Search Results (760)

Background: Femoral neck fractures are rare but serious injuries in children and adolescents, often resulting from high-energy trauma and prone to complications like avascular necrosis (AVN) and nonunion. Even rarer is the development of slipped capital femoral epiphysis (SCFE) following femoral neck fracture, which presents unique diagnostic and treatment challenges. SCFE can destabilize the femoral head, with severe cases requiring complex surgical interventions. Case presentation: This report details a case of a 15-year-old male with autism spectrum disorder (ASD) who developed severe SCFE one month after treatment for a Delbet type III femoral neck fracture. The condition was managed with an Imhäuser intertrochanteric osteotomy (ITO), in situ fixation (ISF), and osteochondroplasty (OChP), supported by virtual surgical planning (VSP) and 3D-printed patient-specific instruments (PSIs) for precise correction and fixation. Discussion: The surgery was completed without complications. Six months after the operation, the patient exhibited a pain-free, mobile hip with radiographic evidence of fracture healing and no signs of AVN. Functional outcomes were favorable despite rehabilitation challenges due to ASD. Conclusions: The Imhäuser ITO, combined with ISF and OChP, effectively addressed severe SCFE after femoral neck fracture, minimizing AVN risk. VSP and PSIs enhanced surgical accuracy and efficiency, demonstrating their value in treating rare and complex pediatric orthopedic conditions. Full article

Rupture of the thyrocervical trunk aneurysm into the thoracic cavity does not occur very often. It is an urgent condition due to hemorrhagic shock by massive hemothorax with potentially fatal consequences. Pregnancy and puerperium are additional risk factors for a rupture of the thyrocervical trunk aneurysm in patients with neurofibromatosis and aneurysms. This is the first case of thyrocervical trunk aneurysm rupture after a Cesarean section in a patient with neurofibromatosis type I noted down in the literature. The patient, a 33-year-old woman with neurofibromatosis type I, three days after an already performed Cesarean section had acute pain in the left area of the neck, swelling, and a hematoma that progressed rapidly to respiratory distress, hemothorax, and hemorrhagic shock. Emergency endotracheal intubation was performed for airway control. Urgent computer tomography angiography procedure showed extracranial artery, thyrocervical trunk aneurysm rupture, and vertebral aneurysm without rupture. The patient was urgently and successfully treated by endovascular coil embolization of a ruptured thyrocervical trunk aneurysm and subsequently thoracic drainage for massive hemothorax. Postoperatively, her left neck pain decreased, after which she had no further neurologic deficits. The patient was discharged 10 days later. Thyrocervical trunk aneurysm rupture is a rare condition with a potential outcome of death which requires urgent intervention. Endovascular coil embolization is a minimally invasive, safe, and efficient treatment for patients with rupture of thyrocervical trunk aneurysm and following comorbidities. Full article

Background/Objectives: This study compares clinical and radiological outcomes of open microscopic posterior cervical foraminotomy (PCF) and biportal endoscopic spine surgery (BESS) PCF in multi-level cases. While BESS PCF is effective in single-level surgeries, its role in multi-level procedures remains unclear. Methods: This retrospective cohort study included 60 patients treated for cervical radiculopathy from 2016 to 2023, divided into two groups, open microscopic PCF (Group M, n = 30) and BESS PCF (Group B, n = 30). Clinical outcomes were assessed using visual analogue scale (VAS) scores for neck and arm pain and the neck disability index (NDI). Radiological parameters included cervical angle, segmental angle, range of motion (ROM), and the extent of facetectomy. Results: Both groups showed improvement in the arm pain VAS and the NDI. However, Group B exhibited significantly better neck pain on the VAS at the final follow-up (p = 0.03). Radiologically, Group B maintained lordotic cervical and segmental angles postoperatively, while Group M showed kyphotic changes (p < 0.01). Segmental ROM was larger in Group M, indicating greater instability (p < 0.01). Group B had less extensive facetectomy while achieving comparable foraminal enlargement. Operative time was longer for Group B (p < 0.001). Conclusions: BESS PCF preserves cervical stability and reduces postoperative neck pain compared to open microscopic PCF in multi-level procedures. Despite longer operative times, its benefits in minimizing instability make it a promising option for treating multi-level cervical radiculopathy. Further research with long-term follow-up is recommended. Full article

Background: The role of autonomic nervous system (ANS) modulation in chronic neck pain remains elusive. Transcutaneous vagus nerve stimulation (t-VNS) provides a novel, non-invasive means of potentially mitigating chronic neck pain. This study aimed to assess the effects of ANS modulation on heart rate variability (HRV), pain perception, and neck disability. Methods: In this double-blind randomized clinical trial, 102 participants with chronic neck pain were randomly allocated to one of three groups: t-VNS plus standard-care physiotherapy (SC-PT), heart rate variability biofeedback (HRV-BF) with SC-PT, or SC-PT alone. Interventions were administered three times weekly for 6 weeks. The following outcome measures were assessed at baseline and after 6 weeks: HRV, the visual analog scale (VAS), the pressure pain threshold (PPT), and the neck disability index (NDI). Results: The t-VNS group exhibited significant improvements compared to the HRV-BF and SC-PT groups. Specifically, t-VNS increased the RR interval (mean difference [MD] = 35.0 ms; p = 0.037) and decreased the average heart rate (MD = −5.4 bpm; p = 0.039). Additionally, t-VNS reduced the VAS scores (versus HRV-BF: MD = −0.8 cm, p = 0.044; SC-PT: MD = −0.9 cm, p = 0.018), increased the PPT (versus HRV-BF: MD = 94.4 kPa, p < 0.001; SC-PT (MD = 56.2 kPa, p = 0.001)), and lowered the NDI scores (versus HRV-BF: MD = −4.0, p = 0.015; SC-PT: MD = −5.9, p < 0.001). Conclusions: t-VNS demonstrated superior effectiveness compared to HRV-BF and SC-PT in regulating HRV, alleviating pain, and enhancing functional capabilities in individuals with chronic neck pain. Full article

Background: Dibothriocephalus nihonkaiense (previously known as Diphyllobothrium nihonkaiense) infection is not common in Hong Kong. D. nihonkaiense is a fish-borne cestode parasite that infects humans after consuming raw or insufficiently cooked fish containing plerocercoids. Case presentation: We reported a case of D. nihonkaiense infection in a 40-year-old woman who presented with a complaint of epigastric pain and diarrhea. A curvilinear opacity was seen at the upper quadrant of the abdomen via abdominal X-ray. An incomplete 80 cm long strobila of D. nihonkaiense without a scolex and neck was found in her feces. A grayish-brown oval egg with an inconspicuous operculum and small knob at the abopercular end was also found. Species-level identification was performed using Nanopore sequencing. Complete blood count and serum vitamin B12 level were tested to check for megaloblastic anemia and vitamin B12 deficiency, respectively. Laboratory investigations demonstrated an elevated percentage of monocytes in peripheral blood. A single oral dose of praziquantel (25 mg/kg) was prescribed to the patient. There was no evidence of relapse after the treatment. Conclusions: We reported a case of D. nihonkaiense infection using Oxford Nanopore NGS as a tool for accurate parasite identification. Full article

PURPOSE: Job profiles such as heavy vehicle drivers and transportation office workers that involve prolonged static and inappropriate postures and forceful exertions often impact an individual’s health, leading to various disorders, most commonly musculoskeletal disorders (MSDs). In the present study, various individual risk factors, such as age, weight, height, BMI, sleep patterns, work experience, smoking status, and alcohol intake, were undertaken to see their influence on MSDs. METHODS: The modified version of the Nordic Questionnaire was administered in the present cross-sectional study to collect data from 48 heavy vehicle drivers and 40 transportation office workers. RESULTS: The analysis revealed low back pain (LBP), knee pain (KP), and neck pain (NP) to be the dominant pains suffered by the participants from both occupational groups. LBP, KP, and NP were suffered by 56%, 43.75%, and 39% heavy vehicle drivers and 47.5%, 40%, and 27.5% transport office workers, respectively. From the insignificant value of Chi-square, it can be inferred that the participants from both occupations experience similar levels of LBP, KP, and NP. The Bayesian model applied to the total sample showed that NP influenced KP, which further influenced the LBP of the workers. Age was predicted as LBP’s most significant risk factor by the logistic regression model when applied to the total sample, while NP was found to decrease with an increase in per unit sleep. CONCLUSIONS: The overall results concluded that heavy vehicle drivers and office workers, irrespective of their different job profiles, endured pain similarly. Full article

Background/Objectives: Posterior neck, trapezius, and interscapular pain, exacerbated by poor posture such as forward head and rounded shoulders, is common. In this study, we aimed to assess the clinical outcomes of isotonic saline injections at nerve entrapment points (NEPs) within the sternocleidomastoid (SCM) and scalenus medius (SM) muscles for alleviating spinal accessory nerve (SAN) and dorsal scapular nerve (DSN) compression in patients suffering from posterior neck, trapezius, and interscapular pain. Methods: In this retrospective study, 68 patients were included, with 34 receiving isotonic saline injections and 34 undergoing Extracorporeal Shock Wave Therapy (ESWT) as a control. The clinical outcomes were evaluated using the Visual Analog Scale (VAS) and Percent Pain Intensity Difference (PPID) before and after therapy. The effectiveness of isotonic saline injections targeting NEPs in the SCM and SM muscles in relieving pain associated with SAN and DSN entrapment was assessed. Results: Both treatments significantly reduced VAS and PPID scores, with injection therapy showing a larger treatment effect size (Cohen’s d: 3.521 for VAS and 3.521 for PPID) compared to ESWT (Cohen’s d: 1.379 for VAS and 1.710 for PPID). The mean clinically important difference observed for VAS was 4.2, exceeding the expected value of 2.6, indicating a substantial improvement in pain and patient quality of life. Conclusions: Isotonic saline injections at the NEPs of SAN and DSN within the SCM and SM muscles might potentially reduce posterior neck, trapezius, and interscapular pain associated with possible nerve entrapment, without causing complications. Further research is needed to validate these findings in larger, controlled trials. Full article

Background: Non-specific chronic neck pain is a prevalent musculoskeletal disorder with a significant impact on individuals’ quality of life. The lack of consensus on effective therapeutic management complicates the establishment of standardized treatment protocols. Home exercise programs have yielded positive results. This study aimed to assess the effectiveness of a telerehabilitation program distributed through videoconferencing for patients with non-specific chronic neck pain compared to a home-based exercise program. Methods: A randomized controlled trial was conducted involving 36 participants who were divided into two groups: the experimental group (n = 18) received manual therapy combined with telerehabilitation, while the home-based group (n = 18) received the same manual therapy treatment along with recommendations for home exercises. Key outcome measures, including neck-related disability, kynesiophobia, anxiety and depression, pain intensity, pressure pain threshold, quality of life, and adherence to self-treatment, were evaluated at baseline and post-treatment. Results: No statistically significant differences were observed between groups. However, both groups demonstrated improvements in all study variables except for the mental component of quality of life immediately post-treatment. Conclusions: After eight weeks of manual therapy and exercise, both the telerehabilitation and home-based exercise programs resulted in significant improvements in disability, pain, and kynesiophobia, indicating that telerehabilitation is as effective as home-based exercise. Full article

This retrospective study compares the clinical outcomes of the Minimally Invasive Reduction and Osteosynthesis System (MIROS) and intramedullary nailing (IMN) in treating isolated surgical neck fractures of the humerus. A total of 42 patients were included, with 18 treated using MIROS and 24 with IMN. The primary outcomes assessed were the complication rates, functional recovery (DASH score), pain levels (VAS), and radiological healing. The MIROS group exhibited a higher complication rate (22.2% vs. 8.8%), with K-wire migration and superficial infections being the most frequent. Patients treated with MIROS reported lower postoperative pain (VAS 45 ± 25.7) compared to the IMN group (VAS 58.1 ± 12.5). Both groups demonstrated radiological healing within three months, but one MIROS patient required reoperation due to hardware failure. No significant differences were observed in the DASH scores between the groups. Our findings suggest that IMN is a preferable treatment option for younger patients with good bone quality, while MIROS may still be beneficial for elderly patients with significant comorbidities, albeit with a higher risk of complications. Future prospective studies are recommended to confirm these findings. Full article

Background: Although neck injuries secondary to sporting activities in the pediatric demographic presenting to the emergency department (ED) are common, predictors of needing higher-level care (HLC) outside immediate treatment and release are not clear. The aim of this study was to describe how these neck injuries present in the United States (US) and identify predictors of HLC. Methods: We interrogated the US National Electronic Injury Surveillance System (NEISS) database for presentations to the ED of pediatric patients (aged 6–18 years old) whose primary complaint was neck injury in the setting of sport between 2014 and 2023. Statistical analysis utilized weighted estimates to evaluate incidence and then univariate and multivariate regression analyses were carried out to identify parameters associated with HLC for these patients. Results: Overall, a national weighted total of 360,885 ED presentations were estimated to have occurred in the last decade without any statistical change over the years. The mean age was 12.7 years, with more males (60.0%) than females (40.0%). The most common race observed was Black (50.6%), and these injuries most commonly occurred at a sporting complex (62.9%). Neck strains (59.9%) were the most common diagnosis seen across all presentations, followed by neck pain (29.1%), neck contusions (including abrasion) (6.4%), neck fractures (1.7%) and neck lacerations (0.8%). Ultimately, the majority of presentations were treated and released from the ED (95.5%). There were 4.5% of presentations, however, that did require HLC. Older age (OR 1.07, p = 0.004), male gender (OR 1.51, p = 0.002), involvement of other body part(s) (OR 1.45, p = 0.007) and non-strain neck injuries (OR 11.8, p < 0.001) were all independent, statistically significant predictors of HLC. Football (18.6%) was the most common sport associated with these presentations overall, but this was driven mostly by male cases. For females, the most common sport associated with these presentations was cheerleading (12.3%). Conclusions: In the last decade, neck injuries secondary to sporting activities in the pediatric demographic presenting to the ED have remained consistent. We have identified a unique set of predictors for presentations requiring HLC. These findings can be used in tandem with the findings that there are a number of gender-specific sports that drive these presentations to develop more sensitive and specific protocols for both primary prevention and ED triaging. Full article

Background: The external carotid artery (ECA) supplies blood to various facial and neck regions and may contribute to collateral cerebral perfusion. With the rise in carotid artery stenting (CAS) as a treatment for carotid stenosis, ECA overstenting has become a common procedure feature. This study aimed to assess the incidence, characteristics, and duration of facial pain following CAS, hypothesizing that ECA overstenting may contribute to facial pain. Materials and Methods: This prospective study included 55 patients treated with CAS for internal carotid artery (ICA) stenosis at a single center. Patients’ facial pain was evaluated using a numeric rating scale (NRS) before, immediately after, and 24 h post-CAS. Patient data, including demographics, comorbidities, and procedural details, were analyzed to assess the relationship between ICA stenosis degree, ECA diameter changes, and facial pain incidence. Results: CAS was associated with intraoperative facial pain in 27.27% of patients, with 7.28% reporting residual pain 24 h post-procedure. Pain occurrence was significantly higher in patients with lower ICA stenosis (p = 0.04). The median ECA diameter decreased from 4.11 mm to 3.16 mm (p < 0.001) after CAS, with ECA overstenting observed in 96.4% of cases. No significant relationship was found between pain severity and stent width or length. Conclusions: This study highlights that CAS significantly decreases the diameter of ECA. Additionally, ECA overstenting might be associated with perioperative and postoperative facial pain, emphasizing the need for careful monitoring of ECA patency following CAS. Full article

Background: Schwannomas, predominantly benign nerve sheath tumors, are typically found within the intradural extramedullary space of the spinal cord with potential extradural expansion. Other typical localizations are the upper limbs and neck area. Pure epaxial paraspinal schwannomas are very rare, often asymptomatic, and predominantly occur in the thoracic region, with only a handful of cases reported globally. The range of differential diagnoses for paraspinal lesions is extensive, emphasizing the importance of accurate diagnosis to ensure optimal therapy and avoid unnecessary treatments. Method: We conducted a systematic literature review searching for published recommendations for paraspinal lesion management in addition to examining the case of a 49-year-old male patient who presented with a history of persistent back pain. A thorough medical history and physical examination were followed by ultrasound and MRI, revealing a well-defined paravertebral mass spanning from T7 to T9. A secure ultrasound-guided biopsy was performed, leading to a preliminary diagnosis of paraspinal schwannoma. Subsequently, complete surgical resection was performed. Results: pathological reports confirmed the initial diagnosis of paraspinal schwannoma. Further investigation using FMI and RNA sequencing did not detect any specific genetic anomalies aside from an NF2 gene mutation. A follow-up MRI conducted six months later showed no signs of recurrence. Conclusions: The broad spectrum of differential diagnoses for paraspinal lesions necessitates a multidisciplinary approach to ensure accurate diagnosis and tailored treatment. This approach involves meticulous imaging interpretation followed by a secure biopsy procedure to obtain preliminary pathology results, ultimately leading to the implementation of the most suitable surgical treatment. Full article

Background and Objectives: Multilevel cervical spondylotic myelopathy (MCSM) presents complex challenges for surgical management, particularly in patients with kyphosis or significant anterior pathology. This study aimed to assess the long-term efficacy of modified expansive open-door laminoplasty (MEOLP) combined with short-level anterior cervical fusion (ACF) in providing decompression, preserving alignment, and maintaining range of motion (ROM) over a nine-year follow-up. Materials and Methods: A retrospective analysis was conducted on 124 MCSM patients treated with MEOLP combined with ACF between 2011 and 2015. MEOLP, a muscle-sparing posterior approach, was combined with ACF to correct sagittal misalignment and address anterior compression. Key outcome measures included the Pavlov ratio, C2–C7 angle, Japanese Orthopedic Association (JOA) score, and Visual Analog Scale (VAS) for neck pain. Patients were monitored for adjacent segment degeneration (ASD) and other postoperative changes over the long-term follow-up. Results: At nine years post-surgery, patients demonstrated significant improvements in decompression and cervical alignment. The mean C2–C7 angle increased, reflecting enhanced lordotic curvature, while the Pavlov ratio showed maintained canal expansion. JOA scores improved significantly, indicating reduced myelopathy symptoms, and VAS scores for neck pain decreased, reflecting symptom relief. Despite these positive outcomes, ASD was noted, especially in patients with reduced preoperative disk height, highlighting the need for strategies to mitigate degeneration at adjacent segments. Conclusions: MEOLP combined with short-level ACF is a viable and durable option for managing complex MCSM cases, offering effective decompression, alignment correction, and ROM preservation. The limitations of this study, including its retrospective, single-center design and the lack of quality-of-life assessments, underscore the need for future multi-center studies with broader outcome measures. These findings support MEOLP with ACF as an alternative approach in cases where traditional laminoplasty may be insufficient. Full article

Introduction: Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient’s quality of life. In recent years, there has been a growing use of patient-reported outcome measures in palliative care, particularly to evaluate symptoms, quality of care, and well-being. Aim: To evaluate the sociodemographic and clinical profile, symptom distress, and perceived quality of life in oncology palliative care patients admitted to a specialized palliative care unit in Portugal. Methods: This study was cross-sectional, descriptive, and correlational, carried out in the inpatient setting of the palliative care unit at a tertiary oncology hospital (at admission). The evaluated protocol included a sociodemographic and clinical questionnaire, as well as two measurement instruments: the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Scale (POS), both filled out by the patients. Data analysis was conducted using IBM SPSS^® Statistics version 25.0, with a significance level set at 5% (p < 0.05). Results: The majority of participants in this sample were male (61.7%), with a mean age of around 72 years. More than half of the patients admitted (n = 34; 56.7%) were being monitored in outpatient care. Digestive and head and neck cancers were the most commonly found in the sample (41.7% and 20%, respectively). A significant correlation was found between high symptom intensity and poorer quality of life and care (p < 0.01). This association was particularly pronounced for symptoms such as pain, weakness, depression, anxiety, and anorexia. Conclusions: This study revealed a positive correlation between overall symptom severity and a perceived deterioration in quality of life, well-being, and quality of care. Future studies should consider utilizing alternative assessment tools for evaluating symptoms and quality of care. Additionally, including non-cancer palliative patients in similar studies may provide further valuable insights. Full article

Background and Clinical Significance: Femoral neck fracture frequently occurs in the elderly population but may also present in patients diagnosed with primary cancer or bone metastases. A pathological, oligosymptomatic fracture associated with epithelioid haemangioendothelioma (EHE), a rare endothelial cell-derived sarcoma, is uncommon. Case Presentation: A 44-year-old patient underwent biopsy procedures three times (2010, 2012, 2013) for a focal lesion of the left ischium, none confirming its malignant nature. The last biopsy revealed a neoplastic tissue with features of discrete dysplasia. The lesion did not undergo medical follow-up for seven consecutive years. In August 2020, the patient presented with right lower limb pain. A CT scan, PET/CT scan, and biopsy confirmed EHE with spindle/sarcomatous features. In November 2020, chemotherapy (5xADIC) started (PET/CT confirmed a partial response). After its completion in July 2021, bone progression occurred and sirolimus-based therapy was started. After 3 months, a small liver metastasis was visualized on PET/CT, which did not result in the termination of treatment. In December 2021, pamidronate-based antiresorptive therapy was started. Liver metastasis remained stable in follow-up CT scans. Due to pelvic and spinal lesions, the patient was assisted by elbow crutches and underwent radiotherapy, remaining professionally active. The patient did not report any trauma, but in August 2023, a subsequent CT scan revealed a subcapital fracture of the left femoral neck in the fusion phase. Due to pelvic changes and the stable nature of the fracture, surgical treatment was abandoned. Conclusions: An oligosymptomatic femoral neck fracture, not requiring medical intervention is considered a rare complication of bone cancer. Full article