Comparing outcomes between patients admitted through clinic versus emergency department with degenerative cervical myelopathy.

Clinical Characteristics and Predictive Factors of Symptomatic Skeletal Events in Patients With Metastatic Castration-Sensitive Prostate Cancer Treated With Denosumab.

Uncoupled bone remodeling drives myeloma bone disease in Vk*MYC mouse model of multiple myeloma.

Is strict use of denosumab or zoledronate Beneficial to patients with bone metastatic Disease?

Progressive back pain in elderly individuals may be caused by spine infections, metastatic cancers, or hematologic malignancies. Spine infections, such as spondylodiscitis, often result from hematogenous spread by staphylococci, streptococci, or gram-negative bacilli, whereas Clostridium species is a rare cause of spondylodiscitis. Lymphoma involving the spine can mimic infectious spondylodiscitis and lead to irreversible neurological damage. We report an elderly Thai woman with clostridial spondylodiscitis and lymphoma coexisting at the thoracic spine, highlighting the importance of a broad differential diagnosis in such cases. A 79-year-old Thai woman with osteoporosis and a previous T10 compression fracture, treated with denosumab, presented with worsening back pain radiating to both legs for five months, along with fatigue, anorexia, and a 7kg weight loss. She developed a fever and weakness before admission. Initial treatment with ceftriaxone and cefixime temporarily alleviated her symptoms, but paralysis and sensory loss later worsened. At Siriraj Hospital, examination revealed complete paraplegia, and MRI showed spondylodiscitis and epidural abscesses at T10-T11, causing spinal cord compression. CT-guided biopsy identified gram-positive bacilli, and partial 16S rRNA sequencing showed 97.23% identity with Clostridium tarantellae. IV metronidazole was started. Additionally, tissue pathology revealed diffuse large B-cell lymphoma involving the thoracic spine. Staging CT showed extensive lymphadenopathy, but her bone marrow was unaffected. After four weeks of metronidazole, her pain improved, but neurological deficits remained. R-CHOP chemotherapy was initiated while continuing metronidazole. Unfortunately, she developed severe Acinetobacter baumannii pneumonia, which led to septic shock and respiratory failure. She died 74 days after admission. This case highlights the rare coexistence of spinal infection and lymphoma-an uncommon and challenging diagnosis in elderly patients with progressive back pain. The coexistence of infectious spondylodiscitis and spinal lymphoma is rare, posing diagnostic and therapeutic challenges that demand multimodal evaluation and prompt treatment to prevent complications and improve outcomes.

Transforaminal endoscopic diskectomy is an effective approach for treatment of thoracic and lumbar disk pathologies. Classically, intraoperative neuromonitoring is used in these approaches given the risk to the exiting nerve root during transforaminal targeting. The trans-superior articular process (trans-SAP) approach is a targeting technique that docks on the ventrolateral SAP, allowing access to lateral recess pathology. This approach theoretically minimizes risk to the exiting nerve root which could occur with targeting or aberrant reaming. We investigate the safety of the trans-SAP approach by analyzing intraoperative neuromonitoring events in transforaminal endoscopic cases. A retrospective analysis of 180 transforaminal endoscopic cases using the trans-SAP approach and free-running electromyography (EMG) neuromonitoring was performed. Cases were performed at 4 institutions; Houston Methodist Hospital, University Of Michigan, University of Washington, and Texas Back Institute, from 2021 to 2024. Neuromonitoring data using free-running EMG were carefully reviewed for each case and adverse monitoring events or EMG triggers were recorded. Free-running EMG neuromonitoring was used in 180 of the 212 reviewed cases (84.91%). No adverse monitoring events or EMG triggers were recorded in 179 of the 180 monitored trans-SAP approach cases (99.44%). Three were performed awake with conscious sedation and no recorded events during targeting. One case was deemed safe without neuromonitoring based on thoracic foraminal pathology without cord compression. In the single case with a neuromonitoring event, multiple episodes of spontaneous neurotonic EMG activity were recorded during the dissection and diskectomy portion of the case, ultimately subsiding. The trans-SAP approach for endoscopic diskectomy allows for safe access in transforaminal surgery. There was only one neuromonitoring event during the initial targeting in the 180 monitored or 3 awake trans-SAP cases included in this study that resolved without intraoperative or postoperative symptoms. These results could obviate the need for intraoperative neuromonitoring in these cases.

Radiographic myelography is the traditional diagnostic method for detecting cervical spinal cord compression in horses but it is limited by superimposition and restriction to sagittal plane imaging. Computed tomography (CT) and CT myelography overcome many of these limitations yet previous CT protocols have not allowed dynamic imaging in flexion and extension comparable to radiographs. To describe and evaluate a novel CT myelography protocol that enables imaging of the equine cervical vertebral column (C2/3 to C7/T1) in flexion, neutral, and extension, and to compare intervertebral angle measurements with those obtained from radiographic myelography. Prospective clinical study. Eight horses with clinical signs related to the cervical vertebral column underwent CT myelography and radiographic myelography under general anaesthesia. A mobile gantry CT system combined with a custom support platform enabled controlled repositioning of the cervical vertebral column. Intervertebral angles (C2/3 to C6/T1) were measured in flexion, neutral, and extension by three blinded image reviewers. Agreement between modalities was assessed using ANOVA, Bland-Altman plot, and concordance correlation coefficients. The entire dynamic CT myelography protocol was completed within 45 min. Across all positions and cervical segments, no statistically significant differences were found between CT and radiographic myelography angle measurements (p > 0.01). All horses recovered uneventfully from anaesthesia, and no contrast-related adverse effects were observed. Small sample size and the absence of repeated intra-observer measurements. Intervertebral angles served as a proxy for motion but did not directly assess the degree of spinal cord compression. Dynamic CT myelography is feasible, safe, and provides positional sensitivity comparable to radiographic myelography, while overcoming the limitations of superimposition and enabling multiplanar evaluation. This novel protocol offers a reliable diagnostic alternative for assessing cervical spinal pathology in horses and allows complete coverage of the cervical vertebral column from C2 to T1.

Interventional radiology in bone metastases: current concepts and perspectives.

As one of the most lethal malignant tumors worldwide, the highly invasive and metastatic nature of lung cancer leads to a generally poor prognosis for patients. Among the complications associated with lung cancer, skeletal-related events (SREs) resulting from bone metastases, including bone pain, pathological fractures, hypercalcemia, and spinal cord compression, significantly impair quality of life and reduce survival rates. The long non-coding RNA HOTAIR, which has been linked to various cancers, plays an unclear role in lung cancer bone metastasis and the regulation of the immune microenvironment. In this study, we investigated the expression of HOTAIR in non-small cell lung cancer (NSCLC) and its impact on the immune microenvironment using bioinformatics, microscopy, and functional assays. Our findings indicate that elevated HOTAIR expression is associated with poorer prognosis based on transcriptomic analyses. Bioinformatics validation in independent GEO datasets and clinical tissue samples also confirmed the prognostic value of HOTAIR in NSCLC bone metastasis subgroups. Mechanistically, HOTAIR expression was correlated with alterations in immune cell infiltration patterns, including reduced B-cell and CD8+ T-cell signatures, and was accompanied by increased NF-κB and ERBB pathway activity. These observations suggest that exosome-associated HOTAIR may influence tumor progression-related processes and osteoclast-associated events relevant to bone metastatic progression. Furthermore, the Feiyanning formula (FYN) demonstrated inhibitory effects on tumor growth and metastasis-related phenotypes in experimental models.

Study DesignRetrospective.ObjectiveTo evaluate the association between mechanical instability and neurological deficit in spinal tuberculosis (TB), and compare it against previously recognized radiological parameters.MethodsClinical and radiological data of patients with active thoracic spinal TB were evaluated. Instability was assessed using the Spinal Tuberculosis Instability Scoring System (STISS) by Rajasekaran et al. Neurological status and radiological parameters were analysed to identify the factors associated with neurological deficit.ResultsA total of 122 patients were included. The average age was 51 ± 18years, and 54.9% were males. 40 (32.8%) patients had neurological deficits at presentation. Based on the STISS, 71 (58%) patients were categorised as stable, 10 (8.2%) as potentially unstable, and 41 (34%) as definitely unstable. On MRI, cord signal changes and epidural compression were noted in 18% and 64% of the patients, respectively. Definite instability was found to be the strongest independent association of neurological deficit (OR 9.77, 95% CI 2.85-38.9, P < 0.001), followed by greater canal encroachment area (CEA) (OR 1.08, 95% CI 1.03-1.13, P = 0.002). In a stable spine with epidural compression, the predicted probability of neurological deficit is 27%. In an unstable spine, the likelihood of neurological deficit is 50% even without epidural compression, and highest (63%) when instability was associated with epidural compression.ConclusionMechanical instability is the strongest independent association of neurological deficit in spinal TB, even in the absence of epidural compression. Incorporating the Spine Instability Scoring System into routine clinical evaluation improves risk stratification, enables timely decision-making, and can prevent irreversible neurological deficits.

Central nervous system involvement in multiple myeloma (CNS-MM) is a rare complication usually observed in advanced relapse or refractory settings. The detection of malignant plasma cells in the cerebrospinal fluid (CSF) on the basis of morphology and flow cytometry (FCM) confirms this extra-medullary lesion. The records of 459 MM patients treated between 2016 and 2025 were reviewed, identifying four cases with CSF involvement. CSF and bone marrow samples were processed and analyzed on the basis of morphology and FCM using a dedicated 9-color panel to detect malignant plasma cells. Interleukin-6 (IL-6) and interleukin-10 (IL-10) concentrations were also measured in the CSF using Cytometric Bead Assay. Three patients were in complete remission when CSF analysis revealed CNS-MM. Two patients presented no cerebral lesions, although spinal cord compression was observed for one of them. Two patients presented interference in FCM analysis, supporting the penetration of daratumumab into the CSF. Interleukin measures in the CSF showed low or undetectable IL-10 levels but elevated IL-6 concentrations in some cases. Overall prognosis was poor, with the death of three patients and only one remaining alive at 2 years. CNS-MM could be the first sign of relapse among patients previously in complete remission. It should be envisaged in the case of any myeloma patient with unexplained neurological symptoms, even when imaging is negative. Flow-cytometry panels need to be optimized for plasma-cell detection, especially among patients treated with anti-CD38 antibodies. Identifying patients at risk remains crucial, but prognostic biomarkers such as IL-6 still require validation.

Background: Chiari malformation (type 1) is a rare condition in which the cerebellar tonsils descend through the foramen magnum into the spinal canal. This in turn leads to compression of the spinal cord at foramen magnum interfering with the flow of cerebrospinal fluid leading to craniospinal dissociation and as a result hydrocephalus and syringomyelia. Sometimes it occurs secondary to space occupying lesions in intracranial compartments.

Introduction: Slow spinal cord compression refers to the intra- or extra-medullary development of an expansive lesion in the spinal canal. It represents a diagnostic and therapeutic challenge in our setting, sometimes leading to a poor prognosis. In this study, we examine the epidemiological, diagnostic, and therapeutic aspects of slow spinal cord compression in our setting, while identifying prognostic factors. Patients and Method: This is a retrospective study conducted over a period of six years, from January 1, 2019, to December 31, 2024. It focused on the medical records of 47 patients who were hospitalized in the neurosurgery department of Fann Hospital in Dakar during the study period. Study parameters included epidemiological, diagnostic, histological, therapeutic, and prognostic factors. Results: The average age of our series is 51.06 years, with a predominance of males (63.8%). The time to consultation was greater than 3 months in 78.7% of cases. Neurological examination suggested a picture of slow spinal cord compression, which was confirmed by CT scan in 70.2% of cases and MRI in 78.7%. The predominant location was dorsal (53.19%), followed by dorsolumbar (23.41%) and cervical (23.4%). In this series, 41 patients (87.23%) underwent surgery, while 6 patients (12.77%) did not undergo surgery due to severe deterioration in their clinical condition. Treatment was based on anterior and/or posterior decompression with biopsy or excision, followed by osteosynthesis as indicated. Conclusion: Slow tumor compression of the spinal cord is rare in neurosurgical practice in Dakar. Clinical suspicion leads to imaging, particularly MRI, followed by histological analysis of the surgical specimen. The etiologies are dominated by spinal metastases, and the prognosis is guarded given the late consultations and delayed diagnosis fueled by poverty, cultural convictions, and endogenous beliefs.

We report the case of an 8-year-old girl with B-cell precursor acute lymphoblastic leukemia (BCP-ALL), who presented with a symptomatic epidural mass at the initial diagnosis. She had persistent back pain and mild neurological symptoms. Magnetic resonance imaging (MRI) revealed an epidural mass extending from L2 to the sacrum without spinal cord compression. A bone marrow examination confirmed BCP-ALL. A biopsy was deferred because of procedural risks, and systemic chemotherapy combined with corticosteroids was initiated. Her symptoms resolved rapidly, and follow-up MRI showed a marked regression of the mass. In selected patients without severe neurological deficits, careful observation after chemotherapy initiation may precede invasive diagnostic procedures.

A cross-sectional study. This study aimed to investigate cognitive impairment in degenerative cervical myelopathy (DCM) and examine its relationship with radiographic spinal cord compression. Degenerative cervical myelopathy is a leading cause of chronic non-traumatic spinal cord injury. While its motor and sensory manifestations are well established, the potential impact on cognitive function remains underexplored. A total of 965 participants were enrolled: 383 DCM patients (Group A), 122 cervical spondylotic radiculopathy (CSR) patients (Group B), and 460 healthy controls (Group C). Cognitive performance was evaluated with the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), and the Basic Cognitive Aptitude Test (BCAT). Propensity-score matching (A:B:C=2:1:2) was used to balance age, sex, and education; additional stratified analyses by age (≤50, 51-60, 61-70, and >70 years) and education (≤6, 7-12, and ≥13 years of education) were performed. Compression ratio (CR) and maximum spinal cord compression (MSCC) were measured on cervical MRI. Correlation analyses were used to explore the association between radiographic spinal cord compression and cognitive function. After matching, DCM patients exhibited significantly lower MoCA (20.61 ± 3.76) and MMSE (26.23 ± 2.84) scores than both CSR and control group (all P < 0.001); this disadvantage persisted across every age and educational stratum. MSCC correlated negatively with MoCA (r = -0.118, P = 0.022) and MMSE (r = -0.124, P = 0.017), with stronger associations in single-level DCM (MoCA r = -0.218, P = 0.008; MMSE r = -0.237, P = 0.004). The number of compressed segments did not influence global cognition. Cognitive impairment is significantly associated with DCM, which is influenced by age, education, and the degree of spinal cord compression.

Residual giant thoracic disc herniations after open decompression are uncommon and present a significant surgical challenge, particularly in the setting of prior instrumentation and distorted anatomy. Here, the authors present a case of salvage full-endoscopic resection of a residual giant, centrally calcified thoracic disc herniation causing persistent spinal cord compression following prior transpedicular decompression and instrumented fusion. A 37-year-old woman presented with persistent thoracic pain, gait disturbance, and myelopathic symptoms after partial improvement from an initial open T6 to T7 transpedicular decompression with T6 to T8 fusion. Magnetic resonance imaging and computed tomography demonstrated a residual giant calcified disc herniation at T6 to T7 with severe spinal cord compression and signal change. The patient underwent revision right-sided full-endoscopic thoracic discectomy using preoperative trajectory planning, docking on preserved osseous landmarks, ventral cavity creation, and controlled disc mobilization. The patient experienced rapid postoperative recovery with immediate resolution of thoracic pain and sustained improvement in gait and balance. This case demonstrates that full-endoscopic thoracic discectomy can be safely and effectively applied as a salvage technique to achieve spinal cord decompression in complex revision settings following failed open thoracic disc surgery.

Study DesignOnline questionnaire following the CHERRIES framework.ObjectivesDegenerative cervical myelopathy (DCM) is a heterogenous condition with a broad clinical presentation profile. Understanding the adoption of clinical signs and symptoms for both diagnostic and surgical decision-making could inform the development of standardised diagnostic criteria for DCM. Therefore, we sought to survey orthopaedic spine surgeons and neurosurgeons in secondary care across Australasia (New Zealand and Australia).MethodsAn online 19-item questionnaire was distributed to orthopaedic spine surgeons and neurosurgeons across Australasia. It examined factors influencing diagnostic and surgical decision-making, including responses to clinical vignettes. Post-stratification weighting was applied and an exploratory post-hoc pattern analysis was performed.ResultsSeventy-two completed responses were analysed. For diagnosis, gait clumsiness (86.1%), hand clumsiness (76.4%) and reduced hand dexterity (75.0%) were the most frequently selected symptoms, and hyperreflexia (83.3%) and ankle clonus sign (68.1%) were the most commonly selected clinical signs. Symptom severity, myelomalacia, and extent of cord compression were ranked as the top 3 variables influencing surgical decision-making for over 70% of surgeons. In clinical vignettes, most (72.2%) chose serial observation for asymptomatic cord compression; however, accompanying myelomalacia was found to increase the chance of offering surgery from 5.6% to 34.7%.ConclusionsAlthough several signs and symptoms were commonly used to diagnose DCM, a broad range of features were employed, reflecting substantial variability amongst Australasian surgeons. Surgical decision-making also varied, particularly for asymptomatic cord compression with myelomalacia. These findings reinforce the need for standardized diagnostic criteria and referral pathways.

Determinants of anatomical decompression in symptomatic degenerative cervical myelopathy: A quantitative MRI analysis of unsatisfactory surgical outcomes.

Management of glioblastoma intramedullary spinal cord metastasis with advanced intraoperative techniques: a case series and systematic review.

Endoscopic Trans-Costovertebral Approach to Thoracic Discectomy for Central Calcified Disc Herniations: A Technical Note.