Explore the vast range of titles available.

Background The incidence of unilateral facet fracture of the cervical spine is approximately 10% of all cases of spinal trauma. Herein, we report an extremely rare case of traumatic nerve root injury due to a unilateral facet fracture of the cervical spine caused by a direct external force. Case presentation A 66-year-old Japanese man was injured by a direct hit from an iron object on the right side of the posterior neck at a construction site and was transported to our hospital. At the initial visit, a neurological examination revealed severe paresthesia of the C8 area and motor weakness of finger extension and abduction on the right side. Computed tomography (CT) revealed a unilateral facet fracture of C7/T1 on the right side. Magnetic resonance imaging (MRI) revealed no injury to the intervertebral disc, supraspinous or interspinous ligament, or spinal cord. We diagnosed him with C8 nerve root injury on the right side due to a unilateral facet fracture of C7/T1 on the right side caused by a direct external force. In the present case, we diagnosed no rotational instability because the cause of injury is a direct external force. Thus, the patient was conservatively treated with Philadelphia collar immobilization for 3 months. His paresthesia in the C8 area on the right side and his motor weakness of finger extension and abduction gradually improved within 2 months after the injury. An X-ray image did not reveal any progression of the C7/T1 facet dislocation. At the final follow-up, 1 year after the injury, his paresthesia or motor weakness was ultimately improved, and CT revealed a complete union of the bony fragment of the facet. Conclusions When a unilateral facet fracture of the cervical spine is treated, conservative treatment may be successful despite the nerve root injury in patients with no rotational instability and no disc or posterior ligament injury. This case highlights the potential for conservative treatment as a viable approach in such cases, suggesting that, when carefully selected, patients may benefit from conservative treatment, contributing to clinical decision-making in similar cases.

Background This study compared patient characteristics, clinical outcomes, and antibiotic durations between patients undergoing posterior fixation for gram-negative rods (GNR) or gram-positive cocci (GPC) thoracolumbar pyogenic spondylitis. Methods In this multicenter retrospective cohort study, 53 patients who underwent minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis were categorized into a GPC or GNR group based on the identified causative organisms. Patient characteristics, surgical outcomes, and postoperative infection control were compared between the two groups to identify factors affecting antibiotic duration. Results The patients in the GNR group ( n  = 14) were older (77.2 years versus 70.1 years; p  = 0.008), had a higher incidence of a history of abdominal-pelvic infections (4 versus 0; p  = 0.003), required longer preoperative antibiotics (5.9 weeks versus 3.0 weeks; p  = 0.035), and had more unplanned additional surgeries due to poor infection control ( n  = 4 versus n  = 1; p  = 0.014) than those in the GPC group ( n  = 39). Furthermore, GNR infection independently predicted longer preoperative antibiotic duration ( p  = 0.002, β = 0.43). Conclusions Pyogenic spondylitis with GNR is associated with the need for prolonged antibiotic treatment and higher rates of unplanned additional surgeries due to poor infection control as compared to GPC-associated pyogenic spondylitis. Older age and a history of abdominal-pelvic infections tend to complicate the management in these patients; therefore, tailored treatment strategies are required to optimize treatment duration and minimize complications. Clinical trial number Not applicable.

Purpose Pyogenic spondylodiscitis is a significant health concern, particularly in older individuals. Minimally invasive surgical techniques, such as posterior fixation, are promising for infection control; however, their mechanisms remain unclear. This study aimed to clarify how posterior fixation promotes infection control in an animal model. Methods Thirty female Wistar rats were used to create a pyogenic spondylodiscitis model by injecting methicillin-sensitive Staphylococcus aureus into the intervertebral space between the 6th and 7th coccygeal vertebrae. Three days post-injection, rats were divided into fixation and control groups. The fixation group underwent posterior fixation with an external fixator, whereas the control group underwent screw insertion alone. Bone destruction was assessed via microcomputed tomography on postoperative days (POD) 7, 14, and 21. Immunohistochemistry for cathepsin K and receptor activator of nuclear factor-kappa B ligand (RANKL) was performed on POD 7 samples to assess osteoclast activity. Results The fixation group showed less bone destruction than the control group at POD 14 (35% vs. 56%, p  = 0.0007) and POD 21 (30% vs. 52%, p  < 0.0001). The cathepsin K-positive area was significantly reduced in the fixation group ( p  = 0.027). RANKL expression was localized within the intervertebral disc in the fixation group, whereas RANKL was strongly expressed on the bone surface adjacent to the disc in control. The RANKL-positive area was also reduced in the fixation group ( p  = 0.041). Conclusions Our combined model of pyogenic spondylodiscitis and posterior fixation supports the theory that posterior fixation stability suppresses RANKL and osteoclast expression, promoting infection control.

Assessing intraoperative hemodynamics with Surgical Apgar Score (SAS) and preoperative nutritional status with the Controlling Nutritional Status (CONUT) score are said to be useful to predict postoperative complications in many surgical services, but little is reported in the field of spinal surgery. The purpose of this study was to assess the utility of SAS and the CONUT score for predicting the risk of major postoperative complications after spinal surgery. We included 659 people who undergone spinal surgery in our institute in eight consecutive years. The occurrence of postoperative major complications was investigated. Background clinical information, surgical information including the SAS and the CONUT score, and the length of postoperative hospital stay were collected. The risk factors of postoperative complications were assessed statistically. Complications occurred in 117 cases (17.8%). The multivariate analysis showed that history of diabetes mellitus (odds ratio [OR] 1.81: P  = 0.035), coronary disease (OR 3.33; P  = 0.009), American Society of Anesthesiologists Physical Status (OR 1.71; P  = 0.025), use of instruments (OR 2.07; P  = 0.026), operation time (OR 1.30; P  < 0.001), SAS (OR 0.59; P  < 0.001), and CONUT (OR 1.34; P  < 0.001) were independent risk factors of major complications after spinal surgery. Assessing the intraoperative hemodynamics with SAS and preoperative nutritional status with the CONUT score was useful in predicting major postoperative complications after spinal surgery. People who are detected as high risked people should be managed carefully after spinal surgery.

Stage-specific embryonic antigen-3-positive pluripotent-like/macrophage-like multilineage-differentiating stress-enduring (Muse) cells are a distinct subpopulation of mesenchymal stromal cells (MSCs), accounting for 1% to several percent of MSCs. Although stem cell therapy for spinal cord injury (SCI) typically targets the subacute phase to avoid the hostile acute environment, the therapeutic window for Muse cells remains unclear. C57BL/6J mice with severe T9 contusion SCI received a single tail vein injection of human bone marrow-derived (BM) Muse cells, BM-MSCs (both 5 × 104 cells), or vehicle at 2, 8, 14, or 28 days post-injury (DPI) without immunosuppressants. Among the different administration time points, the 2-DPI Muse cell group exhibited significantly higher Basso Mouse Scale scores than the BM-MSC and vehicle groups from 14 days after injection, while no significant differences were observed at the other administration time points. The 2-DPI Muse cell group showed significantly greater homing to the injured spinal cord than the BM-MSC group, with persistent engraftment and neural-lineage marker expression at day 42. Ablation of engrafted Muse cells at day 42 partially reversed locomotor recovery, suggesting that engrafted Muse cells contributed to functional recovery. These findings suggest that intravenous Muse cell therapy exerts timing-dependent therapeutic effects after SCI, with greater efficacy during the early post-injury phase.

Purpose This study aimed to evaluate the difference in treatment duration and unplanned additional surgeries between patients with unidentified causative organisms on empiric antibiotics and those with identified organisms on selective antibiotics in treating thoracolumbar pyogenic spondylitis with minimally invasive posterior fixation. Methods This multicenter retrospective cohort study included patients with thoracolumbar pyogenic spondylitis refractory to conservative treatment who underwent minimally invasive posterior fixation. Patients were divided into the identified (known causative organism) and unidentified groups (unknown causative organism). We analyzed data on demographics, antibiotic use, surgical outcomes, and infection control indicators. Results We included 74 patients, with 52 (70%) and 22 (30%) in the identified and unidentified groups, respectively. On admission, the identified group had higher C-reactive protein (CRP) levels and more iliopsoas abscesses. The duration to postoperative CRP negative was similar in the identified and unidentified groups (7.13 vs. 6.48 weeks, p  = 0.74). Only the identified group had unplanned additional surgeries due to poor infection control, affecting 6 of 52 patients (12%). Advanced age and causative organism identification increased the additional surgery odds (odds ratio [OR], 8.25; p  = 0.033 and OR, 6.83; p  = 0.034, respectively). Conclusion The use of empiric antibiotics in minimally invasive posterior fixation was effective without identifying the causative organism and did not prolong treatment duration. In patients with identified organisms, 12% required unplanned additional surgery, indicating a more challenging infection control. Causative organism identification was associated with the need for additional surgery, suggesting a more cautious treatment strategy for these patients.

Assessment of human gait posture can be clinically effective in diagnosing human gait deformities early in life. Currently, two methods-static and dynamic-are used to diagnose adult spinal deformity (ASD) and other spinal disorders. Full-spine lateral standing radiographs are used in the standard static method. However, this is a static assessment of joints in the standing position and does not include information on joint changes when the patient walks. Careful observation of long-distance walking can provide a dynamic assessment that reveals an uncompensated posture; however, this increases the workload of medical practitioners. A three-dimensional (3D) motion system is proposed for the dynamic method. Although the motion system successfully detected dynamic posture changes, access to the facilities was limited. Therefore, a diagnostic approach that is facility-independent, has low practice flow, and does not involve patient contact is required. We focused on a video-based method to classify patients with spinal disorders either as ASD, or other forms of ASD. To achieve this goal, we present a video-based two-stage machine-learning method. In the first stage, deep learning methods are used to locate the patient and extract the area where the patient is located. In the second stage, a 3D CNN (convolutional neural network) device is used to capture spatial and temporal information (dynamic motion) from the extracted frames. Disease classification is performed by discerning posture and gait from the extracted frames. Model performance was assessed using the mean accuracy, F1 score, and area under the receiver operating characteristic curve (AUROC), with five-fold cross-validation. We also compared the final results with professional observations. Our experiments were conducted using a gait video dataset comprising 81 patients. The experimental results indicated that our method is effective for classifying ASD and other spinal disorders. The proposed method achieved a mean accuracy of 0.7553, an F1 score of 0.7063, and an AUROC score of 0.7864. Additionally, ablation experiments indicated the importance of the first stage (detection stage) and transfer learning of our proposed method. The observations from the two doctors were compared using the proposed method. The mean accuracies observed by the two doctors were 0.4815 and 0.5247, with AUROC scores of 0.5185 and 0.5463, respectively. We proved that the proposed method can achieve accurate and reliable medical testing results compared with doctors' observations using videos of 1 s duration. All our code, models, and results are available at https://github.com/ChenKaiXuSan/Walk_Video_PyTorch. The proposed framework provides a potential video-based method for improving the clinical diagnosis for ASD and non-ASD. This framework might, in turn, benefit both patients and clinicians to treat the disease quickly and directly and further reduce facility dependency and data-driven systems.

Dysphagia is a known complication following anterior cervical spine surgery, but it has also been reported after laminoplasty. We sought to determine the incidence of dysphagia following cervical laminoplasty. Prospective, multicenter, observational study of patients who underwent cervical laminoplasty or posterior lumbar spinal surgery between April 2022 and May 2024. We measured clinical characteristics, operative data, radiological parameters, and perioperative visual analog scale (VAS) for neck and throat pain. Dysphagia was assessed using the 10-item Eating Assessment Tool preoperatively and 1 week postoperatively, with new-onset dysphagia defined as a worsening of ≧ 3 points from the preoperative score. There were 79 patients in the cervical group and 89 in the lumbar group. The incidence of new-onset dysphagia was significantly higher in the cervical group (10.1%) than in the lumbar group (2.2%, P  = 0.046). Within the cervical group, patients who developed new-onset dysphagia had significantly higher VAS scores for postoperative neck pain and throat pain than those without dysphagia. The incidence of new-onset dysphagia after cervical laminoplasty was significantly higher than that in the lumbar group. Patients who developed new-onset dysphagia had significantly greater postoperative neck and throat pain, suggesting that postoperative pain is associated with the development of new-onset dysphagia.

Introduction Surgical site infection (SSI) is one of the most serious postoperative complications following instrumented spinal surgery. We previously reported the potential of continuous local antibiotic perfusion (CLAP) to retain implants for patients with SSI following instrumented spinal surgery. We conducted a retrospective multicenter study to elucidate the efficacy and limitations of CLAP for patients with SSI following instrumented spinal surgery. Methods A total of 40 patients treated with CLAP for SSI after instrumented spinal surgery were included in this study. The implant retention rate was calculated. We investigated the influence of age, presence of diabetes, number of fused vertebrae, causative pathogens, duration from diagnosis to CLAP initiation, white blood cell (WBC) count (× 10 3 /μL), and C-reactive protein (CRP) level on the development of SSI after CLAP. Patients were divided into two groups: a favorable outcome group ( n  = 28), in which SSI was promptly controlled after CLAP, and a poor outcome group ( n  = 12), in which additional surgery was required or fatal outcomes occurred after CLAP. The relationship between these two groups was evaluated. Results In 13 of 40 patients, implants had already been removed before CLAP initiation. Excluding these cases, control of SSI with implant retention was achieved by CLAP in 22 of 27 patients (81%). In the poor outcome group, antibiotic-resistant pathogens were detected at a higher rate than in the favorable outcome group ( p  = 0.022), and the WBC counts at 1 week after CLAP were significantly increased compared with the favorable outcome group (poor outcome group 7.7 ± 2.4, favorable outcome group 5.8 ± 1.6; p  = 0.013). Conclusions Application of CLAP enabled SSI control with a high rate of implant retention. However, detection of antibiotic-resistant pathogens and increased WBC count 1 week after initiating CLAP may predict poor control of SSI, even after CLAP.

Background/Objectives: Spontaneous spinal subdural hematoma (SSSDH) is a rare and severe condition that causes rapid neurological decline. Spontaneous spinal epidural hematoma (SSEH) presents similarly but is more common, and surgical management differs because SSSDH requires an intradural approach. Few studies have assessed the reliability of magnetic resonance imaging (MRI) features used to distinguish SSSDH from SSEH in patients requiring surgery. Methods: We retrospectively reviewed 27 patients who underwent surgical evacuation of spinal hematomas at two institutions (2015–2025). Definitive hematoma location was determined intraoperatively. Four MRI features—shape (crescentic vs. biconvex), location (ventral vs. dorsal), craniocaudal length (<5 vs. ≥5 segments), and spinal region—were independently evaluated by two reviewers. Inter- and intra-rater reliability was assessed using agreement rate and Cohen’s kappa (κ) with 95% confidence intervals (95% CIs). Results: Among 27 cases, three (11.1%) were SSSDH and 24 were SSEH. Hematoma location, length, and spinal region demonstrated perfect inter- and intra-rater agreement (κ = 1.00). For hematoma shape, intra-rater agreement was good (96.2%, κ = 0.84; 95% CI 0.52–1.00), whereas inter-rater agreement was poor to fair (84.6%, κ = 0.26; 95% CI −0.25–0.77). Notably, two of the three SSSDHs demonstrated a biconvex configuration, and 83.3% of SSEHs also exhibited a biconvex morphology. Conclusions: MRI features such as hematoma location, extent, and spinal level were highly reproducible, whereas hematoma shape showed limited reliability. Although ventral hematomas most strongly suggest SSSDH, atypical SSEH presentations occur. When dorsal exposure reveals no epidural hematoma, intradural exploration should be promptly considered.