: A Case Report

Weight-Bearing CT with Maximum Ankle Dorsiflexion to Identify Impingement and Tibial Plafond Stress Fracture: A Case Report.

A 25-year-old male pole vaulter presented with several months of right ankle pain. Radiographs showed an anterior tibial osteophyte with a small intra-articular body suggesting impingement. Weight-bearing computed tomography (CT) revealed an associated tibial plafond stress fracture. Subsequent arthroscopy with osteophyte resection and loose body removal significantly improved symptoms, and he gradually resumed training. Stress fractures should always be considered in athletes with ankle pain. A unique aspect of this case was the use of weight-bearing CT in diagnosis and surgical planning. To our knowledge, this is the first described case in which weight-bearing CT was used in this fashion.

Clinical and Radiological Changes at the Adjacent Segments Following Cervical Spine Surgery: A Retrospective Study

Background and Aim: Adjacent segment disease (ASD), radiological and clinical, is observed in many of the patients who undergo cervical inter-body fusion with/without graft, and with/without plating. This study aims to evaluate the proportion of ASD among patients who underwent cervical spine fusion surgery, to study the severity of degenerative radiographic findings at adjacent levels, and to determine sites and patterns of ASD. Methods and Materials/Patients: A descriptive study was performed on patients who underwent a previous cervical arthrodesis procedure in the last 2-5 years and continued follow-up as neurosurgery outpatients. A total of 59 patients who qualified for the inclusion criteria were included in the study. Results: Spine fixation was commonly performed at a single level mostly with sample size (54.2%, n=32) then at two levels (42.4%, n=25) and three levels (3.4%, n=2). Adjacent segment degeneration was present in the spine fixation level subgroup at a single level of 9 cases (28.12%), two levels of 9 cases (36%), and three-level fixations of 2 cases (100%). Six patients (10.2%) out of 59 patients developed radiculopathy. Among twenty-two cases (37.3%) with new changes at adjacent levels, reduced disc height was the most common one (18.6%, n=11). Anterior and posterior osteophytes with reduced disc height were found in 2 cases. Therefore, actual new changes were present in 20 cases only. The most common level of C4-C5 was observed for the development of ASD (13.6%, n=8). ASD developed at cranial to fusion in 13 cases (22%), caudal to fusion in 5 cases (8.5%), and at both levels in 2 patients. Conclusion: Adjacent segment disease was observed in a significant number of patients who underwent cervical spine surgery as evident from the results but only 6 out of 20 cases with radiological evidence of ASD were symptomatic. Changes were observed commonly at the C4/C5 level.

Oropharyngeal Dysphagia &amp; Aspiration in a 63-Year-Old Man- A Case Report

Introduction: Dysphagia due to nonmalignant causes is not an uncommon occurrence in patients over the age of 60. Males are more affected than the females. It can be associated with significant morbidity and mortality especially as it increases the risk for malnutrition, and pneumonias due to aspiration etc. Case Presentation: We present this rare case of worsening dysphagia and episodes of choking in a 63year old male due to large anterior cervical osteophytes. X-ray and flexible laryngoscopy revealed a large bulge over the posterior pharyngeal wall in the midline. Conclusion: Dysphagia in the elderly can lead to increased morbidity and life-threatening complications. Anterior osteophytes are found in nearly 20% to30% of the elderly population but rarely cause dysphagia. However, in some cases especially when associated with diffuse idiopathic skeletal hyperostosis (DISH/ Forestier’s disease) and ankylosing spondylitis these can cause severe dysphagia. In many cases of symptomatic anterior osteophytes surgery is considered an ultimate measure to relieve symptoms, decrease mortality, and improve the quality of life. We did a thorough literature search to know the prevalence and management of dysphagia due to anterior osteophytes.

Disc degeneration is easily occurred at the same and adjacent cephalad level in cervical spine when Modic changes are present

ObjectiveThis research aimed to evaluate the influence of Modic changes (MCs) on disc degeneration at the same and adjacent cephalad levels in the cervical spine.MethodsThis research retrospectively reviewed 1036 patients with neck pain, upper limb pain, or numbness who were treated at our out-patient clinic and underwent cervical MRI and cervical anteroposterior/lateral radiography from Jan, 2016 to Jan, 2021. MCs and disc degeneration parameters at same and nearby cephalad levels of MCs were evaluated. Discs were divided into the MCs, adjacent, and control groups, and the association between MCs and disc degeneration at the same and adjacent cephalad levels was investigated.ResultsOf the 1036 patients whose MRI scans were reviewed, 986 met the inclusion criteria (503 women and 483 men; average age, 62.8 years; scope of 35–79 years). The prevalence of MCs in the cervical spine was 13.0% (128/986). Type I, II, III changes were observed in 38 (29.69%), 82 (64.06%), and 8 (6.25%) patients, respectively. MCs were most frequently identified at the C5–6 (59/986; 5.98%) and C6–7 (38/986; 3.85%) levels. Disc with MCs showed worse outcomes with regard to disc degeneration grade, anterior osteophyte formation than the adjacent and control groups (p < 0.05), whereas they were more severe in the adjacent group compared to normal group.ConclusionOur findings indicate that MCs increased disc degeneration at the same and nearby cephalad levels in cervical spine, and the severity of degeneration at the same segment was more serious than that at the cephalad level.

Are New Diagnostic Criteria Needed? Diffuse Idiopathic Skeletal Hyperostosis Concealed by Cervical Radiculopathy: A Case Report

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) involves widespread ossification of ligaments in the skeleton with associated nonspecific symptoms. Cervical DISH may result in dysphagia and orthopnea but can be missed with accompanying spinal pathology. CASE REPORT: A 52 year-old man with a history of coronary artery disease presented with worsening neck pain radiating to the bilateral upper extremities. Magnetic resonance imaging revealed ventral osteophytes at C3-C7 and moderate stenosis at C4-C5. The patient underwent cervical epidural steroid injections resulting in partial pain relief. However, axial neck pain persisted and he reported new-onset dysphagia and orthopnea. Subsequent imaging showed C2-C7 anterior osteophytes with tracheal displacement, confirming the DISH diagnosis. The patient underwent resection of the osteophytes and had subsequent complete symptom resolution. CONCLUSION: Although radicular symptoms improved with an injection, dysphagia not previously mentioned was concerning. DISH is routinely missed in the setting of spinal pathology, such as radiculopathy. The presence of anterior cervical spine osteophytes should prompt further respiratory or swallow evaluation. KEY WORDS: Pain medicine, spine, dysphagia, orthopnea, DISH, cervical spine

Can Anterior Osteophyte Fractures Be Distinguished From Fracture Mimics in the Subaxial Cervical Spine? A Retrospective Analysis Evaluating Reported Fractures With Clinical Management Correlation.

This study aimed to retrospectively distinguish true- from false-positive fractures of anterior subaxial cervical osteophytes, which were reported on noncontrast computed tomography reports, and to correlate the imaging findings with patient symptoms and analyze the downstream impact on management of both true and false positive fractures. A total of 127 patients had computed tomography reports of anterior osteophyte fractures. Radiology reports and imaging studies were evaluated to distinguish true fractures from fracture mimics. We analyzed imaging features including rigid spine (RS), prevertebral soft tissue swelling (PVSTS), and instability. We categorized symptoms and examination findings into 3 groups (0, asymptomatic; 1, neck pain; 2, neurological symptoms). Management was categorized into 3 groups (0, no treatment; 1, external bracing; 2, surgery). Associations between imaging features, fracture classification, clinical symptoms, magnetic resonance imaging utilization, and management were calculated using χ2 with Cramer V test to determine effect size. Eighty patients had false-positive fractures, and 47 were true positive. There were significant associations between magnetic resonance imaging utilization and fracture classification (P ≤ 0.001), PVSTS (P ≤ 0.005), patient symptoms (P ≤ 0.001), and patient management (P ≤ 0.001). There were significant associations between patient management and fracture classification (P ≤ 0.001), patient symptoms (P ≤ 0.001), PVSTS (P ≤ 0.001), imaging findings of instability (P ≤ 0.001), and RS (P ≤ 0.021). There were significant associations between fracture classification and patient symptoms (P ≤ 0.045), and RS (P ≤ 0.006). Subaxial isolated anterior osteophyte fractures fell into 3 major categories. By our methodology, if a suspected fracture was determined to be a fracture mimic in an asymptomatic patient, it was unlikely to be clinically significant. Isolated anterior osteophyte fractures without neurological symptoms or more concerning imaging findings can be treated conservatively. Finally, fractures that demonstrate indirect signs of instability or are associated with RS are more associated with surgical management.

Anterior meniscus extrusion is associated with anterior tibial osteophyte width in knee osteoarthritis – The Bunkyo Health Study

BackgroundIn knee osteoarthritis (OA), medial meniscus extrudes both medially and anteriorly. We reported that full-length width of medial tibial osteophyte, which comprises cartilage and bone parts, is directly associated with medial meniscus extrusion in early-stage knee OA and hypothesized that anterior tibial osteophyte (ATO) is also associated with anterior meniscus extrusion (AME). Thus, we aimed to examine their prevalence and relationship. MethodsElderly subjects (638 females and 507 males; average 72.9 years old) in the Bunkyo Health Study cohort were enrolled. MRI-detected OA changes were evaluated according to the Whole Organ Magnetic Resonance Imaging Score. ATO was evaluated using the method which can assess both cartilage and bone parts of osteophyte by pseudo-coloring images of proton density-weighted fat-suppressed MRI. ResultsMost subjects showed the Kellgren-Lawrence grade 1/2 of the medial knee OA (88.1%), AME (94.3%, 3.7 ​± ​2.2 ​mm), and ATO (99.6%, 4.2 ​± ​1.5 ​mm). Among the OA changes, AME was most closely associated with full-length width of ATO (multivariable β ​= ​0.877, p ​< ​0.001). The area under the receiver operating characteristic curve for determining the presence of AME as evaluated by ATO width was 0.75 (95% confidence interval 0.60–0.84, p ​< ​0.001). The odds ratio for the presence of AME as evaluated by ATO width at 2.9 ​mm was 7.16 (4.23–12.15, p ​< ​0.001, age, gender, BMI, and K-L adjusted). ConclusionsAME and ATO were inevitably observed in the elderly subjects and AME was closely associated with full-length width of ATO. Our study provides the first evidence on the close relationship between AME and ATO in knee OA.

Anterior Thoracic Discectomy and Fusion for Symptomatic Ventral Bone Spur Associated Type I Cerebrospinal Fluid Leak: A Technical Report and Operative Video.

Technical Report. Cerebrospinal fluid (CSF) leak secondary to anterior osteophytes at the cervico-thoracic junction is a rare cause of intracranial hypotension. In this article we describe a technique for anterior repair of spontaneous ventral cerebrospinal fluid leaks in the upper thoracic spine. In this technical report and operative video, we describe a 23-year-old male who presented with positional headaches and bilateral subdural hematoma. Dynamic CT myelography demonstrated a high flow ventral cerebrospinal fluid leak associated with a ventral osteophyte at the level of the T1-T2 disc space. Targeted blood patch provided only temporary improvement in symptoms. An anterior approach was chosen to remove the offending spur and micro-surgically repair the dural defect. The patient had complete resolution of his preoperative symptoms after primary repair. In select cases, an anterior approach to the upper thoracic spine is effective to repair Type 1 cerebrospinal fluid leaks.

Association of Radiographic Alignment, Degree of Ankle Instability, Concomitant Pathology, and VAS Pain Scores after the Brostrom-Gould Procedure for Chronic Ankle Instability

Category: Sports; Ankle; Arthroscopy Introduction/Purpose: The Brostrom-Gould procedure is the gold standard surgical treatment for patients with chronic ankle instability (CAI) whose symptoms are refractory to conservative treatment. The purpose of this study is to investigate the relationship between preoperative radiographic alignment, intraoperative stress testing, concomitant pathology, and postoperative pain scores in patients undergoing Brostrom-Gould procedures. Specific questions included: 1) Is preoperative radiographic alignment predictive of the degree of lateral ankle instability noted intraoperatively? 2) Is the degree of ankle instability associated with the presence of OCD lesions and peroneal tendon pathology? 3) Is the degree of ankle instability associated with postoperative VAS pain? and 4) Does concomitant pathology affect final VAS pain score? Methods: A retrospective study was performed of all patients who underwent lateral ankle ligament reconstruction by a single surgeon from 2002 to 2020. Patients who underwent concomitant hindfoot fusion procedures or ankle arthroplasty were excluded. Demographic and clinical information was recorded from the electronic medical record. Preoperative radiographic measurements were taken using weightbearing ankle films. Intraoperative stress views were evaluated to determine the talar tilt. All data was tested for normality. Parametric and nonparametric univariate statistics were used to determine the relationship between preoperative weightbearing radiographic measurements, preoperative MRI findings, intraoperative talar tilt measurement, and postoperative outcomes. Results: 181 patients with a median follow-up of 1 year were included. Complications included delayed wound healing in 5.6%, superficial infection in 2.8%, and nerve symptoms in 11%. The reoperation rate was 5%, including revision lateral ankle ligament reconstruction (4/181), debridement for infection (1/181), and wound revision (4/181). Increased preoperative anterior distal tibial angle (ADTA) was associated with an increased intraoperative talar tilt (p=0.0073). Increased intraoperative talar tilt was associated with an increased prevalence of osteochondral lesions of the talus (p=0.0176). Mean VAS scores improved from 4.6 preoperatively to 1.9 postoperatively (p&lt;0.0001). Neither the preoperative radiographic alignment nor the degree of intraoperative instability were predictive of final VAS score. Patients with osteochondral lesions had higher final VAS pain scores than patients without osteochondral lesions (p=0.0134). Conclusion: In patients undergoing lateral ankle ligament reconstruction for CAI, preoperative ankle alignment was associated with the degree of ankle instability. It is unclear if an increased ADTA predisposes to great instability, or if larger anterior distal tibia osteophytes are formed in patients with more severe instability, leading to a larger ADTA. Increased instability was associated with a higher rate of osteochondral lesions, and patients with osteochondral lesions tended to have more pain postoperatively. This information may be helpful in counseling patients regarding surgical treatment and postoperative expectations.

Limitations of minimally invasive posterior cervical foraminotomy—a decompression method of posteriorly shifting the nerve root—in cases of large anterior osteophytes in cervical radiculopathy: A retrospective multicenter cohort study

BackgroundPosterior cervical foraminotomy against anterior osteophyte is an indirect decompression procedure but less invasive compared to anterior cervical discectomy and fusion. Residual compression to the nerve root may lead to poor surgical outcomes. Although clinical results of posterior cervical foraminotomy for osteophytes are not considered better than those of disk herniation, osteophyte size and the association of the decompression area with poor surgical outcomes remain unclear. This study aimed to identify the limitations of minimally invasive posterior cervical foraminotomy for cervical radiculopathy and discuss the methods to improve surgical outcomes. MethodsWe analyzed 55 consecutive patients with degenerative cervical radiculopathy who underwent minimally invasive posterior cervical foraminotomy. Minimum postoperative follow-up duration was 1 year. We divided the patients into nonimproved and improved groups. The cutoff value between preoperative and postoperative Neck Disability Index scores was 30% improvement. Preoperative imaging data comprised disk height, local kyphosis, spinal cord compression, anterior osteophytes in the foramen, and anterior osteophytes of >50% of the intervertebral foramen diameter. Postoperative imaging data comprised craniocaudal length and lateral width of decompressed lamina, preserved superior facet width, and area of decompressed lamina. ResultsFifty-five patients were divided into two groups: nonimproved (n = 19) and improved (n = 36). The presence of osteophytes itself was not significant; however, the presence of osteophytes of >50% of the foramen diameter increased in the nonimproved group (P = 0.004). Mean lateral width and mean area of decompressed lamina after surgery significantly increased in the improved group (P = 0.001, P = 0.03). ConclusionThe presence of anterior osteophytes >50% of the diameter of the foramen led to poor improvement of clinical outcomes in minimally invasive posterior cervical foraminotomy. However, the larger the lateral width and area of the decompressed lamina, the better the surgical outcome.

Spinal fractures in the setting of diffuse idiopathic skeletal hyperostosis conservatively treated via orthosis: illustrative cases.

BACKGROUNDFractures in patients with diffuse idiopathic skeletal hyperostosis (DISH) are considered highly unstable injuries with high risk for neurological injury. Surgical intervention is the standard of care for these patients to avoid secondary spinal cord injuries. Despite this, certain cases may necessitate a nonoperative approach. Herein within, the authors describe three cases of cervical, thoracic, and lumbar fractures in the setting of DISH that were successfully treated via orthosis.OBSERVATIONSThe authors present three cases of fractures in patients with DISH. A 74-year-old female diagnosed with an acute fracture of a flowing anterior osteophyte at C6–C7 treated with a cervical orthosis. A 78-year-old male with an anterior fracture of the ankylosed T7–T8 vertebrae managed with a Jewett hyperextension brace. Finally, a 57-year-old male with an L1–L2 disc space fracture treated with a thoraco-lumbo-sacral orthosis. All patients recovered successfully.LESSONSIn certain cases, conservative treatment may be more appropriate for fractures in the setting of DISH as an alternative to the surgical standard of care. Most fractures in the setting of DISH are unstable, therefore it is necessary to manage these patients on a case-by-case basis.

The Effect of Preoperative Cervical Spondylosis on Heterotopic Ossification After Cervical Disc Replacement.

Retrospective cohort study. This study aimed to explore the effect of preoperative cervical spondylosis on the heterotopic ossification (HO) formation in different locations after cervical disc replacement (CDR). The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical spondylosis on the HO formation after CDR were analyzed according to the location of HO. Multivariate logistic regression was performed to identify the independent factors. 149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO after CDR included the disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes and facet joint degeneration. The incidence of adjacent segment degeneration (ASD) was significantly higher in the PHO group compared to that without PHO at the last follow-up (P = .003). The disc height loss in high-grade HO was significantly more than that in low-grade group (P = .039). Multivariate analysis identified disc height loss was the only independent factor for PHO (P = .009). No significant degenerative factors related to the formation of AHO were found. Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. The disc height loss was an independent risk factor for PHO formation. Rigorous criteria for the extent of preoperative disc height loss should be used when selecting appropriate candidates for CDR.

An unusual presentation of thoracic diffuse idiopathic skeletal hyperostosis (DISH) and video-assisted thoracoscopic surgery (VATS).

Introduction and importanceDiffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and Forestier and Rotes-Querol disease, is a systemic condition characterized by calcification and ossification of ligaments and entheses which often mainly affects the thoracic spine. Anterior osteophyte compression of the esophagus resulting in dysphagia and dyspepsia is extremely rare in symptomatic thoracic DISH.Case presentationA 72-year-old male presented with dyspepsia and dysphagia for 10 months. A large beak-like anterior osteophyte, detected by a radiographic study and by a Barium esophagogram test at the T9-T10 level of the thoracic spine, was established by gastrointestinal medicine specialists to be the cause of the symptoms. The large anterior osteophyte was removed using video-assisted thoracoscopic surgery (VATS). At the one-year follow-up, the patient's symptoms had significantly improved and there was no recurrence of the osteophyte or the dyspepsia and dysphagia.Clinical discussionThoracic DISH rarely presents with dysphagia and dyspepsia due to the greater mobility of the esophagus in the area of the thoracic spine than in the area of the cervical spine. This is the first reported case of symptomatic thoracic DISH treated by anterior thoracic osteophytectomy with VATS. The treatment was effective with no post-operative complications.ConclusionAnterior thoracic osteophytectomy with VATS is an effective surgical treatment option for this condition.

Zenker's Diverticulum in Forestier Disease: Chance or Causality?

Introduction:Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker’s diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. Forestier disease is a clinical entity characterized by ossification of anterolateral vertebral ligament and anterior osteophyte formation along the anterolateral spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between Forestier disease and the onset of Zenker’s diverticulum.Materials and Methods:A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords.Results:The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment; 30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64.8 (+/- 11.31) years. Conclusions:We assume that the anatomical abnormalities in Forestier disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker’s diverticulum. Hence, it is always recommended to investigate the presence of Zenker’s diverticulum in a patient with Forestier disease, especially for the life-threatening complications of Zenker’s diverticulum.

The Current Role of Ankle Arthrodesis in Hemophilic Patients.

There are several manners to take care of the hemophilic ankle in the initial phases of degeneration of the articular cartilage, in the event that hematologic prophylaxis is unsuccessful in accomplishing no bleeds. Some of these are nonoperative, with which management must start. These are Physical and Rehabilitation Medicine protocols and the utilization of orthoses (patellar tendon bearing). When these are unsuccessful, more aggressive types of treatment can be utilized, such as radiosynovectomy and some surgical operations (open or arthroscopic removal of anterior osteophyte of the distal part of the tibia, arthroscopic ankle debridement). Nonetheless, in the late phases of degeneration of the articular cartilage (advanced arthropathy), the solely options are surgical: ankle fusion or total ankle arthroplasty. The review of the literature has shown that the percentage of consolidation is between 90% and 100%, and that the percentage of postoperative infection is between 0% and 10%%. When the Ilizarov external fixator is utilized for ankle fusion, the percentage of pin tract infection is around 14%. Ankle fusion is a secure surgical technique that meliorates articular pain and improves the quality of life of hemophilic patients.