Prevalence and characteristics of lumbar ribs: a meta-analysis with anatomical and clinical considerations.

BACKGROUND: Lumbar ribs (LR) are a rare and relatively unknown anatomical abnormality of the lumbar spine. The literature provides better understanding regarding other spinal congenital variations like cervical ribs or lumbosacral transitional vertebrae, which are rather commonly recognised conditions. Thus, this meta-analysis aimed to provide data on prevalence and key characteristics of LR. METHODS: Relevant databases were systematically searched for studies reporting the prevalence, laterality and geographic distribution of LR. No exclusion criteria based on language and date of original articles were employed. The pooled prevalence estimates (PPE) were calculated using a random-effects model. To assess the between-study heterogeneity, the I2 statistic and Chi-square test were utilized. Throughout the investigation, the PRISMA guidelines were adhered to scrupulously. Evaluation of the included studies' reliability was made with the AQUA tool. RESULTS: In total, 9 studies were included in this meta-analysis. The pooled prevalence estimate (PPE) of LR was 2.1% (95%CI: 1.0-4.6). In studies based on CT imaging, LR were found in 1.6% (95%CI: 0.6-4.3) of patients and in Xray based studies in 2.1% (95%CI: 0.4-11.1) of patients. Lumbar ribs were bilateral in majority of individuals (65.4%, 95%CI: 39.4-84.6) and could be most frequently encountered in Europe with PPE of 2.8% (95%CI: 3.0-20.0), then in East Asia with PPE of 1.5% (95%CI: 1.0-19.2) and Middle East with PPE of 1.1% (95%CI: 0.6-20.0). CONCLUSIONS: The findings of our study indicate that LR are a common anatomical variation of lumbar spine, contrary to previous beliefs. In a clinical practice, when a patient presents with a non-specific low back pain, a possible occurrence of LR should be taken into consideration. The presence of LR may be misleading for surgeons and result in wrong-level spine surgeries.

The prevalence and anatomy of recurrent artery of Heubner: a meta analysis with neurosurgical considerations.

BACKGROUND: The recurrent artery of Heubner (RAH) is typically the largest medial lenticulostriate branch of the anterior cerebral artery (ACA). Neurosurgical procedures such as aneurysm treatment on the anterior part of the circle of Willis can result in damage of the RAH leading to neurological deficits. The aim of this study was to identify the gaps and provide comprehensive data on the prevalence and anatomical characteristics of the RAH with neurosurgical considerations. METHODS: The major electronic databases were thoroughly searched to identify the eligible studies. The information concerning study type, geographical origin, prevalence of the RAH, course and origin of the RAH, symmetry of origin and number of RAHs in each hemisphere, and morphometric data were extracted. The PRISMA guidelines were rigorously followed throughout the study. The AQUA tool was used to evaluate the reliability of included studies. RESULTS: A total of 34 studies (n = 3645 hemispheres) were included in the meta-analysis. The analysis revealed that the RAH was present in 97.5% (95%CI: 95.5-98.6) of the hemispheres, originating most frequently from the A2 segment (42.2%, 95%CI: 35.0-49.7) or the ACoA-ACA junction (41.6%, 95%CI: 34.0-49.6), and coursing anteriorly (47.6%, 95%CI: 38.7-56.6) or superiorly (43.9%, 95%CI: 34.4-53.8) in relation to ACA. Almost a quarter of patients had more than one RAH, which was on average 22.82 mm (SD: 1.35, 95%CI: 20.16-25.47; I2 = 99.1%, p < 0.01) long and reached 0.76 mm (SD: 0.05, 95%CI: 0.66-0.85; I2 = 99.4%, p < 0.01) in diameter. CONCLUSIONS: As the RAH is present in the majority of the population, it is important to be aware of the wide variations in its anatomy. This will help to prevent postoperative neurological deficits by avoiding undesirable complications during surgeries that are performed in close proximity to the anterior segment of the circle of Willis.

Innovative Synchronous Use of a Reverse Sural Flap and Reverse Hemisoleus Muscle Flap for Post-traumatic Lower Leg Reconstruction: A Case Report With a Long Term Follow-Up and a Quality of Life Assessment.

We present a case report of a 47-year-old male with an extensive tissue deficiency of the right lower leg. The patient was hospitalized for approximately one month in the intensive care unit following a motorcycle accident that resulted in polytrauma. He suffered a fracture of frontal and parietal bones, traumatic brain injury, intracerebral hematoma with a subarachnoid hemorrhage and thoracic trauma. At first, lower leg wound was treated with a negative pressure wound therapy vacuum-assisted closure (VAC) dressing. Afterwards, he was qualified for a surgical wound closure with synchronous use of two reverse flow flaps: a reverse sural flap (RSF) and a reverse hemisoleus muscle flap (RHMF). Both flaps were dissected, and the RHMF was used to cover the exposed bone and the fracture site while the RSF closed the distal part of the wound. Split-thickness skin graft was meshed in scale of 1:1.5 and used to cover the RHMF and the remaining lower leg wounds. In the following days, uneventful wound healing was observed and the patient was discharged on day 34. The patient was invited for a follow-up examination two years after the procedure. His quality of life was assessed using SF-36 and Lower Extremity Functional Scale. It was determined to be satisfactory when compared to patients with identical injuries. Ultrasound examination of the gradient and blood flow velocity showed preserved graft perfusion and no structural abnormalities were detected. Adequate wound preparation and the choice of surgical technique allowed rapid healing and, above all, salvage of the limb that was at high risk of amputation.

The prevalence and anatomy of accessory navicular bone: a meta-analysis.

PURPOSE: There have been over 40 descriptions of the common developmental variants of the accessory ossicles of the feet. Although predominantly asymptomatic, they sometimes may be linked to painful conditions. One of the most common accessory ossicles in the foot is the accessory navicular bone (AN), located on the medial side of the foot. Our research provides a first meta-analysis on this topic that establishes its frequency by contrasting 39 studies from across the globe. METHODS: Up to February 2024, PubMed and Embase databases were thoroughly searched for research on the AN. Eligible data regarding AN prevalence was extracted. This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: A total of 39 studies, 11,015 patients, and 36,837 feet were analyzed in our study. The pooled prevalence estimate (PPE) of AN was found to be 17.5% (95%CI: 11.5-25.7) and 12.6% (95%CI: 10.1-15.5) in patients and feet analyses, respectively. Accessory navicular occurred bilaterally in 50.0% of patients, with similar distribution in gender-based groups (21.1% of males and 22.0% of females were confirmed with AN). Accessory navicular was most prevalent in the East Asian population (38.4%) and least prevalent in North Americans (8.0%). No significant differences in AN prevalence were found when comparing different imaging modalities (X-ray and cadaver dissection). CONCLUSION: Accessory navicular is a common finding in imaging studies. Its prevalence depends on the population covered by the study but is not affected by the patient's gender or the imaging modality utilized for AN assessment.

Indomethacin-responsive trigeminal autonomic cephalgias: a review of key characteristics and pathophysiology.

Trigeminal autonomic cephalgias (TACs) are a well-defined subset of uncommon primary headaches that share comparable onset, pathophysiology and symptom patterns. TACs are characterised by the presentation of one-sided and high-intensity trigeminal pain together with unilateral cranial autonomic signs, which can include lacrimation, rhinorrhea, and miosis. The International Classification of Headache Disorders 3rd Edition recognises four different headache entities in this group, with cluster headache as the most recognised among them. Hemicrania continua (HC) and paroxysmal hemicrania (PH) are both distinctive cephalgias of which the diagnostic criteria include an absolute response to indomethacin. Consequently, for this reason they are often referred to as 'indomethacin-responsive' TACs. The main focus of this review was to discuss the state of knowledge regarding the pathophysiology and key characteristics of PH and HC. Given the limited understanding of these conditions, and their exceptionally uncommon prevalence, a correct diagnosis can pose a clinical challenge and the search for an effective treatment may be prolonged, which frequently has a serious impact upon patients' quality of life. The information provided in this review is meant to help physicians to differentiate indomethacin-sensitive cephalgias from other distinct headache disorders with a relatively similar clinical presentation, such as cluster headache, trigeminal neuralgia, and various migraine conditions.