Narrow Canal Research Articles

Central lumbar stenosis. Recommendations of the Russian Association for the Study of Pain (RASP)

Narrowing of the central spinal canal in the lumbar spine (central lumbar stenosis, CLS) is one of the most common causes of lumbar pain, disability and spinal surgery in the elderly. The most common is acquired degenerative CLS, in which the main role play lumen-narrowing medial intervertebral disc herniating with ossification phenomena and marginal bone proliferation on the sides of the vertebral bodies – osteophytes, hypertrophy of the facet joints with their medial displacement, hypertrophy of the yellow ligament. The development of CLS can also be a consequence of spondylolisthesis, postoperative changes, rheumatic diseases and other causes. Both the compression of the cauda equine roots due to narrowing of the spinal canal and their ischemia, caused by compression of the radicular vessels and venous congestion play an important role in the pathogenesis of CLS. CLS develops in elderly age and occurs predominantly in men. The main clinical manifestation of CLS is neurogenic (caudogenic) intermittent claudication, which manifests as pain, numbness and weakness in the legs when the patient walks or stands for a long time but subsides when the patient sits or stands and bends forwards (flexion in the lumbar spine). The diagnosis of CLS is confirmed by magnetic resonance imaging (MRI), which shows a narrowing of the spinal canal and makes it possible to rule out specific causes of lumbar pain. It is important to note that, according to MRI, CLS often occurs at an older age, so its detection in the absence of clinical manifestations does not require an immediate discussion of the prospects of surgical treatment. Pain in patients with CLS according to MRI may be musculoskeletal in nature. Therefore, the diagnosis of CLS should include specific clinical manifestations and stenosis on MRI. In patients without clinical manifestations of CLS, osteoporosis and severe concomitant somatic diseases, only conservative therapy is recommended. Modern conservative treatment of CLS includes an educational program, therapeutic exercises (kinesiotherapy), psychological therapy methods for emotional disorders (cognitive-behavioral therapy), manual therapy and pharmacotherapy. Complex conservative treatment of CLS can reduce pain, improve the patient's condition and in some cases increase the patient's walking distance.

Long Term Surgical Outcome of Canal-Tympanoplasty in Patients with Schuknecht Type B Congenital Aural Stenosis.

Congenital aural atresia (CAA) is a complex condition that can present in various forms, including Schuknecht type B stenosis, characterized by a congenitally narrow bony external auditory canal (EAC). This study aims to evaluate the long-term surgical outcomes of canal-tympanoplasty in patients with CAA Schuknecht type B. The study included 21 ears diagnosed with CAA Schuknecht type B that underwent canal-tympanoplasty. The large EAC and tympanic membrane were reconstructed using conchal flap meatoplasty, bony EAC drilling, ossicular reconstruction, and overlay tympanoplasty. Standard pure-tone audiometry was analyzed at various time points post-surgery: 3, 6, 12, and 24-60 months. The incidence of postoperative complications was evaluated. The hearing outcomes of canal-tympanoplasty were satisfactory in this case series. Serviceable hearing was achieved in all patients after 3 months and was sustained for 1 year in 85% of patients. The air-bone gap (ABG) improved from 39.3 ± 15.1 dB preoperatively to 13.7 ± 7.4 dB at 3 months, 16.4 ± 10.5 dB at 6 months, 19.1 ± 11.7 dB at 12 months, and 21.5 ± 16.1 dB at 2-5 years postoperatively. Three patients underwent revision canal-tympanoplasty due to hearing deterioration (14.3%). There were no cases of postoperative infection, facial nerve weakness, vertigo, deterioration of bone conduction thresholds, or complete restenosis of the EAC. Canal-tympanoplasty was a satisfactory surgical intervention for patients with CAA Schuknecht type B. The procedure resulted in significant improvements in hearing outcomes, with serviceable hearing that lasted for several years. The risk of postoperative hearing deterioration and/or revision surgery within 1 year was acceptable.

Migraine-like headache due to frontal osteitis and meningitis in a delayed diagnosis of SAPHO syndrome: A case report and literature review

Synovitis, acne, pustulosis, hyperostosis, and osteomyelitis (SAPHO) syndrome is a rare polygenic autoinflammatory disorder that is associated with headaches of different etiological origins. Herein we report the case of a patient with SAPHO syndrome and provide a literature review. The patient was a 64-year-old female who complained of a recurrent headache, which had persisted for several years, and diffuse arthralgias. A computed tomography-angiogram demonstrated the narrowing of the left carotid canal. The patient had an erythrocyte sedimentation rate of 19 mm/s, and her cerebrospinal fluid contained 20 leukocytes/μL (13 mononuclear) and 0.43 g/L of proteins. Bone scintigraphy showed radiotracer uptake in the frontal bones and spine. The patient’s son had previously been diagnosed with SAPHO syndrome; therefore, the possibility of a disorder in the same spectrum was considered. Corticotherapy followed by sulphasalazine resolved the symptoms. This case illustrates an atypical cranial and meningeal involvement of the SAPHO autoinflammatory process. Our findings underscore the importance of considering immune-mediated disorders in the differential diagnosis of headaches.

A case of incidentally detected spina bifida at DV1 level in a fighter pilot: Aeromedical deliberations

A failure of closure neural tube normally results in spina bifida. The lesions may occur anywhere along the spine but are more common in the lumbosacral region (90%) in comparison to the thoracic (6%) or cervical (3%) spines. According to policy guidelines, all cases of spina bifida are unfit for all branches and trades in military flying, except for spina bifida in the sacrum and 5th lumbar vertebra, if completely sacralized. When various congenital defects are considered, spina bifida at the SV1 level is relatively innocuous. However, an anomaly in the upper spinal regions is associated with the narrowing of the spinal canal, which may be accompanied by herniation of meninges. This could be exacerbated and lead to abrupt incapacitation during flight when a spine like this is subjected to high +Gz accelerations or ejection forces. This paper highlights a case of a fighter aircrew who was incidentally detected to have spina bifida at 1st dorsal vertebra level during evaluation for cervical prolapsed intervertebral disc and the aeromedical deliberations for its disposal.

Congenital Internal Auditory Canal Stenosis

A 3-year-old boy underwent evaluation for possible cochlear implantation. He had failed a neonatal otoacoustic emission (OAE) hearing screen. A combined auditory brainstem response/auditory steady-state response (ABR/ASSR) test battery confirmed the presence of a severe hearing loss on the right and a profound hearing loss on the left. No Joint Committee on Infant Hearing (JCIH) risk factors for early childhood hearing loss1 were identified. Rehabilitation via hearing aid amplification and auditory-verbal speech therapy was unsuccessful. Computerized tomographic (CT) imaging of the temporal bone was performed to identify the presence of any inner ear abnormalities. No abnormalities of the cochlea, vestibule and semicircular canals on both sides were identified by the radiologist. The internal auditory canals were described as “fairly symmetrical without widening”, and the study was officially reported as an “unremarkable study of the temporal bones”. Independent review of the CT imaging revealed the presence of seemingly narrow internal auditory canals (IAC) on both sides. (Figure1A) The width of the IACs on the axial plane were measured by drawing a perpendicular line starting from the posterior wall of the IAC, 2 mm inside the posterior lip of the internal auditory meatus, and ending on the anterior canal wall, as described by McClay et al.2 Measurements taken utilizing the length measurement tool in the DICOM imaging software (RadiAnt DICOM Viewer, Version 2024.1, Medixant) indicated an IAC width of 1.78 mm on the right (with severe hearing loss) and 1.37 mm on the left (with profound hearing loss). (Figure 1B) These measurements confirmed the presence of bilateral internal auditory canal stenosis, a diagnosis defined by a canal of 2 mm or less on highresolution CT.3

An Analysis of Hearing Outcomes in Children with Hutchinson-Gilford Progeria Syndrome

Aims/Background Few hearing loss studies have been conducted in patients with progeria, and only the possibility of low-frequency conductive hearing loss has been mentioned. The primary objective of this study is to perform a comprehensive analysis of the clinical audiological characteristics of children with Hutchinson-Gilford progeria syndrome (HGPS), and the secondary objective is to analyse the causes of their hearing loss and what can be done to enable them to hear as well as possible. Methods Ten children with HGPS underwent impedance audiometry (tympanogram), otoacoustic emissions, and pure-tone audiometry tests. Otoscopic examination and imaging were also performed in the patients with abnormal hearing. Results Five patients had normal hearing, while the other five had varying degrees of hearing impairment manifesting as mild to moderate low-frequency or full-frequency conductive hearing loss. Otoscopic examination of those patients with abnormal hearing showed a narrowing of the external auditory canal, a thinning of the tympanic membrane, and a distorted cone of light. Further, computed tomography of one patient showed a poorly defined temporal bone morphology with scant pneumatization of the mastoid process. Conclusion Patients with HGPS differ from normally aging individuals with a predominant conductive pattern of hearing loss as opposed to sensorineural deafness, with more lower-frequency hearing impairment due to poor pneumatization of the mastoid process and the possible formation of osteophytes in the temporal bone.

Exploring Variations in Lumbar Canal Width: An MRI Study on Asymptomatic Patients by Age and Gender.

Background: Lumbar spinal stenosis is a common degenerative condition, especially in older adults, leading to significant morbidity. Age, gender, and lumbar level variations in spinal canal width are critical in assessing stenosis risk. Many patients exhibit radiographic narrowing without clinical symptoms. This study analyzed the risk of lumbar stenosis by age, gender, and lumbar levels (L1-S1) using the MRI of patients without clinical signs of narrowing. Materials and Methods: This retrospective study included 120 patients, aged 20 to 75, who underwent lumbar MRI for unrelated reasons. Spinal canal widths were measured at five lumbar levels (L1-2 to L5-S1), and stenosis risk was classified as low, borderline, or high based on narrowing thresholds. Data were grouped by age and gender to assess the stenosis risk distribution. Results: The analysis revealed a progressive increase in stenosis risk from the upper to lower lumbar levels. At L4-5 and L5-S1, females aged 61-75 exhibited the highest proportions in borderline- and high-risk categories. While most patients were classified as low risk, many older patients showed radiographic narrowing without clinical symptoms. Males generally had wider canals and lower risk. Conclusions: Age and gender significantly impact lumbar stenosis risk, particularly in older females. The findings highlight the importance of clinical correlation despite radiographic evidence of stenosis and suggest potential for AI-based detection systems in enhancing assessments of spinal canal narrowing.

NCMP-18. A CASE OF METASTATIC GLIOBLASTOMA MULTIFORME

Abstract Glioblastoma multiforme (GBM) is the most common primary brain tumor and rarely causes metastasis. We present a case of a 43-year-old female who developed tingling and heaviness in her right lower extremity in March 2023. This sensation progressed to involve her entire right hemi-body over the next two months. She presented to the emergency department where an MRI show a large left frontal parietal mass measuring 5.2x3.7x3.7cm with significant mass effect. She underwent surgical resection and surgical pathology showed IDH1-mutant R132H, retained ATRX, MGMT promoter mutation, and ki-67 of 80%. She received 6 weeks chemoradiation and then started maintenance temozolomide at 150mg/m2. Temozolomide was increased to 200mg/m2 for cycle 3 maintenance. In March 2024, she presented to the hospital with pain radiating down her legs and saddle anesthesia. MRI lumbar spine showed infiltrating osseous mass at S1 and S2 and bilateral sacral ala with anterior and posterior extraosseous invasion, invading the spinal canal resulting in moderate to severe spinal canal narrowing and compression of the sacral nerve roots. She underwent biopsy of the lesion which showed IDH wildtype metastatic GBM. She also underwent lumbar puncture and cerebrospinal fluid cytology was negative. She experienced pancytopenia limiting chemotherapy options. In April 2024, she underwent PET scan which showed hypermetabolic epidural soft tissue in spinal canal at L5-S1 level, widespread hypermetabolic skeletal lesions, tiny left cervical level 4 lymph node, small hypermetabolic right hilar, aortocaval, left retroperitoneal nodes and a tiny left common iliac node. The incidence of extracranial metastasis is 0.4-2.0% with less than 25 reported cases of bone marrow spread. This is thought to be rare due to the absence of lymphatics within the brain and the limited survival associated with GBM. This metastasis may occur through vascular invasion, perineural spread, lymphatics, direct invasion, or iatrogenic spread into soft tissues.

Accuracy of Video Otoscopy in Predicting the Presence of Middle Ear Effusion in Children Compared to Tympanometry: A Diagnostic Study.

Middle ear effusion (MEE) is the primary cause of conductive hearing impairment among children, predominantly occurring up to the age of two years. The gold standard for detecting MEE is tympanometry (Grayson-Stadler, Eden Prairie, Minnesota). This study explores a less costly alternative, the video otoscope (Inventis S.R.L, Padova, Italy). The primary objective is to compare video otoscopy with tympanometry in terms of its ability to diagnose MEE. The secondary objective is to explore the prevalence of MEE in special populations. We conducted a retrospective diagnostic study that included patients aged 0-18 years who visited the pediatric otolaryngology clinic for suspected MEE over a two-year period. Clinical presentation, otoscopy findings, and tympanometry results were reviewed. The data were analyzed using IBM SPSS Statistics for Windows, Version 24(Released 2016; IBM Corp., Armonk, New York). The significance of the results was assessed using the chi-squared test. We included 337 patients with a mean age of 5.1 years (standard deviation = 2.68); 967 tympanometry tests were available for comparison with the corresponding ears. Validity tests showed that the sensitivity of video otoscopy was 79.5%, the specificity was 56.9%, the positive predictive value was 89.6%, and the negative predictive value was 37.4%. The overall accuracy was 75.5%. These results were statistically significant. Video otoscopy was capable of diagnosing MEE in children 89.6% of the time. However, tympanometry is still needed in specific conditions, such as narrow ear canals, dull tympanic membranes, and clear tympanic membranes in patients with decreased hearing, a history of ear infections, or speech delay.

Non-surgical treatment for tandem spinal stenosis: a systematic review protocol

BackgroundTandem Spinal Stenosis (TSS) is a disease characterised by the narrowing of the spinal canal in two or more non-adjacent areas of the spine, often affecting both the cervical and lumbar vertebrae. Doctors and patients increasingly favour non-surgical treatments that have the function of relieving symptoms and improving outcomes. This systematic review aims to evaluate the effectiveness and safety of non-surgical therapies for TSS and comprehensively summarise existing evidence.Methods and analysisWe will conduct comprehensive searches, both manual and electronic, of literature published up to 30 September 2024; database searches will commence after the publication of this agreement, with an estimated commencement date of 1 December 2024, and the end date is 31 May 2025, without language restrictions. Key databases such as MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform, China National Knowledge Infrastructure, China Biomedical Literature Database, China Scientific Journal Database and Wan-Fang Database will be explored. In addition, we will include resources such as library journals and conference abstracts. Following the identification and screening of all randomised controlled trials focusing on non-surgical treatments for TSS, two investigators will perform a meta-analysis of the included studies. The findings will be summarised as the risk ratio for binary data and the standardised or weighted mean difference for continuous data.Ethics and disseminationEthical approval is not required, as the review does not involve individual patient data. The review’s findings will provide clinicians with evidence on using non-surgical treatments for TSS, disseminated through peer-reviewed publications or conferences.PROSPERO registration numberCRD42024496634.

Defining multilevel developmental cervical spinal stenosis using MRI.

Developmental cervical spinal stenosis (DcSS) is a well-known predisposing factor for degenerative cervical myelopathy (DCM) but there is a lack of consensus on its definition. This study aims to define DcSS based on MRI, and its multilevel characteristics, to assess the prevalence of DcSS in the general population, and to evaluate the presence of DcSS in the prediction of developing DCM. This cross-sectional study analyzed MRI spine morphological parameters at C3 to C7 (including anteroposterior (AP) diameter of spinal canal, spinal cord, and vertebral body) from DCM patients (n = 95) and individuals recruited from the general population (n = 2,019). Level-specific median AP spinal canal diameter from DCM patients was used to screen for stenotic levels in the population-based cohort. An individual with multilevel (≥ 3 vertebral levels) AP canal diameter smaller than the DCM median values was considered as having DcSS. The most optimal cut-off canal diameter per level for DcSS was determined by receiver operating characteristic analyses, and multivariable logistic regression was performed for the prediction of developing DCM that required surgery. A total of 2,114 individuals aged 64.6 years (SD 11.9) who underwent surgery from March 2009 to December 2016 were studied. The most optimal cut-off canal diameters for DcSS are: C3 < 12.9 mm, C4 < 11.8 mm, C5 < 11.9 mm, C6 < 12.3 mm, and C7 < 13.3 mm. Overall, 13.0% (262 of 2,019) of the population-based cohort had multilevel DcSS. Multilevel DcSS (odds ratio (OR) 6.12 (95% CI 3.97 to 9.42); p < 0.001) and male sex (OR 4.06 (95% CI 2.55 to 6.45); p < 0.001) were predictors of developing DCM. This is the first MRI-based study for defining DcSS with multilevel canal narrowing. Level-specific cut-off canal diameters for DcSS can be used for early identification of individuals at risk of developing DCM. Individuals with DcSS at ≥ three levels and male sex are recommended for close monitoring or early intervention to avoid traumatic spinal cord injuries from stenosis.

Characteristics of sagittal spinopelvic alignment in Thai population: a cross-sectional study.

The prevalence of spinal deformity is a significant health concern often associated with the aging process. It is primarily attributed to the thickening of spinal joints, ligament pathologies, or the narrowing of the spinal canal, leading to compression of the spinal cord and nerve roots, and subsequently causing musculoskeletal problems. When considering corrective surgery for adult spinal deformities, it is crucial for spine surgeons to take into account the standard values of sagittal spinopelvic alignment. Notably, there is currently a lack of specific data on this aspect within the Thai population. Therefore, our study was focused on evaluating the alignment in the Thai population. To analyze sagittal spinopelvic alignment parameters in the asymptomatic Thai population and compare them with other populations. This study was designed as a cross-sectional analysis involving 194 participants, wherein the sagittal spinopelvic parameters were evaluated utilizing radiographic images. The measurements of the sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) were determined by averaging the assessments conducted by two orthopedic residents and a spine surgeon. In addition, participants' demographic information was obtained through questionnaires, and further analysis was performed on age, gender, and body mass index data. The study also encompassed the determination of correlations between various parameters and the comparison of these parameters with other populations. The body mass index (BMI) of the study participants demonstrated significant associations with several spinal parameters. Specifically, BMI showed significant correlations with sagittal vertical axis (SVA) (r = 0.2, p = 0.09), pelvic incidence (PI) (r = 0.4, p < 0.01), lumbar lordosis (LL) (r = 0.2, p = 0.02), sacral slope (SS) (r = -0.2, p = 0.02), and pelvic tilt (PT) (r = 0.2, p = 0.02). The SS exhibited a statistically significant decline with increasing age (p = 0.04). Furthermore, the mean SVA, PI, LL, SS, and PT differed significantly between the study participants and the Indian population. In addition, the SS was notably lower when compared to the European population. The study revealed the spinopelvic parameters in a cohort of healthy Thai population and observed a correlation between their body mass index (BMI) and pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Notably, the average SS among Thai adults was found to be statistically lower than that of individuals from Indian, European Caucasian, Asian, and Mexican populations. These insights hold potential value as a reference when strategizing surgical interventions for Thai patients with spinal deformities.

Utility of cervical dynamic magnetic resonance imaging for evaluating patients with cervical myelopathy: a retrospective study.

Retrospective observational study. This study aimed to evaluate the utility of cervical dynamic magnetic resonance imaging (dMRI) in the assessment of cervical canal stenosis. Cervical spondylotic myelopathy has been intricately linked to both static and dynamic narrowing of the cervical spinal canal. Traditional MRI with the neck in a neutral position fails to identify the dynamic changes and may lead to misdiagnosis. Cervical dMRI is a promising tool for evaluating cervical myelopathy, enabling clinicians to assess spinal cord compression, segmental instability, and alterations in range of motion, often missed on conventional imaging. A retrospective analysis was conducted on 369 patients with symptoms of cervical myelopathy assessed using cervical dMRI. After assessing the subaxial cervical spine at each disc level (C3-T1), significant changes in the degree of central canal stenosis were determined. The appearance and extent of hyperintense lesions on T2-weighted sequences were also noted. Overall, 653/1,845 (35.39%) disc levels showed an increase in stenosis grade on extension MRI, with 168/653 (25.72%) and 180/653 (27.56%) disc levels changing from grades 0/1 to grades 2 and 3, respectively. Moreover, 120/369 (32.52%) patients showed a mean increase of 1.55±0.75 levels of compression on extension MRI when compared to neutral MRI. A fresh-appearing hyperintense lesion was observed in 79 (4.28%) disc levels on flexion MRI, which was not visualized on neutral MRI. Cervical dMRI may help surgeons plan for surgery, discuss the prognosis with the patient, and safeguard themselves from medico-legal issues arising from improper or missed diagnosis and treatment.

Comparative study of total hip arthroplasty with and without femoral osteotomy in Crowe Ⅳ developmental dysplasia of the hip

To compare the clinical effects of total hip arthroplasty(THA) with and without femoral osteotomy in Crowe Ⅳ developmental hip dislocation(DDH). The data on 46 patients who underwent THA for unilateral Crowe Ⅳ DDH between 2012 and 2017 were analyzed retrospectively. They were divided into two groups according to the different surgical methods. There were 24 patients in the osteotomy group, 3 males and 21 females, with an average age of (47.3±9.0) years old ranged from 34 to 57 years old;and 22 patients in the non-osteotomy group, 2 males and 20 females, with an average age of (51.6±8.3) years old ranged from 40 to 61 years old. The operative time, bleed loss, postoperative drainage volume, postoperative complications, ROM of hip, Harris hip score, limb length discrepancy(LLD), and radiological data were recorded. The femoral dislocation height and the implantation depth of sleeve were measured. All patients were followed up. The mean follow-up time was (3.8±1.2) years ranged from 2 to 6 years in the osteotomy group and (3.2±0.9) years ranged from 1 to 5 years in the non-osteotomy group. The operative time(136.8±18.9) min, bleed loss (709.8±89.4) ml, postoperative drainage volume(308.8±98.2) ml of osteotomy group were all significantly greater than those of non-osteotomy group(100.7±15.8)min, (516.5±103.3) ml, (245.3±79.3) ml (P<0.05). The Harris score at the latest follow up was significantly increased compared with preoperative score in two groups (P<0.05), but there was no significant difference between two groups (P>0.05). The LLD at last follow up was significantly increased compared with preoperative LLD in two groups, the LLD in non-osteotomy group(0.7±0.2) cm showed signifcant smaller than the two osteotomy group(1.2±0.4) cm. Between osteotomy and non-osteotomy groups, the preoperative range of motion of hip joint [(89.5±19.7) °vs (102.5±16.8) °], the preoperative height of dislocation of femoral head [(4.56±0.61) cm vs (3.10±0.73) cm], the proximal implant depth of S-ROM [(0.93±0.36) cm vs (1.67±0.28) cm] was significantly different (P<0.05). Eleven patients in the osteotomy group still had claudication, and 4 patients in the non-osteotomy group had mild claudication (P<0.05). In non-osteotomy group, 3 patients developed nerve injury (1 patient of sciatic nerve, 2 patients of femoral nerve) and 1 case developed periprosthetic fracture. In osteotomy group, 2 case of dislocation and 2 cases of periprosthetic fractures. Whether osteotomy or not can achieve satisfactory results for treating Crowe type Ⅳ DDH and significantly improve LLD. However, osteotomy is more complex and time-consuming, limb length difference is greater, and the incidence of claudication is higher. Furthermore, patients with smaller preoperative hip mobility, higher femoral dislocation, limb lengthening≥4 cm and severely narrow femoral proximal canals are prone to be peformed with subtrochanteric osteotomy.

Role of IL3RA in a Family with Lumbar Spinal Stenosis.

Lumbar spinal stenosis (LSS) is a degenerative spinal condition characterized by the narrowing of the spinal canal, resulting in low back pain (LBP) and limited leg mobility. Twin and family studies have suggested that genetics contributes to disease progression. However, the genetic causes of familial LSS remain unclear. We performed whole-exome and direct sequencing on seven female patients from a Han Chinese family with LBP, among whom four developed LSS. Based on our genetic findings, we performed gene knockdown studies in human chondrocytes to study possible pathological mechanisms underlying LSS. We found a novel nonsense mutation, c.417C > G (NM_002183, p.Y139X), in IL3RA, shared by all the LBP/LSS cases. Knockdown of IL3RA led to a reduction in the total collagen content of 81.6% in female chondrocytes and 21% in male chondrocytes. The expression of MMP-1, -3, and/or -10 significantly increased, with a more pronounced effect observed in females than in males. Furthermore, EsRb expression significantly decreased following IL3RA knockdown. Moreover, the knockdown of EsRb resulted in increased MMP-1 and -10 expression in chondrocytes from females. We speculate that IL3RA deficiency could lead to a reduction in collagen content and intervertebral disk (IVD) strength, particularly in females, thereby accelerating IVD degeneration and promoting LSS occurrence. Our results illustrate, for the first time, the association between IL3RA and estrogen receptor beta, highlighting their importance and impact on MMPs and collagen in degenerative spines in women.

Sex Disparity in the Canal-to-Body Ratio of the Cervical Spine Indicating the Prevalence of Cervical Myelopathy: A Cross-Sectional Study

Abstract Background A narrow spinal canal and large vertebral body have been thought to be risk factors for cervical myelopathy. It is generally known that males are more likely to develop cervical myelopathy than females. Thus, sex is also a factor that contributes to myelopathy. The anteroposterior (AP) diameter of the cervical spinal canal is well-established as a primary factor of myelopathy. Objective To investigate the sex discrepancy in the canal-to-body ratio of the cervical spine on magnetic resonance imaging (MRI). Materials and Methods This cross-sectional study included 59 males and 59 females, all aged between 20 and 40 years. Morphological parameters, including height, AP diameter of the vertebral body, and AP diameter of the spinal canal, were measured on sagittal T2-weighted MRI cervical spine images for each participant. The canal-to-body ratio, obtained by dividing the spinal canal's AP diameter by the vertebral body's AP diameter, served as a key metric. The average canal-to-body ratio values compared between male and female groups at each spinal level (C3–C7) elucidate potential gender-related differences. Results The height and the AP diameter of the vertebral body were larger in males than in females throughout C3–C7. There was a statistically significant difference between males and females. The AP diameter of the spinal canal was similar for both genders, with no statistically significant difference between them. The mean canal-to-body ratio was significantly larger in females than in males, with a statistically significant difference between males and females at each spinal level. Conclusion Females had a larger canal-to-body ratio, and men had a significantly lower one. The canal-to-body ratio method was thought to be superior to the absolute value of the AP diameter of the spinal canal for the diagnosis of canal stenosis.

Comparison of Anterior versus Posterior Approach for the Treatment of Cervical Compressive Myelopathy Due to Ossification of the Posterior Longitudinal Ligament

Abstract Background Cervical myelopathy is a dysfunction of the spinal cord. It is often caused by a narrowing of the cervical spinal canal. Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly. Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). The pathogenesis of OPLL is poorly understood. Some have suggested it as a variant of diffuse idiopathic skeletal hyperostosis (DISH). Purpose The purpose of the study is to perform a systematic review and meta-analysis to evaluate the Clinical results of anterior and posterior approaches for the treatment of cervical compressive myelopathy Due to cervical ossification of the posterior longitudinal ligament (OPLL). Methods Randomized clinical trials, prospective cohort, retrospective observational cohort, and case-control Studies that compare the surgical outcome of an anterior versus a posterior approach for cervical myelopathy due to OPLL from January 2006 to October 2021. Databases (PubMed, EMBASE, Cochrane library). A total of 12 studies (1070patients) were included in this systematic review and meta-analysis. Results indicated that no statistically significant differences between the anterior group and posterior group in terms of preoperative mJOA score [P = 0.23, SMD = 0.9; heterogeneity: (P = 0.85); I2 = 18%, while the postoperative JOA score was significantly higher in the anterior surgery group compared with the posterior surgery group [P 0.004, SMD = 0.67; heterogeneity: P &amp;lt; 0.001; I2 = 82%. The recovery rate was significantly higher in the anterior surgery group compared with the posterior surgery group of patients with canal-occupying ratio &amp;lt; 50%- ≥ 60% [P &amp;lt; 0.01, SMD = 0, 43; heterogeneity: (P &amp;lt; 0.57); I 2 = 91%]. The overall recovery rate (regardless the canal occupying ratio) was significantly higher in the anterior surgery group compared with the posterior surgery group [P &amp;lt; 0.01 SMD = 0.84. It also revealed that the postoperative complication rate [P &amp;lt; 0.01 OR = 1.88, operation time [P &amp;lt; 0.01 SMD = 1.52, intra operative blood loss [P = 0.04 SMD = 0.74 are higher in the anterior group. Conclusion Based on the results of this meta-analysis, anterior approach surgery was associated with better overall (Regardless of the canal-occupying ratio) postoperative neural function than posterior approach in the treatment of cervical compressive myelopathy due to OPLL. We thought anterior approach especially preferable to patients with canal-occupying ratio &amp;gt; 50%-60%, although it leads to a higher surgical trauma and incidence of surgery- related complications. Posterior approach surgery was relatively safer with lower surgical trauma and incidence of complications. We also suggest posterior approach for patients with canal-occupying ratio &amp;lt; 50%-60%.

Radiographic Predictors of Postoperative Inferior Alveolar Nerve Injury in Mandibular Third Molar Surgery

BackgroundCone-beam computed tomography (CBCT) provides additional three-dimensional information on the relationship between the mandibular third molar (M3M) and the inferior alveolar nerve (IAN). As such, CBCT is being increasingly utilized in pre-operative M3M assessment. PurposeThe purpose of the study was to compare the radiographic findings on panoramic and CBCT and their association with post-operative IAN paresthesia. Study design, setting and sampleWe conducted a retrospective cohort study in a sample of patients referred to the Department of Oral and Maxillofacial Surgery at the Royal Dental Hospital of Melbourne, for management of impacted M3Ms. Patients were included in this study if they had one or more high risk findings on OPG, had both OPG and CBCT imaging taken and if at least one M3M had been extracted. Subjects were excluded from this study if their M3Ms were not extracted or if a CBCT was not indicated. Independent variablesThe independent variable was radiographic features identified on OPG (Rood and Shehab’s radiographic signs, root morphology, impaction type, Pell and Gregory classification) and CBCT (number and location of roots, severity of IAN compression and the presence of ankylosis). Outcome variableThe outcome variable was post-operative neurosensory function defined as any reported paresthesia at 2-week post-procedural review. CovariatesThe covariates were patient demographic information (age, sex). AnalysesVariables were initially assessed with univariate logistic regression analysis to determine factors related to developing post-operative paresthesia. Multivariate logistic regression analysis was then used to assess the association between positive univariate study variables and post-operative paresthesia, while adjusting for potential confounders. Covariates were assessed using an omnibus likelihood ratio test and included if they were statistically significant at the p<0.05 level. ResultsThe study sample consisted of 257 subjects who underwent surgical removal of n=386 M3Ms. The mean age was 25.9 (SD = 7.05). The panoramic features of narrowing of canal, diversion of canal and dark/bifid roots were identified as statistically significant associations of post-operative paresthesia. No CBCT features were significantly associated of post-operative paresthesia. Conclusions and RelevanceCertain panoramic features, along with patient age, are significant predictors of IAN paresthesia. CBCT findings were not significant predictors upon multivariate analysis, thus additional CBCT imaging did not significantly improve ability to predict paresthesia.

Comparative evaluation of pediatric endodontic rotary file systems to bending and torsion tests: A finite element analysis

Background and objectiveThe introduction of Paediatric NiTi instruments has transformed the field of paediatric endodontics. However, no studies are available on the mechanical behaviour of these files, wherein Finite Element Analysis (FEA) was found to play a major role. The objective of this study is to evaluate the mechanical behavior of three commercially available pediatric endodontic rotary file systems to bending and torsion stress analysis test through Finite Element Analysis (FEA). MethodsA Finite Element Analysis study was performed on three commercially available pediatric endodontic rotary files (Pro AF baby, Kedo SG and Neoendo pedoflex) available for cleaning and shaping the narrow root canals of the deciduous teeth to bending and torsion tests with the boundary conditions according to ISO 3630-1 specifications. ResultsIn the bending analysis, Pro AF baby files were found to withstand the complete bending tests without yielding with a maximum von Mises stress of 1366 MPa, and Kedo SG, Neoendo Pedoflex file exhibited maximum von Mises stress of 2296 MPa, 1971 MPa. Under torsion tests Kedo SG exhibited maximum stress distribution, while Neoendo Pedoflex and Pro AF baby files exhibited similar stress distribution. ConclusionPro AF baby file effectively withstood the rigorous 45 -degree bending examination without experiencing yielding, while Kedo SG file exhibited higher flexibility. Under torsional resistance test, all the three instruments exhibited similar stress distribution under the yield limit. In summary, the mechanical behaviour (bending and torsion) of pediatric rotary file systems were influenced by design of the files.

A first step towards the detection of damage processes in endodontic Ni-Ti alloy files, using acoustic emission

Despite major instrumental developments over the last decade, endodontic files are still not infallible. It is well known that NiTi rotary files can break without any visible sign of deformation. Instrument breakage under combined flexion-torsion loading is still common in clinical practice. Unfortunately, breakage of this type of instrument mainly occurs in narrow canals, through pinching in the apical region. When such an incident occurs, the endodontist must adopt a debris retrieval strategy that is both stressful and not guaranteed success. This study proposes a new method for experimental damage detection leading to the fracture of Ni-Ti shape memory alloy endodontic files. It is based on the acoustic emission (AE) technique and mechanical parameters measured in real-time and image analysis. It has been shown that the AE results correlate with the damage observations and torque and force measurements recorded during the tests.Having carried out numerous root canal treatment on resin blocks, it appears that this new detection and analysis technique can be used to analyze and anticipate the first signs of damage leading to endodontic file failure. The technological development of such a method, at the level of the engine itself, associated with the act in service procedure, would constitute a revolution in the field of endodontics.