Thoracic Spine Research Articles

Does Post-Tetanic Transcranial Stimulation Augment the Wave Amplitudes of Spinal Cord Evoked Potential (Tc-SCEP)?

Study design Prospective within-subjects study. Objectives Although motor-evoked potential (MEP) amplitude can reportedly be increased by tetanic stimulation of the peripheral nerves before transcranial electrical stimulation (TES), no reports have described on whether tetanic transcranial stimulation augments the wave amplitudes of spinal cord-evoked potentials (Tc-SCEP). The primary purpose of this study was to investigate whether tetanic stimulation induces waveform amplification of Tc-SCEP. The secondary purpose was to elucidate the mechanism of the amplification effect of tetanic stimulation. Methods We recruited 20 patients who underwent cervical or thoracic spine surgeries. We compared the compound muscle active potentials (CMAPs) of Tc-MEP and Tc-SCEP before and after tetanic stimulation of the median or tibial nerve. Results Although the CMAP wave amplitudes of the abductor pollicis brevis (APB) and abductor hallucis (AH) showed significant enlargement on Tc-MEP following tetanic stimulation of the median and tibial nerves, an augmentation effect regarding Tc-SCEP (203 μV [without tetanic stimulation], 212 μV [tetanic stimulation of the median nerve], and 208 μV [tetanic stimulation of tibial nerve]) could not be demonstrated. Conclusion Although MEP amplitudes can be enlarged by tetanic stimulation of the peripheral nerves, the amplification mechanism may not involve the lateral corticospinal tract from the brain stem to the anterior horn.

New evidence for the presence of carcharodontosaurid theropod dinosaurs in the Late Cretaceous of Uzbekistan

ABSTRACT An incomplete posterior dorsal vertebra ZIN PH 2646/16 from the Upper Cretaceous (Turonian) Bissekty Formation of Uzbekistan has a highly pneumatized centrum and neural arch. The centrum has a lateral pneumatic foramen that is divided by a septum. The neural arch is invaded through a lateral pneumatic foramen above the neurocentral suture and has deeply excavated prezygapophyseal-centrodiapophyseal and centrodiapophyseal fossae. The interior of the preserved portion of the neural spine is pneumatic. In the structure of the fossae on the neural arch and the presence of a double pneumatic foramen on the centrum, ZIN PH 2646/16 closely resembles the carcharodontosaurid Acrocanthosaurus from the Early Cretaceous of North America. Thus, we identify ZIN PH 2646/16 as Carcharodontosauridae indet. Carcharodontosauridae were previously known from the Bissekty Formation from Ulughbegsaurus uzbekistanensis, which is based on an incomplete maxilla.

Case series study and finite element analysis of a new cervicothoracic fixation device

ObjectiveTo introduce a specialized device designed for the fixation of the cervical-thoracic spine and describe its surgical installation, finite element analysis, and clinical outcomes.MethodsA finite element model of the C6-T1 segment was developed and validated, and simulations of subtotal resection of anterior cervical vertebrae, artificial vertebrae placement, and titanium plate fixation were performed. The model was subjected to a 75 N load to simulate the weight of the head and a 1 N·m force to simulate flexion, lateral bending, and axial rotation. The analysis focused on range of motion, total stress, stress in the artificial vertebrae, and stress in the device. The clinical outcomes were evaluated in a retrospective case series of 140 patients with cervical spine fractures.ResultsUnder the same loading conditions, the maximum stresses on specialized anatomical and biomechanical devices for the fixation of the cervicothoracic segment of the spine during neutral, forwards flexion, backwards extension, left lateral bending, right lateral bending, left rotation, right rotation and other working conditions were 25.097 MPa, 149.480 MPa, 64.150 MPa, 67.804 MPa, 72.754 MPa, and 117.98 MPa, respectively. And, the maximum ROMs were 2.230 mm, 5.585 mm, 4.682 mm, 3.184 mm, 3.061 mm, 4.451 mm, and 4.645 mm. Compared with those in the preoperative period, the patients’ CL, OPCL, UCL, LCL, UROM, LROM, VAS score, NDI score, JOA score, intervertebral space height at the injured segment, cervical anterior kyphosis angle, Cobb angle, vertebral displacement, ASIA grade, fracture classification, and vertebral displacement improved (P < 0.05). Sixty-two patients had dysphagia, and 3 patients experienced leakage of cerebrospinal fluid.ConclusionThe design of the new cervicothoracic internal fixation device conforms to the anatomical structure of the cervicothoracic spine, which can provide immediate stability, better screw placement and adequate bone grafting, and reduce the risk of complications. Despite some disadvantages, it is a good device for segmental fixation of the cervical and thoracic spine.

A survey of bridging bone on chest radiography shows a greater than expected prevalence of marginal syndesmophytes.

The recognition of thin marginal spinal syndesmophytes is important, in part due to their association with non-traumatic or mildly traumatic vertebral fractures. To determine a lower limit on the prevalence of marginal spinal syndesmophytes using chest radiographs. We conducted a retrospective analysis of 500 chest radiographs, assessing the prevalence of thin marginal syndesmophytes, bridging or near-bridging osteophytes, and flowing paravertebral ossifications in the thoracic intervertebral discs among individuals aged 16 years and older in a North American city. Among the 500 participants, we observed that thin vertical marginal syndesmophytes were present in 17 (3.4%) cases, bridging or near-bridging osteophytes were present in 126 (25.2%) cases, and flowing paravertebral ossifications were present in 37 (7.4%) cases. Out of the 17 participants with thin marginal syndesmophytes, 10 exhibited a bamboo-like spine appearance, defined as the presence of ≥4 contiguous levels of bridging marginal syndesmophytes. Analysis of syndesmophyte distribution per vertebral level indicated a higher frequency of involvement in the mid to lower thoracic spine, maximal at T9/10. The presence of thin marginal syndesmophytes in the thoracic spine on routine chest radiographs is substantially more prevalent than would be anticipated based on the existing literature. The feasibility of reliably identifying these syndesmophytes in the spine and the impact of this on morbidity should be further investigated due to their association with advanced ankylosing spondylitis and their susceptibility to fractures.

SCIseg: Automatic Segmentation of Intramedullary Lesions in Spinal Cord Injury on T2-weighted MRI Scans.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To develop a deep learning tool for the automatic segmentation of the spinal cord and intramedullary lesions in spinal cord injury (SCI) on T2-weighted MRI scans. Materials and Methods This retrospective study included MRI data acquired between July 2002 and February 2023 from 191 patients with SCI (mean age, 48.1 years ± 17.9 [SD]; 142 males). The data consisted of T2-weighted MRI acquired using different scanner manufacturers with various image resolutions (isotropic and anisotropic) and orientations (axial and sagittal). Patients had different lesion etiologies (traumatic, ischemic, and hemorrhagic) and lesion locations across the cervical, thoracic and lumbar spine. A deep learning model, SCIseg, was trained in a three-phase process involving active learning for the automatic segmentation of intramedullary SCI lesions and the spinal cord. The segmentations from the proposed model were visually and quantitatively compared with those from three other open-source methods (PropSeg, DeepSeg and contrast-agnostic, all part of the Spinal Cord Toolbox). Wilcoxon signed-rank test was used to compare quantitative MRI biomarkers of SCI (lesion volume, lesion length, and maximal axial damage ratio) derived from the manual reference standard lesion masks and biomarkers obtained automatically with SCIseg segmentations. Results SCIseg achieved a Dice score of 0.92 ± 0.07 (mean ± SD) and 0.61 ± 0.27 for spinal cord and SCI lesion segmentation, respectively. There was no evidence of a difference between lesion length (P = .42) and maximal axial damage ratio (P = .16) computed from manually annotated lesions and the lesion segmentations obtained using SCIseg. Conclusion SCIseg accurately segmented intramedullary lesions on a diverse dataset of T2-weighted MRI scans and extracted relevant lesion biomarkers (namely, lesion volume, lesion length, and maximal axial damage ratio). SCIseg is open-source and accessible through the Spinal Cord Toolbox (v6.2 and above). Published under a CC BY 4.0 license.

Surgical resection following chemoradiotherapy for thoracic SMARCA4-deficient undifferentiated tumor: a report of two cases

BackgroundThoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a high-grade malignant neoplasm with a poor prognosis. Most cases of SMARCA4-UT have extensive chest wall and mediastinum involvement. The efficacy of surgical resection has not been clearly established. Here, we report two surgical cases of SMARCA4-UT with chest wall invasion after chemoradiotherapy.Case presentationThe first patient was a 40-year-old man with back pain. Computed tomography revealed a 6.8 cm mass in contact with the thoracic vertebrae near the intervertebral foramen, which was suspected to involve the third to fifth ribs. The patient was diagnosed with SMARCA4-UT with clinical T3N0M0 stage IIB. The tumor shrank after chemoradiotherapy, and conversion surgery combined with partial vertebrectomy was performed. Histopathological findings revealed 30% residual tumor in the tumor bed. Thirty-six days after surgery, the patient developed multiple liver metastases and peritoneal dissemination. Chemotherapy combined with immune checkpoint inhibitor treatment was performed, resulting in tumor shrinkage. However, peritoneal dissemination recurred within a short interval. The patient died 5 months postoperatively. The second patient was a 74-year-old man with chest pain. Computed tomography revealed a 7.4-cm mass in the left upper lobe with invasion of the third and fourth ribs. The patient was initially diagnosed with non-small cell lung cancer with clinical T4N1M0 stage IIIA. The tumor shrank after induction chemoradiotherapy, and a left upper lobectomy combined with the chest wall resection was performed. Based on histopathological findings, the patient was diagnosed with SMARCA4-UT. The residual tumor percentage was 3%. The patient was followed up for 12 months postoperatively without recurrence.ConclusionsWe performed the complete resection of SMARCA4-UT following chemoradiotherapy. The two surgical cases had different postoperative courses. Radical surgery after chemoradiotherapy is effective for local control. However, its long-term prognostic efficacy remains unclear. Multidisciplinary approaches and further investigations of novel therapeutic options are required.

First Finding of an Ichthyosaur in the Udmurtia (Cis-Ural Region, Russia)

A dorsal vertebra of an ichthyosaur is described from the fluvial deposits of the Kama River (Votkinsk District, Udmurt Republic, Russia). This vertebra belonged to a fairly large ichthyosaur about 5–6 m long, apparently one of the largest ichthyosaurs known from European Russia. The find is redeposited, and it is problematic to establish its exact age: most likely, the vertebra was brought by the Kama River from Jurassic–Cretaceous outcrops located upstream.

Epidemiological aspects of syringomyelia in a 19-year old cohort of spinal cord injury patients

ObjectiveTo determine the prevalence, clinical and radiological risk factors, and surgical management of post-traumatic syringomyelia (PTS) in a 19-year cohort study of Spinal Cord Injury (SCI) patients treated at a SCI rehabilitation center. MethodsRetrospective study of SCI patients in whom PTS was radiologically confirmed between January 2000 and December 2018. Protocols for assessing signs and symptoms of PTS were applied prior to PTS diagnosis and treatment and later at neurosurgical and rehabilitation reviews. The variables analyzed were prevalence, demographic data, trauma event, clinical and radiological risk factors, location and size of the syrinx, and effectiveness of the surgical procedures. ResultsOver the 19-year period, review of 920 SCI patients revealed 85 patients who met the clinical and neuroradiological criteria for the diagnosis of PTS and who were prospectively followed. Road traffic accidents were the leading cause of injury (n = 58; 68.2%), syringomyelia was most commonly observed in the thoracic spine (n = 56; 65.9%), and upper extremity paresis was the most common indication for surgical treatment (n = 27; 45%). Surgical treatment was indicated in 48 patients and the operative procedures included 29 syringopleural shunts (60.4%), 17 adhesiolysis (35.4%), and two syringosubarachnoid shunts (4.1%). The prevalence of PTS was 9% and was higher in patients with ASIA impairment scale grade A injuries. Most patients with PTS (63/85, 74.1%) were treated surgically at the time of injury. There was a significant reduction both in the extent (p = 0.05) and largest area (p = 0.001) of the syrinx after surgical treatment. Reoperation rates were 47% and 37.9% for adhesiolysis and syringopleural shunting, respectively. ConclusionFollow-up and routine clinical examination of SCI patients is critical for the diagnosis of PTS in patients with late neurological deterioration. Surgical treatment has a positive impact in reducing the size of the syrinx as seen on postoperative MRI.

Morphometric Evaluation of the Thoracic and Lumbar Vertebral Canal and Spinal Cord Using Computed Tomography in Healthy Korean Shorthair Cats.

This study aimed to evaluate the spinal morphometry of the thoracic and lumbar regions in normal Korean Shorthair cats using computed tomography (CT) and to investigate the relationship with variables such as sex, age and body weight. Fifteen clinically healthy Korean Shorthair cats (eight males, seven females) from Seoul National University Veterinary Medical Teaching Hospital were included in this retrospective study. Measurements of the height, width and area of the vertebral canal and spinal cord on CT images were taken at the cranial, middle and caudal points of the thoracic and lumbar vertebrae by three observers, and the ratios of the spinal cord area to the vertebral canal area were calculated. The significance of the differences in measurements between sexes and correlations with age and body weight were analysed. The mean age of the cats was 7 years (range: 2-12 years), with a mean weight of 5.27 kg (range: 2.6-8.3 kg). The height, width and area of the vertebral canal and spinal cord were significantly greater in males than in females (p < 0.05). The ratios of the spinal cord area to the vertebral canal area showed no significant difference between sexes (p > 0.05), and no significant correlations were found between the ratios of the spinal cord area to the vertebral canal area and age or body weight. This study provides useful reference intervals for spinal morphometry in the thoracic and lumbar regions of healthy Korean Shorthair cats and investigate the relationship with variables such as sex, age and body weight. This anatomical information may assist in the diagnosis and prognosis of thoracic, lumbar vertebral and spinal cord diseases using CT.

Evaluation of Intervertebral Disc Space Width Between 10th and 11th Thoracic Vertebrae in Cats Using Radiography and Magnetic Resonance Imaging.

It is well known that the T10-T11 intervertebral disc space is usually narrower than the adjacent intervertebral disc spaces in most dogs. However, whether the T10-T11 disc space is narrower than the adjacent disc spaces is not well-established in cats. To measure the intervertebral disc space width of the T10-T11 disc space and to compare it with that of the adjacent disc spaces using radiography and magnetic resonance imaging (MRI). In Groups 1 (101 clinically normal cats) and 2 (32 cats without spinal diseases from T8 to T13), dorsal width (DW), central width (CW) and ventral width (VW) of the T8-T13 disc spaces were measured by radiography or MRI. Significant differences of the DW, CW and VW among disc spaces measured by radiography and MRI were evaluated. Intra- and interobserver reliabilities were measured by intraclass correlation coefficient. In Groups 1 and 2 using radiography, the DW and CW of the T10-T11 disc space were significantly narrower than those of adjacent disc spaces (p<0.05). The DW of the T8-T12 disc spaces was significantly narrower than that of the T12-T13 disc space in Group 1 using radiography. In Groups 1 and 2 using radiography, the CW and VW of the T8-T11 disc spaces were significantly narrower than those of the T11-T13 disc spaces. In Group 2 using MRI, the DW of the T10-T11 disc space was significantly narrower than that of the T11-T13 disc spaces. The VW of the T8-T11 disc spaces was significantly narrower than that of the T11-T13 disc spaces. The T10-T11 intervertebral disc space on radiography is statistically narrower than the adjacent intervertebral disc spaces in normal cats. The cranial thoracic intervertebral disc spaces (T8-T11) are usually narrower than the caudal thoracic intervertebral disc spaces (T11-T13) on radiography and MRI.

Effects of Palliative Surgical Treatment for Spinal Metastases on the Patient's Quality of Life With a Focus on the Segment of the Metastasis: A Prospective Multicenter Study.

Prospective multicenter study. Palliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments. We prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper-middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared. All groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9). Palliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.

The effectiveness of intramuscular dry needling stimulation in treating trigger points: A case series

Myofascial trigger points are a common presentation in clients with chronic spinal pain. Various techniques are used to manage trigger points and are considered a vital part of chronic spinal pain management. Reducing pain caused by trigger points may be effective in improving function. Case series can provide preliminary evidence and assist in feasibility assessment. The objective of this case series is to document the feasibility of intramuscular dry needling stimulation in managing trigger-point-induced chronic pain. Three individuals aged 35, 33, and 28 years presented to a private clinic with chief complaints of scapular region muscular pain, and their management is reported in this case series. Initial physical examination revealed tenderness over D6 and D8. There was a palpable para spinal muscle hypertonicity and reduced thoracic spine mobility to both sides in all the three clients. The presence of multiple trigger points bilateral to the spine indicated postural dysfunction, which altered pain on changing thoracic posture. Clients were treated with dry needling with intramuscular stimulation over trigger points, paraspinal muscle and inferior to scapula by a therapist trained in the technique. The frequency was kept at 1.5 Hz and intensity was as tolerated by the patient. Outcome measures were taken using VAS, RMDQ and digital inclinometer for thoracic spine rotation. Subject one reported a change of 22 mm in VAS after the first week and 40 mm in the fourth week. It also reported an improvement in mobility to both side rotations by 20 degrees in the first week and full towards the fourth week. Subject two and three improved VAS by 10 mm in week one and 35 mm towards the fourth week. Full mobility was achieved in the fourth week in both cases. RMDQ scores improved significantly in the three cases. The three cases demonstrate significant improvement in both symptoms and function based on outcome measures. This indicates the efficacy of treating thoracic spine myofascial trigger points with dry needling and intramuscular stimulation, but a large-scale study is recommended.

Pathogenesis of thoracic ossification of the ligamentum flavum

Thoracic ossification of the ligamentum flavum (TOLF) is characterized by ectopic ossification of the ligamentum flavum in the thoracic spine and is considered the main cause of thoracic spinal stenosis and spinal cord disease. Osteoblast specific transcription factor Osterix (Osx) is required for bone formation, and there is no bone formation or ossification without Osx. Surgical intervention is recognized as the only effective method for TOLF treatment with set of complications. However, underlying mechanisms of TOLF are not well understood. This paper summarizes the pathogenesis of TOLF. Some relevant factors have been discussed, such as mechanical stress, genetic susceptibility genes, endocrine and trace element metabolism abnormalities, which may associate with TOLF. More recent studies using proteomics technology and RNA sequencing approach have discovered that some new factors participate in TOLF by upregulation of Osx gene expression including inflammatory factors. TOLF is a unique disease involving multiple factors. On the other hand, studies on TOLF pathogenic mechanism may provide new ideas for finding possible upstream regulatory factors of Osx and further developing novel drugs to stimulate new bone formation to treat osteoporosis.

Unilateral Biportal Endoscopic Decompression for Thoracic Spinal Stenosis Secondary to Ossification of the Ligamentum Flavum

Ossification of the ligamentum flavum (OLF) in the thoracic spine is a cause of thoracic myelopathy that is more commonly found in East Asian populations (Koreans, Japanese, Chinese) than in others. Early diagnosis and sufficient surgical decompression can improve the functional prognosis for thoracic OLF. Surgical decompression is necessary and should be done as soon as the symptoms develop. There is a wide range of possible treatments, from standard open laminectomy to endoscopic decompression surgery. This video demonstrates the least invasive technique of decompressive laminectomy with bilateral decompression and removal of thoracic OLF through unilateral biportal endoscopic spinal surgery. The authors present the case of an 81-year-old male patient who presented with bilateral lower extremity weakness, numbness, pain, and ataxia. Magnetic resonance imaging and computed tomography scans of the whole spine showed the presence of OLF with severe spinal canal stenosis and a cord signal change at the T9–10 level. He underwent biportal endoscopic decompression and removal of thoracic OLF at T9–10. On the discharge day (postoperative day 7), motor power and pain had significantly improved. He could stand and independently ambulate with a walker.

Analysis of the prevalence characteristics and risk factors of pulmonary tuberculosis combined with extrapulmonary tuberculosis in elderly patients

To analyze the clinical features, epidemiological characteristics, risk factors, and complication characteristics of pulmonary tuberculosis (PTB) combined with extrapulmonary tuberculosis (EPTB) in elderly patients (aged > 60 years). Clinical data were collected from pathogen positive elderly patients with PTB hospitalized in a teaching hospital in Zhejiang from 2017 to 2023. We retrospectively analyzed the risk factors for complications of EPTB in elderly patients with PTB by univariate and multivariate logistic regression models. We also described the characteristics of complications in PTB with EPTB. A total of 781 PTB elderly patients were enrolled, of whom 86 (11.01%) had complicated EPTB. The most commonly invasive sites for EPTB were thoracic spine (17.53%), cervical lymph nodes (13.40%), and meninges (12.37%). 60 < aged < 80 years (OR = 2.876, 95%CI 1.290–6.412; P = 0.010), anaemia (OR = 2.212, 95%CI 1.135–3.967; P = 0.018) and osteoporosis (OR = 4.925, 95%CI 1.501–16.160; P = 0.009) were the independent risk factors for PTB with EPTB infection. PTB with EPTB had a higher proportion of multiple serous cavity effusion (19.8% vs. 12.2%) and longer hospitalisation (17 vs. 15, P = 0.004). 60 < aged < 80 years, anaemia and osteoporosis were found to be independent risk factors for PTB with EPTB in elderly patients. We compared the epidemiological and clinical characteristics of PTB with EPTB. These results are important for improving the diagnosis of EPTB, reducing complications, and improving prognosis.

Luminal shape and aortic remodelling after total arch replacement for type A aortic dissection: conventional and frozen elephant trunks.

This study was performed to assess postoperative aortic remodelling (AR) after total arch replacement (TAR) for acute type A aortic dissection (AAD) with a frozen elephant trunk (FET) or conventional elephant trunk (cET). Furthermore, the shape of the residual true lumen (TL) was analyzed based on elliptical Fourier analysis (EFA) and evaluated as a predictor of AR. This study involved patients who underwent TAR with a cET or FET for AAD from December 2006 to January 2023 at five institutions. AR was assessed at the levels of the 4th thoracic vertebra (Th4), Th7, Th10, and above the coeliac trunk. The shape of the residual TL at all four levels was analyzed based on EFA to calculate shape patterns as principal component (PC) values. Inverse probability of treatment weighting (IPTW) was performed for adjustment between the groups. In total, 180 patients (88 with cET and 92 with FET) were enrolled. The complete AR rate, defined as false lumen remodelling throughout the entire descending thoracic aorta, was significantly higher in the FET than cET group (63.4% vs 32.0%, P = 0.0013). The IPTW-adjusted Fine-Gray regression model revealed that the mean PC2 (hazard ratio, 0.22; P < 0.001) and PC3 (hazard ratio, 0.24; P = 0.009) of the four levels were independent predictors of complete AR. In AAD repair, the AR rate was significantly higher with use of the FET than cET. The shape patterns of the residual TL can be an important reference for predicting postoperative AR.

Accounts of Spine and Paraspinal Disease while Playing Golf

The twisting motion associated with the golf swing puts the intervertebral discs and the paraspinal musculature under stress. The objective of this study was to characterize the spinal and paraspinal pathologies associated with golf and their outcomes. The National Electronic Injury Surveillance System (NEISS) was queried for emergency department visits between 2003-2023 for golf-related injuries with body part codes "neck", "upper trunk", and "lower trunk", which includes the cervical, thoracic, and lumbar spine, respectively. Narratives were screened for relevance and reports related to spinal and paraspinal injuries were included. Weighted survey analysis was utilized to construct national estimates. Injury and diagnosis trends were analyzed using binomial logistic regression, and time trends were analyzed with a linear model. P-value of < 0.05 was considered significant. A total of 1441 relevant samples led to a national estimate of 69,153 emergency department visits for golf-related spinal-/paraspinal injuries between 2003-2023. The weighted mean age of those injured was 52.8 years, and the majority were male (85%, 95% CI 83-87). Strain was the most diagnosed injury (57.5%, 95% CI 54-61). Those aged > 55 years constituted more injuries than any other age group (50.1%, 95% CI 47-53). Injuries in the lumbar region accounted for most cases (76.9%, 95% CI 74-80). Injury frequency did not change over the years (p= 0.54), although the age of injury did increase over time (p < 0.001). Golf-associated paraspinal injuries are more common than neurological injuries, necessitating study into their mechanisms and onset.

Dogs with severe tracheal flattening exhibit lower degrees of left lateralization of the cervical esophagus.

Herein, we investigated the positional relationship between the cervical esophagus and trachea using computed tomography (CT) images in dogs with tracheal flattening. From these CT images, the ratio of the tracheal diameters in the short (vertical) and long (horizontal) axes of the tracheal ring (S/L ratio) and the vertebra - trachea - esophagus (VTE) angle were measured at the point from the 3rd cervical (C3) to the 3rd thoracic vertebra (T3) levels. The VTE angle in dogs with tracheal flattening with an S/L ratio under 0.24 tended to be smaller than the angles at the level from C4 to T2 in dogs with an S/L ratio over 0.25. The positional relationship between the esophagus and trachea seems to be possibly related to tracheal cross-sectional shape.

Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes.

Although pseudoangina is most commonly caused by cervical disc herniation, several cases have been described where thoracic herniation produced symptoms of pseudoangina. If thoracic herniation can produce angina-like pain, then it is important to consider whether pathology of the thoracolumbar spine, in general, can trigger false pain syndromes distinct from pseudoangina. We seek to provide the most comprehensive study regarding the diagnosis and treatment of spinal conditions causing false pain syndromes. Systematic review of the current literature using PRISMA 2020 recommendations. We queried the literature and systematically selected relevant studies according to PRISMA guidelines. Across 22 selected studies, the sample size was 30 patients, and a total of 26 met the criteria for statistical analysis. Seven (26.9%) of these patients presented with a chief complaint of pseudoangina resulting from thoracic disc herniation. 73.1% (19/26) of patients exhibited pain mimicking visceral origin. Overall, 13/19 (68.4%) patients exhibited thoracic spine disease only and 4/19 (21.1%) patients were affected at lumbar levels only, while 2 (10.5%) patients exhibited thoracolumbar herniation. Presentations included abdominal pain (11/19) mimicking appendicitis or pancreatitis, flank pain mimicking renal colic (8/19), and 2 cases of scrotal pain/orchalgia. Symptom durations ranged from acute (<24h) to 7 years. Treatments were reported for 18/19 patients and all treated patients reported alleviated pain. Seven out of 18 patients were managed conservatively while 11/18 were treated surgically. Misdiagnosis resulted in unnecessary surgery (pancreaticojejunostomy) or other invasive procedures. In spinal disorders manifesting with atypical pain syndromes, delay in proper diagnosis and unnecessary treatments can, unfortunately, cause prolonged patient suffering and increased cost of health care. As a result, some have proposed that spinal screening should be incorporated into clinical examinations involving false pain syndromes.

Implementing enhanced recovery after surgery protocol in elderly patients following multi-level posterior lumbar or thoracolumbar instrumented fusion for degenerative diseases.

Enhanced recovery after surgery (ERAS) is an evidence-based multimodal perioperative management strategy. The aim of the present study was to analyze the clinical efficacy of ERAS in elderly patients (> 70 years old) undergoing multi-level posterior lumbar or thoracolumbar instrumented fusion for degenerative diseases. Patients older than 70 years undergoing multi-level lumbar or thoracolumbar instrumented fusion for degenerative disk diseases or spinal stenosis from January 2017 to December 2018 (non-ERAS group) and from January 2020 to December 2021 (ERAS group) were enrolled in present study. Patient-specific and procedure-specific clinical characteristics were collected. Univariate and multivariate regression were performed to determine the risk factors related to length of stay (LOS) and complications. A total of 233 patients were enrolled in this study, 70 in non-ERAS group and 163 in ERAS group. There were comparable baseline characteristics between groups. Further there were no significant differences in 90-day readmission rates and complication rates. However, we observed a significant reduction in LOS (14.89 ± 7.78 days in non-ERAS group versus 11.67 ± 7.26 days in ERAS group, p = 0.002) and overall number of complications (38 in non-ERAS group versus 58 in ERAS group, p = 0.008). Univariate linear regression denoted that operation time (p < 0.001), intraoperative blood loss (p < 0.001), intraoperative blood transfusion (p < 0.001), fusion number ≥ 5 (p < 0.001), spinal surgery including the thoracic spine (p < 0.001), CCI > 2 (p = 0.018), ERAS (p = 0.003) and spinal surgery including lumbar (p = 0.030) were associated with LOS. Furthermore, multivariate linear regression showed that ERAS (p = 0.001), CCI > 2 (p = 0.014), and Fusion number ≥ 5 (p = 0.002) were independent risk factors for LOS. Analogously, univariate logistic regression revealed that longer operation time (p = 0.005), more intraoperative blood loss (p < 0.001), more intraoperative blood transfusion (p = 0.001), fusion number ≥ 5 (p = 0.001), ERAS (p = 0.004) and spinal surgery including thoracic spine (p = 0.002) were related to complications, while implementing ERAS was associated with less complications. Multivariate logistic regression denoted that implementation of ERAS (p = 0.003), Intraoperative blood loss (p = 0.003) and Fusion number ≥ 5 (p = 0.008) were independent risk factors for postoperative complications. In conclusion, the present study reported the first ERAS principles performed in multi-level lumbar or thoracolumbar instrumented fusion for degenerative conditions. Our outcomes shown that the implementation of ERAS in these populations is favorable for reducing LOS and decreasing overall number of complications though the comparable complication rates between two groups. Totally, our ERAS protocols were safe and feasible in these populations.