Identifying the changes of NP proteome due to GCs and the biological functions of proteins can lead to new ways of treatment and open new fields in NP research.

Background Patients with Marfan syndrome commonly require spinal deformity surgery. The purpose of this case report is to present a rare thoracotomy complication. We present the management of such a patient. Case summary In a known case of Marfan syndrome, an 18-year-old Persian man was admitted to our hospital with scoliosis. The patient underwent radiological examinations, and thoracic scoliosis of 70° was diagnosed. A right thoracotomy for anterior spinal fusion from the sixth rib and posterior spinal fusion were performed successfully. Two months later, he was readmitted because of winging of the right scapula due to serratus anterior palsy. Electromyography and nerve conduction velocity confirmed long thoracic nerve injury. Conservative treatment was provided. Ultimately, the patient recovered completely in the last follow-up visit 6 months after the surgery. Discussion This is the first report of ipsilateral winged scapula after thoracotomy. Attention needs to be paid to surgical techniques in patients with Marfan syndrome.

Introduction: Intramedullary ependymoma (IE) is adults' most common intramedullary spinal tumor. Tumors usually extend one to eight segments in the cervical region. In this case report, we reported a patient with massive IE spanning from the fourth ventricle to the T4 segment of the spinal cord, which surgically treated with laminectomy from occiput to T4 Case Presentation: A 42-year-old man who is a known case of IE with progressive upper extremities paraesthesia and gait disturbance. Four years ago he refused surgery and presented with dysphagia. The patient's MRI demonstrated an intramedullary spinal cord tumor extending from the fourth ventricle to T4. Conclusions: massive spinal ependymoma is a rare, benign, slow-growing tumor, and patients present symptoms years before diagnosis. Upon confirmation of the diagnosis, the tumor must be surgically removed.

Background: Primarily diagnosed in the first two decades of life, unicameral bone cysts (UBCs) are benign cystic lesions of the bone. More than 90% of UBCs are located in the proximal femur or proximal humerus of skeletally immature patients, however in this case report we report a middle-aged patient with multiple lesions in unusual sites. Case Report: A 42-year-old patient presented to our institute with multiple bony lesions in the right and left tibias, proximal radius, ulna, and the second metacarpus. The lesions were later pathologically proven to be UBCs. A multimodality treatment approach was selected including decompression-only, extended curettage, bone grafting, and prophylactic fixation based on the lesion size and anatomic location. All these methods proved to be effective with no disease relapse and complete radiographic obliteration of the cavities. Conclusion: UBCs could occur in much older patients than generally believed and the proper method of treatment should be individualized based on the lesion’s characteristics.

Simple bone cyst (SBC) is not a common lesion in the spine and especially in the vertebral body. We intend to report two cases of SBC located in the vertebral body, and review the literature. Two cases include a 24 year-old male and 26 year-old male with vertebral body lesion of T12 and L5 vertebrae,retrospectively. Both lesions were found to be SBC and confirmed by pathology. Both cases were managed with surgery, the cavity was filled with bone graft and posterior spinal fusion and instrumentation with pedicle screws, and rods were carried out. There was no recurrence. There have been 21 cases of SBCs in English literature, and only 8 cases have been reported in the vertebral body. SBC is a rare benign lesion in the spine and it should be considered in the differential diagnosis when suggested by radiologic investigations.

Background: Thoracic disc herniation is a rare illness and is mainly asymptomatic. There are some surgical approaches to treat symptomatic patients, and none has absolute dominance over the others. For this reason, there is a debate between spine surgeons to decide which method could help these patients with better efficacy and safety. Objectives: To seek the potential differences between the two of these methods, the conventional anterior transthoracic and the more recent modified transfacet approaches, we conducted this study. Methods: This is a retrospective case-series study comparing the anterior transthoracic and the modified transfacet method; each of these approaches was preferred and performed by one surgery team. Patients were divided into two groups based on the procedure and assessed using Frankel’s score, visual along scale (VAS) score, short-form health survey questionnaire (SF-36), and the spine functional index (SFI). Results: Eleven patients underwent a transthoracic approach, and eight patients had a posterior transfacet pedicle-sparing approach. The Frankel’s score improved at least one score in ten patients from the transthoracic group and seven patients from the transfacet pedicle-sparing group. No major difference was found between the two groups concerning SFI and SF-36 questionnaire. Conclusions: This study exhibited satisfying efficacy and safety of the modified transfacet pedicle-sparing method compared to the transthoracic approach. Both improved Frankel’s scores, SFI, and patients’ quality of life. Despite encountering some limitations, especially a small number of subjects, our study suggests that these surgical methods could be used efficiently considering the patient’s comorbidities, location of the herniated disc and its calcification, and experience and skill of the surgeon.