Hasil untuk "Diseases of the musculoskeletal system"

Henriette M. Eijking, Robin Voskuilen, Pieter Tilman et al.

Abstract Introduction Osteoarthritis (OA) is a common and disabling joint condition that requires accurate assessment for effective management. Variability in radiographic classification of OA severity can impact diagnostic accuracy and treatment decisions. This study evaluates the interobserver reliability of radiographic grading systems for hip and knee OA severity. Methods This retrospective study included 576 patients diagnosed with hip or knee OA between 2016 and 2023 who underwent radiographic evaluation. Radiographs were independently scored by three orthopaedic surgeons and three radiologists using established classification systems (Kellgren-Lawrence (K-L), Croft for hip; K-L, Ahlbäck, Brandt and Osteoarthritis Research Society International (OARSI) for knee OA). Interobserver agreement was assessed using kappa statistics. Results A total of 296 hip OA patients (mean age 69.5 ± 8.7, 62% female, 67% underwent surgery) and 280 knee OA patients (mean age 69.8 ± 8.4 years, 41% female, 53% underwent surgery) were assessed. For hip OA, interobserver agreement was moderate using K-L (κ = 0.552) and Croft (κ = 0.468). For knee OA, moderate agreement was found for the KL (κ = 0.598) and Ahlbäck (κ = 0.463), and substantial for Brandt (κ = 0.625), and OARSI (κ = 0.648) classifications. Overall, radiologists assigned higher OA severity scores than orthopaedic surgeons. Conclusion This study shows fair to moderate agreement between orthopaedic surgeons and radiologists in diagnosing hip and knee OA. Based on our data, we recommend the Kellgren-Lawrence as the grading system for lower extremity osteoarthritis. However, grading minute osteophytes and early-stage osteoarthritis remains challenging.

Austin Bell-Hensley, Victor Gustavo Balera Brito, Lei Cai et al.

Britton W. Brewer, Rachel Shinnick, Allen E. Cornelius et al.

Changes in athletic identity have been documented after injury and other sport transitions in nomothetic investigations. Patterns of change in athletic identity after injury have not been examined systematically at the individual level. In the current study, secondary analyses were performed on two data sets (N = 43 and N = 80) in which athletic identity values were available for before and at least six months after anterior cruciate ligament (ACL) reconstruction. A stable pattern of athletic identity was most common (48–68% of participants), followed, respectively, by a decreasing pattern (19–45% of participants) and an increasing pattern (7–14% of participants) in both data sets, with a trend toward a decreasing pattern over time in the data set in which athletic identity values were available up to two years after surgery. Partial support was obtained for the claim that decreases in athletic identity after ACL surgery are related to postoperative perceptions of knee symptoms and function. The current intraindividual findings complement the results of nomothetic studies and suggest that although stability of athletic identity after sport injury seems to be the norm, changes in athletic identity are also common and should be considered in applied work with athletes who have sustained injuries.

Gamze Dilek, Mehtap Kalcık Unan, Kemal Nas

Calcium pyrophosphate deposition (CPPD) disease represents a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate crystals within the articular joints and adjacent soft tissues. The manifestation of CPPD can present in a variety of clinical forms, including acute pseudogout episodes, chronic inflammatory arthritis, a variant associated with osteoarthritis, and the “crowned dens” syndrome; alternatively, it may be identified incidentally during radiological assessments. The condition is predominantly observed in individuals aged over 60 years, with its incidence escalating in correlation with advancing age. The presence of CPP crystals activates the innate immune response, subsequently eliciting an inflammatory cascade. Among the mechanisms implicated in this inflammatory process are the activation of the nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing 3 (NLRP3) inflammasome, and the secretion of matrix metalloproteinases. The elevation of pro-inflammatory cytokines such as IL-6, IL-8, TNF-α, and pro-IL-1β exacerbates the inflammatory state within the affected joint. Although there is a marginally higher prevalence of CPPD in females, this gender disparity is not deemed statistically significant. CPPD may also manifest in younger and middle-aged populations, necessitating vigilance regarding potential metabolic disorders or hereditary conditions in such cases. The diagnosis of CPPD is predominantly established through a combination of clinical assessment and imaging modalities. The definitive diagnostic criterion involves the identification of CPP crystals in synovial fluid utilizing polarized light microscopy. Clinically, CPPD can be misdiagnosed as rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), infectious arthritis, and other crystal-related arthropathies. The recently developed classification criteria by ACR/EULAR in 2023 are intended to enhance the precision of diagnosis. This review seeks to encapsulate the pathophysiology, clinical presentation, and diagnostic approaches related to CPPD disease, informed by contemporary literature.

Yuhan Xia, Kazuki Inoue, Ting Zheng et al.

AbstractInflammation plays a crucial role in the development of various disease conditions or is closely associated with them. Inflammatory cytokines like TNF often engage in interactions with other cytokines and growth factors, including TGFβ, to orchestrate inflammatory process. Basal/endogenous TGFβ signaling is a universal presence, yet the precise way TNF communicates with TGFβ signaling to regulate inflammation and influence inflammatory levels in macrophages has remained elusive. To address this question, this study utilized genetic approaches and a combination of molecular and cellular methods, including conditional TGFβ receptor knockout mice, human cells, RNAseq, ATACseq and Cut & Run‐seq. The results reveal that the TGFβ signaling functions as a vital homeostatic pathway, curtailing uncontrolled inflammation in macrophages in response to TNF. Conversely, TNF employs two previously unrecognized mechanisms to suppress the TGFβ signaling. These mechanisms encompass epigenetic inhibition and RBP‐J‐mediated inhibition of the TGFβ signaling pathway by TNF. These mechanisms empower TNF to diminish the antagonistic influence exerted by the TGFβ signaling pathway, ultimately enhancing TNF's capacity to induce heightened levels of inflammation. This reciprocal suppression dynamic between TNF and the TGFβ signaling pathway holds unique physiopathological significance, as it serves as a crucial “braking” mechanism. The balance between TNF levels and the activity of the endogenous TGFβ signaling pathway plays a pivotal role in determining the overall extent of inflammation. The potential for therapeutically augmenting the TGFβ signaling pathway presents an intriguing avenue for countering the impact of TNF and, consequently, developing innovative strategies for inflammation control.

Christopher A. Mecoli, David Fiorentino, Jemima Albayda et al.

ObjectiveThe objective of this study was to describe the frequency, co‐occurrence, and cancer association of anti–cell division cycle and apoptosis regulator 1 (anti‐CCAR1) and anti‐Sp4 in two large independent adult dermatomyositis (DM) cohorts.MethodsAnti–transcription intermediary factor 1γ (anti‐TIF1γ)–positive patients with DM from two independent cohorts were studied to determine the serologic overlap of anti‐CCAR1 and anti‐Sp4 autoantibodies measured by enzyme‐linked immunosorbent assay. Associations between cancer‐associated myositis (CAM) and antibody‐defined subgroups within anti‐TIF1γ–positive patients with DM were determined.ResultsA total of 305 anti‐TIF1γ–positive patients with DM were studied: 169 patients from Johns Hopkins and 136 patients from Stanford. In each cohort, approximately one‐third of anti‐TIF1γ–positive patients with DM were anti‐Sp4 positive, one‐third were anti‐CCAR1 positive, 20% were positive for both, and half of patients were negative for both. There was a strong association with CAM in patients lacking both these antibodies (Johns Hopkins, odds ratio [OR] 12.9 [95% confidence interval (CI) 3.6–89.5]; Stanford, OR 4.5 [95% CI 1.8–13.2]). The strongest negative association with CAM was found in patients with anti‐Sp4 or anti‐CCAR1 (Johns Hopkins, OR 0.07 [95% CI 0.01–0.27]; Stanford, OR 0.22 [95% CI 0.07–0.55]).ConclusionBoth anti‐Sp4 and anti‐CCAR1 autoantibody subgroups are negatively associated with CAM. Although the magnitude of this association is substantial, cancer occasionally occurs in patients positive for either specificity. Conversely, approximately half of anti‐TIF1γ–positive patients with DM are negative for both antibodies (anti‐Sp4/anti‐CCAR1 negative), and thus this subgroup may warrant more intensive cancer surveillance.

Wenchao Wang, Zhenkai Ma, Xuemin Feng et al.

Abstract Objective Transferrin receptor-1 (TfR1) plays important roles in controlling cellular iron levels, but its role in OA pathology is unknown. Herein we aim to investigate the role of TfR1 in OA progression and its underlying mechanisms. Methods TfR1 expression in cartilage during OA development were examined both in vivo and in vitro. Then IL-1β was used to induce chondrocytes degeneration in vitro and TfR1 siRNA was used for observing the effect of TfR1 in modulating iron homeostasis, mitochondrial function and degrading enzymes expression. Also the inhibitor of TfR1 was exploited to analyze the protective effect of TfR1 inhibition in vivo. Results TfR1 is elevated in OA cartilage and contributes to OA inflammation condition. Excess iron not only results in oxidative stress damage and sensitizes chondrocytes to ferroptosis, but also triggers c-GAS/STING-mediated inflammation by promoting mitochondrial destruction and the release of mtDNA. Silencing TfR1 using TfR1 siRNA not only reduced iron content in chondrocytes and inhibited oxidative stress, but also facilitated the mitophagy process and suppressed mtDNA/cGAS/STING-mediated inflammation. Importantly, we also found that Ferstatin II, a novel and selective TfR1 inhibitor, could substantially suppress TfR1 activity both in vivo and in vitro and ameliorated cartilage degeneration. Conclusion Our work demonstrates that TfR1 mediated iron influx plays important roles in chondrocytes degeneration and OA pathogenesis, suggesting that maintaining iron homeostasis through the targeting of TfR1 may represent a novel therapeutic strategy for the treatment of OA.

Zihan Ding, Wu Zhou, Deliang Wang et al.

Abstract Objective Traumatic spinal cord injury (TSCI) stands as one of the most profoundly damaging and debilitating conditions. This study aims to explore the potential of magnetic resonance imaging (MRI) variables and peripheral inflammatory indicators as promising biomarkers. It aims to understand their significance in evaluating the severity and predicting the prognosis of TSCI. Furthermore, the study aims to ascertain whether combining these indicators could enhance the accuracy of injury assessment and predictive prognostic ability. Methods A multicentre retrospective cohort study was conducted to assess the severity and prognostic value of MRI variables and peripheral inflammatory response biomarkers in patients with acute cervical TSCI. The study involved 374 patients with acute cervical TSCI drawn from the First Affiliated Hospital of Nanchang University and the Second Affiliated Hospital of Nanchang University. The severity and prognosis of patients with acute cervical TSCI were assessed using the American Spinal Injury Association Impairment Scale (AIS). The correlation between MRI variables, peripheral inflammatory response biomarkers, admission severity, and the 1-year follow-up prognosis was analysed. Results After the initial assessment using the AIS grade system, 169 (49.2%) patients fell into the severe category for cervical TSCI (AIS A–B), while 205 (50.8%) patients were classified as non-severe cases (AIS C–E). The MRI variables (intramedullary lesion length [IMLL], Brain and Spinal Injury Centre [BASIC], maximum spinal cord compression [MSCC], and maximum canal compromise [MCC]) and inflammatory response biomarkers (white blood cells [WBCs], neutrophils, and C-reactive protein [CRP]) exhibited a consistent decrease correlating with the severity grades noted upon admission. Among the 374 patients assessed, 147 (39.3%) experienced a poor prognosis, as indicated by the AIS grade during the 1-year follow-up. MRI variables and peripheral inflammatory response biomarkers declined in correspondence with the follow-up AIS grades. Sex (p < 0.001), IMLL (p < 0.001), MSCC (p < 0.001), MCC (p < 0.001), BASIC (p < 0.001), WBC (p < 0.001), neutrophils (p < 0.001), and CRP (p < 0.001) were statistically significant in predicting poor outcomes. Through multivariate logistic regression analysis, BASIC score and CRP emerged as independent predictors of poor prognosis. Notably, the model combining the BASIC score and CRP yielded a larger area under the curve compared to models using only the BASIC score or CRP individually. Conclusions The BASIC score and CRP are crucial biomarkers for evaluating the severity of cervical TSCI and predicting prognosis. Their combination proved to be a more robust determinant of injury severity and a better predictor of neurological recovery.

Zige Liu, Tianxiang Yang, Jun Li et al.

Abstract This study aimed to evaluate the clinical efficacy of percutaneous coaxial large-channel endoscopic lumbar interbody fusion (PCLE-LIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spinal stenosis. The clinical data of patients with degenerative lumbar spinal stenosis who underwent PCLE-LIF (experimental group) and TLIF (control group) surgery from September 2019 to September 2021 were retrospectively analyzed. We collected clinical data and compared the two groups in terms of perioperative parameters, treatment response rate, inflammatory response markers, postoperative complications, postoperative pain, and functional recovery. The results showed that the treatment outcomes in the experimental group were significantly better than those in the control group. Specifically, perioperative parameters and inflammatory response markers in the experimental group were significantly better than those in the control group, with statistically significant differences (P < 0.05). The overall treatment response rate in the experimental group was significantly higher than that in the control group (P < 0.05). Meanwhile, the incidence of postoperative complications in the experimental group was lower than that in the control group, postoperative VAS pain scores and ODI functional scores were lower, and postoperative JOA functional scores were higher than those in the control group, with statistically significant differences (P < 0.05). In conclusion, PCLE-LIF appears to be a promising technique with better clinical outcomes in the treatment of degenerative lumbar spinal stenosis.

Jiaxiang Tao, Mohammad Ikbal Choudhury, Debonil Maity et al.

AbstractTissue stem cell niches are regulated by their mechanical environment, notably the extracellular matrix (ECM). Skeletal muscles consist of bundled myofibers for force transmission. Within this macroscopic architecture, quiescent Pax7-expressing (Pax7+) muscle stem cells (MuSCs) are compressed between ECM basally and myofiber apically. Muscle injury causes MuSCs to lose apical compression from the myofiber and re-enter the cell cycle for regeneration. While ECM elasticities have been shown to affect MuSC’s renewal, the significance of apical compression remains unknown. To investigate the role of apical compression, we simulate the MuSCs’ in vivo mechanical environment by applying physical compression to MuSCs’ apical surface. We demonstrate that compression drives activated MuSCs back to a quiescent stem cell state, regardless of basal elasticities and chemistries. By mathematical modeling and cell tension manipulation, we conclude that low overall tension combined with high axial tension generated by compression leads to MuSCs’ stemness and quiescence. Unexpectedly, we discovered that apical compression results in up-regulation of Notch downstream genes, accompanied by the increased levels of nuclear Notch1&3 in a Delta ligand (Dll) and ADAM10/17 independent manner. Our results fill a knowledge gap on the role of apical compression for MuSC fate and have implications to stem cells in other tissues.

P. Corrigan, T. Neogi, L. Frey-Law et al.

Enrique Calvo-Aranda, Fernando Perez-Ruiz

Gout is the most common inflammatory arthritis and a global health problem. In addition to joint involvement, urate crystals induce chronic inflammation, leading to increased cardiovascular risk in gout. Thus, cardiovascular disease is the leading cause of death in gout and numerous studies have revealed an increase in cardiovascular-related mortality in these patients. However, despite the efficacy of urate-lowering therapies, such as allopurinol and febuxostat, suboptimal management of gout and poor adherence continue to make it difficult to achieve better outcomes. Treat-to-target strategy may help change this, as in other diseases such as rheumatoid arthritis. Nevertheless, even with a well-defined clinical target (absence of flares and tophi disappearance), the numerical target [serum uric acid (SUA) < 5 mg/dL or < 6 mg/dL] still varies depending on current guidelines and consensus documents. Recently, several trials [Long-Term Cardiovascular Safety of Febuxostat Compared with Allopurinol in Patients with Gout (FAST), REasons for Geographic And Racial Differences in Stroke (REGARDS)] have shown better cardiovascular outcomes in those patients who achieve SUA levels < 5 mg/dL. Likewise, some observational studies, mostly based on imaging tests such as ultrasound and dual-energy computed tomography, have found better results in the magnitude and speed of reduction of urate joint deposition when SUA < 5 mg/dL is achieved. Based on an analysis of the available evidence, SUA < 5 mg/dL is postulated as a more ambitious target within the treat-to-target approach for the management of gout to achieve better joint and cardiovascular outcomes in patients with cardiovascular risk or severe disease.

Yuchen Zhang, Di Liu, Djandan Tadum Arthur Vithran et al.

Abstract Osteoarthritis (OA) is a prevalent degenerative disease accompanied by the activation of innate and adaptive immune systems-associated inflammatory responses. Due to the local inflammation, the expression of various cytokines was altered in affected joints, including CC motif chemokine ligands (CCLs) and their receptors (CCRs). As essential members of chemokines, CCLs and CCRs played an important role in the pathogenesis and treatment of OA. The bindings between CCLs and CCRs on the chondrocyte membrane promoted chondrocyte apoptosis and the release of multiple matrix-degrading enzymes, which resulted in cartilage degradation. In addition, CCLs and CCRs had chemoattractant functions to attract various immune cells to osteoarthritic joints, further leading to the aggravation of local inflammation. Furthermore, in the nerve endings of joints, CCLs and CCRs, along with several cellular factors, contributed to pain hypersensitivity by releasing neurotransmitters in the spinal cord. Given this family’s diverse and complex functions, targeting the functional network of CCLs and CCRs is a promising strategy for the prognosis and treatment of OA in the future.

Jiannan Li, Carolyn Kim, Chi-Chun Pan et al.

Hsuan-Hsiao Ma, Hui-Kuang Huang, Cheng-Yu Yin et al.

Abstract Introduction Fixed-angle plate fixation can be an effective treatment for distal radius fractures (DRFs). However, patients with existing ulnar positive variance might be at risk of developing symptoms of ulnar-sided wrist pain (USWP). Ulnar shortening osteotomy (USO) is one of the main treatment options for USWP. We hypothesized that a limited radial distraction at the fracture site at the time of surgery for DRF would be functionally equivalent to an indirect USO and that if this were done in a patient with an ulnar plus morphology it could potentially decrease the risk of USWP. Methods This retrospective study was conducted at a single institution and all the surgeries were performed by single surgeon. A total of 136 patients (92 women and 44 men) with a mean age of 55 years were enrolled with 57 patients in the distraction group (from 2014 to 2017) and 79 patients (from 2011 to 2013) in the non-distraction group. Patients were assessed USWP. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Visual Analogue Scale (VAS) for pain, grip strength, and range of motion for the wrist. Results The mean follow-up was 37.9 months (range, 28–61 months). The radiographs at postoperative 2-year follow-ups showed the mean ulnar positive variance was 1.3 mm (range, 1–2 mm) in the distraction group and 3.5 mm (range, 2-5 mm) in the non-distraction group. The average of the distraction length was 2.32 mm (range, 2–3 mm). At the 2-year follow-ups, USWP presented in 7% (four patients) in the distraction group, which was significantly less than the incidence of 28% (22 patients) in the non-distraction group. The distraction group exhibited significantly better DASH scores and grip strength and less subsequent ulnar-shortening osteotomy for ulnar-sided wrist pain. Conclusions The radial distraction procedure performed during DRFs fixation could possibly reduce the occurrence of postoperative USWP and improve the functional outcomes. Level of evidence Level III, Therapeutic.

Elana J. Bernstein, Sara Jaafar, Shervin Assassi et al.

ObjectiveInterstitial lung disease (ILD) is the leading cause of death in patients with systemic sclerosis (SSc). Although pulmonary function tests (PFTs) are commonly used to screen for ILD in patients with SSc, studies have shown that they lack sensitivity for the detection of ILD in general SSc cohorts. This study was undertaken to assess the performance characteristics of PFTs for the detection of ILD in patients with early diffuse cutaneous SSc (dcSSc), a population at high risk for the development of ILD.MethodsWe performed a retrospective cohort study of patients enrolled in the Prospective Registry of Early Systemic Sclerosis at 11 sites in the US between April 2012 and January 2019. Patients were included if they underwent spirometry and high‐resolution computed tomography (HRCT) of the chest. We calculated the performance characteristics of PFTs for the detection of ILD on HRCT.ResultsThe study included 212 patients, 54% of whom had radiographic ILD. For the detection of ILD on HRCT imaging, a forced vital capacity (FVC) <80% predicted had a sensitivity of 63%. The combination of FVC <80% predicted or diffusing capacity for carbon monoxide (DLco) <80% predicted improved the sensitivity to 85%. An FVC <80% predicted had a negative predictive value (NPV) of 61%, while the combination of FVC <80% predicted or DLco <80% predicted had an NPV of 70%.ConclusionPFTs alone are an inadequate screening tool for the diagnosis of ILD in patients with early dcSSc. HRCT should be part of the ILD screening algorithm in patients with dcSSc.

Marian A. Ackun-Farmmer, Clyde T. Overby, Brittany E. Haws et al.

Alexandra Maldonado López, Brian C. Capell

Dynamic modifications on RNA, frequently termed both, “RNA epigenetics” and “epitranscriptomics”, offer one of the most exciting emerging areas of gene regulation and biomedicine. Similar to chromatin-based epigenetic mechanisms, writers, readers, and erasers regulate both the presence and interpretation of these modifications, thereby adding further nuance to the control of gene expression. In particular, the most abundant modification on mRNAs, N6-methyladenosine (m6A), catalyzed by methyltransferase-like 3 (METTL3) has been shown to play a critical role in self-renewing somatic epithelia, fine-tuning the balance between development, differentiation, and cancer, particularly in the case of squamous cell carcinomas (SCCs), which in aggregate, outnumber all other human cancers. Along with the development of targeted inhibitors of epitranscriptomic modulators (e.g., METTL3) now entering clinical trials, the field holds significant promise for treating these abundant cancers. Here, we present the most current summary of this work, while also highlighting the therapeutic potential of these discoveries.

Karolina Gawronska MSc, Jacek Lorkowski MD, PhD, DSc

Introduction: Studies revealed COVID-19 atypical symptoms such as falls, delirium, confusion, dizziness, unusual fatigue in older patients. Falls in the older population and their consequences are one of the leading causes of disability; they significantly reduce the quality of life and lead to loss of independence and impaired social functioning. The aim of this study is to present the possible correlation between COVID-19 and diseases of the musculoskeletal system, in particular the occurrence of fall-related injuries. Significance: This article highlights the importance of falls as one of the atypical symptoms of COVID-19 infection in older adults, which is not directly associated with infection and could be misinterpreted. Methods: The conducted meta-analysis is based on a review of the scientific literature available in English, French, Dutch, Polish in the PubMed/MEDLINE, Cochrane Library, Embase, Scopus, PEDro, GBL databases from December 1, 2019 to July 30, 2020, covering Clinical Trial, Randomized Controlled Trial, Meta-Analysis, Systematic Reviews and Case Reports. The following keywords were taken into account: fall, (hip/pertrochanteric/proximal femur) fracture, aged and COVID-19. Twenty-seven references were accepted for final analysis. Results: It was found that symptoms such as falls observed in the older adults can be associated with COVID-19 infection. Falls and slips are also the most common mechanism for hip fracture during the pandemic outbreak. Conclusions: According to authors of this study, atypical presentations of COVID-19 should be considered when screening and testing the people at increased risk due to their age. However, further prospective studies are urgently needed to investigate the possible correlation between COVID-19 and falls in older adults.

Jeanette Henkelmann, Timm Denecke, Philipp Pieroh et al.

Abstract Background Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD. Methods We retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD. Results uSpD was detected by MRI in 69 of 79 patients (87%). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed. Conclusions Due to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.