Study Design: Retrospective Cohort Study. Objectives: Unilateral biportal endoscopy (UBE) provides a minimally invasive option for treating lumbar spinal stenosis, enabling faster recovery but requiring surgical precision. This study aims to establish a learning curve model for UBE in central lumbar spinal stenosis, focusing on surgical duration and neuromonitoring data. Methods: Data were collected from a senior orthopedic spine surgeon’s cases involving lumbar spinal stenosis. Neuromonitoring was performed during UBE, recording each dural and root irritation as a risk. Surgical details, including operative time (from first incision to final suture) and neuromonitoring events, were documented. The RA-CUSUM method in Python was used to evaluate proficiency, adjusting for procedure time. Results: Seventy-eight patients with central lumbar spinal stenosis were included. RA-CUSUM analysis, integrating neuromonitoring and surgical time, indicated significant proficiency gains by the 16th case, with reductions in procedural time and neural irritations. CUSUM analysis based solely on operative time showed stabilization and efficiency improvements by the 35th case. Conclusion: Proficiency in UBE surgery is generally achieved by the 16th case regarding neuromonitoring management and by the 35th case regarding time efficiency. These findings are valuable for surgeons transitioning to UBE, although the results may not fully generalize to those without prior surgical experience. Continued research and structured training are essential to optimize UBE outcomes.

Angiosarcomas are malignant tumors, which originate from the vessel endothelium and resemble the vessel structure. Stewart-Treves syndrome is an angiosarcoma which in general, develops in female patients after mastectomy and axillary lymph node dissection and is associated with chronic lymphedema. The prognosis of this rare complication is very poor. We present the case of a 52-year-old female who had undergone mastectomy due to breast cancer and 13 years later required shoulder disarticulation due to Stewart-Treves syndrome.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

Purpose: Scapholunate interosseous ligament (SLIL) injury is the most common cause of carpal instability and may lead to scapholunate advanced collapse if untreated. While several anatomical wrist variations have been implicated in other wrist pathologies, limited studies have explored their role in SLIL injuries. This study aimed to compare specific anatomical parameters on wrist radiographs between patients with arthroscopically confirmed SLIL injuries and healthy individuals to identify potential anatomical predispositions. Methods: This study analyzed bilateral wrist radiographs of 87 patients who underwent arthroscopic dorsal capsulodesis for SLIL injuries between 2010 and 2023. A control group of 87 asymptomatic individuals with normal wrist radiographs was also included. Standardized anteroposterior and lateral wrist X-rays were collaboratively evaluated by three orthopedic surgeons. Parameters measured included radial inclination (RI), lunate fossa inclination (LFI), ulnar variance (UV), lunate tilting angle (LTA), lunate uncovering index (LUCI), carpal height ratio (CHR), palmar tilting angle (PTA), and lunate morphology. Group comparisons were performed, and a multiple logistic regression analysis was conducted using variables found to be significant in univariate analysis to identify independent anatomical predictors of SLIL injury. Results: There were no significant differences between the SLIL-injured patient group and the control group in terms of gender, age, and side (p > 0.05). RI (p < 0.001) and LFI (p = 0.016) were significantly lower, while LTA (p < 0.001) was significantly higher in the SLIL-injured patient group. Multiple logistic regression analysis revealed that lower RI (OR: 0.853, 95% CI: 0.769–0.946; p = 0.003) and higher LTA (OR: 1.126, 95% CI: 1.052–1.204; p = 0.001) were independently associated with SLIL injury. LFI did not remain significant in the final model. No significant differences were observed in UV, LUCI, PTA, CHR, or lunate type between groups. Conclusion: Low RI and increased LTA may represent anatomical risk factors for SLIL injury. Other parameters were not associated with an increased risk of injury. This study was not designed to establish a radiological diagnosis of SLIL injury; rather, it demonstrates that SLIL injuries may be influenced by individual anatomical variations. Further large scale studies are needed to validate these findings and to better understand the anatomical contributions to SLIL injury susceptibility.

Purpose: Adjacent segment disease (ASD) is a recognized complication following lumbar fusion, characterized by new symptomatic and radiological degeneration at levels adjacent to the fused segment. While revision decompression with extended fusion has traditionally been performed, minimally invasive fusion-sparing strategies such as unilateral biportal endoscopic (UBE) decompression have gained attention. High-level evidence regarding their effectiveness in carefully selected stable ASD remains limited. Methods: This retrospective cohort study included 17 consecutive patients with clinically and radiologically confirmed ASD treated with isolated UBE posterior decompression between 2022 and 2025. Patients with radiographic instability requiring fusion were excluded. Clinical outcomes included Visual Analog Scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and walking capacity assessed by the self-paced walking test (SPWT). Radiological evaluation included MRI-based canal measurements and standing lateral radiographs assessing segmental kyphosis and sagittal alignment. Pre–post comparisons were performed using paired statistical analyses. Results: Median age was 66 years (IQR 64–70). Significant postoperative improvements were observed in SPWT distance and duration ( p < 0.001), VAS-back and VAS-leg scores ( p < 0.001), and ODI ( p < 0.001). MRI demonstrated significant enlargement of canal dimensions at the ASD level ( p < 0.001). Segmental kyphosis improved modestly without deterioration of global sagittal balance. Two perioperative complications (one dural tear, one epidural hematoma) were managed successfully without permanent neurological deficit. Conclusion: In carefully selected patients with stable ASD, UBE posterior decompression provides meaningful pain relief, functional improvement, and effective neural decompression while preserving sagittal alignment. This tissue-sparing approach may be considered a treatment option in selected high-risk or elderly patients. Level of evidence: IV.