This study investigated a novel motorized drive wheel designed to replace one of the four outer castors of a hospital bed. Existing beds can be retrofitted using a plug-and-play approach, offering considerable potential to reduce the physical burden on healthcare workers during bed transport. Thirteen nurses moved a standardized hospital bed-with and without the drive wheel-through a realistic course including ramps, curves, and elevators. Objective biomechanical parameters (hand forces, spinal compression, muscle activity) and subjective assessments (Borg scale, System Usability Scale) were recorded. The drive wheel significantly reduced physical load, lowering hand forces by 22% and spinal compression by 20%. Shoulder, neck, and lower-back muscle activity also decreased significantly. Perceived exertion was reduced by 69%, and usability was rated as "excellent." The motorized drive wheel evaluated in this study substantially reduced physical load in everyday clinical care, although recommended ergonomic limits were not met in all situations.

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

BACKGROUND AND OBJECTIVES: Cervical ossification of the posterior longitudinal ligament (OPLL) is a progressive condition that leads to spinal cord compression, yet clinicians frequently encounter a significant mismatch between radiological severity and clinical symptoms. This study aimed to identify the most reliable radiological predictors of myelopathy in patients with severe cervical OPLL, with a specific focus on spinal cord–based parameters that account for individual anatomic variations. METHODS: We retrospectively reviewed 300 patients with severe cervical OPLL (occupying ratio >50%). Radiological metrics included occupying ratio, space available for the spinal cord, cord compression ratio, compressed spinal cord cross-sectional area, and %decreased spinal cord area (SCA) (percentage reduction from normal area). Myelopathy was defined as a modified Japanese Orthopaedic Association (mJOA) score ≤17. RESULTS: Among all parameters, %decreased SCA demonstrated the highest diagnostic accuracy for myelopathy [area under curve (AUC) 0.904; 95% CI: 0.863-0.941; cutoff: 15.2%; sensitivity 82.3%; specificity 91.8%], significantly outperforming the occupying ratio (AUC 0.717) and space available for the spinal cord (AUC 0.751). For moderate myelopathy (mJOA ≤14), %decreased SCA showed even higher discriminative performance (AUC 0.931, cut-off 16.3%). It also showed the strongest correlation with mJOA (ρ = −0.772, P < .001) and was the most significant independent predictor in multivariate analysis (β = −0.118 per 1% increase; P < .001). In addition, T2 signal change, OPLL morphology, male sex, and increased local range of motion were independent factors associated with myelopathy severity. CONCLUSION: %Decreased SCA is a highly reliable, cord-specific indicator for assessing myelopathy severity in patients with severe cervical OPLL. Our findings suggest that clinical impairment is determined by a combination of cord-based measurements, dynamic factors (range of motion), and intrinsic cord changes, rather than simple bony canal dimensions alone. LEVEL OF EVIDENCE: Class III.

Choroid plexus cysts are benign, typically asymptomatic cystic lesions found almost exclusively in the brain's lateral ventricles, often noted during second-trimester fetal ultrasounds and usually resolving spontaneously before the 28th week of gestation. Spinal intramedullary choroid plexus cysts remain extremely rare, with only few cases documented in theliterature to date. This case describes a 55-year-old man with thoracic spinal cord compression due to a choroid plexus cyst, highlighting a rare differential diagnosis for adult spinal cord lesions. A 55-year-old Middle Eastern Syrian male with no remarkable medical history complained of chronic and persistent dorsal pain, and recently noted weakness in his lower extremities. A comprehensive neurological examination identified radicular pain radiating to the left lower limb along with evident muscular weakness in his right and left lower limbs. A thoracic magnetic resonance imaging identified a cystic lesion in the T5-T6 level, and the patient underwent cyst marsupialization and fenestration. Subsequent histopathological sampling and examination confirmed the diagnosis of choroid plexus cyst (refer to Graphical Abstract). Choroid plexus cysts, though exceptionally rare in the spinal cord, should be considered in the differential diagnosis of intramedullary cystic lesions. Magnetic resonance imaging plays a crucial role in identifying these cysts and distinguishing them from other spinal pathologies. In symptomatic patients, surgical decompression may be warranted. Definitive diagnosis relies on histopathological analysis.

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.

Background: Leptospirosis is a zoonotic infection caused by Leptospira interrogans, commonly seen in tropical regions and associated with significant morbidity due to its multisystem involvement. “Severe disease manifestations include hepatic dysfunction, acute kidney injury (AKI), and hemorrhagic complications. While renal involvement is frequently reported, neurological complications are relatively uncommon and typically present as aseptic meningitis or encephalopathy. Spontaneous spinal epidural hematoma is an exceedingly rare complication and has been sparsely documented in association with leptospirosis. Early recognition of such atypical manifestations is critical to prevent irreversible neurological damage and improve patient outcomes. Case Presentation: A 32-year-old male farmer presented with fever, myalgia, vomiting, and oliguria for five days. Clinical evaluation revealed icterus, pedal edema, thrombocytopenia, hyperbilirubinemia, and severe acute kidney injury. Leptospira IgM ELISA was positive, confirming the diagnosis. During hospitalization, the patient developed sudden-onset lower limb weakness and urinary retention. Magnetic resonance imaging of the spine revealed a posterior epidural hematoma extending from T8 to L1, causing spinal cord compression. The patient was treated with intravenous ceftriaxone, hemodialysis, and correction of coagulopathy. Given stable neurological status, conservative management of the hematoma was adopted”. The patient showed significant renal recovery and partial neurological improvement with physiotherapy.

Neurofibromatosis type 1 (NF1) is a multisystem neurocutaneous disorder associated with skeletal dysplasia, dural ectasia, and, less commonly, spinal meningoceles. Although these lesions are often asymptomatic, they may progressively enlarge over time, resulting in spinal deformity and compression of adjacent neurovascular and aerodigestive structures. Cervical and cervicothoracic meningoceles are particularly rare and pose unique diagnostic and management challenges. A 43-year-old woman with NF1 presented with progressive gait imbalance and left upper limb dysesthesia and weakness more than 1 decade after initial diagnosis of a right-sided cervical meningocele that had been managed conservatively. Serial imaging over 11 years demonstrated gradual enlargement of a cervicothoracic lateral meningocele, ultimately measuring more than 10 cm, with associated severe kyphoscoliosis, vertebral scalloping, foraminal widening, spinal cord deviation, and displacement of the vertebral and carotid arteries, as well as anterior compression of the esophagus and airway. Neurological deficits correlated with foraminal compression at the C5-T1 levels. Brain MRI additionally revealed bilateral optic pathway gliomas, suggesting a more extensive NF1 phenotype. Given progressive neurological decline and neurovascular compromise, surgical repair of the anterior cervical meningocele was performed, resulting in marked postoperative radiological improvement and relief of mass effect. Spinal meningoceles associated with NF1 may follow an indolent but progressive course over many years, emphasizing the necessity of long-term clinical and radiological surveillance even in initially asymptomatic patients. Cervical involvement, although uncommon, can lead to significant spinal deformity and neurovascular compression. Early recognition of clinical deterioration should prompt timely surgical reassessment. Multidisciplinary management is essential in patients with complex NF1 manifestations, particularly when spinal pathology coexists with other CNS tumors. https://thejns.org/doi/10.3171/CASE26112.

An 8-year, 10-month-old female spayed British Shorthair cat was referred for progressive tetraparesis. At presentation, the cat was non-ambulatory with left-sided hemiparesis Cervical magnetic resonance imaging showed presence of extradural disc material causing moderate spinal cord compression at C3-C4 and C4-C5 levels, and mild compression at C5-C6 level. A double ventral slot surgery was performed at the C3-C4 and C4-C5 levels. Following an initial neurological deterioration, the cat made a steady recovery and was fully ambulatory 10 days postoperatively. At the 12-month follow-up, the cat showed only mild left pelvic limb monoparesis. Intervertebral disc disease is still rarely reported in cats, compared to other species. This report describes the use of two adjacent ventral slots to manage multilevel compressive cervical intervertebral disc disease in a British Shorthair cat, with its 12-month follow-up.

Systemic management of spinal metastases: current strategies and future directions.

To evaluate the palliative efficacy of re-irradiation stereotactic body radiotherapy (SBRT) for painful spinal metastases. In this single-centre, single-arm, phase II study, patients with painful spinal metastases (pain score ≥2 on a 0-10 scale) from solid tumours were enrolled. Eligibility criteria included absence of epidural spinal cord compression, and irradiation history (excluding SBRT) with an interval of ≥3months. The prescribed dose was 24Gy in two fractions; the maximum spinal cord dose constraint was 12.2Gy. The primary endpoint was the pain response rate at 6months in evaluable patients. Among 35 spinal lesions in 34 patients registered between July 2019 and June 2024, 11 (31%) lesions were severely painful (score, 8-10), 16 (46%) were radioresistant, and 14 (40%) involved ≥3 consecutive vertebrae. The median prior equivalent dose in 2-Gy fractions (α/β=10) was 33 (range, 23-70) Gy, and median interval between irradiations was 12 (range, 3-114) months. The median follow-up period was 9 (range, 2-51) months. Among evaluable patients, pain response was 84% at 3months and 83% at 6months, whereas complete response (CR) was 48% and 56%, respectively. In the intention-to-treat analysis, pain response was 60% at 3months and 43% at 6months, whereas CR was 34% and 29%, respectively. The 6-month local failure rate was 7%. Two (6%) patients experienced grade 3 toxicities. Re-irradiation SBRT achieved substantial pain relief with acceptable toxicity, warranting larger randomized trials against conventional radiotherapy.

Delayed neurological deterioration caused by a postoperative high-pressure cerebrospinal fluid (CSF) collection is an uncommon but clinically recognized complication after thoracic decompression complicated by incidental durotomy. We report a case of delayed thoracic myelopathy due to a tension subfascial CSF collection and summarize relevant literature. A 55-year-old woman with thoracic myelopathy due to ossification of the posterior longitudinal ligament at T2-4 and ossification of the ligamentum flavum at T5-6 underwent posterior decompression and instrumented fusion (T2-6 laminectomy with T1-6 instrumentation). An incidental dural tear occurred at T5-6 and was managed with an onlay artificial dural patch reinforced with fibrin glue and gelatin sponge. The wound drain was removed on postoperative day 7. On postoperative day 9, she developed acute left lower-extremity weakness. MRI demonstrated a large subfascial CSF collection causing significant spinal cord compression, consistent with a tension pseudomeningocele. Bedside subfascial incision and continuous closed low-level drainage (with the drainage bag kept at bed level) resulted in rapid neurological improvement. After recurrence following drain removal, ultrasound-guided drainage was performed, leading to sustained symptom relief. At 3-month follow-up, she had full motor recovery and follow-up MRI confirmed resolution of the collection with adequate decompression. A tension subfascial CSF collection after incidental durotomy can mimic recurrent stenosis and cause delayed thoracic myelopathy. When imaging confirms a compressive CSF collection, continuous closed low-level subfascial drainage may be considered before revision surgery.

Introduction and Objectives: Intradural extramedullary (IDEM) spinal tumors constitute the most common group of intraspinal tumors and frequently present with progressive neurological deficits due to spinal cord or nerve root compression. Conventional laminectomy, though widely used, is associated with significant postoperative morbidity and spinal instability. With advancements in minimally invasive spine surgery, unilateral hemilaminotomy has emerged as an alternative approach aimed at preserving spinal stability while achieving adequate tumor excision. Materials and Methods: This hospital-based longitudinal observational study was conducted in a tertiary care neurosurgical center between January 2014 and December 2018. A total of 30 patients with IDEM tumors who underwent surgical excision using unilateral hemilaminotomy were included. Ethical approval was obtained, and written informed consent was secured from all participants. Preoperative evaluation included detailed neurological assessment using Nurick’s grading and magnetic resonance imaging for tumor localization. Results: The study population had a mean age of 51 years with equal gender distribution. Thoracic spine was the most commonly involved region. Gross total tumor excision was achieved in all cases without conversion to conventional laminectomy. There was a statistically significant improvement in neurological status, with mean Nurick grade improving from 2.63 preoperatively to 0.30 postoperatively (p < 0.0001). Schwannomas were the most common histopathological diagnosis, followed by meningiomas. Conclusion: Minimally invasive unilateral hemilaminotomy is a safe and effective surgical approach for IDEM tumors, providing excellent neurological outcomes with minimal morbidity while preserving spinal stability. This technique represents a reliable and durable alternative to conventional laminectomy.

Protocol OBJECTIVES: Degenerative cervical myelopathy (DCM) is caused by degenerative changes of the spinal column that lead to progressive spinal cord compression. Early identification of DCM is paramount to ensure appropriate specialist referral, timely intervention, and optimal treatment outcomes. Unfortunately, diagnosis of DCM is often delayed and may be missed entirely. A lack of screening or referral criteria has been identified as a major contributor of diagnostic delay. The objectiveof this study is to outline the methodology that will be used to develop screening criteria for DCM. We propose a three-step approach for establishing screening criteria for DCM using data-driven and expert-based methods that includes a combination of patient-reported symptoms and clinical signs obtained from physical examination. Our approach includes: (i) an initial scoping review of inclusion criteria used in DCM research studies; (ii) criteria generation through systematic reviews of the literature as well as surveys of individuals with lived experience and international multidisciplinary experts in DCM; and (iii) criteria reduction via a consensus process. Our framework intends to foster the development of valid, reliable and sustainable screening criteria that could improve awareness of DCM, influence practice decisionsand reduce delays to diagnosis .

While surgery for thoracic disc herniation causing spinal cord compression has traditionally been an inpatient procedure, fraught with risk and often requiring multilevel fusion, recent advances in endoscopic surgery challenge this paradigm. This study presents a single-surgeon case series of endoscopic thoracic discectomy performed in an ambulatory setting, outlining 1) the surgical technique, 2) patient selection and characteristics, and 3) postoperative outcomes. The goal of this study was to assess the safety and feasibility of performing endoscopic thoracic discectomy in an ambulatory surgery setting. A single-surgeon retrospective case series of patients undergoing endoscopic thoracic discectomy at an ambulatory surgery center between 2023 and 2025 was analyzed. Giant calcified discs causing spinal cord compression were excluded. Demographics, comorbidities, operative details, and postoperative outcomes were collected. Primary outcomes included surgical site infection, 90-day emergency department visit, readmission, and reoperation. Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) physical function scores were compared between baseline and 3 months. Descriptive analysis was performed. Of the 39 patients undergoing endoscopic thoracic discectomy at an ambulatory surgery center, the mean age was 54.9 (SD 14.3) years, and 46.2% were male. Discectomy was performed at a single level in 92.3% of cases, most commonly T7-8 (26.2%), T12-L1 (16.7%), and T11-12 (14.3%). Preoperatively, 84.6% of patients had spinal cord compression, 23 (59.0%) were myelopathic, and 24 (61.5%) had a motor deficit. The mean operative duration was 107.6 (SD 46.4) minutes and the mean estimated blood loss was 12.7 (SD 19.1) ml. A dural tear in 1 patient was the only intraoperative complication. Regarding postoperative complications, 2 patients (5.1%) underwent reoperation, for a retained disc fragment in 1 patient and a CSF leak in the other. No surgical site infections were observed. PROMIS-29 physical function scores improved significantly from baseline (mean 35.1 [SD 7.3]) to 3 months (mean 41.6 [SD 8.0]; p = 0.004). In a single-surgeon series, endoscopic thoracic discectomies performed in an ambulatory surgery center were safe and feasible, with low perioperative morbidity, minimal blood loss, and meaningful early functional improvement. Where conventional management typically demands multilevel fusion or costotransversectomy, with a multiday hospital stay, endoscopic techniques offer a transformative alternative, making thoracic disc surgery safe and feasible even in outpatient environments.

Bone disease in patients with multiple myeloma (MM) is associated with vertebral complications, which include vertebral fractures and spinal cord compression (SCC). Bone-modifying agents (BMAs), namely bisphosphonates and denosumab, are recommended to reduce skeletal-related events in MM, yet their efficacy in preventing vertebral fractures and SCC remains unclear. To determine the efficacy of bone-modifying agents (BMAs) in reducing the risk for vertebral fractures and SCC in adults with MM. Systematic review and meta-analysis following PRISMA guidelines. A systematic search of PubMed, Embase, and Web of Science databases was performed on July 11, 2024. Risk of bias, reporting bias, and evidence certainty were evaluated using the RoB 2 tool, funnel plot and Egger's test, and the GRADE approach, respectively. Relevant data were extracted and pooled for pairwise and network meta-analysis. After removing duplicates, 1,354 studies were screened, 108 full-text studies were reviewed for inclusion, and 11 randomized trials were included in the analysis. Compared to no treatment or placebo, lower-potency bisphosphonates were associated with a reduction in the risk for vertebral fractures, with a pooled RR of 0.72 (95% CI: 0.61-0.85, p=.0001), suggesting a 28% reduction in risk. Zoledronate was the most efficacious bisphosphonate in the network meta-analysis, with a 64% reduction in vertebral fracture risk compared to no treatment or placebo (RR=0.36, 95% CI: 0.16-0.77, p=.009). None of the included studies reported the clinical significance of these vertebral complications, and no studies that investigated denosumab met inclusion criteria. Meta-analysis for the SCC outcome was inconclusive due to limited evidence. The body of literature indicates that bisphosphonates, particularly zoledronate, significantly reduce the risk for vertebral fractures in patients with MM, at least in trial conditions. Additional evidence is necessary to evaluate the real-world clinical impact of these findings, clarify the effects on risk for SCC, and investigate denosumab.

In ovo vaccination is an effective method of immunization that allows protection early in the life of the chick but requires precision during the administration. This present report describes an occurrence of cervical vertebral malformations in broiler chicks that coincide with mechanical failure of an in ovo vaccination system, in the absence of other detected infectious, nutritional, or toxic etiologies. Cervical scoliosis was observed in 2%-8% of chicks at hatch or within days post hatch in the affected flock, which all came from the same hatchery. Gross and histologic examination of eleven 30-day-old chickens revealed a cervical vertebral misalignment and fusion of the articular cartilage of adjacent vertebrae, with spinal cord compression, without evidence of inflammation. It is hypothesized that a malfunctioning in ovo vaccine injector with a bent needle might have caused mechanical trauma during the injection at day 18 of incubation, possibly contributing to the lesions observed in the chickens. Recurrent Enterococcus faecalis and Escherichia coli infections were also recorded in young chicks, a problem that persisted during the lifespan of the flock, possibly induced by compromised hygiene from the defective injector. These findings indicate that in ovo vaccination equipment malfunction could represent an underrecognized contributing factor to vertebral deformities in chicks.

To investigate the association between denosumab use and 2-year all-cause mortality and incident skeletal-related events (SREs) in patients with lung cancer and bone metastases. This retrospective cohort study utilised electronic records from an international clinical database. The enrolment period was between January 1, 2010, and December 31, 2020, followed by a 2-year follow-up period. Data were extracted from TriNetX, a global clinical research platform with electronic medical records from more than 120 healthcare organisations for over 250 million patients in 19 countries. A total of 52,521 eligible patients were recruited and divided into 2 groups based on the use of denosumab. Propensity score matching (PSM) was used to balance baseline demographic and clinical characteristics between study groups. After PSM, the study and control groups each comprised 2735 patients with similar baseline characteristics. The primary outcome was all-cause mortality during the 2-year follow-up period. Incident SRE diagnoses, encompassing pathologic fractures, radiation therapy to bone, spinal cord compression, and hypercalcaemia, were examined as secondary outcomes. During the 2-year follow-up period, overall mortality was significantly lower in the study group than in the control group (53.8% vs 55.1%; hazard ratio [HR], 0.74; 95% CI, 0.69-0.80; P < .001). The study group also had a longer median survival time (467 days vs 292 days), a higher survival probability during the follow-up period (P < .001), and a significantly lower risk of SREs (HR, 0.42; 95% CI, 0.33-0.53; P < .001). Survival benefits and reduction of SRE risk associated with denosumab were consistent across most subgroups. In this large international cohort, patients treated with denosumab had lower mortality and fewer SREs than those who did not receive denosumab, adding to the growing body of evidence supporting its clinical benefit.

Surgical technique video alongside a detailed technical report. To present an open door posterior cervical laminoplasty step-by-step surgical technique guide. Cervical laminoplasty is a motion-sparing surgical technique that addresses cervical myelopathy resulting from spinal cord compression, largely in a degenerative setting. This procedure decompresses the spinal cord while maintaining the integrity of posterior stabilizing structures, minimizing postoperative kyphosis, and eliminating pseudoarthrosis risk. Laminoplasty has also demonstrated superior improvement in neck disability compared with fusion, while achieving comparable long-term outcomes for functional status, pain, quality of life, and satisfaction. We present an open door posterior cervical laminoplasty step-by-step guide, both video and written format, illustrating clinical scenarios where this technique may be applicable, complications, pearls and pitfalls. The full video of the surgical technique can be found at: https://www.youtube.com/watch?v=q2WVlSFcjjA . Laminoplasty can be performed for cervical myelopathy secondary to cervical spondylosis, multilevel disc herniation, congenital stenosis, and ossification of the posterior longitudinal ligament. Careful preoperative evaluation of the cervical alignment is essential. The surgical technique involves a posterior midline approach, C3 laminectomy, C7 dome laminectomy, and preparation of opening and hinge troughs. Laminoplasty opening is performed, and plate reconstruction is recommended for stability. Complications reported include: C5 palsy, axial neck pain (minimized by preserving Semispinalis cervicis insertions), loss of cervical motion, and dural tear. Cervical laminoplasty provides effective spinal cord decompression for cervical myelopathy, yielding outstanding outcomes when performed with meticulous surgical technique. Preservation of posterior structures avoids postoperative immobilization and graft-related complications. Careful attention to each surgical step is essential for maximizing patient benefit and minimizing potential complications.

Decades-Late Recurrence of Oncocytic Thyroid Carcinoma Presenting With Spinal Cord Compression

Stereotactic Body Radiation Therapy Boost Following Urgent 3D Conformal Radiation Therapy for Metastatic Epidural Spinal Cord Compression: A Phase 1 Feasibility Study.