Journal of Orthopaedic Science最新文献

{"title":"Morphological characteristics of the flexor hallucis longus groove and tendon quality in patients with hallux rigidus: A CT-based study.","authors":"Dan Moriwaki, Tomoyuki Nakasa, Yasunari Ikuta, Shingo Kawabata, Satoru Sakurai, Saori Ishibashi, Munekazu Kanemitsu, Nobuo Adachi","doi":"10.1016/j.jos.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.013","url":null,"abstract":"<p><strong>Background: </strong>The etiology of hallux rigidus is still unknown and elucidating targeted factors to prevent hallux rigidus or improve treatment outcomes is essential. An association between flexor hallucis longus (FHL) tendon tightness and hallux rigidus development has been suspected; however, the characteristics of the FHL tendon in the hallux rigidus remain unclear. This study aimed to explore the quality of the FHL tendon and the morphological characteristics of the FHL tendon groove at the talus and sustentaculum tali in the pathogenesis of hallux rigidus.</p><p><strong>Methods: </strong>Twenty-one feet with hallux rigidus and 15 feet without hallux rigidus were retrospectively reviewed. The ratio of the FHL tendon groove depth to the FHL tendon anteroposterior diameter (groove/tendon ratio), Hounsfield unit (HU) values of the cancellous bone below the FHL tendon groove to those of the navicular (groove HU ratio) were measured using computed tomography at the talus and sustentaculum tali. The ratio of HU values inside the FHL tendon to those inside the tibialis anterior tendon (tendon HU ratio) were measured at the FHL tendon groove of the talus, that of the sustentaculum tali, and below the sesamoids.</p><p><strong>Results: </strong>The depth of the FHL tendon groove, groove/tendon ratio, and groove HU ratio were significantly larger in the hallux rigidus group; the FHL tendons of the hallux rigidus group were deeply fitted into the FHL groove than those of the control group. The tendon HU ratio was significantly smaller in the hallux rigidus group.</p><p><strong>Conclusions: </strong>The FHL tendon in the hallux rigidus can be more constrained at the FHL groove of the talus and sustentaculum tali, and its quality can change compared to that in healthy feet. Tightness of the FHL tendon should be considered when treating hallux rigidus.</p><p><strong>Level of evidence: </strong>Ⅲ.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The sun shines on the growing path\": The 40th Annual Research Meeting of the Japanese Orthopaedic Association.","authors":"Yasuyuki Ishibashi","doi":"10.1016/j.jos.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.007","url":null,"abstract":"","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Constant-Murley score categorization to assess outcomes after reverse shoulder arthroplasty following complex proximal humeral fracture.","authors":"Francisco Antonio Miralles-Muñoz, Emilio Sebastiá-Forcada","doi":"10.1016/j.jos.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.011","url":null,"abstract":"<p><strong>Background: </strong>The Constant-Murley (CM) score is considered the gold standard of shoulder scoring systems. However, it does not include scoring categorization, and in some acute traumatic processes, a paired comparative analysis is not feasible. The purpose of this study was to determine cutoff values for the CM score that indicate a specific category on the outcome score following reverse total shoulder arthroplasty (rTSA) for fracture.</p><p><strong>Methods: </strong>Consecutive patients with complex proximal humeral fracture who underwent rTSA from 2010 to 2022, were included in the study. Two years of postoperative follow-up was required. Postoperative clinical evaluations were conducted using the CM and University of California, Los Angeles (UCLA) scores. The correlation between CM and UCLA scores was analyzed. Then, the receiver-operating characteristic (ROC) curve was utilized to determine the cutoff points in CM scores that most effectively distinguished between categories. The UCLA categories were used as the external criterion.</p><p><strong>Results: </strong>132 patients completed the evaluations at the 2-year follow-up. Among them, 112 (84.8 %) were females and 20 (15.2 %) were males, with a mean age of 73.5 years. The UCLA score showed a strong correlation with the CM score (r = 0.936; 95% CI 0.911-0.954; p = 0.000). For the CM score, the cutoff for an excellent outcome was 67.5 (AUC 0.963, 95% CI 0.925-1.000), 56.5 (AUC 0.920, 95% CI 0.872-0.969) for good, 41.5 (AUC 0.701, 95% CI 0.617-0.784) for fair, and <41.5 (AUC 0.965, 95% CI 0.939-0.990) for poor.</p><p><strong>Discussion: </strong>According to the cut-off values in the CM score used to categorize the outcomes after rTSA in proximal humeral fractures, an excellent outcome was considered a score equal to or greater than 68, good between 57 and 67 points, fair between 41 and 56 points, and a poor outcome with a score equal to or less than 40 points.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial prophylaxis with ampicillin/sulbactam versus cefazolin for orthopedic implant-related surgical site infections: A retrospective cohort study.","authors":"Masaki Hatano, Yusuke Sasabuchi, Shotaro Aso, Koji Yamada, Hisatoshi Ishikura, Takeyuki Tanaka, Sakae Tanaka, Hideo Yasunaga","doi":"10.1016/j.jos.2025.03.010","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.010","url":null,"abstract":"<p><strong>Background: </strong>Cefazolin is widely used for surgical prophylaxis in orthopedic implant surgeries. However, there is insufficient evidence of the superiority of cefazolin over other antibiotics, such as ampicillin/sulbactam (ABPC/SBT), in reducing surgical site infection (SSI). Moreover, concerns exist regarding the adverse events associated with these antimicrobial agents, such as Clostridioides difficile infection. This study aimed to evaluate the comparative effectiveness of ABPC/SBT versus cefazolin prophylaxis in reducing SSI and all-cause mortality rates and its safety regarding Clostridioides difficile infection in major orthopedic implant surgeries.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the Diagnosis Procedure Combination database in Japan. We included adult patients who underwent a major orthopedic implant surgery between July 2010 and March 2022. Patients underwent surgery with either cefazolin or ABPC/SBT prophylaxis. The primary outcome was in-hospital SSI, whereas the secondary outcomes were 90-day SSI, 1-year SSI, in-hospital all-cause mortality, and Clostridioides difficile infection. The outcomes were compared between the two groups using propensity-score overlap weighting.</p><p><strong>Results: </strong>We identified 440,651 eligible patients, including 17,651 in the ABPC/SBT group and 423,000 in the cefazolin group. The propensity-score overlap weighting successfully balanced patient and institutional characteristics between the groups. No significant differences were observed in in-hospital SSI (risk difference, -0.02 %; 95 % confidence interval (CI), -0.13 to 0.10 %), 90-day SSI (risk difference, 0.00 %; 95 % CI, -0.13 to 0.14 %), 1-year SSI (risk difference, -0.02 %; 95 % CI, -0.17 to 0.13 %), or in-hospital mortality (risk difference, -0.01 %; 95 % CI, -0.05 to 0.04 %) between the groups. However, the ABPC/SBT group had a significantly lower Clostridioides difficile infection (risk difference, -0.02 %; 95 % CI, -0.03 to -0.01 %) than that of the cefazolin group.</p><p><strong>Conclusions: </strong>ABPC/SBT may be comparable to cefazolin as an alternative therapy for preventing early SSIs in patients who undergo major orthopedic implant surgery, with a lower risk of Clostridioides difficile infection.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of titanium-coated PEEK cages with two blades in anterior cervical decompression fixation: Bone fusion rates and surgical outcomes.","authors":"Taiki Hayashi, Shizumasa Murata, Hiroki Iwahashi, Hiroshi Hashizume, Hiroshi Iwasaki, Shunji Tsutsui, Masanari Takami, Keiji Nagata, Yuyu Ishimoto, Masatoshi Teraguchi, Yoshimasa Mera, Toshiya Shitahodo, Shingo Inoue, Kota Kawamura, Aozora Kadono, Kusushi Murai, Yoji Kitano, Hiroshi Yamada","doi":"10.1016/j.jos.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.009","url":null,"abstract":"<p><strong>Background: </strong>Cervical degenerative diseases are prevalent in aging populations. Anterior cervical discectomy and fusion is a common surgical intervention. This study aimed to compare the efficacy of titanium-coated polyether ether ketone cages with blades and artificial bone grafting with that of conventional polyether ether ketone cages with screws and autologous bone grafting in anterior cervical discectomy and fusion.</p><p><strong>Methods: </strong>This retrospective study reviewed 61 patients who underwent anterior cervical discectomy and fusion for cervical spondylotic myelopathy at our institution. Patients were divided into two groups according to the treatment: polyether ether ketone cage with screws (Group S, n = 39) and titanium-coated polyether ether ketone cage with blades (Group B, n = 22). The primary outcome was the bone fusion rate at 6 months postoperatively. Secondary outcomes included operative time, intraoperative blood loss, retropharyngeal cavity width, wound pain, Japanese Orthopaedic Association scores, radiographic measurements, and cage subsidence.</p><p><strong>Results: </strong>The bone fusion rate was higher in Group B (93.3 %) than in Group S (78.7 %), albeit not significantly (p = 0.077). Group B had significantly shorter operative times (107.7 ± 27.3 vs. 139.9 ± 50.1 min, p = 0.007) and lower blood loss (21.4 ± 20.5 vs. 42.1 ± 35.7 mL, p = 0.016). Group B also experienced significantly lesser wound pain on postoperative day 3 (2.0 ± 1.0 vs. 3.0 ± 1.3, p = 0.002). The retropharyngeal cavity width at C5 was significantly smaller in Group B on days 3 (6.3 ± 1.9 vs. 7.6 ± 1.6 mm, p = 0.004) and 7 (5.2 ± 2.5 vs. 6.9 ± 2.9 mm, p = 0.025). No significant between-group differences were noted in the retropharyngeal cavity width at C7, Japanese Orthopaedic Association scores, radiographic measurements, or cage subsidence.</p><p><strong>Conclusion: </strong>Although the bone fusion rates were similar, the reduced surgical time and patient morbidity associated with graft harvesting suggest that titanium-coated polyether ether ketone cages with blades could improve patient care in anterior cervical discectomy and fusion.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensive high signal intensity area on T2-weighted MRI in the spinal cord is associated with spinal segment instability and potentially worse clinical outcomes in patients with cervical spondylotic myelopathy.","authors":"Naoki Yamaguchi, Kazuya Kitamura, Kenta Suzuki, Shin Obara, Haruo Sasaki, Takahiro Nakagawa, Akimasa Yasuda, Kazuhiro Chiba, Keisuke Horiuchi","doi":"10.1016/j.jos.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.008","url":null,"abstract":"<p><strong>Background: </strong>Patients with cervical spondylotic myelopathy often have increased signal intensity area (ISI) in the spinal cord on T2-weighted magnetic resonance imaging. The ISI is usually located at the level of the spinal cord compression, most often at the intervertebral segments, but in some patients, it extends to the level of the adjacent vertebral body. The purpose of this study was to elucidate the clinical characteristics associated with extensive ISI in the spinal cord and its potential impact on surgical outcomes.</p><p><strong>Methods: </strong>Patients with cervical spondylotic myelopathy who underwent posterior decompression surgery at our hospital from 2015 to 2021 were included in this study. ISI was found in 65 patients in a total of 78 intervertebral segments. Patients were divided into two groups according to the extent of ISI; the intervertebral disc group (D group; 34 patients, 44 %) and the vertebral body group (B group; 44 patients, 56 %), each consisting of patients with ISI within or beyond the intervertebral disc level. Radiographic and clinical parameters were analyzed and compared between the two groups.</p><p><strong>Results: </strong>A greater degree of C2-7 lordosis (p = 0.01), higher percentage of intervertebral segments with instability (p = 0.04), and longer symptom duration (p = 0.001) were significantly associated with the B group. Although the differences did not reach statistical significance, the percentage of intervertebral segments with spondylolisthesis was higher (p = 0.08) and the JOA recovery rate was lower (p = 0.11) in the B group compared to the D group.</p><p><strong>Conclusions: </strong>Patients with cervical spondylotic myelopathy who have extensive ISI are associated with spinal segment instability, prolonged symptom duration, and potentially worse surgical outcomes.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrieval-augmented generation enhances large language model performance on the Japanese orthopedic board examination.","authors":"Juntaro Maruyama, Satoshi Maki, Takeo Furuya, Yuki Nagashima, Kyota Kitagawa, Yasunori Toki, Shuhei Iwata, Megumi Yazaki, Takaki Kitamura, Sho Gushiken, Yuji Noguchi, Masataka Miura, Masahiro Inoue, Yasuhiro Shiga, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori","doi":"10.1016/j.jos.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.003","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) have shown potential in medical applications. However, their effectiveness in specialized medical domains remains underexplored. The integration of Retrieval-Augmented Generation (RAG) has been proposed to improve these models by reducing hallucinations and enhancing domain-specific information access. Through this evaluation, we aim to assess whether RAG can effectively bridge the gap between LLMs' current capabilities and the accuracy needed for medical use by examining GPT-3.5 Turbo, GPT-4o, and o1-preview on the 2024 Japanese Orthopedic Specialist Examination.</p><p><strong>Methods: </strong>A specialized database was created using the \"Standard Textbook of Orthopedics\", and GPT-3.5 Turbo, GPT-4o, and o1-preview were evaluated with and without RAG. Models were tested on text-based and image-based questions exactly as presented in Japanese. An error analysis was conducted to identify key performance factors.</p><p><strong>Results: </strong>GPT-3.5 Turbo showed no substantial improvement with RAG, with its overall accuracy remaining at 28 %, compared to its baseline of 29 % without RAG. GPT-4o rose from 62 % to 72 %, while o1-preview increased from 67 % to 84 %. Error analysis indicated that GPT-3.5 Turbo primarily failed to apply retrieved data, whereas GPT-4o and o1-preview made errors when the database lacked relevant information or when dealing with image-based questions.</p><p><strong>Conclusions: </strong>The integration of RAG significantly boosted performance for GPT-4o and especially o1-preview. While both models surpassed the passing threshold, o1-preview demonstrated a level of proficiency relevant to clinical practice. However, RAG did not improve performance on GPT-3.5 Turbo because it lacks effective reasoning abilities.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of horizontal versus Akin Osteotomy of the proximal phalanx for hallux valgus.","authors":"Itaru Morohashi, Atsuhiko Mogami, So Kameda, Tomoji Matsuo, Takahisa Ogawa, Osamu Obayashi, Kazuo Kaneko, Muneaki Ishijima","doi":"10.1016/j.jos.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.006","url":null,"abstract":"<p><strong>Background: </strong>Currently, Akin osteotomy is widely used for hallux valgus. However, it is associated with several complications such as prolonged fusion, pseudarthrosis, overcorrection, and big toe shortening. To prevent such issues, a novel method can be used. In 2019, horizontal osteotomy of the proximal phalanx (HOPP) was established. The current study aimed to assess the outcomes of Akin osteotomy and HOPP for hallux valgus.</p><p><strong>Methods: </strong>Akin osteotomy was performed on 20 feet (Akin group) and HOPP on 14 feet (HOPP group).</p><p><strong>Results: </strong>One year after the surgery, the bone union rates of the Akin and HOPP groups were 95 % and 100 %, respectively. The average bone union period of the HOPP group (3.2 months, standard deviation: 0.80) was significantly shorter than that of the Akin group (5.8 months, standard deviation: 3.53) (P < 0.05). The 3-month bone union rate of the HOPP group was significantly higher than that of the Akin group (93 % vs. 45 %, P < 0.05). The mean shortening of the lateral proximal phalanx did not significantly differ between the Akin and HOPP groups (P = 0.46). However, the HOPP group had a significantly lesser medial shortening of the lateral proximal phalanx than the Akin group (P < 0.05). Moreover, the HOPP group had reduced shortening of the proximal phalanx. None of the patients in the HOPP group developed complications. However, some patients in the Akin group presented with complications such as osteotomy dissection, screw abduction, and protrusion.</p><p><strong>Conclusion: </strong>HOPP is an excellent option as it has a high bone union rate, can facilitate easy angle adjustment, and does not cause significant shortening of the lateral proximal phalanx.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative series.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing S1 nerve root block using three-dimensional computed tomography imaging: Identifying the ideal fluoroscopic angle and predicting S1 neural foramen position.","authors":"Noritaka Suzuki, Toshiaki Kotani, Shuhei Ohyama, Kotaro Sakashita, Shun Okuwaki, Shuhei Iwata, Yasushi Iijima, Masaya Mizutani, Tsuyoshi Sakuma, Sumihisa Orita, Kazuhide Inage, Yasuhiro Shiga, Masahiro Inoue, Shohei Minami, Seiji Ohtori","doi":"10.1016/j.jos.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>S1 nerve root block (S1NRB) is frequently used to diagnose and treat lumbosacral and lower limb pain. However, the visibility of the S1 neural foramen can be obscured by factors including intestinal gas, increasing the procedure's technical difficulty. This study identified the optimal fluoroscopic angle for S1NRB and standardized the technique using three-dimensional (3D) computed tomography (CT) images.</p><p><strong>Methods: </strong>We analyzed 3D CT images of 101 patients with lumbar degenerative diseases (lumbar disc herniation and lumbar spinal canal stenosis). The reference position angle (RPA) was defined as the angle where the superior endplate of the sacrum appears straight, whereas the tunnel view angle (TVA) was defined as the angle where the anterior and posterior S1 neural foramina coincide. We evaluated the relationship between the RPA and TVA, measured the position of the S1 neural foramen at the RPA using the S1 spinous process and sacroiliac joint as landmarks, and analyzed correlations with sex and body size.</p><p><strong>Results: </strong>The mean RPA and TVA were 32.4 ± 6.4° and 34.0 ± 6.2°, respectively, with a mean difference of 1.5 ± 2.8° (r = 0.897, p < 0.0001). The horizontal distance from the S1 spinous process to the S1 neural foramen was 23.1 ± 2.1 mm, and to the sacroiliac joint was 52.0 ± 4.3 mm, with a ratio of 44.5 ± 3.4 %. The vertical distance from the S1 spinous process to the S1 neural foramen was -1.2 ± 1.7 mm caudally. In 84.2 % of the cases, the S1 neural foramen was located 0-4 mm caudal to the S1 spinous process and at 40-50 % of the horizontal distance between these landmarks. These parameters showed no significant differences based on sex or body size.</p><p><strong>Conclusions: </strong>RPA, using the superior endplate of the sacrum as a reference, closely approximates the TVA and is a useful indicator of the optimal fluoroscopic angle for S1NRB. The S1 neural foramen position can be predicted using anatomical landmarks, irrespective of patient characteristics.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel, easy-to-use scoring system for the diagnosis of extraforaminal stenosis of lumbosacral transition using X-ray and CT scan.","authors":"Kohei Takahashi, Myo Min Latt, Takumi Tsubakino, Manabu Suzuki, Takeshi Nakamura, Takeshi Hoshikawa, Tomowaki Nakagawa, Ko Hashimoto, Takahiro Onoki, Toshimi Aizawa, Yasuhisa Tanaka","doi":"10.1016/j.jos.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of extraforaminal stenosis of the lumbosacral transition (ESLT) using conventional two-dimensional (2D) magnetic resonance imaging (MRI) (2D-MRI) is challenging, with some overlooking of ESLT. It is desirable to have criteria for determining whether patients require additional three-dimensional MRI (3D-MRI). In this study, we created a simple scoring system to screen for ESLT using X-rays and computed tomography (CT).</p><p><strong>Methods: </strong>Ninety-two cases with unilateral L5 radiculopathy were recruited. We used 3D-MRI to determine the presence of ESLT. X-rays and CT were assessed by two examiners. X-rays were assessed for \"vertebral inclination\", \"lumbosacral overlap sign\", \"lordosis angle\", \"disc height\", and \"vacuum phenomenon\". Axial CT slices were assessed for \"transverse process drooping,\" \"nearthrosis\" between transverse process and sacral ala, \"osteosclerosis\" of L5 endplate, and \"osteophyte\". Correlation between ESLT and each radiological variable was assessed. Reproducible variables were defined as >0.6 for both intra- and interobserver agreement. Multivariate logistic regression analysis was performed using the radiological variables that were correlated with ESLT and judged to be reproducible. Finally, a score was assigned to each selected variable considering the odds ratio (OR), and a radiological index for screening the extraforaminal stenosis (RISE) score was established. The receiver operating characteristic (ROC) curve analysis was performed for external validation.</p><p><strong>Results: </strong>Vertebral inclination (>3°) (OR: 4.8, p = 0.003), nearthrosis (OR: 10.2, p < 0.001), and osteophyte (OR: 5.2, p = 0.002) were selected. Considering the OR, 1 point was assigned to vertebral inclination and osteophyte, and 2 points were assigned to nearthrosis, obtaining RISE score (0-4 points). The area under the ROC curve was 0.91.</p><p><strong>Conclusions: </strong>The RISE score accurately predicted the presence of ESLT, allowing aids in the selection of cases that require 3D-MRI.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}