Sarcopenia is widely recognized as a significant risk factor for fractures; however, its role in osteoporotic vertebral fractures (OVFs) remains underexplored. This study aimed to evaluate the prevalence of sarcopenia in patients with OVFs and its relationship with clinical characteristics and outcomes. This retrospective analysis included 142 patients treated for OVFs at a single institution from January 2022 to June 2024. Quantitative assessments of sarcopenia were performed using axial MRI images at the L4 vertebral level. Measurements included the psoas cross-sectional area (pCSA), which was normalized using the psoas muscle index (PMI = pCSA/height2) and the psoas muscle lumbar vertebral body index (PLVI = pCSA/vertebral body area). Fat infiltration (FI) and functional cross-sectional areas (fCSA) were determined using ImageJ®. Sarcopenia was defined using established PMI cutoffs. Clinical parameters, osteoporosis diagnostics (DXA T-scores, CT-based Hounsfield units [HU]), and patientoutcomes were collected. Patients had a median age of 81years (IQR 74-85), and 94 (66.2%) were female. Sarcopenia was identified in 103 patients (72.5%). Patients with sarcopenia had significantly lower BMI, lower serum albumin, and reduced T-scores of the lumbar spine compared to those without sarcopenia. Multiple (≥ 2) vertebralfractures were significantly more frequent in patients with sarcopenia (37.2% vs 18%, p = 0.018). Logistic regression revealed that patients with sarcopenia were 2.78 times more likely to have multiple fractures (95% CI; 1.1-6.9, p = 0.027). Additionally, a significant negative correlation between FI and T-scores of the lumbar spine was observed (r = -0.242, p = 0.037). By contrast, no significant differences were seen in CT HU values, time to postoperative mobilization, length of hospital stay, or incidence of postoperative wound infections. Sarcopenia is highly prevalent among OVF patients and significantly increases the risk of multiple acute fractures. Assessment and management strategies for OVF patients should routinely incorporate evaluation for sarcopenia.

ABSTRACTHydatid disease is a parasitic infection that primarily affects the liver and lungs, but spinal involvement is very rare. We report a case of recurrent primary vertebral and paravertebral hydatid cysts and discuss the diagnostic and therapeutic challenges associated with this condition. A 48‐year‐old woman with a history of spinal hydatidosis resection involving the T2 to T7 and T11 to the distal lumbar spine 8 years earlier presented with mid‐back pain and intermittent fever. Magnetic resonance imaging (MRI) showed two masses, measuring 21 mm and 22 mm, located at the anterolateral border of the T3 vertebral body and in the adjacent soft tissues. The patient underwent spinal revision surgery, and histopathological evaluation confirmed the diagnosis of hydatid cysts. Since spinal hydatidosis is associated with high morbidity and is often misdiagnosed, it should be considered in the differential diagnosis of spinal cystic lesions, particularly in regions endemic for echinococcosis.

Opportunistic Quantitative Analysis of Bone Mineral Density and Vertebral Height in Cardiac Transplant Recipients Using Routine Chest CT Scans.

Py-GC-MS/MS quantification of microplastics in vertebrate tissues: Addressing false positives of polyethylene.

Deep Learning-based Automated Opportunistic Osteoporosis Screening Using Chest LDCT and Lumbar CT: A Multicenter Cohort Study.

Don't ignore the patient with a "fragility fracture"! Risk factors for bleeding from stable pelvic fractures.

Vertebral bone marrow clot breakthrough: a powerful osteogenic and antibacterial scaffold for spinal fusion surgery.

Subject: Letters to the editor: Re: rates of lumbar vertebral body compression fracture after basivertebral nerve ablation: A retrospective study utilizing a large national database

Background/Objectives: Long-term bisphosphonate (BP) therapy is an effective treatment for osteoporosis but has been associated with rare complications such as atypical femoral fractures (AFFs). Emerging reports suggest that similar insufficiency fractures may also occur in other skeletal sites, including the lumbar pedicles. This study reports two rare cases of isolated bilateral lumbar pedicle stress fractures in patients on prolonged BP therapy. Along with a structured literature review, the objective was to evaluate whether diagnostic criteria derived from those used for AFFs may apply to these atypical vertebral fractures. Methods: Two patients with osteoporosis and on long-term BP therapy diagnosed with isolated lumbar pedicle stress fractures were retrospectively analyzed. A structured literature review identified similar reported cases. All cases were evaluated using the 2010 American Society for Bone and Mineral Research AFF criteria to assess applicability to isolated pedicle stress fractures. Results: Both patients demonstrated bilateral lumbar pedicle fractures without vertebral body involvement. One was treated conservatively; the other underwent robotic-assisted percutaneous pedicle screw fixation with documented fracture healing at six months. The literature review identified eight similar cases of isolated pedicle fractures in patients on prolonged BP therapy. Clinical course and imaging findings demonstrated stress-type features analogous to AFFs. The proposed AFF-based diagnostic criteria for pedicular insufficiency fractures were found to be applicable to all ten patients. Conclusions: Isolated bilateral pedicle stress fractures may represent a spinal analog of AFFs. Based on shared clinical and imaging features, we propose preliminary diagnostic criteria for atypical pedicular insufficiency fractures. Increased awareness and standardized criteria may aid in early diagnosis and reporting, encouraging further studies on this rare spinal entity.

Pedicle screw loosening (PSL) is a significant complication in transforaminal lumbar interbody fusion (TLIF), often associated with poor bone quality. This study evaluates the predictive value of MRI-based pedicle bone quality (PBQ) and vertebral body quality (VBQ) scores for PSL, hypothesizing that PBQ is a stronger predictor than VBQ. This retrospective cohort study analyzed 394 patients who underwent TLIF between January 2018 and January 2021. Preoperative PBQ and VBQ scores were derived from sagittal T1-weighted MRI images. The primary outcome measure was PSL, which was evaluated in accordance with established radiographic criteria. Secondary outcomes included fusion rates and patient-reported outcomes. Statistical analyses included receiver operating characteristic curves to determine predictive accuracy and multivariate logistic regression to identify other risk factors for PSL. PBQ demonstrated superior predictive performance for PSL relative to VBQ, with higher sensitivity (75.93% vs. 50.00%) and specificity (92.31% vs. 87.06%). In addition, PBQ yielded higher positive predictive value (78.85% vs. 59.34%) and negative predictive value (91.03% vs. 82.18%). The discriminative ability of PBQ was further supported by a larger area under the ROC curve (0.894, 95% CI: 0.856-0.932) compared with VBQ (0.722, 95% CI: 0.664-0.781). Independent risk factors associated with PSL included advanced age, lower hip bone mineral density T-scores, longer fusion constructs, and reduced fusion rates. Furthermore, patients who developed PSL reported significantly higher postoperative back pain scores. MRI-derived PBQ and VBQ scores independently predict PSL, with PBQ demonstrating superior performance. Incorporating PBQ into preoperative planning may improve surgical decision-making and potentially enhance outcomes in patients with reduced bone strength. Additionally, lower hip BMD T-scores, reduced fusion rates, longer fusion constructs, and advanced age were identified as significant risk factors for PSL.

Studies have shown that there are significant individual differences in the prognosis of osteoporotic vertebral compression fractures. The underlying mechanisms are closely related to the choice of surgical method, the distribution of bone cement within the vertebral body, and the degree of recovery of the injured vertebral height. Although some scholars have explored this issue, there is still a distinct lack of evidence from systematic comparative studies. How to achieve optimal cement distribution and individualized and precise treatment remains a key concern for spine surgeons. A retrospective cohort study was conducted to include 106 patients with single-segment osteoporotic vertebral compression fractures admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from May 2019 to February 2025, and they were divided into percutaneous vertebroplasty group (n=55) and percutaneous vertebral kyphoplasty group (n=51) according to surgical methods. The postoperative VAS scores, Oswestry dysfunction index, localized posterior convexity angle of the injured vertebrae, cement dispersion height and its percentage, and the incidence of postoperative complications at 6-month follow-up were compared between the two groups, to investigate the influence of cement dispersion height on surgical outcomes based on the quantitative analysis of imaging between PVP and PKP. There was no statistically significant difference in the general data of the two groups (p>0.05); the two groups showed significant differences in perioperative surgery-related indexes (p<0.05).VAS score, Oswestry dysfunction index, and localized posterior convexity angle of the injured vertebrae were lower than that of the preoperative period on the first day after surgery and at 6 months after surgery in both groups (p all <0.05); the differences in Oswestry dysfunction index and localized posterior convexity angle of the injured vertebrae were significant in the comparison of the two groups (p all <0.05); ODI index and localized posterior convexity angle of the injured vertebrae were significantly different in the PKP group as compared with the PVP group at 6 months after surgery (p all >0.05); and ODI index and localized posterior convexity angle of the injured vertebrae were significantly different in the two groups. The difference between the PKP group and the PVP group was statistically significant (p<0.05); the difference between the PKP group and the PVP group was statistically significant (p<0.05); the difference between the PKP group and the PVP group in the ODI index at 6 months postoperatively was statistically significant (p>0.05).The differences in the heights of the anterior vertebral column, middle column and vertebral body, and their cement dispersion heights and the percentage of dispersion heights between the two groups were statistically significant (p all <0.05); the heights of the anterior vertebral column, middle column and vertebral body, and their cement dispersion heights and percentage of dispersion heights of the PKP group were significantly superior to those of the PVP group after surgery (p all <0.05).The differences in the rates of cement leakage and adjacent vertebral fracture between the two groups were significant (p all <0.05); the rates of cement leakage and the risk of secondary fracture of vertebral body of neighboring segments between the two groups were significantly different, and the PKP group was better. (p<0.05). Both PVP and PKP can significantly improve pain and other symptoms and improve the prognosis of patients with osteoporotic vertebral compression fracture.The PVP procedure has significant advantages in terms of operation time, frequency of intraoperative imaging monitoring, and volume of cement infusion. However, the PKP group was superior in terms of postoperative vertebral body height recovery, control of cement leakage, improvement of visual analog score (VAS) for pain, and recovery of Oswestry dysfunction index (ODI). The latest study further found that the three-dimensional dispersion height of the cement in the vertebral body and its percentage of the vertebral body volume can be used as a potential imaging predictor to evaluate the efficacy of the two surgical procedures, which provides a new reference dimension for the selection of the clinical surgical procedures and prognosis assessment.

The aim of the study is to answer the question about existing a relationship between sacral spina bifida occulta (SBO) and the occurrence of degenerative changes in spinal joints based on the examination of 30 skeletal remains (adults only; 9 females, 18 males, and 2 individuals of undetermined sex) from Dabr󷫩 (beginning of the 17th century, Poland). According to a small sample size age range has not been taken into account in the analyses. SBO, osteophytes, porosity, Schmorls nodes on the vertebral body, and articular processes on the vertebrae were examined. In Dabr󷫩 sample only partial clefts of SBO were assessed. Results show that individuals with SBO are not likely to experience osteoarthritic changes of the spine. Correlations were not statistically significant between sacral SBO and most degenerative changes in the spine. The coefficient for all types of changes was negative, suggesting individuals with SBO are less likely to develop degenerative changes in the spine. The only degenerative change significantly correlated with SBO was porosity. The present study confirms medical study analyses in which the relationship between these two phenomena has been assessed. Apparently, sacral SBO did not significantly affect the spinal health of past human populations. These results could enrich our knowledge of SBO etiology.

Eosinophilic granuloma (EG) is the most benign and localized form of Langerhans cell histiocytosis (LCH), a rare disorder. Spinal involvement is uncommon, particularly in very young children; Methods: In this report, we present a rare case of a 23-month-old boy with progressive neck deviation and difficulty walking following an unwitnessed fall. Imaging revealed a lytic lesion causing complete collapse of the T1 vertebral body (vertebra plana) with soft tissue extension and spinal cord compression. The patient underwent urgent posterior spinal instrumentation from C7 to T2, tumor debulking, spinal cord decompression, and biopsy; Results: Histopathological examination confirmed the diagnosis of EG (LCH). Postoperatively, the patient showed marked neurological improvement without complications; Conclusion: This case emphasizes the importance of considering EG in the differential diagnosis of spinal lesions in very young children and highlights the challenges in its diagnosis and management. The case is complemented by a focused review of pediatric spinal EG, outlining clinical presentation, diagnostic approach, and management strategies..

Diffuse idiopathic skeletal hyperostosis (DISH), or Forestier’s disease, is a non-inflammatory condition characterized by the calcification and ossification of spinal ligaments and entheses, especially the anterior longitudinal ligament. Its prevalence increases with age and it is more common in males. The term DISH usually refers to the imaging aspects of this condition, while “Forestier’s disease” is used for the clinical correlates of the condition, especially the development of dysphagia. Diagnosis is usually made with conventional radiography, based on the Resnick and Niwayama criteria: flowing osteophytes over at least four contiguous vertebral bodies, the preservation of intervertebral disk space, absent facet and costovertebral joint ankylosis, and absent sacroiliac joint abnormalities. A “melted candle wax” appearance along the spine is typical of the advanced disease. Large anterior osteophytes in the cervical spine lead not only to stiffness and chronic neck pain, but also to compressive symptoms such as dysphagia, dysphonia, and even airway compromise. Digital Dynamic Radiography (DDR), thanks to a flat-panel detector system, captures high-temporal resolution sequential low-dose radiographs at high frame rates in dynamic motion studies to provide functional information. We report the case of a 50-year-old female patient diagnosed with Forestier’s disease. Cervical radiography showed coarse anterior osteophytes and calcifications typical of DISH. The patient complained about persistent cervical pain and significant dysphagia. To investigate the underlying mechanism, a DDR with barium oral administration was performed. The examination confirmed the mechanical narrowing of the pharyngeal lumen caused by bulky anterior osteophytes. Given the severity of the symptoms, the patient underwent a surgical resection of the osteophytic and calcified components, with a subsequent improvement of swallowing function. This case highlights how DDR provides functional and morphological information in patients with dysphagia related to cervical DISH.

Spinal infectious disease (SID) is an infectious condition caused by specific pathogens that invade the vertebral bodies, intervertebral discs, and adjacent paravertebral tissues through trauma, surgery, or hematogenous spread. Although the incidence of SID is relatively low, it often leads to quite severe consequences. In recent years, with the intensification of population aging, the increasing number of patients with diabetes, immunosuppression, and long-term vascular access, the advancement of imaging technologies and diagnostic methods, as well as the growth in the number of spinal surgeries, the incidence of spinal infections has shown a gradual upward trend. We report a case of a 59-year-old male patient with cervical spine infection. Combined with relevant literature, we discuss the clinical symptoms, key diagnostic points, and treatment principles of this condition, aiming to provide guidance for clinical practice.

A retrospective study. To explore the efficacy of short-segment fixation with bone cement augmentation in the treatment of unstable Kümmell disease. Kümmell disease, characterized by delayed post-traumatic osteonecrosis of the vertebral body, often results in progressive vertebral collapse and instability, posing challenges for surgical management. Bone cement augmentation combined with short-segment fixation has emerged as a potential solution, but its long-term efficacy and safety require further evaluation. From January 2017 to June 2022, retrospective study was conducted on the clinical data of patients with single-segment unstable Kümmell disease. A total of 45 cases unstable Kümmell disease patients with an average age of 71.4±6.0 years were included. The disease duration was 23.1±8.1 months. The bone mineral density (BMD) T-value was -3.5±0.4 SD. Each patient was treated with short-segment fixation with bone cement augmentation and posterolateral bone graft fusion. Evaluation outcomes include the visual analog scale (VAS), Oswestry disability index (ODI), anterior vertebral height, kyphosis Cobb angle. The operation time was 116.0±21.7 minutes, the intraoperative blood loss was 156.2±54.8mL. All patients were followed-up for an average of 36.6±8.7 months. Compared with preoperative, VAS, ODI, and kyphosis Cobb angle were significantly decreased postoperative (P<0.05), and anterior vertebral height was significantly increased postoperative (P<0.05). Compared with postoperative, VAS, ODI were significantly decreased last follow-up (P<0.05), and anterior vertebral height, kyphosis Cobb angle was were not significantly changed last follow-up (P<0.05). At the last follow-up, all patients fixed segments were fused. There was no failure of internal fixation during the follow-up. Short-segment fixation with bone cement augmentation in the treatment of unstable Kümmell disease is feasible and effective, can improve the clinical symptoms of patients, better correct kyphosis, and maintain the height of the injured vertebra, with fewer complications.

Vertebral body metastases represent one of the most frequent manifestations of skeletal tumor dissemination and must be considered in the differential diagnosis of unexplained back pain, particularly in patients with aknown history of oncological diseases. The associated morbidity, including spinal instability, deformity, pathological fractures and severe pain, is substantial. Healthcare professionals are regularly confronted with this complex clinical scenario in both outpatient and inpatient settings. Athorough medical history, especially the identification of red flags (e.g., prior trauma and/or malignancy) is critical. Early initiation of appropriate imaging studies, timely evaluation of the clinical urgency and expedited referral to specialized spine centers constitute the foundation for effective interdisciplinary treatment planning. This article outlines the key diagnostic and organizational principles required for the evaluation and further management of patients with vertebral metastases.

Bone marrow edema (BME) in the vertebral body, a key feature of spondyloarthritis (SpA), is not uncommon in diffuse idiopathic skeletal hyperostosis (DISH). Our study aims to compare the vertebral BME patterns on MRI between DISH and SpA. This retrospective study included 273 patients with DISH and 132 patients with SpA who underwent whole-spine MRI. Two radiologists jointly assessed primary imaging features on radiographs and MRI of the spines, followed by independent evaluations of BME characteristics including the presence, location, signal intensity and associated finding of BME to distinguish between DISH and SpA groups. Imaging characteristics of BME were compared with univariate and multivariate logistic regression tests using Generalized Estimating Equations. Patients with DISH were significantly older than those with SpA (68.3 ± 9.3 vs. 38.9 ± 13.5 years, P < 0.001). BME was more prevalent in SpA than in DISH (31.8% vs. 20.9%, P = 0.016). In SpA, BME was significantly more likely to appear at the posterior corner (odds ratios (ORs) from multivariate logistic regression for reviewers 1 and 2: 46.01 and 38.95, respectively) or posterior band (ORs, 41.38 and 15.42), and demonstrate stronger hyperintensity (ORs, 7.66 and 7.99). BME with fatty changes was also associated with the diagnosis of SpA (ORs, 2.52 and 2.59). Characteristic BME patterns on spine MRI, particularly posterior location, marked hyperintensity, and accompanying fatty changes, could help distinguish SpA from DISH in diagnostically challenging cases with overlapping MRI manifestations.

Background: Vertebral Compression Fractures (VCFs) are the most common osteoporotic fracture, posing a significant clinical and public health burden, especially in aging populations. They result from compromised vertebral bodies failing under load, leading to pain, kyphotic deformity, functional decline, and an increased risk of subsequent fractures. Aim: This article aims to provide a comprehensive overview of the integrated management of VCFs. It synthesizes information on the etiology, pathophysiology, clinical evaluation, and evidence-based treatment strategies, emphasizing a multidisciplinary approach involving pharmacy, nursing, and physical therapy. Methods: The study is a detailed narrative review. It consolidates current evidence and clinical guidelines on VCF management, covering classification systems (e.g., AO Spine, Osteoporotic Fracture classification), diagnostic imaging (X-ray, CT, MRI), and a spectrum of management options from conservative care to surgical intervention. Results: The review finds that effective VCF management is multifaceted. Conservative management, including analgesia, bracing, and physical therapy, is first-line for stable fractures. For unstable or painful fractures refractory to conservative care, vertebral augmentation procedures (vertebroplasty, kyphoplasty) or surgical stabilization are effective. The prognosis is highly variable and depends on fracture morphology, underlying etiology (osteoporosis, trauma, malignancy), and patient comorbidities. A successful outcome hinges on an interprofessional team to optimize bone health, manage pain, restore function, and prevent complications. Conclusion: A patient-centered, interprofessional approach is fundamental to managing VCFs, integrating medical, rehabilitative, and surgical strategies to improve outcomes and quality of life.

Multi-segmental spinal tuberculosis is a severe infectious disease of the spine affecting multiple vertebral bodies, often leading to spinal instability, progressive kyphosis, and irreversible neurological impairment. Its diagnosis and treatment are notably challenging due to the extensive distribution of lesions and severe bone destruction. A retrospective analysis was conducted on 95 patients with multi-segmental spinal tuberculosis involving four or more vertebrae, who were treated at the Department of Orthopedics, General Hospital of Ningxia Medical University, from January 2001 to December 2024. All patients underwent a combined surgical strategy of posterior long-segment pedicle screw fixation followed by anterior radical debridement, decompression, and autologous iliac crest structural bone grafting. Clinical efficacy was systematically evaluated by assessing preoperative and postoperative indicators, including Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Cobb angle, Visual analog Scale (VAS) for pain, and Oswestry Disability Index (ODI). At 6months postoperatively, ESR and CRP levels approached normal values and were within the normal range at the final follow-up. The correction rate of the Cobb angle was 48.32% ± 16.77%, with a mean loss of correction of only 4.85° ± 3.27°. The bone graft fusion rate exceeded 90% at 6months and 95% at 1year, with an average fusion time of 4.5months. At the final follow-up, successful bone fusion was achieved in all patients, with 89 cases (93.7%) achieving Bridwell Grade I fusion and 6 cases (6.3%) achieving Bridwell Grade II fusion. VAS pain scores and ODI scores were significantly lower at 6months post-surgery compared to preoperative values and continued to decrease thereafter. Neurological function showed significant improvement. No severe neurological complications were observed. Only two patients experienced wound complications and four had transient hepatic or renal dysfunction, all of whom recovered after conservative or minimally invasive treatment. The combined surgical approach of posterior long-segment internal fixation with anterior debridement and intervertebral autologous strut bone grafting is effective in controlling infection, correcting kyphosis, reconstructing spinal stability, and promoting neurological recovery in patients with multi-segmental spinal tuberculosis. The incidence of perioperative complications is low and manageable. Given the single-center, retrospective design of this study, further multi-center, prospective, randomized controlled trials are needed to validate its safety and long-term efficacy.