Citations

Abstract Background Native vertebral osteomyelitis (NVO) is a life-threatening spinal infection with considerable clinical burden. Although increasing literature has described its features and associated treatment failure, large-scale cohorts with long-term follow-up remain limited. Herein, we evaluated a large cohort of patients with NVO to characterize the clinical manifestations, management, and long-term outcomes, and to further explore factors associated with treatment failure.Table 1.Baseline characteristics of patients with native vertebral osteomyelitisTable 2.Treatment, failure rates, and mortality in patients with native vertebral osteomyelitis Methods We conducted a retrospective multicenter cohort study of adults (≥18 years) with NVO across Mayo Clinic sites between 1999 and 2024. Data on demographics, clinical manifestations, antimicrobial therapy, and surgical intervention were collected. Cumulative incidence of treatment failure was estimated as a function of follow-up accounting for the competing risk of death. Independent predictors of treatment failure were evaluated in a multivariable Cox regression model with time-dependent covariates.Table 3.Multivariable predictors of treatment failure in patients with native vertebral osteomyelitisFigure 1.Cumulative incidence of death and treatment failure following diagnosis of native vertebral osteomyelitis(A) Short-term (12-month) cumulative incidence of death and treatment failure (magnified view of the first year from panel B).(B) Long-term (up to 7 years) cumulative incidence of death (dotted orange line) and treatment failure (solid blue line). Results Among 1,255 patients included (median age 67 years; 66% male), lumbosacral involvement was most common (65%), with multilevel vertebral involvement ( >2 levels) in 21%. Epidural abscesses were present in 43%, paravertebral abscesses in 42%, and psoas abscesses in 20%. Pathogens were identified in 77%, most commonly S. aureus (50%; MSSA 37%, MRSA 13%), followed by Streptococcus species (22%), and Gram-negative bacilli (11%) (Table 1). The median total antibiotic duration was 59 days (IQR, 42–132). Surgical intervention was performed in 13% after a median of 2 days (IQR, 1-5). Treatment failure occurred in 162 patients during a median follow-up of 2.8 years (6-month and 5-year cumulative incidence were 11% and 14%, respectively), with the median time to failure of 3.1 months. Cumulative mortality was 12% at 6 months and 33% at 5 years (Table 2, Figure 1). Diabetes (HR 1.90, 95% CI 1.16–3.12), multilevel vertebral involvement (HR 1.75, 95% CI 1.22–2.51), and MRSA infection (HR 2.11, 95% CI 1.06–4.18) were independently associated with increased risk of treatment failure (Table 3). Conclusion This 25-year study highlights the persistent burden of treatment failure in NVO and associated risk factors, underscoring the importance of early recognition of high-risk features to optimize outcomes. Disclosures All Authors: No reported disclosures

Abstract Background Native joint septic arthritis (NJSA) is a serious musculoskeletal infection requiring timely surgical intervention to prevent long-term morbidity. Although current guidelines recommend early surgical debridement, supporting data, particularly on long-term outcomes, remain scarce. Given this, we evaluated the association between surgical timing and 1-year clinical outcomes using the Desirability of Outcome Ranking (DOOR) framework, applied for the first time in NJSA.Table 1.Desirability of Outcome Ranking (DOOR) ordinal scaleTable 2.Baseline demographic, clinical characteristics, and treatment outcomes Methods We conducted a retrospective multicenter cohort study of adults (≥18 years) with NJSA who underwent surgery across Mayo Clinic campuses between 2012 and 2021. Clinical outcomes at one year were assessed using a 9-level DOOR scale, incorporating survival, treatment failure (relapse, reinfection, readmission, or significant surgical events), and joint recovery (full vs qualified) (Table 1). Time to surgery from hospital admission was analyzed both as a continuous variable and as categories: < 1, 1–2, or ≥3 days.Table 3.Associations between duration and outcomesFigure 1.Association Between Time to Surgery and DOOR Scores in Native Joint Septic Arthritis.A) Distribution of Modified DOOR Scores by Surgical Timing. B) Modeled Probability of DOOR Scores by Time to Surgery. Results Among 268 patients (median age 62 years, 61% male), 30% underwent surgery < 1 day from admission, 47% within 1–2 days, and 24% at ≥3 days. At 1 year, 57% achieved full recovery without unfavorable events (DOOR score 1), while treatment failure occurred in 34% (Table 2). In unadjusted analyses, longer surgical delay was significantly associated with higher DOOR scores (per IQR increase [from 0 to 2 days], OR: 1.5; 95% CI: 1.0–2.1; p = 0.026) and with increased 1-year mortality (HR: 1.7; 95% CI: 1.1–2.6; p = 0.019) and treatment failure (HR: 1.5; 95% CI: 1.1–2.0; p = 0.007). Similar results were obtained when delay was used as a categorical 3-level variable, with the highest risk observed in patients undergoing surgery after ≥3 days. After adjusting for age and Charlson index, only the association between surgical delay and treatment failure remained statistically significant (HR: 1.5; 95% CI, 1.1–2.0; p=0.016) (Table 3, Figure 1). Conclusion Delayed surgical intervention for management of NJSA was independently associated with higher risk of treatment failure at 1 year. These findings reinforce current guideline recommendations for timely operative management and further underscore the potential of the DOOR framework to capture clinically meaningful, multidimensional outcomes in NJSA. Disclosures All Authors: No reported disclosures

The treatment landscape for multiple myeloma (MM) is evolving rapidly and includes several new options. The management must be tailored to the individual. The NCCN Guidelines for MM provide a framework to base decisions regarding diagnosis, workup, treatment, and follow-up of both newly diagnosed and previously treated relapsed/refractory MM. This manuscript outlines the recommendations from NCCN Guidelines for MM specific to newly diagnosed MM (NDMM).

Objective Cervical artery dissection (CeAD) may be limited to the extracranial extradural space or extend to the intradural space. Intradural extension can potentially increase the risk of stroke and subarachnoid hemorrhage. However, the factors associated with intradural extension and its impact on clinical outcome remain unclear. Methods This was a secondary analysis of the STOP‐CAD observational, multi‐center study. Patients with CeAD and intradural extension (CeADid) were compared with those with pure CeAD extradural dissections (CeADed) using multiple regression analyses. Results Of 4,023 patients with CeAD, 534 (13.3%) had CeADid. In comparison to patients with CeADed, those with CeADid more often had clinical overt stroke or transient ischemic attack (TIA) at presentation, acute infarcts on imaging, a vertebral artery affected, and severe stenosis of the involved vessel ( p < 0.001 for all). In contrast, carotid involvement and complete occlusions were more frequent in patients with CeADed ( p < 0.001 for both). CeADid was associated with a shift in the distribution of scores on the modified Rankin Scale (mRS) toward worse functional outcome (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.62–0.92) but the odds for favorable outcomes (mRS = 0–2) did not differ between the groups after appropriate adjustments on multivariate analysis. CeADid was independently associated with higher mortality at 180 days on multivariate analysis (adjusted OR = 2.84, 95% CI = 1.50–5.38). Interpretation CeADid is associated with more severe clinical presentation, a shift toward less favorable outcomes, and higher mortality rates. These findings suggest that CeADid may represent a high‐risk type of CeAD. ANN NEUROL 2026;99:1189–1197

Background Deep brain stimulation (DBS) has been investigated for patients with drug-resistant epilepsy who are not candidates for resective surgery. Because different types of epilepsy involve distinct brain networks, numerous DBS targets have been explored, yet a comprehensive synthesis is lacking. Methods To provide a comprehensive overview of this expanding literature, we conducted a systematic review of studies for DBS in epilepsy, including case series, prospective and retrospective studies. We collected data on surgical targets, individual disease characteristics, outcomes and precise electrode placements. DBS electrode coordinates were gathered into a common template space and related to clinical outcomes. Results We included 124 studies, corresponding to 1210 patients and 20 distinct surgical targets. While the anterior (ANT) and centromedian (CM) nuclei of the thalamus remain the most studied, we also review less commonly used targets that show promise for specific forms of epilepsy and may warrant further investigation. Substantial variability in targeting strategies and electrode placement was observed within each of the target regions. Importantly, significant relationships between stimulation location and outcomes were identified for ANT-DBS and CM-DBS. For ANT-DBS, shorter distance to the mammillothalamic tract junction was associated with greater seizure reduction on both study-level and patient-level analyses (r=−0.55, p<0.001 and r=−0.51, p<0.001, respectively). For CM-DBS, localisation effects may be dependent on the form of epilepsy, with stimulation of the parvocellular CM being associated with better outcomes in generalised epilepsy. Conclusions Our results emphasise the importance of accurate targeting in DBS for epilepsy. Our database and atlas of DBS targets are made publicly available, potentially serving further meta-analytical work. PROSPERO registration number CRD420250649304.

Abstract Cutaneous squamous cell carcinoma (cSCC) poses significant clinical challenges due to its rising incidence and potential for metastasis. Histopathologic risk stratification is further limited by substantial inter-observer variability. Unsupervised AI approaches based on content-based image retrieval offer scalable and interpretable decision support for diagnostic pathology. The objective of this study was to evaluate the use of image retrieval within histopathology atlases to stratify cSCC tumor differentiation from whole-slide images (WSIs), while comparing different patch selection and feature extraction strategies. This retrospective study included 552 archived WSIs comprising 385 well-differentiated, 102 moderately differentiated, and 66 poorly differentiated cases collected across Mayo Clinic sites in Arizona, Florida, and Minnesota. Image atlases were constructed using multiple patch aggregation strategies (Mosaic, Collage, and Montage) and deep learning encoders (KimiaNet, PathDino, and H-Optimus-0). A leave-one-WSI-out evaluation framework was used to assess differentiation classification performance using accuracy, specificity, sensitivity, and F1 score. Mosaic combined with KimiaNet achieved the highest Top-1 accuracy (74.9%) and specificity (92.6%), while Mosaic with H-Optimus-0 yielded the best Top-5 accuracy (79.0%) and macro-F1 score (62.6%). Collage combined with KimiaNet produced the highest Top-5 specificity (99.5%). The generalizability of the evaluated AI models varied across hospitals, reflecting differences in imaging protocols, staining practices, and patient populations. Overall, unsupervised image search and retrieval provides effective, annotation-free support for cSCC differentiation and has the potential to enhance dermatopathology workflows when appropriate combinations of patch selection and feature ex-traction methods are employed.

Background: Neck lacerations sustained while playing ice hockey are rare but potentially fatal. Neck laceration protectors (NLPs) have been around for decades but only lately are becoming required by leagues given recent fatalities. Purpose: To outline the relevant neck anatomy at risk, describe rink-side evaluation and management techniques, review historical and contemporary NLP mandates, and conclude with evidence-based recommendations. Study Design: Narrative review; Level of evidence, 5. Methods: A review of the literature regarding neck lacerations in ice hockey was utilized for content collection. Google Scholar and PubMed were queried for peer-reviewed articles relevant to the topic. Keywords including “ice hockey,” “neck lacerations,” “neck laceration protector,” and combinations thereof were used to identify relevant literature. Results: Neck lacerations are rare but can be fatal given that they often damage zone II neurovascular structures. While numerous international leagues require mandates for NLPs, notable holdouts include the National Hockey League and the National Collegiate Athletic Association. Numerous materials and builds for NLPs are capable of withstanding penetration from a skate slash, although they possess differences in comfort and neck range of motion. Conclusion: NLPs have the capacity to prevent significant and potentially fatal laceration injuries in ice hockey. Based on the available data, implementing NLP mandates appears to be in the interest of player safety.

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain in young, active athletes. American football players place high demands on the hip due to the sport's requirements for pivoting, cutting, and loading in deep flexion. Although arthroscopic treatment of FAI in professional National Football League (NFL) players has shown favorable outcomes, football-specific outcomes in non-NFL athletes remain limited. Purpose: To report the return-to-sport (RTS) rates and functional outcomes at a minimum 2-year follow-up for active American football players competing at multiple levels after primary hip arthroscopy for FAI. Study Design: Case series; Level of evidence, 4. Methods: An institutional database was queried to identify all active American football players who underwent primary hip arthroscopy with labral repair between 2010 and 2023. Demographic characteristics, radiographic parameters, procedure details, complications, and reoperations were collected. Follow-up was completed at a minimum of 2 years to obtain updated patient-reported outcome measures (PROMs) as well as football-specific data, including current participation and RTS status. PROMs were reported as mean ± standard deviation, and categorical variables, including RTS, were reported as frequencies. Pre- versus postoperative PROMs were compared using t tests or Mann-Whitney U tests to assess outcomes. Results: In total, 49 hips in 38 male football players (age, 18.1 years; range, 14-26 years) were included. Most athletes played at the high school (74%) or college level (21%). A total of 51% played as linemen. Labral repair was performed in all cases. At a mean 7.6 years, mean modified Harris Hip Score was 90 ± 13, Hip Outcome Score–Activities of Daily Living was 95 ± 7, and Hip Outcome Score–Sport was 89 ± 17. Overall mean surgery satisfaction was 8.7 ± 1.7 (out of 10). Significant postoperative improvements were observed in all PROMs ( P ≤ .002). Twelve players (32%) did not attempt RTS due to other nonmedical factors and were excluded from return to sport analysis. A total of 23 (88%) players achieved RTS, and 3 players (12%) did not. Two players (8%) cited other injuries, and 1 player (4%) continued to have hip limitations. Four hips (8%) underwent reoperation at a mean 4.9 years postoperative. Conclusion: Amateur American football players undergoing primary hip arthroscopy for FAI demonstrated excellent patient-reported outcomes and a high RTS rate of 88%, when excluding those who did not return for nonmedical reasons, at a mean 7.6-year follow-up. Notable positional differences were observed across multiple levels of play. Although outcomes were generally favorable, both medical and nonmedical factors could limit return to sport, particularly among high school and college athletes.

Inferior vena cava (IVC) pathology is often underrecognized on non-dedicated imaging examinations, yet it carries significant diagnostic and clinical implications, particularly in acute emergency settings. This review highlights the complementary roles of ultrasound (US) and computed tomography (CT) in the assessment of IVC abnormalities. The US provides real-time, bedside evaluation of IVC patency, caliber, and hemodynamics, whereas CT offers detailed anatomic and structural characterization critical for diagnosis and management. The review aims to systematically discuss congenital variants, thrombotic, traumatic, systemic conditions, and neoplastic involvement of the IVC, emphasizing their imaging features and clinical relevance.

Abstract Background Immunohistochemically detected phosphorylated α‐synuclein (p‐α‐syn) in cutaneous nerves has been found in >95% of patients meeting consensus criteria for dementia with Lewy bodies (DLB); however, its performance in prodromal stages (mild cognitive impairment‐Lewy body [MCI‐LB]) and clinical practice is unknown. Objective We evaluated skin biopsy for p‐α‐syn in a convenience cohort of patients with suspected MCI‐LB or DLB in a tertiary care setting. Methods 53 patients underwent commercially available skin biopsy for skin nerve p‐α‐syn as part of a clinical evaluation for suspected MCI‐LB/DLB. Consensus MCI‐LB/DLB criteria blinded to skin biopsy result were applied through retrospective chart review; those not definitively meeting criteria were considered questionable synucleinopathy (QS). Results Median age at skin biopsy was 70 years (range, 43–87 years) with 81% men. 36 patients (68%) had positive skin biopsies. 32/43 (74%) patients meeting clinical consensus criteria for DLB/MCI‐LB had a positive skin biopsy, with higher frequency in MCI‐LB (87%) compared with DLB (60%). 4/10 (40%) QS had positive biopsies. One patient with a positive skin biopsy had no evidence of central nervous system (CNS) α‐syn on autopsy. Conclusions Positive skin biopsy for p‐α‐syn occurs across the spectrum of cognitive presentations of Lewy body disease including prodromal DLB, albeit at a lower frequency in this retrospective review of atypical cases compared with typical clinical presentations. A positive skin biopsy may not reflect CNS synucleinopathy as the etiology for a patient's symptoms in some cases. Longitudinal studies of skin biopsies for p‐α‐syn in suspected MCI‐LB/DLB with autopsy confirmation are needed. © 2025 International Parkinson and Movement Disorder Society.