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Background: Closure of the ventral dura mater of the thoracic spinal cord is challenging because it requires both avoiding spinal cord damage and obtaining sufficient working space in an anatomically narrow area. We report a case of superficial siderosis (SS) due to chronic bleeding from a thoracic ventral dural defect in which we preformed dural repair using as a simple sutureless method and obtained good results. Case Description: A 75-year-old man complained of slowly progressive gait, speech, and hearing disturbances over 5 years. Magnetic resonance imaging (MRI) showed SS in the brain and the spinal cord and a dural defect ventral to the spinal cord at the T2 level. Neurological examination revealed bilateral cerebellar ataxia and mild motor weakness in left iliopsoas muscle. T2 and T3 hemi-laminectomy was performed in the prone position. Transdurally, a dural defect on the ventral side of the spinal cord and a fluid-filled space beyond it could be observed. With endoscopic assistance, a blood clot in the space was confirmed. For dural closure, we performed a simple manipulation using a collagen-based dural graft. The graft was cut into pieces, softened with saline, and simply packed into the space with minimal strain on the spinal cord despite the narrow space. The postoperative clinical course was uneventful. Postoperative MRI at 1 year showed the space had disappeared. Conclusion: In patients with SS, sutureless dural closure using a collagen-based dural graft allows for effective, minimally invasive dural closure, even for thoracic ventral lesions. [ABSTRACT FROM AUTHOR]

Osteoporosis is under-diagnosed while detectable by measuring bone mineral density (BMD) using quantitative computer tomography (QCT). Opportunistic screening for low BMD has previously been suggested using lumbar QCT. However, thoracic QCT also possesses this potential to develop upper and lower cut-off values for low thoracic BMD, corresponding to the current cut-offs for lumbar BMD. In participants referred with chest pain, lumbar and thoracic BMD were measured using non-contrast lumbar- and cardiac CT scans. Lumbar BMD cut-off values for very low (< 80 mg/cm3), low (80–120 mg/cm3), and normal BMD (> 120 mg/cm3) were used to assess the corresponding thoracic values. A linear regression enabled identification of new diagnostic thoracic BMD cut-off values. The 177 participants (mean age 61 [range 31–74] years, 51% women) had a lumbar BMD of 121.6 mg/cm3 (95% CI 115.9–127.3) and a thoracic BMD of 137.0 mg/cm3 (95% CI: 131.5–142.5), p < 0.001. Categorization of lumbar BMD revealed 14%, 35%, and 45% in each BMD category. When applied for the thoracic BMD measurements, 25% of participants were reclassified into a lower group. Linear regression predicted a relationship of Thoracic BMD = 0.85 * Lumbar BMD + 33.5, yielding adjusted thoracic cut-off values of < 102 and > 136 mg/cm3. Significant differences in BMD between lumbar and thoracic regions were found, but a linear relationship enabled the development of thoracic upper and lower cut-off values for low BMD in the thoracic spine. As Thoracic CT scans are frequent, these findings will strengthen the utilization of CT images for opportunistic detection of osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Neck pain (NP) is a prevalent musculoskeletal disorder, especially among individuals with sedentary occupations. The interplay between cervical and thoracic spine mobility is hypothesized to contribute significantly to NP severity, yet this relationship requires further exploration. Methods: This cross-sectional study involved 179 young white-collar workers with NP lasting for at least six weeks. Participants were stratified into mild (n = 78) and moderate (n = 101) pain groups based on their scores on the Northwick Park Neck Pain Questionnaire (NPQ). Cervical and thoracic range of motion (ROM) in the sagittal plane was measured using inclinometers. NP severity was further assessed using the NPQ and the Neck Disability Index (NDI). Correlation, regression, and mediation analyses were conducted to investigate the relationship between cervical and thoracic ROM and NP severity. Results: Thoracic ROM was higher in the mild pain group (median: 47.35, IQR: 10.13) than in the moderate pain group (median: 42.10, IQR: 13.60; p < 0.001). The NDI had a negative correlation with thoracic ROM (r = −0.65; p < 0.05) and a positive correlation with cervical ROM (r = 0.84; p < 0.01). Additionally, thoracic ROM mediated the effect of cervical ROM on NP, particularly influencing NDI scores (p < 0.01). Conclusions: This study found a significant association between reduced thoracic ROM and increased NP severity, highlighting the role of thoracic spine mobility in NP among young white-collar workers. Targeted interventions for thoracic dysfunction may reduce compensatory cervical strain and improve NP management, suggesting that thoracic spine assessments should be integrated into routine clinical evaluations. [ABSTRACT FROM AUTHOR]

Background Thoracic rotation mobility is crucial for athletes in rotational sports such as baseball, golf, and swimming to maintain the proper biomechanics associated with the sport. Accurate differentiation between normal mobility and active and passive physiological deficits in the thoracic region is critical for identifying the need for intervention to the thorax. Purpose To establish the reliability and discriminant validity of visual estimation of thorax rotation range of motion across clinicians of differing experience levels in determining normal mobility and active or passive physiological deficits when utilizing the quadruped lumbar-locked position. Study Design Cross-sectional Methods Thirty-eight subjects (21 female, 17 male) with a mean age of 27 years ± 6.67 were assessed with the quadruped lumbar-locked thorax rotation test by three examiners with various clinical experience in real-time and again one week later. Bilateral active and passive lumbar-locked thorax rotation mobility was assessed by all raters and categorized as "Unrestricted" (≥50°) or "Restricted" (<50°) while a research assistant simultaneously measured the motion with a digital inclinometer. All raters were blinded to the results. All results were analyzed for intra-rater reliability and agreement. Results Test-retest intra-rater reliability ranged from 0.55-0.72 and percent absolute agreement ranged from 0.82-0.89. Inter-rater reliability ranged from 0.45-0.59 while percent absolute agreement between raters ranged from 0.74-0.84. There was a significant difference in range of motion between "Unrestricted" and "Restricted" categories for both active (Unrestricted=54.6-58.9; Restricted=40.4-44.4; p<0.001) and passive motion (Unrestricted=61.3-63.5; Restricted=39.2-39.7; p<0.001). The only interaction effect was for passive left rotation [Rater A Restricted x =34.3(30.4-38.2); Rater C Restricted (x )=43.8(41.3-46.4); p=.000]. Conclusion The quadruped lumbar-locked thorax rotation test demonstrates moderate to substantial test-retest intra-rater and inter-rater reliability regardless of clinical experience. The quadruped lumbar-locked thorax rotation test can accurately discriminate between individuals with active and passive physiological deficits regardless of rater experience using visual estimation. Level of Evidence 3b [ABSTRACT FROM AUTHOR]

Study Design: Technical Report Objective: Cerebrospinal fluid (CSF) leak secondary to anterior osteophytes at the cervico-thoracic junction is a rare cause of intracranial hypotension. In this article we describe a technique for anterior repair of spontaneous ventral cerebrospinal fluid leaks in the upper thoracic spine. Methods: In this technical report and operative video, we describe a 23-year-old male who presented with positional headaches and bilateral subdural hematoma. Dynamic CT myelography demonstrated a high flow ventral cerebrospinal fluid leak associated with a ventral osteophyte at the level of the T1-T2 disc space. Targeted blood patch provided only temporary improvement in symptoms. An anterior approach was chosen to remove the offending spur and micro-surgically repair the dural defect. Results: The patient had complete resolution of his preoperative symptoms after primary repair. Conclusions: In select cases, an anterior approach to the upper thoracic spine is effective to repair Type 1 cerebrospinal fluid leaks. [ABSTRACT FROM AUTHOR]

Rotator cuff related shoulder pain (RCRSP) is a prevalent clinical presentation characterized by substantial diagnostic uncertainty. Some of this uncertainty relates to the involvement of the cervical and thoracic spine as a source of or contributing factor to RCRSP. Thirty-two RCRSP cases and thirty-two asymptomatic controls (AC), recruited from Hospital La Paz-Carlos III between March 2023 and September 2023, were matched for age, gender and hand dominance. Assessed variables included cervical, thoracic range of motion (ROM) and neck disability index (NDI). Independent t-tests were used to compare each of these measurements and multiple linear regression was used to examine the capacity of neck or psychosocial variables to predict the variability of the NDI. The RCRSP group had significantly reduced cervical rotation [RCRSP (111.14 ± 22.98); AC (130.23 ± 21.20), d = 0.86, p < 0.01] and flexo-extension ROM [RCRSP (112.47 ± 2.07); AC (128.5 ± 17.85), d = 0.80, p < 0.01] as well as thoracic spine flexion [RCRSP (33.02 ± 1.14); AC (34.14 ± 1.01), d = 1.04, p < 0.01], extension [RCRSP (28.63 ± 0.89); AC (27.37 ± 0.89), d = −1.40, p < 0.01], right rotation [RCRSP (40.53 ± 10.39); AC (54.45 ± 9.75), d = 1.38, p < 0.01], left rotation [RCRSP (39.00 ± 11.26); AC (54.10 ± 10.51), d = 1.39, p < 0.01] and a significantly increased NDI score [RCRSP (17.56 ± 7.25); AC (2.47 ± 3.25), d = −2.69, p < 0.01]. The variables best explaining neck disability were central sensitization index and SF-12 total score (adjusted R2 = 0.75; p < 0.01). These results suggest that clinicians should assess cervical and thoracic spine mobility in patients with RCRSP. [ABSTRACT FROM AUTHOR]

Vertebral compression fracture is a common disease in the current orthopedic field. However, the occurrence of re-fracture in neighboring vertebrae after surgery is a problem that cannot be ignored, which has a serious impact on the normal life of patients. OBJECTIVE: The aim of this study is to establish four postoperative models with different recovery heights using computed tomography images. By using finite element analysis, we derived the stresses on the neighboring vertebrae at different recovery heights and further explored the importance of postoperative recovery of the height of the injured vertebrae. METHODS: A finite element model of the thoracolumbar spine (T11-L3) was established and validated, on the basis of which four postoperative finite element models of L1 with different recovery heights of 100%, 80%, 60%, and 40% were constructed, in which the cement capacity varied with the recovery height. The specific models are as follows: Model 1 was the postoperative model with normal recovery height, and the cement capacity was 8.3 mL. Model 2 was the postoperative model in which 20% of the anterior height of the L1 was removed and the posterior convexity angle became 10.41°, and the cement capacity was 6.9 mL. Model 3 was the postoperative model in which 40% of the anterior height of the L1 was removed and the posterior convexity angle became 20.17°, and the cement capacity was 4.7 mL. Model 4 was a postoperative model with 60% of the L1 anterior height removed and the posterior convexity angle changed to 28.85°, with a cement capacity of 3.6 mL. For evaluation of the postoperative model, we applied a moment of 7 Nm and an axial force of 500 N. The followings were recorded and analyzed: peak stresses in the L2 upper endplate and T12 lower endplate; peak stresses in the L2 and T12 cancellous bone. RESULTS AND CONCLUSION: (1) The highest peak stresses for each condition of the L2 upper endplate, T12 lower endplate, L2 cancellous bone, and T12 cancellous bone occurred in Model 1 and Model 4. In particular, the T12 lower endplate, except for the posterior extension condition, the anterior flexion, left and right lateral bending, and left and right rotation conditions all reached their highest peak stresses in Model 4, with stresses of 50.3, 33.1, 44.9, 34.3, and 31.9 MPa. (2) Based on the peak stresses in the adjacent vertebral endplates and cancellous bone, after excluding Model 1 and Model 4, the minimum peak stresses for most of the conditions appeared in the Model 2, and the minimum peak stresses appeared in the Model 2 in 66.6% of the cases, especially in the upper endplates of the L2 and cancellous bone except for the posterior extension condition, the minimum peak stresses all appeared on the Model 2. (3) Therefore, controlling the recovery height at about 100% and 40% of the original height was a dangerous recovery height, which had a greater impact on the neighboring vertebrae. Controlling the recovery height at about 80% of the original height may be a more ideal choice. With a recovery height of about 80% of the original height, the adjacent vertebrae are subjected to less stress, thus reducing the risk of re-fracture of the adjacent vertebrae in the patient. [ABSTRACT FROM AUTHOR]

Objective. To conduct a meta-analysis of studies focused on the conservative treatment of thoracolumbar burst fractures, and to determine the efficacy and safety of this method in the observed group of patients. Material and Methods. The study was performed following PRISMA guidelines. Inclusion criteria for meta-analysis were as follows: availability of full-text version of the article in English or Russian; A3 or A4 type fractures according to the AOSpine classification, or burst fractures of types IIA, IIB or IIC according to the Denis classification, or a direct indication of the presence of a burst fracture without its classification; absence of neurological deficit; age over 18 years; detailed description of treatment outcomes or complications; and a follow-up for at least one year. Results. The meta-analysis included 29 articles describing the results of treatment of 1107 patients. At the time of admission, the following radiographic parameters were calculated for patients: mean kyphotic angle, 13.6 (95 % CI, 10.8–16.5), degree of vertebral body compression, 39.9 % (95 % CI, 27.7–52.0), and the degree of compression of the spinal canal lumen, 41.7 % (95 % CI, 29.2–54.2). A follow-up examination revealed a significant increase in segmental kyphosis by 3%, in vertebral body compression by 3.7 %, and lysis of bone fragments with a decrease in the degree of spinal canal stenosis by 2 times. The incidence of neurological deficit and progression of thoracic and lumbar spine instability was 5.8 % (95 % CI, 4.1–8.1) and 6.5 % (95 % CI, 4.5–9.3), respectively. Recovery of work ability according to Denis scale was as follows: W1 and W2 – 74.7 % (95 % CI, 63.9–83.1); W3 – 14.1 % (95 % CI, 10.2–19.3); and W4 and W5 – 14.8 % (95 % CI, 8.8–23.9). Conclusion. Conservative treatment of neurologically intact thoracolumbar burst fractures can be an effective and safe option if the angular deformity does not exceed 16 degrees and the anterior vertebral body compression rate is up to 52 %. With conservative therapy, a twofold reduction in spinal canal stenosis was observed due to the lysis of bone fragments. The pooled prevalence of radiculopathy or myelopathy with conservative therapy was 5.8 %. Orthopedic intervention due to the progression of instability of the damaged segment may be required in 6.5 % of patients. More than 90 % of patients returned to full-time work following conservative therapy. Comparative studies on the effectiveness of conservative therapy versus surgical treatment should be continued to form clear recommendations for the choice of treatment tactics for patients with uncomplicated fractures of the thoracic and lumbar spine.

Abstract Despite a 15% misplacement rate of screws in idiopathic scoliosis surgery, little is known about the relationship between pedicles and nerve structures in the entire thoracic curve. This study aimed to explore the spinal cord’s proximity to the pedicle wall at each thoracic vertebra in the entire thoracic curve, while considering different anatomical changes. Spinal cord to medial pedicle distances were measured on magnetic resonance imaging in 73 patients who underwent posterior spinal fusion with pedicle screw instrumentation. Associations with different variables were examined. A total of 51 patients (69.9%) showed a distance within 2 mm at the apex vertebra on the concave side, more than 50% had a distance within 2 mm in the next thoracic vertebra level above and below, and more than 25% two levels above and below. Weak correlations were found between proximity of the spinal cord at the apex vertebra and vertebra’s level and Cobb angle on the concave side (r = − 0.310, P = 0.008, r = 0.380, P = 0.001, respectively). These results emphasize the importance of thorough assessment when placing thoracic pedicle screws in idiopathic scoliosis patients. Further research is warranted to develop surgical strategies aimed at preventing potentially neurological complications resulting from screw misplacement.

A chordoma is a slow growing, locally invasive, low-grade tumor belonging to the sarcoma family. It mainly affects the sacrum and skull base. We present a case of thoracic chordoma initially presented with epidural hematoma (EDH), which is a rare clinical entity. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes the clinical characteristics and outcome of thoracic chordoma. Our case involves a 60-year-old male who, despite no history of trauma, presented with acute paraparesis. An epidural hematoma was identified at T6 level, leading to a surgical intervention involving T4-6 laminectomy and fixation. Six months subsequent to surgery, the patient experienced progressive lower limb weakness and spasticity. Computed tomography (CT) exhibited erosion of T6 and an associated aggressive mass. Magnetic resonance imaging (MRI) revealed a large heterogenous soft tissue mass arising from the vertebral body and right pedicle of D6, protruding in the epidural space and compressing the spinal cord focally at this level. The mass measured approximately 5 × 4 × 3.5 cm. Magnetic resonance myelography indicated a filling defect at T5–6 level, confirming the intraspinal location of the soft tissue lesion. Complete excision of the mass confirmed the diagnosis of thoracic chordoma. Postoperative follow-up demonstrated notable improvement in the lower limb spasticity and paraparesis, and the patient started adjuvant radiotherapy. This case underscores the importance of maintaining a high index of suspicion when evaluating presentations resembling EDH. [ABSTRACT FROM AUTHOR]

Background/purpose Interventions including posterior glenohumeral mobilizations (PGM), sleeper stretches, and thoracic manipulation are commonly used to address posterior shoulder tightness. The purpose of this study was to assess the effects of adding thoracic manipulation to PGM and sleeper stretches on passive range of motion (PROM), joint mobility, and infraspinatus electromyographic (EMG) activity in shoulders with decreased internal rotation (IR) PROM. Design Randomized Sequential Intervention Laboratory Study Methods Forty individuals with clinically significant IR loss attended two study sessions. Participants were randomized to receive five 30 seconds bouts of either grade III PGM or sleeper stretching. Following a seven-day washout period, all participants attended a second session and received a prescriptive supine HVLA manipulation targeting the T3-4 segment, followed by the previously randomized intervention. Outcome measures included internal rotation PROM, horizontal adduction PROM, posterior glenohumeral joint translation assessed via ultrasound imaging, and EMG activity of the infraspinatus during a PGM. All outcome measures were assessed pre- and immediately post-intervention and compared statistically. Results There were significant within-group, but not between-group, differences for IR and horizontal adduction PROM following a single session of PGM or sleeper stretch. When combined with thoracic manipulation, significantly smaller within session changes of IR PROM were observed for both PGM (mean difference 4.4, p=0.017) and sleeper stretches (mean difference 6.4, p=0.0005). There were no significant between group differences for horizontal adduction PROM, humeral head translation, or EMG activity across all time points. Discussion Both GH posterior mobilizations and sleeper stretches improved IR and horizontal adduction PROM in a single session. The addition of thoracic manipulation prior to local shoulder interventions resulted in smaller gains of both IR and horizontal adduction ROM. [ABSTRACT FROM AUTHOR]

Introduction: Epithelioid hemangioma (EH) is an intermediate locally aggressive tumor that consists of epithelioid cells and endothelial cell differentiation, which can occur at any age, but is most common between the ages of 30 and 40 years. EH in the thoracic spine is rare, and accurate diagnosis is critical to treatment planning. Our aim was to explore the imaging and clinical data of thoracic spine EH to improve the understanding of this rare disease. Methods: From January 1, 2018 to June 30, 2023, a database of thoracic spine masses was retrospectively reviewed. Five patients with histologically proven thoracic spine EH and complete imaging available were identified and analyzed. Computed tomography (CT) and magnetic resonance imaging (MRI) findings were evaluated separately by two radiologists with more than 10 years of experience. Positron emission tomography (PET)/CT was conducted by two nuclear medicine diagnostic technologists with at least 5 years of experience. Results: The patients included three male and two female patients aged 23 to 56 years (mean age was 38.4 ± 14.3 years). All patients underwent CT, MRI, and 18FFDG PET/CT examination before treatment. Four patients were limited to one vertebral involvement, only one patient had multiple vertebral involvement, and all tumors involved the accessories, including one involving the posterior ribs. The maximum diameter of the tumor ranged from 2.7 to 4.3. Conclusions: CT, MRI, and 18F-FDG PET/CT findings of thoracic spine EH have certain characteristics, and understanding these imaging findings will help to obtain accurate diagnosis before surgery. [ABSTRACT FROM AUTHOR]

Cryptococcus neoformans is a type of fungal infection, which primarily affects the central nervous system and lungs of immunocompromised individuals. Spinal infections are known to be a rare manifestation of cryptococcosis. Herein, we report a case of a patient with isolated nonspecific spinal lesions at the T10 vertebra. The patient received non-surgical treatment with antifungal drugs, resulting in satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions In high‐frequency spinal cord stimulation anatomic placement targeting of the T9‐10 disc space is based on “empiric” results that are best replicated with coverage broadly from T8 to T10. This study contains the largest cohort of patients evaluating low thoracic morphology and seeks to address the lack of MRI morphological analysis in literature.This study was a retrospective review of a database of 101 consecutive patients undergoing permanent implant of thoracic SCS for chronic pain. Measurements were carried out on preoperative MRI imaging. Anteroposterior (AP) and lateral dimensions of the spinal cord as well as dural sac were measured. In addition, dorsal cerebrospinal fluid thickness and paddle depression distance were also measured.When comparing morphological dimensions by level, dorsal CSF thickness was smaller at T9‐10 than T7‐8 (p = 0.018). In addition, lateral dural and spinal cord diameters were larger at T10‐11 than T9‐10, contributing to larger dural surface area at T10‐11 (p = 0.028). While trends of dorsal CSF thickness tend to decrease with lower thoracic levels, the ratio of surface area of spinal cord to dural sac appeared to remain relatively constant.Dorsal CSF thickness is smaller at T9‐10 than T7‐8 in chronic pain patients in this cohort. More ellipsoid, cord, and spinal canal diameter measurements were noted at lower levels of the thoracic spinal cord, particularly at T10‐11. This may correlate with anatomical SCS placement. Future studies should evaluate efficacy of SCS therapy for pain based on these anatomical considerations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pathologies involving the thoracic spine region may require a 360-degrees fusion that is routinely achieved through two separate approaches, anterior and posterior. However, it is time consuming and associated with non-negligible postoperative morbidities. Costotransversectomy approach can effectively achieve circumferential spinal decompression, posterior stabilization, and ventral reconstruction in a single approach with high safety profile. OBJECTIVE: To evaluate the efficacy and safety of costotransversectomy approach as a single approach in patients with different thoracic spine pathologies, identifying risk factors for perioperative morbidity. PATIENTS AND METHODS: This is a prospective study of 48 patients with dorsal spine pathologies who were managed by costotransversectomy between January 2018 and December 2020. Patients’ demographics, preoperative assessment, operative data, early postoperative complications, and two-year clinical and radiological follow-up were tabulated and analysed. Risk factors for perioperative morbidity were evaluated. Only variables with p-value <0.05 in univariate analysis were included in multivariate analysis. RESULTS: The study included 48 patients who underwent costotransversectomy for dorsal spinal pathologies. Mean age at presentation was 44 years. Tuberculosis (TB) was the most common indication of surgery. Blood loss ranged between 300 and 800 mL, whereas operative time ranged between 120 and 240 minutes. There was a significant improvement in the functional status of patients. Fusion was achieved in 45 patients (93.75%) during the follow-up period. Morbidity occurred in 9 patients (18.75%). Old age, diabetes mellitus, and TB were significant risk factors for postoperative morbidity in the univariate analysis, and only diabetes mellitus was significant in the multivariate analysis. CONCLUSION: Costotransversectomy is a safe and effective approach for the management of patients with thoracic spine disorders in a single setting, achieving favourable clinical and radiological outcome. Diabetes proved to be a significant risk factor associated with increased postoperative morbidity in a multivariate analysis. [ABSTRACT FROM AUTHOR]

The LECA to the thoracic spine can be used for the removal of posterior mediastinal neurofibromas which causes anterior and lateral spinal cord compression. It provides lateral exposure to the thoracic and lumbar vertebrae without entering the pleural cavity (extra-cavitary) and enables the surgeon to visualize the anterior dural surface better than with other posterior lateral exposures. In this case report, we describe the challenges we face while operating the posterior mediastinal tumour using this surgical approach. This approach provides better access to ventral and lateral thoracic and upper lumbar spine pathologies.

The LECA to the thoracic spine can be used for the removal of posterior mediastinal neurofibromas which causes anterior and lateral spinal cord compression. It provides lateral exposure to the thoracic and lumbar vertebrae without entering the pleural cavity (extra-cavitary) and enables the surgeon to visualize the anterior dural surface better than with other posterior lateral exposures. In this case report, we describe the challenges we face while operating the posterior mediastinal tumour using this surgical approach. This approach provides better access to ventral and lateral thoracic and upper lumbar spine pathologies. [ABSTRACT FROM AUTHOR]

Neuroblastoma (NB) in the adults is extremely rare. Even less encountered is NB involving the adult spine with only a few reported cases. Because of its rarity, there are as yet no well-established treatment guidelines for NB in the adults. Treatment strategies, therefore, are often extrapolated from paediatric data. We report a case of a 51-year-old man with NB involving the thoracic spine who had surgical excision with a good postoperative outcome in the short term. [ABSTRACT FROM AUTHOR]

Ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) are related diseases associated with the ossification of spinal ligaments that can occasionally lead to thoracic myelopathy. We retrospectively analyzed the clinical data of 34 consecutive patients who underwent thoracic spinal surgeries for OPLL and/or OLF at our hospital between July 2010 and June 2022, and statistically compared data between patients with thoracic OPLL (TOPLL; n = 12) and those with thoracic OLF (TOLF; n = 22). The mean age of the TOPLL group was significantly lower than that of the TOLF group (53.7 vs. 68.4 years). The TOPLL group exhibited a greater female predominance than the TOLF group (58.3% vs. 18.2%). The median body mass index of the TOPLL group was significantly higher than that of the TOLF group (33.0 vs. 26.0 kg/m2). Patients with TOPLL significantly required instrumented fusion and repetitive surgical intervention more than those with TOLF (83.3% vs. 9.1%; 50.0% vs. 0.0%). Although neurological deterioration just after the intervention was more common in patients with TOPLL (41.7% vs. 4.6%), no difference was observed in thoracic Japanese Orthopaedic Association score and recovery rate in the chronic phase between TOPLL and TOLF. The TOPLL group had a younger onset, female dominance, and a greater degree of obesity when compared with the TOLF group. The surgery for TOPLL is challenging, considering that it requires long-range decompression and fusion, subsequent operations, careful management, and long-term follow-up, when compared to TOLF, which necessitates only simple decompression.

Background The thoracic spine pathology can lead to severe disability and discomfort. This study aims to identify determinant characteristics in patients with thoracic spine pathologies who present with non-regional complaints such as lumbar/cervical pain and others. Methods A prospective observational descriptive study was conducted at Basrah Teaching Hospital from March 2020 to December 2021, enrolling 114 patients categorized into two groups. Group A included patients with thoracic spine pathology and thoracic pain, while Group B consisted of patients with thoracic spine pathology and non-local symptoms (such as lower lumbar pain, pain in extremities, etc.). Comprehensive clinical evaluations were performed using a specially designed questionnaire. Results The majority of patients were in the 60-79 age group, with females comprising 55 % in Group A and 60 % in Group B. Smoking was observed in 28.98 % of Group A and 26.66 % of Group B. Symptomatic patients with solitary back pain commonly exhibited dorsal root compression symptoms (49.27 %), lower limb weakness (18.84 %), and sphincter dysfunction (7.24 %). Patients with thoracic plus lower and/or neck pain frequently reported paraesthesia (42.22 %) and cervical root symptoms (48.38 %). Kyphotic deformity was present in 20.28 % of Group A and 11.11 % of Group B, while tenderness was observed in 23.18 % of Group A and 13.33 % of Group B. Plain radiograph changes, including disk space narrowing (44.44 %), subchondral sclerosis (29.63 %), curve alterations (29.63 %), and facet arthropathy (25.9 %), were more prevalent in those with symptomatic thoracic back pain (Group A). Conclusion Non-local symptoms in thoracic spine pathologies are common, with complicated and multi-site low back pain being more prevalent than isolated back or thoracic pain. Elderly individuals, females, obesity, and comorbidities appear to be predictive risk factors for low back pain development. Paraesthesia emerges as the most common neurological manifestation, while kyphosis and scoliosis are primary presentations of thoracic pathologies. Multi-modalities of imaging, including plain radiographs, MRI, CT scan, and DEXA scan, can aid in detecting back pathologies. The mainstay of managing symptomatic thoracic pathologies is surgical intervention.

Abstract Background The clay-shoveler fracture, named after Australian clay shovelers from the 1930s, results from high-energy, repetitive pulling mechanisms and is commonly associated with shoveling or digging. This injury primarily affects the lower cervical and upper thoracic vertebrae, particularly the C7 and T1 vertebrae. The avulsion mechanism, caused by stress on the spinous processes, may lead to sudden, severe upper back pain, limiting the affected individual’s ability to work effectively. Case presentation This report presents the case of a 27-year-old boiler operator who experienced persistent neck pain, which did not respond to conservative management. Imaging studies revealed a T1 spinous process fracture with associated soft tissue edema, diagnosed as a clay-shoveler fracture. Conventional treatment with a semirigid cervical collar, analgesia, and rest was administered, leading to a favorable outcome. The clay-shoveler fracture, though rare, should be considered in cases involving repetitive stress on the cervical and thoracic spine, especially in occupations that require heavy lifting. In most instances, conservative management proves effective in relieving pain and enabling recovery. Conclusion Recognizing the clay-shoveler fracture is crucial for timely diagnosis and treatment. This case report underscores the occupational nature of the injury and its association with specific work activities. Further research and reporting of similar cases will contribute to a deeper understanding of this unusual fracture pattern, its risk factors, and optimal management strategies.

Objectives: To examine intervertebral fusion sites along the whole spine of patients with ankylosing spondylitis using computed tomography. Methods: This retrospective study examined intervertebral fusion of five sites (anterior/posterior vertebrae, left/right zygapophyseal joints, and spinous process) on 23 vertebrae in the cervical, thoracic, and lumbar regions of the spine in 40 patients diagnosed with ankylosing spondylitis at our institute between January 2004 and December 2022. Results: Mean age [± standard deviation (SD)] was 40.5 (± 17) years, and mean disease duration (± SD) was 11.4 (± 10.5) years at computed tomography evaluation; 55.9% were human leukocyte antigen B-27–positive. Fifteen (37.5%) patients showed intervertebral fusion in the thoracic and/or cervical regions, but not in the lumbar region. Fusion of posterior vertebrae was observed most frequently in the thoracic region, compared to the cervical and lumbar regions. In particular, more than half of the patients showed fusion of posterior vertebrae Th4–Th5 to Th7–Th8. Conclusions: In 37.5% of patients, intervertebral fusion was evident in the thoracic and/or cervical regions but not in the lumbar region. The most common site and region of intervertebral fusion were the posterior vertebrae of the middle thoracic region. [ABSTRACT FROM AUTHOR]

Trunk postural control differs between individuals with and without chronic low back pain (LBP). Whether this corresponds to differences in hip/spine coordination during the early acute phase of LBP (ALBP) is unclear. To compare hip/spine coordination in relation to seat movements between individuals with and without ALBP when balancing on an unstable seat and to identify coordination strategies to maintain balance using cluster analysis. Cross-sectional observational study. ALBP (n=130) and pain-free (n=72) individuals. Frequency domain measures to evaluate hip/spine coordination (amplitude spectrum, phase angle, and coherence) and time-series measures to assess overall balance performance (center of pressure [CoP] reflecting the amount of seat movements, upper thorax motion as a surrogate for head motion). Participants maintained balance while sitting on a seat fixed to a hemisphere. Seat, hip, and spine (lower lumbar, lumbar, upper lumbar, and thoracic) angular motion and force plate data were recorded. Overall, seat/CoP movements (amplitude spectrum and RMS displacement) were greater (in both planes) and sagittal coordination (coherence) between the hip or lower spine and seat movements was lower in ALBP than controls. Cluster analysis using coherence data revealed different coordination strategies to maintain balance. Separate clusters used a " lower lumbar strategy " and " hip strategy " in the sagittal plane, and a " lower and upper lumbar strategy " and " lower lumbar strategy " in the frontal plane. A cluster using a " low coherence strategy " in both planes was also identified. Hip and lower spine coordination was less in individuals with ALBP in conjunction with a lower quality of overall balance performance. However, interpretation of the relationship between coherence and overall balance performance was not straightforward. Clusters in both the ALBP group and the control group adopted a low coherence strategy, and this was not consistently related to poor overall balance performance. This suggests overall balance performance cannot be inferred from coherence alone and requires consideration of interaction of other different features. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective observational study. Objectives: To evaluate the long-term recurrence rates and functional status of patients with thoracic ossification of the posterior longitudinal ligament (OPLL) after decompression and posterior fusion surgery. Methods: Thirty-seven consecutive patients who underwent posterior thoracic spine surgery at a single institution were retrospectively reviewed. The long-term neurological and functional outcomes of 25 patients who were followed up for ≥10 years after surgery were assessed. Factors associated with the recurrence of myelopathy were also analyzed. Results: The mean preoperative Japanese Orthopaedic Association score was 3.7, which improved to 6.5 at postoperative year 2 and declined to 6.0 at a mean follow-up of 18 years. No patient experienced a relapse of myelopathy due to OPLL within the instrumented spinal segments. However, 15 (60%) patients experienced late neurological deterioration, 10 of whom had a relapse of myelopathy due to OPLL or ossification of the ligamentum flavum (OLF) in the region outside the primary operative lesion, while 4 developed myelopathy due to traumatic vertebral fracture of the ankylosed spine. Young age, a high body mass index, and lumbar OPLL are likely associated with late neurological deterioration. Conclusions: Decompression and posterior instrumented fusion surgery is a reliable surgical procedure with stable long-term clinical outcomes for thoracic OPLL. However, as OPLL may progress through the spine, attention should be paid to the recurrence of paralysis due to OPLL or OLF in regions other than the primary operative lesion and vertebral fractures of the ankylosed spine after surgery for thoracic OPLL. [ABSTRACT FROM AUTHOR]

Phosphaturic mesenchymal tumors (PMT) are rare and distinctive tumors that typically result in paraneoplastic syndrome known as tumor-induced osteomalacia (TIO). We report a case of bilateral osteoporotic femoral neck fracture caused by PMT. PMT was surgically resected, followed by sequential treatment of bilateral femoral neck fractures with total hip arthroplasty (THA). A 49-year-old perimenopausal woman experienced consistent bone pain with limb weakness persisting for over 2 years. Initially, she was diagnosed with early osteonecrosis of the femoral head and received nonsurgical treatment. However, from 2020 to 2022, her pain extended to the bilateral shoulders and knees with increased intensity. She had no positive family history or any other genetic diseases, and her menstrual cycles were regular. Physical examination revealed tenderness at the midpoints of the bilateral groin and restricted bilateral hip range of motion, with grade 3/5 muscle strength in both lower extremities. Laboratory findings revealed moderate anemia (hemoglobin 66 g/L), leukopenia (2.70 × 109 /L), neutropenia (1.28 × 109 /L), hypophosphatemia (0.36 mmol/L), high alkaline phosphatase activity (308.00 U/L), and normal serum calcium (2.22 mmol/L). After surgery, additional examinations were performed to explore the cause of hypophosphatemic osteomalacia. After definitive diagnosis, the patient underwent tumor resection via T11 laminectomy on August 6, 2022. Six months after the second THA, the patient regained normal gait with satisfactory hip movement function without recurrence of PMT-associated osteomalacia or prosthesis loosening. By providing detailed clinical data and a diagnostic and treatment approach, we aimed to improve the clinical understanding of femoral neck fractures caused by TIO. [ABSTRACT FROM AUTHOR]

IntroductionClinical FindingsOutcomesDiscussionThis case report describes the outcomes of a patient with idiopathic pulmonary fibrosis (IPF) treated with manual therapy (MT) in an outpatient physical therapy setting. IPF is a life-threatening interstitial lung disease, often requiring lung transplant for prolonged health related quality of life and survival. There is little literature to support use of MT for IPF.The patient was a 66-year-old male with IPF and on the Organ Procurement and Transplant Network (OPTN). The patient was dependent on oxygen and referred to physical therapy with neck pain, shoulder pain, and headaches. Evaluation revealed impairments classified as thoracic hypomobility paired with upper extremity referred pain, shoulder impairments and neck pain. Headaches were classified as cervicogenic in nature.Improved objective measures of cardiovascular function and quality of life pre- and post- transplant were observed in this patient after 14 treatment visits.The utilization of MT appeared to address the patient’s impairments, improved quality of life, improved pulmonary function and improved transplant outcomes. [ABSTRACT FROM AUTHOR]

Background: The clay-shoveler fracture, named after Australian clay shovelers from the 1930s, results from high-energy, repetitive pulling mechanisms and is commonly associated with shoveling or digging. This injury primarily affects the lower cervical and upper thoracic vertebrae, particularly the C7 and T1 vertebrae. The avulsion mechanism, caused by stress on the spinous processes, may lead to sudden, severe upper back pain, limiting the affected individual's ability to work effectively. Case presentation: This report presents the case of a 27-year-old boiler operator who experienced persistent neck pain, which did not respond to conservative management. Imaging studies revealed a T1 spinous process fracture with associated soft tissue edema, diagnosed as a clay-shoveler fracture. Conventional treatment with a semirigid cervical collar, analgesia, and rest was administered, leading to a favorable outcome. The clay-shoveler fracture, though rare, should be considered in cases involving repetitive stress on the cervical and thoracic spine, especially in occupations that require heavy lifting. In most instances, conservative management proves effective in relieving pain and enabling recovery. Conclusion: Recognizing the clay-shoveler fracture is crucial for timely diagnosis and treatment. This case report underscores the occupational nature of the injury and its association with specific work activities. Further research and reporting of similar cases will contribute to a deeper understanding of this unusual fracture pattern, its risk factors, and optimal management strategies. [ABSTRACT FROM AUTHOR]

Study Design. A prospective, single-center, observational study. Objective. To explore the association between serum levels of bone turnover markers and ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Summary of Background Data. The relationship between bone turnover markers, such as N-terminal propeptide of type I procollagen (PINP) or tartrate-resistant acid phosphate 5b (TRACP-5b), and OPLL has previously been examined. However, the correlation between these markers and thoracic OPLL, which is more severe than cervical-only OPLL, remains unclear. Methods. This prospective study included 212 patients from a single institution with compressive spinal myelopathy and divided them into those without OPLL (Non-OPLL group, 73 patients) and those with OPLL (OPLL group, 139 patients). The OPLL group was further subdivided into cervical OPLL (C-OPLL, 92 patients) and thoracic OPLL (T-OPLL, 47 patients) groups. Patients' characteristics and biomarkers related to bone metabolism, such as calcium, inorganic phosphate (Pi), 25-hydroxyvitamin D, 1a,25 dihydroxyvitamin D, PINP, and TRACP-5b, were compared between the Non-OPLL and OPLL groups, as well as the C-OPLL and T-OPLL groups. Bone metabolism biomarkers were also compared after adjusting for age, sex, body mass index, and the presence of renal impairment using propensity score-matched analysis. Results. The OPLL group had significantly lower serum levels of Pi and higher levels of PINP versus the Non-OPLL group as determined by propensity score-matched analysis. The comparison results between the C-OPLL and T-OPLL groups using a propensity score-matched analysis showed that T-OPLL patients had significantly higher concentrations of bone turnover markers, such as PINP and TRACP-5b, compared with C-OPLL patients. Conclusions. Increased systemic bone turnover may be associated with the presence of OPLL in the thoracic spine, and bone turnover markers such as PINP and TRACP-5b can help screen for thoracic OPLL. [ABSTRACT FROM AUTHOR]

Patients with congenital stenosis of the spine (CSS) present with clinical symptoms at an early age and fewer degenerative hypertrophic changes than the more common degenerative cohort. Literature is lacking in the true prevalence of CSS affecting the 3 segments of the spine in isolation, as well as in tandem in the Indian subcontinent. Anteroposterior spinal canal diameter in axial plane computed tomography at the midvertebral level was measured in asymptomatic patients with whole-spine computed tomography. Spinal canal stenosis was defined as a diameter of <12 mm for the cervical region, <12 mm for the thoracic region, and <13 mm for the lumbar region. Single-level and multilevel stenosis, as well as tandem and triple-region stenosis, were evaluated. The results show the prevalence of CSS as 16.6%, 11.5%, and 20.1% involving the cervical, thoracic, and lumbar spine, respectively. Single-level stenosis affected 90.6%, 94%, and 79.8% of the patients with cervical, thoracic, and lumbar CSS, respectively. Tandem stenosis affected 10.4% of the population (n = 104), with cervicolumbar stenosis being the most prevalent (n = 51, 5%). The presence of CSS in any one segment of the spine was significantly associated with the presence of stenosis at one of the other segments (P < 0.05). Triple-region stenosis was seen in 0.3% (n = 3) patients. The prevalence of cervical, thoracic, lumbar and tandem stenosis from our study is established at 16.6%, 11.5%, 20.1%, and 10.4%. Additionally, our study demonstrates the association between stenosis of the different regions of the spine. [ABSTRACT FROM AUTHOR]

Study design: This is a cross-sectional survey. Objective: The aim was to assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs). Summary of background data: TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions. Methods: Our proposed system classifies 5 types of TDHs using anatomic and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (>40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1 to 4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons with substantial TDH experience rated 10 illustrative cases to determine the system's reliability. Interobserver and intraobserver reliability were determined using the Fleiss kappa coefficient. Surgeons were also surveyed to obtain consensus on surgical approaches for the various TDH types. Results: High agreement was found for the classification system, with 80% (range 62% to 95%) overall agreement and high interrater and intrarater reliability (kappa 0.604 [moderate to substantial agreement] and kappa 0.630 [substantial agreement], respectively). All surgeons reported nonoperative management of type 0 TDHs. For type 1 TDHs, most respondents (71%) preferred posterior approaches. For type 2 TDHs, responses were roughly equivalent for anterolateral and posterior options. For types 3 and 4 TDHs, most respondents (72% and 68%, respectively) preferred anterolateral approaches. Conclusions: This novel classification system can be used to reliably categorize TDHs, standardize description, and potentially guide the selection of surgical approach. Validation of this system with regard to treatment and clinical outcomes represents a line of future study. [ABSTRACT FROM AUTHOR]

PNET of spine are extremely rare, it represent less than 1% of spinal tumors. They are highly invasive and malignant, rapidly growing with grave prognosis. In this case report a 34 yrs lady presented clinically as back ache, urinary symptoms and progressive weakness & spasticity of both lower limbs. After workup patient underwent laminectomy & microscopic gross total excision of tumor, following surgery she improved symptomatically. After confirmation of HPE and IHC she underwent radiotherapy, but she did not tolerate chemotherapy and later on tumor recurred and patient succumbed to the disease. [ABSTRACT FROM AUTHOR]

Anaplastic large cell lymphoma (ALCL) is a rare variety of non-Hodgkin lymphoma that primarily affects children and young adults and is caused by the fusion of the nucleophosmin 1 and ALK genes, which turns on several signalling pathways. Despite the fact that ALCL frequently affects lymph nodes and extranodal sites, involvement of the central nervous system (CNS) is quite uncommon, with symptoms like pain and fever. The spinal localization may result in neurological impairments. T1WI hypointense lesions with T2WI hyperintensity can be observed on MR images, while bone sequestra can be seen in CT scans. The gold standard for diagnosis is still histology, though. Based on distinctive morphological characteristics, immunohistochemical staining can differentiate ALK-positive ALCL from other ALCLs. The prognosis for ALK-positive ALCL is typically better than ALK-negative ALCL, and treatment options include surgery followed by chemotherapy. ALK inhibitors and CAR-T cell therapy are 2 newly developed targeted treatments that have the potential to improve results. This case report illustrates the rarity of CNS ALCL and the difficulties in diagnosis and treatment by describing a 16-year-old female patient with ALCL affecting the thoracic spine and spreading to the mediastinum and surrounding tissue.

Investigating all forces exerted on the patient's body during high-velocity, low-amplitude spinal manipulative therapy (SMT) remains fundamental to elucidate how these may contribute to SMT's effects. Previous conflicting findings preclude our understanding of the relationship between SMT forces acting at the clinician--patient and patient--table interfaces. This study aimed to quantify forces at the clinician-participant and participant-table interfaces during thoracic SMT in asymptnomatic adults. An experienced clinician provided a posterior to anterior SMT centered to T7 transverse processes using predetermined force-time characteristics to 40 asymptomatic volunteers (20 females; average age = 27.2 [4.9] y). Forces at the clinician--participant interface were recorded by triaxial load cells; whereas, forces at the participant-table interface were recorded by the force-sensing table technology. Preload force, total peak force, time to peak, and loading rate at each interface were analyzed descriptively. Total peak vertical forces at the clinician-participant interface averaged 532 (71) N while total peak forces at the participant-table interface averaged 658 (33) N. Forces at the participant--table interface were, on average, 1.27 (0.25) times larger than the ones at the clinician-participant interface. Larger forces at the participant--table interface compared with the ones at the clinician--participant interface during thoracic SMT are consistent with mathematical models developed to investigate thoracic impact simulating a dynamic force-deflection response. [ABSTRACT FROM AUTHOR]

The surgical treatment of thoracic spinal tuberculosis has garnered enormous interest from researchers toward the development of posterior surgical techniques that have contributed to greater use of the 1-stage posterior approach. This study aims to demonstrate the initial clinical experience of a modified total posterior approach, in which the 1-stage posterior approach preserves the posterior spinal column structure by combining with the endoprosthetic implant fusion for thoracic spinal tuberculosis. In this clinical study, we intended to report the initial idea of a modified total posterior approach. In detail, a 1-stage posterior approach was applied to preserve the posterior spinal column structure that could be applied to clinical practice. The employed practical procedure presented a reduced duration of surgical intervention and intraoperative trauma. Nevertheless, further studies with large samples and multiple centers are required to explore the idea comprehensively. This approach offered some advantages in terms of intraoperative exposure, blood loss volume, and length of surgery. Further, multicenter studies with large samples are needed to understand the precise effects and implications of the approach. [ABSTRACT FROM AUTHOR]

Study Design: Pedicle screw study. Objective: The selection of pedicle screw parameters usually involves the surgeon's analysis of preoperative CT imaging along with anatomical landmarks and tactile examination. However, there is minimal consensus on a standardized guideline for selection methods on pedicle screws. We aimed to determine the effects of thoracic screw diameter to pedicle width on pullout strength determined by cortical bone purchase. Methods: Biomechanical study performed with human cadaveric thoracic vertebrae and experimentally validated three-dimensional finite element model instrumented with pedicle screws of various diameters. We used a variable (SD/PW) ratio to express the screw selection. We hypothesized a positive correlation between the pullout load determined by the bone purchase and the SD/PW. This relationship was first investigated in a validated finite element model considering bone purchase related to the strength of an upper thoracic vertebra. Then, the correlation to the entire spine is evaluated. Results: The failure load ranged from 371.3 to 1601.0 N, respectively, for 3 and 6 mm screws. The determinant coefficient was increased to R2=.421 when a linear relationship between pullout load and the SD/PW ratio was used. The peak loads of 1216 and 1288N were found for an SD/PW ratio of.83. Conclusion: We have found that the screw pullout load is more correlated to SD/PW than other pedicle measures for a maximized SD/PW ratio of.83. This particular value should be considered the upper limit of the indicated SD/PW ratio and a means to determine the optimal screw diameter to enhance pullout strength. [ABSTRACT FROM AUTHOR]

The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery. [ABSTRACT FROM AUTHOR]

Background: Spinal aneurysmal bone cysts (ABCs) are rare, histologically benign tumors with aggressive behavior, which may cause bone and soft-tissue destruction, particularly affecting neural elements. Management of these tumors, including treatment modalities and follow-up protocols, remains challenging. Case Description: A 7-year-old boy presented with chest wall pain persisting for two months before admission, accompanied by progressive mono paresis lasting ten days before admission. Myelopathy signs were evident during the examination. Imaging confirmed a multicystic lesion at the T6 level involving the posterior elements of the vertebra, with significant cord compression. Due to deteriorating neurological function, he underwent urgent laminectomy and neural decompression, followed by subtotal tumor resection. Postoperative histopathological examination confirmed the diagnosis of an ABC, and the patient experienced significant neurological recovery. However, after 21 days, the patient was readmitted to the emergency department with severe paraparesis. Magnetic resonance imaging revealed rapid growth of the residual tumor, leading to cord compression. He underwent aggressive total tumor resection, T6 vertebral body corpectomy, and fixation with pedicle screws and cage insertion. Following the second surgery, prompt neurological recovery occurred. Conclusion: This rare case report emphasizes the importance of a close follow-up protocol for spinal ABCs in the pediatric population. It highlights the challenges in managing these tumors and the need for vigilant monitoring to detect and address rapid recurrences. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to present a classification of thoracic spine fractures based on anatomical and biomechanical characteristics. Methods: This is a narrative review of the literature. Results: The classification is based on the relationship between movement and common forces acting on the spine. A mechanistic concept is incorporated into the classification, which considers both movements and the application of forces, leading to pathomorphological characteristics. A hierarchical ranking determines the severity of fractures within the thoracic spine, and treatment recommendations are presented in each category. The fourth column of the spine is incorporated into the classification through direct and indirect mechanisms. Conclusions: The proposed classification accommodates several advantages, such as simplicity and practicality, that make this classification helpful in daily practice. The dynamic relationship between movement and force provides a better understanding of the fracture mechanism. Finally, incorporating the fourth column will strengthen the indication for surgical management. To the best of our knowledge, this classification is the first classification developed uniquely for the thoracic spine fractures and will help to address a critical gap in the literature. [ABSTRACT FROM AUTHOR]

• The location of the sternal notch most frequently corresponds to the T2 or T3 vertebral body. • The sternal angle is most frequently located at the T4 or T5 vertebral body. • Increased patient weight and BMI are associated with relatively cephalad sternal landmarks. • Patient height, sex, and ethnicity are not associated with location differences for either sternal landmark. Understanding the location of surface anatomical landmarks in relation to the cervical and thoracic spine is important for a wide array of clinical applications. The objective of this study was to investigate the influence of patient demographic and anthropometric characteristics on the locations of the sternal notch and sternal angle in relation to the spine using computed tomography (CT) of a large cohort of young adult patients without spinal pathology. Vertebral levels corresponding to the sternal notch and sternal angle were analyzed using CT of 1,035 patients. Influences of patient height, weight, body mass index (BMI), sex, and ethnicity were assessed. 567 male and 468 female patients were included in this study. Mean patient height, weight, BMI, and age were 1.68 ± 0.11 m, 81.94 ± 24.39 kg, 27.79 ± 7.9 kg/m2, and 25.9 ± 5.9 years. Of the 1,035 patients, 495 were Hispanic or Latino, 321 were Caucasian, 130 were African American, 68 were Asian, 5 were identified as "other," and 16 did not have racial or ethnic data available. The location of the sternal notch in relation to the thoracic spine demonstrated a bimodal distribution pattern clustered at the T2 and T3 vertebral bodies. The location of the sternal angle in relation to the thoracic spine demonstrated a bimodal distribution pattern clustered at the T4 and T5 vertebral bodies. Moderate, negative correlations were observed between patient weight and location of the sternal notch (r = −0.447; p <.001) and sternal angle (r = −0.499; p <.001), respectively. Zero significant correlations were observed between patient height and location of the sternal notch (r = −0.045; p =.377) or sternal angle (r = −0.080; p =.229). A weak, negative correlation was observed between patient BMI and location of the sternal notch (r = −0.378; p <.001). A moderate, negative correlation was observed between patient BMI and location of the sternal angle (r = −0.445; p <.001). The locations of the sternal landmarks did not differ based on patient sex, race or ethnicity. The location of the sternal notch most frequently corresponds to the T2 or T3 vertebral body, while the sternal angle is most frequently located at the T4 or T5 vertebral body. Increased patient weight is associated with relatively cephalad sternal landmarks. Patient height, sex, and ethnicity are not associated with either sternal landmark. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) with thoracic curvature primarily progresses from the thoracolumbar region, causing abnormal twisting and rotation of the spinal column. This results in unbalanced, asymmetric loads on each vertebrae and increased demands on the thoracic facet joints to withstand rotational stress from adjacent vertebrae. However, no studies have focused on the stress distribution on the facet joints of the thoracic spine in patients with AIS. This study aimed to investigate the mechanical loading and its distribution on the thoracic facet joints of AIS patients using finite element (FE) analysis and surgical specimens. FE models of the thoracic spine were created from a total of 13 female AIS patients (Lenke type 1, n = 4; Lenke type 2, n = 4; Lenke type 3, n = 5). A load of 200 N on the T3 vertebrae and 30 N each on the bilateral superior articular processes were applied vertically to quantify the contact force on the facet joints from T3 to T11. In addition, morphological and histological analyses were performed on the inferior articular processes obtained during surgery. FE analysis demonstrated that contact forces of the facet joint progressively increased from the mid to lower thoracic spine of the concave side, reaching a maximum around the apex. More than 91% of the load was transmitted by the facet joints at the concave side, resulting in facet joint subchondral sclerosis and hypertrophy. The apical facet joint in AIS helps counteract rotational stress between vertebrae and transfers most stress through the concave side. In conclusion, this study found that asymmetric load transfer in the facet joints leads to subchondral sclerosis and hypertrophy. These findings can enhance our understanding of the stress loading on facet joints and the resulting biological changes and help clarify the mechanisms involved in scoliosis progression. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Thoracic ossification of the posterior longitudinal ligament (OPLL) is a rare condition that is mainlyaccompanied by cervical OPLL or ossification of thoracic ligamentum flavum. In case of causing neurologicalmanifestations, it is preferred to treat the condition surgically. Several surgical procedures were introduced,including anterior, posterior, or combined approaches. Laminectomy with instrumented fusion is the mostpopular procedure utilized via the posterior approach. A 32-year-old obese woman, who suffered from backpain and weakness in both lower extremities for one month, was referred to our spine outpatient clinic. Imagingrevealed lower thoracic OPLL (T7/T8 & T8/T9 & T9/T10). The posterior longitudinal ligament had a mixedossification pattern (beaked and continuing cylindrical). To maintain thoracic spine stability and prevent futurekyphosis, we performed laminectomy and long segment fixation (T7 to T12). The post-operative neurologicalexamination revealed a considerable increase in muscle strength and significant pain relief.

Objective. To describe the technique and analysis of early results of thoracoscopic microdiscectomy for disc herniation in the thoracic spine. Material and Methods. A retrospective single-center study included 19 patients (15 women and 4 men) who underwent thoracoscopic microdiscectomy in 2018–2020. The median age of patients was 45 years (range 21–75 years); the median time from the onset of symptoms to the first visit to a neurosurgeon was 12 months (range 1–152 months). Before admission to the hospital, all patients complained of pain of varying intensity in the thoracic spine and/or along the lateral surface of the chest. Nine (47 %) patients had sensorimotor neurological deficit in the legs. The outcomes of operations were assessed using the modified MacNub scale, and postoperative complications were classified according to the Clavien – Dindo scale. Early results of treatment were evaluated at the first follow-up examination (on average, 2 months after the intervention). Data analysis was performed using the SPSS statistical program (IBM SPSS Statistics, version 27). Results. The immediate postoperative period was mostly uneventful in 15 (79 %) patients. Four (21 %) Clavien – Dindo grade 1 complications were registered: 1 (5 %) case of purulent discitis, 1 (5 %) pneumonia, 1 (5 %) worsening of sensory disturbances in the leg, and 1 (5 %) deep vein thrombosis of the leg. The average length of hospital stay was three days. Favorable results (excellent, improvement or satisfactory) according to the modified MacNub scale were registered in 16 (84 %) patients in two months after surgery. In three (16 %) cases, the symptoms remained unchanged (unsatisfactory according to the MacNub scale). No deterioration was recorded in any of the cases. Statistical analysis of the data (Fischer’s method, Mann – Whitney U-test) showed that the only prognostic factor affecting the outcome of the operation was the localization of the hernia in the lower thoracic region between the T8 and T12 vertebrae (p = 0.007). Thus, all nine patients with a hernia in the midthoracic region (T4–T8) had a favorable outcome of the operation, in 6 (67 %) of them there were no complaints. In three (30 %) out of 10 patients with a hernia in the lower thoracic region, there was no complete cure. All other factors (gender, age, hernia size, etc.) did not have a statistically significant correlation with the outcome. Conclusion. Thoracoscopic microdiscectomy can be used in the surgical treatment of herniations of the thoracic spine. Additional studies are needed to confirm the effectiveness and safety of the technique in the long term.

Chronic inflammatory lesions (CIL) in the body are rare and inflammatory pseudotumor (IPT) is a subtype of CIL. Spine is an uncommon location of CIL, with most cases reported in the thoracic spine. Our objective was to review the current literature on IPT. To the best of our knowledge only about 13 cases are reported till date. A retrospective review of 13 existing cases was done. The etiopathogenesis of CIL is uncertain and total surgical excision remains the mainstay. It's a diagnosis of exclusion after ruling out commonly found lesions, both clinically and radiologically. Only histopathology can confirm the diagnosis. Total surgical resection remains the mainstay of treatment with adjuvant treatment only if there is a residue or a recurrence. CILs are rare lesions in the body with IPT being the commonest. Surgical excision remains the mainstay of treatment and a long-term follow up is warranted. [ABSTRACT FROM AUTHOR]

Rotator cuff related shoulder pain (RCRSP) is a prevalent clinical presentation characterized by substantial diagnostic uncertainty. Some of this uncertainty relates to the involvement of the cervical and thoracic spine as a source of or contributing factor to RCRSP. Thirty-two RCRSP cases and thirty-two asymptomatic controls (AC), recruited from Hospital La Paz-Carlos III between March 2023 and September 2023, were matched for age, gender and hand dominance. Assessed variables included cervical, thoracic range of motion (ROM) and neck disability index (NDI). Independent t-tests were used to compare each of these measurements and multiple linear regression was used to examine the capacity of neck or psychosocial variables to predict the variability of the NDI. The RCRSP group had significantly reduced cervical rotation [RCRSP (111.14 ± 22.98); AC (130.23 ± 21.20), d = 0.86, p < 0.01] and flexo-extension ROM [RCRSP (112.47 ± 2.07); AC (128.5 ± 17.85), d = 0.80, p < 0.01] as well as thoracic spine flexion [RCRSP (33.02 ± 1.14); AC (34.14 ± 1.01), d = 1.04, p < 0.01], extension [RCRSP (28.63 ± 0.89); AC (27.37 ± 0.89), d = −1.40, p < 0.01], right rotation [RCRSP (40.53 ± 10.39); AC (54.45 ± 9.75), d = 1.38, p < 0.01], left rotation [RCRSP (39.00 ± 11.26); AC (54.10 ± 10.51), d = 1.39, p < 0.01] and a significantly increased NDI score [RCRSP (17.56 ± 7.25); AC (2.47 ± 3.25), d = −2.69, p < 0.01]. The variables best explaining neck disability were central sensitization index and SF-12 total score (adjusted R2 = 0.75; p < 0.01). These results suggest that clinicians should assess cervical and thoracic spine mobility in patients with RCRSP.