Teresa Vázquez

The proven involvement of the sinuvertebral nerve (SVN) in discogenic low-back pain and the demonstration that its blockade has been effective in reducing the intensity and frequency of diffuse low back pain have led to an increase in publications related to the characterization of this nerve. However, there is a huge disparity in the observations resulting from the studies carried out, probably due to the technical difficulty of accessing this structure. In recent years, the number of studies in large samples has increased but some important data in relation to the nature of the sinuvertebral nerve remain unpublished. We studied 100 vertebral column segments between L1 and L5, corresponding to both sides of 10 adult cadavers donated to the Body Donation Centre and Dissection Rooms of the Complutense University of Madrid. All levels were carefully dissected to study sinuvertebral nerve origins and some samples of SVN were selected to be routinely paraffin-embedded and serially sectioned with a Minot-type microtome at a 7 µm thickness. Immediately after dewaxing following the standard histology lab protocols, sections from the selected SVN (well-preserved morphology and histologic condition) were subjected to an immunohistochemical protocol to detect CGRP-IH and VIP-IH. Data analysis was performed using IBM SPSS Statistics version 27 and RStudio. The SVN was observed with a single branch (pattern I) in 82 cases (85.4%) and with two branches (pattern II) at the same level in 14 cases (14.6%). Statistical differences were not found in relation to vertebral levels, side or sex. All sinuvertebral nerve samples that underwent immunohistochemical study were positive for CGRP and VIP, suggesting a mixed autonomic (VIP+) and sensory (CGRP+) fibre composition along the nerve trunk. This study confirms the neurochemistry profile of the SVN due to the realization of the immunochemistry characterization directly in the SVN, not in its innervated structures. This information supports the usage of SVN blocking from a pathophysiological point of view for diagnostic and treatment techniques (e.g., Percutaneous Transforaminal Endoscopic Radiofrequency Ablation of the SVN) in discogenic lumbar pain.

The proven involvement of sinuvertebral nerve (SVN) in discogenic low-back pain and the demonstration that its blockade has been effective in reducing the intensity and frequency of diffuse low back pain have led to an increase in publications related to the characterization of this nerve. However, there is a huge disparity in the observations resulting from the studies carried out, probably due to the technical difficulty of accessing this structure. In the last years the number of studies in large samples has increased but some important data in relation to nature of sinuvertebral nerve remain unpublished. We studied 100 vertebral column segments between L1 and L5, corresponding to both sides of 10 adult cadavers donated to the Body Donation Center and Dissection Rooms of the Complutense University of Madrid. All levels were carefully dissected to study sinuvertebral nerve origins and some samples of SVN were selected to routinely paraffin-embedded and serially sectioned with a Minot-type microtome at a 7µm thickness. Immediately after dewaxing following the standard histology lab protocols, sections from selected SVN (well-preserved morphology and histologic condition) were subjected to an immunohistochemical protocol to detect CGRP-IH, and VIP-IH. Data analysis was performed using IBM SPSS Statistics version 27 and RStudio. The SVN was observed with a single branch (pattern I) in 82 cases (85.4%) and with two branches (pattern II) at the same level in 14 cases (14.6%).Statistical differences were not found in relation to vertebral levels, side or sex. All sinuvertebral nerve samples that underwent immunohistochemical study were positive for CGRP and VIP, demonstrating the sympathetic nature of the nerve (VIP+) and its nociceptive component (CGRP+). This study confirms the neurochemistry profile of the SVN thanks due to the realization of the immunochemistry characterization directly in the SVN, not in its innervated structures. This information supports the usage of the SVN blocking from a pathophysiological point of view for diagnostic and treatment techniques (e.g., Percutaneous Transforaminal Endoscopic Radiofrequency Ablation of the SVN) in discogenic lumbar pain.

Background: Midportion Achilles tendinopathy (Mid-AT) is a complex condition that may be exacerbated by anatomical variations of the plantaris tendon. Recent anatomical studies, particularly the classification proposed by Olewnik et al., have enhanced the understanding of plantaris–Achilles interactions and their clinical implications. Objective: This review aims to assess the anatomical types of the plantaris tendon, their imaging correlates, and the impact of the Olewnik classification on diagnosis, treatment planning, and surgical outcomes in patients with Mid-AT. Methods: We present an evidence-based analysis of the six anatomical types of the plantaris tendon and their relevance to Achilles tendinopathy, with emphasis on MRI and ultrasound (USG) evaluation. A diagnostic and therapeutic algorithm is proposed, and clinical outcomes of both conservative and operative management are compared across tendon types. Results: Types I and V were most strongly associated with symptomatic conflict and showed the highest benefit from surgical resection. Endoscopic approaches were effective in Types II and III, while Type IV typically responded to conservative treatment. Type VI, often misdiagnosed as tarsal tunnel syndrome, required combined neurolysis. The classification significantly improves surgical decision-making, reduces overtreatment, and enhances diagnostic precision. Conclusions: The Olewnik classification provides a reproducible, clinically relevant framework for individualized management of Mid-AT. Its integration into imaging protocols and treatment algorithms may improve therapeutic outcomes and guide future research in orthopaedic tendon pathology.

Background: The objective of this study is to detail the terminal distribution of the peroneal artery, which may be at risk in a number of surgical procedures. Five per cent of the population presents with a dominant peroneal artery (arteria peronea magna), which is responsible for the entire foot vascularization. Methods: Anatomic dissection of 54 specimens from 44 cadaveric donors was performed. Twenty belonged to women and 24 to men, whereas 10 lacked traceability data. Mean age of the donors was 75.01 ± 16.14 (range 38-101) years. Ten donors had bilateral extremities. Results: Six types on the terminal distribution of the peroneal artery were identified: type 1 (40.7%), terminal division into anterior perforating branch and posterior peroneal artery (bifurcation); type 2 (14.8%), proximal anterior perforating branch, distal bifurcation; type 3A (18.5%), terminal trifurcation into anastomosis, anterior perforating branch and posterior peroneal artery; type 3B (5.6%), terminal trifurcation where the anastomotic branch bows to join both posterior peroneal and posterior tibial arteries; type 3C (13%), proximal anterior perforating branch, distal trifurcation; type 3D (3.7%), proximal anterior perforating and anastomotic branches, distal trifurcation. Two specimens (3.7%) were nonclassifiable. The mean distance to the most distal anterior perforating branch was 69.37 ± 22.09 mm (from 35.69 to 146.40), whereas the mean diameter was 2.35 ± 0.71 mm (range 0.91-4.24). The most distal anastomosis branched off at 64.80 ± 21.49 mm (from 49.52 to 99.93). Horizontal distances from the fibula to the peroneal artery were, at 5 cm, 0.83 ± 1.21 mm (0-5.76); at 10 cm, 1.24 ± 1.16 mm (range 0-4.96); and at 15 cm, 1.63 ± 1.34 mm (0-5.2). No differences were found for side or gender. Three dominant peroneal arteries were found (5.56%), with a mean diameter of 3.78 ± 0.88 mm. These findings provide the most detailed classification to date and support incorporating peroneal artery mapping into preoperative planning for high-risk procedures. Conclusion: Narrow proximity to the fibula, variation in branching, and dominance patterns suggest that identifying the peroneal vascular bundle intraoperatively is critical to avoid vascular complications. When performing posterior approaches to the ankle, it may be helpful to identify the peroneal vascular bundle and perform the necessary dissections and implant placement as distal as possible to avoid its injury. Clinical Relevance: Understanding the anatomy of the peroneal artery, its branches and anatomical variations, with special mention of the dominant peroneal artery (arteria peronea magna), may help to avoid iatrogenic injury to the peroneal vascular bundle during the varied and increasing number of foot and ankle surgical procedures performed, such as posterior open reduction internal fixation of ankle fractures, ankle arthrodesis, or ankle arthroscopy.

Dissection Rooms (DRs) are key facilities that allow teaching and research on human anatomy, where students and researchers work with human bodies to acquire, increase, or create new knowledge. Usually, DRs work with a Body Donation Program (BDP), where living donors bequeath their bodies for use in teaching and research after they expire. Despite DRs being part of universities worldwide, no common guidelines, regulations, or quality management systems (QMS) exist that could be applied to different countries. With that purpose in mind, we aimed to develop a QMS that could be applied to DRs globally, using a Delphi panel to achieve consensus about the items that should constitute the QMS. The panel was constituted by 20 anatomy professors from 20 different countries, and the 167 standards to create the rules or guidelines that constitute the QMS were divided in five categories: direction, body donation, students, instructors, and research. After two rounds of revisions, 150 standards were considered “essential” or “important” by more than 70% of the participants, thus being incorporated to the Dissection Room Quality System (DRQS). The results of this panel represent a minimum list of items of the DRQS for improving the functioning of DRs globally.

Resumen: Objetivo Describir la técnica quirúrgica de reconstrucción del ligamento escafolunar asistida por artroscopia empleando como donante el extensor carpi radialis longus (ECRL), un músculo que, gracias a sus propiedades biomecánicas, puede ser muy ventajoso en este tipo de cirugía. Técnica Quirúrgica Tras artroscopia diagnóstica inicial según la técnica habitual, se llevó a cabo la reconstrucción ligamentosa empleando un hemitendón del ECRL mediante técnica mínimamente invasiva. Los dispositivos de fijación empleados fueron el SwiveLock para el escafoides y el tornillo de biotenodesis de 3 × 8 mm (Arthrex, Naples, FL, EE.UU.) para el semilunar. Complicaciones La complicación que puede surgir durante la realización de esta técnica es la extracción dificultosa de la plastia, por la intersección entre el primer y el segundo compartimentos extensores. Es fácilmente solventable realizando una incisión intermedia a nivel de la intersección para garantizar la adecuada liberación de la plastia a esta altura. Conclusión Es posible reconstruir el intervalo escafolunar empleando un hemitendón del ECRL, que, por propiedades biomecánicas, puede ser más ventajoso a la hora de restaurar la biomecánica del carpo. Se precisan estudios posteriores para confirmar la idoneidad y la superioridad de este donante frente a otros empleados en las técnicas de reconstrucción.

Objectives: Lately, many countries have restricted or even banned transfat, and palm oil has become a preferred replacement for food manufacturers. Whether palm oil is potentially an unhealthy food mainly due to its high content of saturated Palmitic Acid (PA) is a matter of debate. The aim of this study was to test whether qualitative aspects of diet such as levels of PA and the fat source are risk factors for Metabolic Syndrome (MS) and Metabolic Associated Fatty Liver Disease (MAFLD). Methods: C57BL/6 male mice were fed for 14 weeks with three types of Western diet (WD): 1. LP-WD—low concentration of PA (main fat source—corn and soybean oils); 2. HP-WD—high concentration of PA (main fat source—palm oil); 3. HP-Trans-WD—high concentration of PA (mainly transfat). Results: All types of WD caused weight gain, adipocyte enlargement, hepatomegaly, lipid metabolism alterations, and steatohepatitis. Feeding with HP diets led to more prominent obesity, hypercholesterolemia, stronger hepatic injury, and fibrosis. Only the feeding with HP-Trans-WD resulted in glucose intolerance and elevation of serum transaminases. Brief withdrawal of WDs reversed MS and signs of MAFLD. However, mild hepatic inflammation was still detectable in HP groups. Conclusions: HP and HP-Trans-WD play a crucial role in the genesis of MS and MAFLD.

Recurrence of carpal tunnel syndrome implies the reappearance of symptoms after release surgery. If the cause of recurrence is not an incomplete release, but a traction neuritis, the tendency is to add to the revision surgery of the carpal tunnel the use of flaps to cover the median nerve. These flaps establish a physical barrier between the nerve and the rest of the adjacent structures, preventing adhesions, and providing neovascularization and better nerve sliding.In the present work, we detail a revision surgery in which the first lumbrical muscle is used as a covering flap. This flap has two benefits. Firstly, it acts as a vascularized coverage for the median nerve (avoiding the formation of fibrosis and favoring its sliding); secondly, a structure that takes up space is removed from the carpal tunnel, thus reducing the pressure within it.Along with the explanation of the technique, the present article provides a detailed description of the anatomical variability of the first lumbrical muscle and its vascularization, as well as the results of a cadaveric study on the location of the vascular pedicle of the first lumbrical muscle.

The state of alarm due to Covid‐19 pandemic in Spain stopped all educational and most university research activities. The Spanish Anatomical Society (SAE) Consensus Expert Group on Body Donations piloted a study based on a questionnaire to know the status of body donations and dissection activities during the lockdown, as well as the future implications of Covid‐19 pandemic for body donation programs and anatomy teaching. The questionnaire results show that Spanish Universities refused body donations and stopped all dissection research and teaching. The Covid‐19 expected influence on anatomy teaching was referred to the increase in teaching workforce and resources required to apply the new safety measures to future practical activities, as well as to prepare and adapt teaching material for online‐only programs. The application of reinforced safety measures was expected to be perceived by the respondent's students as a gain in teaching quality, while the transformation of the anatomy courses in online‐only programs will be perceived as a quality decrease. The respondent's concerns about future institutional implications of the pandemic were related to increased costs of the adaptation of the facilities and the reinforced preventive measures, as well as the eventual decrease in donations. The complete lockdown applied to dissection rooms was not justified by scientific evidence and represented a break of the confidence deposed in the institutions by the donors. A consensus is required for the adoption of a renewed, comprehensive protocol for present and future body donations including the evidence Covid‐19 pandemic has contributed to create.