Toronto Western Hospital

Hip arthroscopy is an increasingly common outpatient surgical procedure where postoperative pain can be severe. Peripheral nerve blocks have been evaluated for analgesia following hip arthroscopy; however, there is no consensus on an optimal technique that provides effective local anesthetic-based postoperative analgesia without motor blockade. We hypothesized that the pericapsular nerve group (PENG) block would provide effective motor-sparing analgesia following ambulatory hip arthroscopy. We conducted a randomized placebo-controlled double-blind trial comparing an ultrasound-guided PENG block with 20 mL of 0.5% ropivacaine to a control with a sham injection. Our primary outcomes were cumulative opioid consumption (oral morphine equivalent) and quality of recovery (QoR-15) scores at 24 hours postoperatively. Secondary outcomes included pain, postoperative opioid consumption, time to first analgesic request, postanesthesia care unit (PACU) length of stay, and opioid and block-related side effects. 94 patients were included (47 per group). QoR was similar between groups at 24 hours as measured by the QoR-15 (range 0-150, higher scores indicate better recovery): mean SD 96.8±20.9 in the PENG group versus 101.0±20.9 in the control group (mean difference -4.2; adjusted p=0.414). Opioid consumption at 24 hours was also similar between groups. In adjusted analyses, the PENG group required less opioid analgesia in the PACU (mean difference -9.5 MME; p=0.039) and had a shorter PACU stay (mean difference -20.5 min; p=0.027). Pain scores at rest and on movement decreased over time in both groups, with no consistent differences in overall pain trajectories. Opioid consumption at 48 hours, opioid-related adverse effects and block-related complications were similar between groups. When administered preoperatively, the PENG block provides only modest early perioperative benefits without improving overall postoperative analgesia or QoR in patients undergoing ambulatory hip arthroscopy. Based on these findings, routine preoperative use of the PENG block for ambulatory hip arthroscopy cannot be recommended beyond standard multimodal analgesia, although it may be considered selectively to facilitate early PACU recovery in carefully chosen patients. The potential role of postoperative PENG block as a rescue intervention warrants further investigation. NCT03449680; https://clinicaltrials.gov/study/NCT03449680.

Health-related quality of life (HRQoL) in patients with degenerative cervical myelopathy (DCM) ranks among the lowest across chronic medical conditions. We aim to evaluate the impact of neck pain on postoperative HRQoL after surgical decompression for DCM. We conducted a retrospective analysis of a multicenter international DCM cohort comprising 1047 patients enrolled from 2005 to 2021. Neck pain severity was assessed using the pain intensity subdomain of the Neck Disability Index. Baseline and 1-year HRQoL scores measured using the SF-36 physical component summary (PCS) and mental component summary (MCS) were compared between neck pain and no neck pain cohorts. Multivariable regression models, adjusted for key clinical covariates, were used to examine the association between neck pain severity and HRQoL. Neck pain was present preoperatively in 81.5% of patients. The neck pain group had significantly lower PCS (34.72 ± 9.02 vs 39.56 ± 10.20, P < .001) and MCS scores (40.59 ± 11.73 vs 45.64 ± 12.86, P < .001) compared with the no neck pain group. At 1 year postsurgery, 35.5% reported being pain-free. Increasing neck pain severity was associated with progressively lower PCS (exp β = -3.64, -7.45, and -10.47 for mild, moderate, and severe pain) and MCS scores (exp β = -2.96, -7.69, and -11.80). Persistent moderate and severe neck pain at 1 year independently predicted failure to achieve minimal clinically important difference for PCS [odds ratio = 0.57 (95% CI 0.39-0.83, P < .05) and 0.37 (95% CI 0.25-0.55, P < .05), respectively] and MCS [odds ratio = 0.49 (95% CI 0.34-0.71, P < .05) and 0.60 (95% CI 0.41-0.88, P < .05), respectively]. Model fit predictions for 1-year HRQoL were improved with inclusion of neck pain scores (PCS: χ2 = 37.21, MCS: χ2 = 19.18, both P < .0001). Neck pain is highly prevalent among patients with DCM and is independently associated with poorer postoperative HRQoL. While surgery restores neurological function, optimizing patient-reported outcomes requires adjunctive strategies specifically targeting neck pain.

Spondyloarthritis (SpA), including axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), comprises a diverse but interrelated family of inflammatory diseases characterized by inflammation of the joints and spine. Signs and symptoms of SpA vary widely, as patients experience a diverse spectrum of musculoskeletal and extra-musculoskeletal disease manifestations. Interleukin (IL)-17 is an inflammatory cytokine common to the pathogenesis of SpA disease development and progression. The IL-17A inhibitor secukinumab has been well established in clinical trials and real-world practice as an effective therapeutic tool to efficiently manage SpA indications axSpA and PsA in adults, as well as juvenile PsA (jPsA) and enthesitis-related arthritis (ERA), which are two subtypes of juvenile idiopathic arthritis. This review highlights the comprehensive response to IL-17 inhibition with secukinumab across SpA indications of PsA, axSpA, and ERA/jPsA and within each indication according to established disease domains. We provide context through expert commentary on the effect of inhibiting IL-17 with secukinumab on the full spectrum of SpA disease manifestations, as well as areas in need of further investigation.

Dystonia in children is a heterogeneous condition with variable response to deep brain stimulation (DBS). Brain-age gap, a machine learning-derived metric of structural deviation from norm, may capture signatures that differentiate underlying biotypes and predict outcomes. A brain age model was trained on several thousand normative developmental trajectories (n = 2623). Brain-age gap (the difference between predicted and chronological age) was computed from pre-DBS T1-weighted magnetic resonance imaging in 37 children with dystonia and compared to matched healthy controls. Associations with etiology, Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Pediatric Quality-of-Life (PedsQL) scores were examined. Children with dystonia showed a greater brain-age gap (structural deviation) compared to controls (P < 0.001). Greater gap was linked to worse baseline motor scores and poorer 1-year quality-of-life improvement. Patterns differed by etiology, with distinct regional deviations in genetic and acquired dystonia. Brain-age modeling reveals biologically distinct subtypes of pediatric dystonia and may offer a biomarker for stratification and outcome prediction. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

USA (7%), and Europeans (3%).CVD was most frequent in Asians (13%), then Latin Americans (11%), Europeans (7%), and Africans (3%).Age at SLE diagnosis was not a significant moderator for headache (p=0.59) or CVD (p=0.81),though it showed a trend toward an inverse effect on seizures (p=0.09).Disease duration was not a significant moderator for seizures (p=0.12),but it trended inversely with headache (p=0.07) and CVD (p=0.08).Female gender did not significantly influence headache (p=0.5),seizures (p=0.4), or CVD (p=0.5).Conclusions Neurological CNS symptoms, as defined per the ACR 1999 criteria, in adult-onset SLE vary significantly.Aseptic meningitis, myelopathy, and chorea were rare, while headaches, seizures, and cerebrovascular disease were most common.Common modifiers like age, sex, disease duration, and renal involvement showed some trends but did not consistently affect syndrome occurrence.Clear regional disparities were noted.These findings highlight the need for further research to clarify factors influencing CNS involvement in SLE, refine phenotypic classification, and identify specific biomarkers.