Vertebral Deformities Research Articles

Prevalence and determinants associated with adolescent idiopathic scoliosis: results of screening in Surakarta, Indonesia

Scoliosis is defined as a vertebral deformity characterized by a lateral deviation of at least 10° with vertebral rotation. Adolescent idiopathic scoliosis is generally found in children aged 10-18 years. Changes in the scoliosis curve are influenced by various etiologic factors including age, sex, growth factors, curve location and biomechanical factors. The study was conducted to determine the prevalence of adolescent iidophatic scoliosis in school students aged 12-15 years in Surakarta city. Physical examination using Adam's forward bending test, scoliometer and risk factor questionnaire. The research subjects were 325 people with an age range of 12-15 years. Research subjects are included in the adolescent idiopathic scoliosis category if the Adam's forward bending test is positive and the scoliometer value is >10°. The highest prevalence of adolescent idiopathic scoliosis was found in school children aged 14 years. The prevalence of adolescent idiopathic scoliosis is higher in female (3.4%) than male students (0.3%). Determining factors that might influence the onset of adolescent idiopathic scoliosis including age, gender, biomechanical factors, habits or lifestyles factors and physical activity.

Vertebral osteoporotic fractures: differential diagnosis, therapeutic approaches

Osteoporotic vertebral fractures (OVF) are a severe complication of osteoporosis associated adverse outcomes, acute and chronic pain syndrome. If vertebral fractures (deformities) are detected, osteoporosis is diagnosed regardless of bone mineral density and the 10-year absolute fracture risk scale of the Fracture Risk Assessment Tool, but subject to the exclusion of other metabolic osteopathies. The article presents differential diagnosis of OVF with osteopathies such as osteomalacia, tumors or metastatic lesions of the spine, Paget»s disease, myeloma, hyper parathyroid osteodystrophy, post-traumatic vertebral deformities, Scheuermann-Mau disease. Differential diagnosis between different types of osteopathies is based on features of the clinical picture, history, changes in laboratory parameters (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, vitamin D3 and on data from X-ray of the skeleton examination. It is necessary to take into account conditions under which the vertebral fracture occurred, its localization, prevalence, peculiarities of changes in bone structures, presence or absence of osteoporotic background, degenerative-dystrophic changes in the spine. The tactics of managing the patients with OVF is determined by the time after the fracture, its severity, nature of the pain syndrome and includes non-drug and medical measures. Among non-pharmaceutical measures in the acute period of OVF, there are unloading of the spinal column, use of a corset, and physical therapy. Medical measures are aimed at pain relief using injectable and oral forms of nonsteroidal anti-inflammatory drugs, central acting muscle relaxants and anti-osteoporotic therapy. Dexketoprofen (Dexalgin) is the first-line drug for relief of acute pain in OVF which has a rapid and pronounced analgesic effect. For the anti-osteoporotic therapy, the drugs of choice are parenteral bisphosphonates, denosumab and teriparatide.

Twenty year outcomes following short-segment posterior instrumentation and fusion for thoracolumbar burst fractures: A retrospective observational study.

This study reviews the long-term efficacy of short-segment posterior instrumentation and fusion (SSPIF) in treating thoracolumbar burst fractures. Authors retrospectively reviewed the radiographic results of single-level thoracolumbar burst fractures treated by SSPIF. Vertebral body height and wedge angles were measured on the preoperative, postoperative, and follow-up radiographic images. The degree of pain and work ability was measured using the Denis scale. The analysis consisted of 12 patients with a mean age of 39.7 years (range 21-60) and a mean follow-up of 225.6 ± 20.3 months. There were significant differences among the wedge angles at preoperative and other periods of time, but there was no significant difference between the early postoperative and all other time periods afterwards (P < .001, P = .567, P = .937, P = .879). SSPIF effectively restored the anterior and middle vertebral body height and wedge angle deformities, and the improvement was maintained for almost 20 years after the surgery. Therefore, SSPIF is a safe and effective modality of treatment for thoracolumbar burst fractures.

Glycogen Storage Disease Type I and Bone: Clinical and Cellular Characterization.

Glycogen storage disease (GSD) is the most prevalent inherited disorder of glycogen metabolism for which no causal treatment is available. In recent years, thanks to the improved clinical management, the life expectancy of these patients extended, disclosing previously unidentified adverse conditions in other organs. In this study, we evaluated the clinical bone complications and the cellular responses in 20 patients (aged 14.1 ± 3.4years) affected by GSD type I. Fragility fractures were reported in 35% of the patients, which were older than unfractured patients. They involved appendicular skeletal segments, while no vertebral deformity was detected. 60% of the patients had a bone mineral density (BMD) "below the expected range for age", and lumbar spine (LS) BMD Z-scores positively correlated with muscle strength. Circulating mineral and bone markers showed reduction in the older subjects, with no increase in the pubertal age. Significant correlations could not be detected between circulating markers and LS BMD Z-scores, except for sclerostin levels, which also correlated with muscle strength. The osteoclasts differentiated from patients' peripheral blood mononuclear cells did not show cell-autonomous alterations. However, circulating osteoclast precursors from healthy individuals cultured in the presence of patients' sera exhibited increased osteoclastogenesis compared to control sera suggesting that GSD type I serum factors could affect osteoclast function in a non-autonomous manner. In contrast, circulating osteoprogenitors were unremarkable.

Enhanced Safety and Efficacy of O-Arm Navigation Over C-Arm Guidance in Percutaneous Kyphoplasty for Patients With Osteoporotic Vertebral Compression Fractures and Spinal Deformity: A Comparative Study.

Although percutaneous kyphoplasty (PKP) under C-arm guidance is an effective treatment for osteoporotic vertebral compression fractures (OVCF), obtaining high-definition images in patients with OVCF and spinal deformities can be challenging or insufficient using traditional C-arm guidance, prompting our institution to adopt the O-arm navigation system-which offers comprehensive 3D imaging and precise navigation-and this study compares its safety and efficacy with conventional C-arm-assisted PKP. This was a retrospective study. From February 2019 to February 2022, we enrolled 28 patients with OVCF (44 vertebrae) with spinal deformity treated with O-arm navigation-assisted PKP and 30 patients with OVCF (42 vertebrae) with spinal deformity treated with C-arm-guided PKP. We recorded puncture times, single-segment operation time, number of cases with bone cement leakage, and length of stay. The visual analog scales (VASs), Oswestry disability indexes (ODIs), recovery of Cobbs angle, and vertebral height were used to assess treatment effect before the operation, on the first day postoperation, the first month postoperation, and at the final follow-up. The chi-squared test was utilized for comparing discrete variables, an independent samples t-test was used for continuous variables, and Pearson's chi-squared test and Fisher's exact test were applied for categorical data. Demographic features were comparable between the groups. The O-arm navigation group showed a significant reduction in puncture adjustment per vertebrae, single-segment operation time, and the rate of trocar needle malposition compared to the C-arm guidance group. The rate of cement leakage was decreased in the O-arm-guided PKP group, and other complications did not differ between the two groups. Intragroup comparisons revealed significant improvements in VAS scores and ODI on the first day, first month, and final follow-up after the operation (p < 0.05). The VAS score was significantly lower in the O-arm navigation-assisted PKP group than in the C-arm-guided PKP group on the first day postoperatively (p = 0.049). However, no significant differences in VAS scores were observed between the groups at the first month postoperatively or at the final follow-up. In each follow-up period, there was no significant difference in ODI, Cobb angle, and the percent of anterior vertebral height (AVH %) between the groups. O-arm navigation-assisted PKP demonstrates better clinical safety and efficacy than C-arm-guided PKP, marking it as a minimally invasive, safe, and effective procedure for treating patients with OVCF with spinal deformity.

Safety and efficacy of short percutaneous fixation in AO3 and AO4 lumbar fractures: a single-centre experience of 35 cases.

Spinal fractures with subsequent bone fragment dislocation are among the injuries most feared by patients and physicians. The surgical strategy is tailored to the individual patient's characteristics and often consists of pedicle instrumentation with rod-screw systems. Short instrumentation has been associated with worse spinal correction and increased complications. However, recent studies have suggested similar results in terms of kyphosis correction and the maintenance of sagittal alignment compared to longer instrumentation. This single-center retrospective study was conducted between January 2018 and April 2021. We included 35 single lumbar burst fractures AO Spine grade A3 or A4 with evidence of intra-canal fragments. Patients underwent minimally invasive percutaneous posterior lumbar instrumentation with pedicle screws. Patients received short segmental fixation involving only one level above and below the fractured vertebra. An immediate postoperative computed tomography (CT) scan demonstrated a significant reduction in vertebral kyphotic deformation (11.7° ± 1.6 vs 16.7° ± 5, p<0.001) and sagittal Cobb angle (9.8° ± 1.3 vs 11.7° ± 1.5, p < 0.001). The correction was slightly reduced but remained significant at 12 months for both kyphotic (12.3° ± 1.4, p = 0.03) and sagittal Cobb (10.3° ± 0.9, p = 0.04). Upper lumbar vertebrae showed even larger correction indices compared to lower lumbar segments. No implant failure or screws pullout was seen at the last follow-up. Short spinal fixation is a safe and effective treatment of complete and incomplete burst fractures with posterior bone fragment dislocation. All included patients fared well and achieved good kyphotic correction with no perioperative or long-term complications.

Vertebral deformities in cultured big size Rainbow Trout: Radiological analysis from juvenile to harvest size

Vertebral deformities are a big challenge in Rainbow Trout seawater aquaculture. However, supportive scientific literature is missing. The present study used radiology to follow the development of vertebral deformities in a population of farmed Rainbow Trout as they grew from 36 g to 5.5 kg. In addition, separately collected deformity screening data from three other farmed populations were included for comparison.The fish developed deformities in different vertebral regions over time, eventuating to affect almost the entire vertebral column. At this point, the fish were ∼ 5.5 kg and 93 % of the fish had one or more deformed vertebrae. A negative relationship between severity of deformity (number of deformed vertebrae per individual), and fish length and weight strongly suggest a negative impact on fish welfare. The most frequently affected area was the ural region of the vertebral column. This region is a part of the caudal fin complex which also suffered from degradation of the fin rays. Ural region deformities were also frequent in the separately investigated populations.The current results indicate that Rainbow Trout are not able to maintain normal bone development under current farming conditions, consequently, jeopardizing the welfare of the fish.

Radiographic Diagnosis of Osteoporotic Vertebral Fracture in Older Women and Men Based on Statistical Probability.

A radiographic gold standard to distinguish osteoporotic vertebral fractures (VFs) from nonosteoporotic VFs does not exist. Radiographic fracture-shaped vertebral deformity (FSVD) is common among young populations with normal bone strength. FSVD in an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely associated with compromised bone strength. For more severe grade deformities or when a vertebra is collapsed, experienced readers can make an osteoporotic VF diagnosis with a high degree of certainty. In milder cases, radiographic osteoporotic VF is often diagnosed based on a high probability rather than an absolute diagnosis. For older women, three nonadjacent minimal grade OLVFs (< 20% height loss), one minimal grade OLVF and one mild OLVF (≥ 20∼25% height loss), or one OLVF with ≥ 25% height loss meets the diagnosis of osteoporosis. For older men, a single OLVF with ≥ 33 to 40% height loss is insufficient to suggest the patient has osteoporosis.

[Translated article] Anatomical and biomechanical factors of osteoporotic vertebral fracture and the occurrence of cascade fractures

Osteoporosis weakens the structural strength of bone to such an extent that normal daily activity may exceed the capacity of the vertebra to bear this load. Vertebral fracture and deformity is a hallmark of osteoporosis. The detriment of trabecular bone properties alone cannot explain the occurrence of osteoporotic vertebral fracture. The ability of the spine to bear and resist loads depends on the structural capacity of the vertebrae, but also on loading conditions arising from activities of daily living or low-energy trauma. This review describes the mechanical properties of the vertebral bone, the structural load-bearing capacity of the various elements forming the spine, the neuromuscular control of the trunk, as well as the biomechanics of the loads to which the spine is subjected in relation to the presence of osteoporosis and the risk of vertebral fracture. A better understanding of biomechanical factors may help to explain both the high incidence of osteoporotic vertebral fractures and their mechanism of production. Consideration of these issues may be important in the development of prevention and management strategies.

Computer aided detection for vertebral deformities diagnosis based on deep learning

&lt;p class="p1"&gt;The diagnosis of spinal deformities is one of the most frequent daily clinical routine. X-ray images are used to diagnose s&lt;span class="s1"&gt;e&lt;/span&gt;&lt;span class="s2"&gt;v&lt;/span&gt;eral pathologies in order to reduce harmful radiat&lt;span class="s2"&gt;i&lt;/span&gt;ons of the patient. Spinal deformities are diagnosed essentially from &lt;span class="s2"&gt;v&lt;/span&gt;ertebral shapes, orientations, and positions, so their detection and s&lt;span class="s2"&gt;e&lt;/span&gt;gmentation are major steps required for diagnosis. Deep learning could be applied for automatic diagnosis to detect scoliosis and its &lt;span class="s1"&gt;v&lt;/span&gt;ariants with a &lt;span class="s2"&gt;f&lt;/span&gt;&lt;span class="s1"&gt;av&lt;/span&gt;ourable performance. In this stud&lt;span class="s3"&gt;y&lt;/span&gt;, based on 609 spinal anterio&lt;span class="s1"&gt;r&lt;/span&gt;-posterior x-ray images obtained from the public Spine&lt;span class="s4"&gt;W&lt;/span&gt;eb, we &lt;span class="s2"&gt;e&lt;/span&gt;xamine generat&lt;span class="s1"&gt;i&lt;/span&gt;&lt;span class="s2"&gt;v&lt;/span&gt;e ad- &lt;span class="s2"&gt;v&lt;/span&gt;ersarial net&lt;span class="s2"&gt;w&lt;/span&gt;ork (GAN) based architectures and co&lt;span class="s5"&gt;n&lt;/span&gt;&lt;span class="s1"&gt;v&lt;/span&gt;olutional neural net&lt;span class="s2"&gt;w&lt;/span&gt;ork (CNN) based architectures models that are capable of automatically detecting anomalies in radiograph and achi&lt;span class="s1"&gt;e&lt;/span&gt;&lt;span class="s2"&gt;v&lt;/span&gt;e &lt;span class="s2"&gt;e&lt;/span&gt;xpert-l&lt;span class="s1"&gt;e&lt;/span&gt;&lt;span class="s2"&gt;v&lt;/span&gt;el performances in &lt;span class="s1"&gt;v&lt;/span&gt;arious fi&lt;span class="s6"&gt;e&lt;/span&gt;lds pr&lt;span class="s2"&gt;o&lt;/span&gt;viding a solid comparat&lt;span class="s1"&gt;i&lt;/span&gt;&lt;span class="s2"&gt;v&lt;/span&gt;e stud&lt;span class="s3"&gt;y&lt;/span&gt;. Most of the implemented models are apt to automatically distinguish limits between &lt;span class="s2"&gt;v&lt;/span&gt;ertebrae so determining their shape with a &lt;span class="s2"&gt;v&lt;/span&gt;ery good visual performance. The GAN-based archite&lt;span class="s2"&gt;c&lt;/span&gt;ture estimates the required &lt;span class="s2"&gt;v&lt;/span&gt;ertebral landmarks with an accura&lt;span class="s2"&gt;c&lt;/span&gt;y rate of 0.966, signify its capacity for automatic scoliosis assessment in a clinical setting.&lt;/p&gt;

First records of abnormal fishes in the Arctic and possible reasons of the anomalies

External anomalies in fish are diverse and include abnormal development of external organs (eyes, jaws, fins, etc.), deformity and curvature of the trunk, discoloration of the skin, reversal of the sides (in flounders) and others that reduce the survival of individuals with such disorders. Although they are not uncommon in nature, reports of fish anomalies in Arctic seas are extremely rare. There have been no published records of anomalous Bering flounder Hippoglossoides robustus or polar cod Boreogadus saida. We document here for the first time on albinism, ambicoloration, reversal of the sides, or curved spine in individuals of Bering flounder, as well as a specimen of polar cod with a vertebral deformity captured in the western Chukchi Sea. Photographs of both normal and abnormal individuals are provided. We hypothesize that of all the possible causes of the anomalies we have found, the most likely is the recent dramatic warming in the Arctic.

Effect of temperature on growth, expression of growth regulating genes, and deformity development of juvenile European plaice (Pleuronectes platessa)

The flatfish European plaice is a demersal, temperate species and a candidate for marine aquaculture. To better understand growth and the mechanisms involved in growth regulation, juvenile plaice (initial mean weight ± SEM, 10.4 ± 0.1 g) were reared in triplicate rearing tanks at three different temperature: ambient (average of 8.6 °C), 12 °C and 16 °C, for 100 days. Interactions between growth, expression of growth regulating genes, and skeletal development were studied to determine optimal rearing conditions for juvenile plaice. Juvenile plaice grew fastest at 16 °C, followed by the 12 °C group. The condition factor was inversely correlated to increased temperatures and was highest in the 8.6 °C group. At the start of the experiment, 11% of the fish had vertebra deformities. Increasing temperature resulted in higher frequency and severity of malformations, and the 8.6 °C group had 8% less vertebra deformities at the end of the experiment compared to other two groups. The 12 °C and 16 °C groups had similar frequency of deformed fish, however, the 16 °C had more severe deformities, measured as number of deformed vertebrae per fish. Temperature affected gene transcript levels of ghr, igf-1, and igf-1r in muscle and liver tissue differently. Hepatic igf-1 transcript levels increased with increased growth and temperature. Muscular igf-1r transcript levels increased with increasing temperature in each sampling, indicating that igf-1r corresponded with muscular growth. Based on the present findings, a rearing temperature of 12 °C is recommended for on-growing of juvenile plaice.

[Translated article] Diagnostic imaging in patients with vertebral compression fractures

Vertebral compression fractures by osteoporosis (OVF) is usually a diagnostic problem and coincides on the age group of metastatic vertebral compression fractures (MVF). Although radiography is the first diagnostic technique, generally is not accurate for depicting demineralization and soft tissue lesions. Magnetic resonance (MRI) is the diagnostic choice. The most relevant signs are intravertebral fluid collection or fluid signal, other vertebral deformities without oedema and older age. Among the most relevant findings for diagnosis MVF are soft tissue mass and pedicle intensity signal asymmetries. However, reproducibility of these findings in clinical practice is moderate.

Cadmium impacts on calcium mineralization of zebrafish skeletal development and behavioral impairment

Cadmium (Cd) poses significant risks to aquatic organisms due to its toxicity and ability to disrupt the cellular processes. Given the similar atomic radius of Cd and calcium (Ca), Cd may potentially affect the Ca homeostasis, which can lead to impaired mineralization of skeletal structures and behavioral abnormalities. The formation of the spinal skeleton involves Ca transport and mineralization. In this study, we conducted an in-depth investigation on the effects of Cd at environmental concentrations on zebrafish (Danio rerio) skeletal development and the underlying molecular mechanisms. As the concentration of Cd increased, the accumulation of Cd in zebrafish larvae also rose, while the Ca content decreased significantly by 3.0 %−57.3 %, and vertebral deformities were observed. Transcriptomics analysis revealed that sixteen genes involved in metal absorption were affected. Exposure to 2 µg/L Cd significantly upregulated the expression of these genes, whereas exposure to 10 µg/L resulted in their downregulation. Consequently, exposure of zebrafish larvae to 10 µg/L of Cd inhibited the body segmentation growth and skeletal mineralization development by 29.1 %−56.7 %. This inhibition was evidenced by the downregulation of mineral absorption genes and decreased Ca accumulation. The findings of this study suggested that the inhibition of skeletal mineralization was likely attributed to the disruption of mineral absorption, thus providing novel insights into the mechanisms by which metal pollutants inhibit the skeletal development of fish.

Thoracic and vertebral deformities in lung transplantation: perioperative complications and long-term prognoses

BackgroundLung transplantation (LTx) is a crucial therapeutic strategy for patients suffering from end-stage respiratory diseases, necessitating precise donor-recipient size matching to ensure optimal graft function. While standard allocation protocols rely on predicted lung capacity based on factors such as sex, age, and height, a subset of patients with respiratory diseases presents an additional challenge – thoracic or vertebral deformities. These deformities can complicate accurate volume predictions and may impact the success of lung transplantation.MethodsIn this retrospective cohort study of patients who underwent LTx at Tohoku University Hospital between January 2007 and April 2022, with follow-up until October 2022, the primary objective was to assess the influence of thoracic and vertebral deformities on perioperative complications, emphasizing interventions, such as volume reduction surgery. The secondary objective aimed to identify any noticeable impact on long-term prognoses in recipients with these deformities.ResultsOf 129 LTx recipients analyzed, 17.8% exhibited thoracic deformities, characterized by pectus excavatum, while 16.3% had vertebral deformities. Perioperative complications, requiring delayed chest closure, tracheostomy, and volume reduction surgery, were more prevalent in the deformity group. Thoracic deformities were notably associated with the need for volume reduction surgery. However, long-term prognoses did not differ significantly between patients with deformities and those without. Vertebral deformities did not appear to significantly impact perioperative or long-term outcomes.ConclusionsThis study highlights the prevalence of thoracic deformities in LTx recipients, correlating with increased perioperative complications, particularly the potential need for volume reduction surgery. Importantly, these deformities do not exert a significant impact on long-term prognoses. Additionally, patients with vertebral deformities, such as scoliosis and kyphosis, appear to be manageable in the context of LTx.

Effect of selected environmental factors on the growth and survivability of the larvae of the Chinese sleeper Perccottus glenii Dybowski 1877

The aim of this study was to determine the influence of the temperature (range 15 to 25°C), pH (6 to 9) and salinity of water (between 0 to 10‰) on the growth, condition and survival of larvae of the Chinese sleeper. During the 28‐day experimental rearing, the highest average body weight of 81.3 ± 16.3 mg was reached in fish from the group maintained at a water temperature 25°C, and was almost five times higher than the weight at the temperature of 15°C (15.6 ± 2.2 mg). A significantly higher body weight of Chinese sleeper larvae was also recorded in the group reared in alkaline water (pH 9), compared to those kept in acidic and neutral water. Statistically significant differences between the groups (p≤0.05) were recorded for the condition index (K) values and relative body weight (SGR) only in the experiment with different water temperatures of fish rearing. The highest number (16% of the initial stock) of abnormal larvae, associated with a lower jaw and vertebral structure deformities, was recorded in the group reared at 5‰ salinity (Z5). Simultaneously, 100% mortality of the stock was noted by the 10th day of rearing in the 10‰ salinity. The cumulative mortality of the Chinese sleeper larvae related to cannibalism Types I and II in all the experimental rearing was low, oscillating between 0.5% and 11.5% in the groups bred in water with a pH 9 and 0‰ salinity, respectively. The study results may help determine the critical values of water parameters that promote or limit development in the early stages of the Chinese sleeper and could be used in activities related to eradicating or significantly reducing the increasing abundance of this alien invasive fish species in freshwater ecosystems.

The problems with pin bones: Intermuscular bone development and function in salmonids and their implications for aquaculture

AbstractA healthy skeletal system is fundamental to fish welfare and performance and a key physiological feature of a robust fish. The presence of skeletal deformities in farmed salmonids is a persistent welfare problem in aquaculture, and one which threatens to impede industry growth. Deformities of the fine bones of fish, such as ribs and intermuscular bones (IBs), have received less attention than vertebral body deformities, despite their potential to compromise fish welfare and product quality. IBs, commercially known as pin bones, are small spicule‐like bones embedded in the muscle fillets of salmonids, cyprinids and other basal teleost species. In farmed basal teleosts, they impact fish processing, have negative effects on the economic value of fish and present a potential consumer health concern if ingested. Current understanding of IB development and function in teleosts has mostly relied on morphological research. More recently, advances in our understanding of molecular mechanisms of IB development in cyprinids have been made, largely due to the exploration of breeding IB‐free fish for use in aquaculture. In this review, we explore the existing literature on IBs in teleosts, highlight the points of contention within this field of research and identify the significant knowledge gaps about the development and function of salmonid IBs. To our knowledge, there is no available research on the function of IBs and scarce research concerning IB development in salmonids. Future research on teleost IBs would benefit from the use of consistent terminology to facilitate interdisciplinary collaboration and identify research outputs in this field.

Spine Involvement and Vertebral Deformity in Patients Diagnosed with Chronic Recurrent Multifocal Osteomyelitis.

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disorder of bone, typically arising adjacent to the physes of long bones but also seen throughout the skeleton. For patients with spinal involvement, CRMO lesions can cause compression deformities with a range of severity from minimal anterior wedging to circumferential height loss, known as vertebra plana. This study examines a large cohort of CRMO patients to determine the prevalence of spine involvement and vertebral deformity. This is a retrospective review of all patients with a diagnosis of CRMO seen at our institution between January 2003 and December 2020. These patients were identified through a prospectively maintained database of all CRMO patients seen at the institution. A retrospective review was undertaken to identify all patients with spinal involvement and determine the prevalence of CRMO in the spine and its effects on vertebral height and deformity. Of 170 patients included in this study, 48 (28.2%) were found to have spinal involvement. Among patients with spinal involvement, vertebral body lesions were identified in 27 (56.3%) patients. The remaining lesions were in the sacrum or posterior elements. Radiographic evidence of the vertebral body height loss was noted in 23 of these 27 patients. This cohort of CRMO patients demonstrates that 28% of patients have spinal involvement, and 48% of those patients have vertebral body height loss. While the ideal treatment for spinal CRMO has yet to be determined, imaging studies, including whole-body MRI and spine-specific MRI, are useful in identifying vertebral lesions and deformities. Identification and surveillance of these lesions are important as the disorder has a relapsing and remitting course, and patients can develop significant vertebral body height loss. Once deformity has developed, we have seen no evidence of reconstitution of the height of the collapsed vertebra. Bisphosphonates have been successful in preventing the progression of vertebral body height loss. Level II: Retrospective study investigating spinal involvement and prevalence of vertebral body deformity in patients diagnosed with CRMO.

Percutaneous kyphoplasty in the treatment of Kümmell disease in lumbar scoliosis: A case report

BACKGROUND Due to mechanical imbalance in the spine, elderly scoliosis patients tend to develop vertebral fracture nonunion, i.e. , Kümmell disease, when osteoporotic vertebral compression fractures occur. However, accompanying vertebral rotational deformities make surgical procedures challenging risky. Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them. We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty (PKP) under O-arm guidance. CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall. She was diagnosed with Kümmell disease based on physical and radiologic examinations. The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty, resulting in a significant alleviation of low back pain. CONCLUSION PKP has good efficacy in treating Kümmell disease. However, surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine. O-arm assisted operations play a crucial role in decreasing surgical risks.

Indo-Pacific humpback dolphins face extirpation in Shantou waters

The Indo-Pacific humpback dolphin is an inshore species occurring in productive estuarine and coastal areas of the Indo-Pacific. Since the end of the 20th century, coastal region of China has experienced tremendous economic expansion, exposing this dolphin species to a wide range of human activities. Despite frequent voices of concern in the past three decades calling for research and conservation attention, protracted debates were not followed by constructive conservation actions due to the lack of or inconsistent use of demographic data. The current study examined 13-year sighting and photo-identification data collected for a small and little known population of humpback dolphins off the coast of Shantou (ST) in the northern South China Sea. Compared to conspecific populations inhabiting large or medium-sized estuarine systems, the ST dolphins have much larger home range (mean = 181.3 km2, S.D. = 87.7) which, however, has been shrinking recently due to coastal reclamations and expanding aquaculture farming. Although at least two dolphin births were recorded between 2010 and 2022, there was no successful recruitment of a non-calf individual. Meanwhile, the population shrank by 29.4 %, with the most updated population size of only 12 individuals, estimated in 2022. Based on the current demographic trend, we predict that the ST humpback dolphins will be extirpated within one or two decades. Furthermore, as the dolphins are aging and becoming less reproductively viable, there is little chance to reverse the declining trend even without additional stressors. Moreover, we noticed prevailing vertebral column deformities amongst the ST dolphins, possibly a sign of inbreeding depression of a small population. The present study exemplifies a typical case of a small, isolated and locally endangered dolphin population that is approaching local extinction without efficient monitoring program and conservation action. We emphasize that without solution-based research and efficient conservation planning, other humpback dolphin populations in China might soon follow in the steps of ST humpback dolphins.