Triple-negative breast cancer (TNBC) is known to have a poor prognosis and limited treatment options, namely chemotherapy. Different molecular studies have recently classified TNBC into different subtypes opening the door to potential new-targeted treatment options. In this review, we discuss the current standard of care in the treatment of TNBC in the neoadjuvant, adjuvant and metastatic settings. In addition, we summarize the ongoing phase III clinical trials evaluating different associations between the 3 pillars of anticancer treatment: chemotherapy, targeted therapy and immunotherapy.

Introduction: The calcaneal lengthening procedure (CLP) is a well-known surgical technique used for the correction of symptomatic planovalgus foot deformities. Literature shows a significant rate of relapse and undercorrection of the foot post-operatively. Factors determining the failure or success of CLP are still not well understood. The purpose of this retrospective study was to assess the most significant factors related to the failure of this procedure. Methods: A case-control retrospective study was conducted on 50 patients (80 feet) aged 12.4±2.5 years who underwent CLP. A clinical (demographic parameters, etiology, Gross Motor Function Classification System (GMFCS) level) and radiological evaluation were assessed preoperatively and repeated postoperatively at 56.5±32.5 months. Two methods of osteotomy bone fixation were studied: K-wires vs. eight-plate. Standing anteroposterior (AP) and lateral (L) radiographs were done, and the following radiographic parameters were measured: calcaneocuboid (CC) joint subluxation classified into normal, moderate, and severe (L); AP and L talo-first metatarsal (T1MT) angle; AP talonavicular (TN) coverage angle; AP and L talocalcaneal (TC) angle; calcaneal pitch (CP) angle; and L talo-horizontal (TH) angle. Mosca’s criteria were used for clinical and radiological assessments. The association between demographic data, clinical and radiological results, and the variation between preoperative and postoperative angles were studied. The main risk factors affecting clinical results and CC joint subluxation were investigated (logistic regression and analysis of covariance (ANCOVA)). Results: Satisfactory clinical results were associated with satisfactory radiological ones on Mosca’s criteria (p<0.001). The use of an eight-plate for osteotomy fixation gave better results than K-wires (79% vs. 59%). Radiological angles were improved in both techniques postoperatively (increase of CP and L-TC and decrease of AP-T1MT, AP-TC, AP-TN, and L-T1MT, all p<0.05). Non-satisfactory clinical results were associated with a high GMFCS level, a low preoperative AP-TN coverage angle, and a low preoperative CP angle (R2=0.45). Both a young age and a low CP angle preoperatively were associated with CC subluxation (R2=0.31). Conclusion: The neurological status and the severity of the planovalgus foot deformity preoperatively were the main risk factors affecting clinical outcomes after CLP. However, young age and the severity of the deformity preoperatively were the main risk factors behind CC joint subluxation affecting CLP outcomes.

The aim was to study the validity of free-standing position using modifiers for assessing cervical spine alignment. A total of 26 asymptomatic subjects (45 ± 11years) and 13 with spinal deformities (30 ± 21years) underwent lateral radiographs using EOS®, while adopting 3 different positions, in 2 sequences, without mirror and then with mirror (m) placed in front of them: first, the neutral standing position (upper extremities positioned on the sides of the body, P1 and P1m), then free-standing (P2 and P2m) and modified free-standing (P3 and P3m) positions (shoulders flexed at 90° and fingers placed on clavicles then cheeks, respectively). Participants were asked not to move their trunk and shoulders when moving from P1 to P2 and then P3. Eighteen cervical radiographic parameters were calculated from the 6 radiographs. The effects of shoulder flexion, mirror placement, and finger positioning on cervical alignment were studied using a repeated-measures ANCOVA. Mirror placement had no effect on cervical alignment. Concerning the effect of shoulder flexion, C2–C7 and T1 slopes were significantly decreased in P2 and P2m (C2–C7 = 10° and 8°; T1 slope = 26° and 24°, respectively) and P3 and P3m (C2–C7 = 9° and 9°; T1 slope = 25° and 26°, respectively) compared to P1 and P1m (C2–C7 = 14°and 14°; T1 slope = 29°and 30°, respectively), without exceeding the uncertainty level. Assessment of cervical alignment is valid on whole-spine radiographs when the shoulders are flexed (free-standing position). Clear instructions regarding the shoulder position at 90°, without moving the trunk, neck, and head before placing the fingers on the clavicles or cheeks, can ensure a cervical alignment comparable to that obtained with the neutral position, which is considered the most physiological one.

Background and Objectives: Fragility fractures of the sacrum are increasingly recognized in elderly osteoporotic patients and can cause persistent pain, immobility, and progressive pelvic ring instability. We previously described a modified S1 corridor targeting the higher-density cranial–ventral S1 vertebral body for safe percutaneous implant placement. This study reports the clinical outcomes of osteoporotic and pathologic sacral fractures treated through this corridor and presents an exploratory comparison of two 3D-printed titanium sacroiliac fusion implants: the triangular iFuse™ Implant System and the threaded iFuse TORQ™ (SI-BONE, Inc., Santa Clara, CA, USA). Materials and Methods: This retrospective single-center study analyzed 58 patients with fragility or pathologic sacral fractures (FFP IIIb–V; OF 2–5) treated via the modified S1 corridor between January 2021 and March 2026. Of these, 27 patients received triangular iFuse™ implants, and 31 patients received threaded iFuse TORQ™ implants. The primary outcome was procedural safety (implant revision, neurological injury, cortical breach). Secondary outcomes included the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pain, operative time, and need for additional fixation. Group comparisons used non-parametric tests; multivariable linear regression adjusted for age, fracture severity (OF classification), and additional fixation. Results: At a mean follow-up of 17.8 ± 9.1 months (iFuse) and 4.1 ± 2.1 months (TORQ), no implant revisions, clinically significant cortical breaches, or neurological injuries were observed in either group. Patient-reported outcome data were available for 48 of 58 patients (20 iFuse, 28 TORQ). Patients in the iFuse™ group were older (80.9 ± 8.5 vs. 76.0 ± 9.8 years; p = 0.050), and OF classification differed between groups, with a higher proportion of OF 4 fractures in the TORQ™ group (p = 0.003). After adjustment for age, OF classification, and additional fixation, TORQ™ implantation was associated with a 15.6-point lower postoperative ODI (p < 0.001), a 13.5-point greater ODI improvement (p < 0.001), a 0.94-point lower postoperative VAS (p = 0.006), and a 1.36-point greater VAS reduction (p < 0.001). Findings remained significant in a sensitivity analysis restricted to patients without additional fixation. Conclusions: Sacroiliac fusion via a modified density-oriented S1 corridor was safe for both large implant types, with no revisions in the analyzed cohort. In this retrospective, non-randomized cohort, threaded iFuse TORQ™ implants were associated with better patient-reported outcomes after adjustment for baseline imbalances. Because the groups were not randomized and follow-up duration differed substantially, these comparative findings are hypothesis-generating and require confirmation in prospective, controlled studies.

Background and Clinical Significance: Osteoblastomas are rare, benign but locally aggressive bone tumors with a predilection for the posterior elements of the spine. Their clinical, radiological and histopathological presentation often overlaps with that of osteoid osteomas, leading to diagnostic and therapeutic challenges—particularly in atypical locations such as the anterior thoracic spine. Case Presentation: We report two cases of young female patients (aged 35 and 30 years) presenting with persistent thoracic back pain unresponsive to NSAIDs. In the first case, imaging revealed a lesion at the right T7 pedicle initially attributed to osteoid osteoma; CT-guided thermoablation was declined due to proximity to neural structures. At this stage, we chose percutaneous transpedicular ablation by drilling through the centrum of the lesion (Nidus) surgically. After this transpedicular resection with initial symptom improvement, the patient developed recurrence with lesion progression into both anterior and posterior columns, requiring a second, open, surgical intervention. In the second case, a lesion at the left T11 pedicle and transverse process was identified directly as osteoblastoma due to size and radiological morphology; initial biopsy was non-diagnostic due to specimen fragmentation. In both cases, histopathology was inconclusive or misleading, while clinical and radiological features—including NSAID unresponsiveness, lesion size, and anatomical extent—favored osteoblastoma. Both patients underwent surgical resection via posterior costotransversectomy, partial hemivertebrectomy, expandable cage placement, and posterior instrumentation (T5–T8 and T10–T12, respectively). The postoperative courses were complicated by thoracic events—hemothorax in the first case and pulmonary embolism in the second—both of which were managed successfully. At follow-up, both patients were neurologically intact and pain-free. Conclusions: These cases emphasize the diagnostic overlap between osteoid osteoma and osteoblastoma and highlight the importance of clinical and radiographic correlation when histopathology is inconclusive. A posterior-only approach with costotransversectomy may be a valid strategy in selected cases of thoracic spinal tumors, although specific complications such as hemothorax must be considered.

Background: Implant supply strategy in spine surgery affects operative workflow, resource utilization, and packaging-related material use, yet has received limited systematic investigation. This study evaluates single-sterile implants versus multipack implants using a hospital-based Health Technology Assessment (HB-HTA) framework. Methods: A non-randomized, mixed-methods comparative study was conducted at a tertiary academic spine center. Time measurements were recorded during eight posterior fusion procedures (four per supply type; n = 18 single-pack screws, n = 20 multipack screws) across three process steps: implant retrieval, sterile transfer, and instrument preparation. Time measurements were recorded per packaging unit; per-implant comparisons were additionally derived for operational interpretation. Packaging volume, weight, and packaging-related CO₂-equivalent estimates were calculated per implant. Standardized questionnaires were distributed to operating-room (OR) nurses (n = 14/21; 66.7%) and institutional surgeons (n = 11/11; 100%). Manufacturer-provided descriptive process and cost data were analyzed. Results: Multipack implants were associated with consistently shorter handling times across all measured process steps. Mean retrieval time per packaging unit was 25.4 s (multipack) versus 58.7 s (single-pack); retrieval time was significantly shorter for multipack units on the Mann–Whitney U test (p = 0.004), a result that was robust to supply-related outlier events (p = 0.001 after their post hoc exclusion). Packaging-normalized sterile-transfer burden per implant was reduced by a factor of 4.76. Instrument preparation was faster with multipack systems (15.6 s vs. 25.2 s). Packaging volume per implant was reduced by a factor of 5.6, and packaging weight by a factor of 2. Packaging-related CO₂-equivalent estimates were lower for multipack implants (0.017 kg vs. 0.026 kg per implant). Survey responses indicated predominantly positive evaluations of workflow and handling efficiency. A trade-off was identified regarding the potential disposal of unused implants (noted by 73% of institutional surgeons). Manufacturer-provided descriptive data suggested scale effects in packaging and sterilization processes. Conclusions: Under high-volume academic conditions, multipack implants were associated with shorter implant-handling process times, favorable staff perceptions, and reduced packaging-related material burden while introducing trade-offs that require local evaluation. These exploratory findings suggest that the implant supply strategy is an underexplored but potentially relevant dimension of surgical process optimization in spine surgery.