WorldWideScience

Sample records for thoracolumbar vertebral body

  1. Vertebral body spread in thoracolumbar burst fractures can predict posterior construct failure.

    Science.gov (United States)

    De Iure, Federico; Lofrese, Giorgio; De Bonis, Pasquale; Cultrera, Francesco; Cappuccio, Michele; Battisti, Sofia

    2017-10-23

    The load sharing classification (LSC) laid foundations for a scoring system able to indicate which thoracolumbar fractures, after short-segment posterior-only fixations, would need longer instrumentations or additional anterior supports. We analyzed surgically treated thoracolumbar fractures, quantifying the vertebral body's fragment displacement with the aim of identifying a new parameter that could predict the posterior-only construct failure. This is a retrospective cohort study from a single institution. One hundred twenty-one consecutive patients were surgically treated for thoracolumbar burst fractures. Grade of kyphosis correction (GKC) expressed radiological outcome; Oswestry Disability Index and visual analog scale were considered. One hundred twenty-one consecutive patients who underwent posterior fixation for unstable thoracolumbar burst fractures were retrospectively evaluated clinically and radiologically. Supplementary anterior fixations were performed in 34 cases with posterior instrumentation failure, determined on clinic-radiological evidence or symptomatic loss of kyphosis correction. Segmental kyphosis angle and GKC were calculated according to the Cobb method. The displacement of fracture fragments was obtained from the mean of the adjacent end plate areas subtracted from the area enclosed by the maximum contour of vertebral fragmentation. The "spread" was derived from the ratio between this subtraction and the mean of the adjacent end plate areas. Analysis of variance, Mann-Whitney, and receiver operating characteristic were performed for statistical analysis. The authors report no conflict of interest concerning the materials or methods used in the present study or the findings specified in this paper. No funds or grants have been received for the present study. The spread revealed to be a helpful quantitative measurement of vertebral body fragment displacement, easily reproducible with the current computed tomography (CT) imaging technologies

  2. Depression of the Thoracolumbar Posterior Vertebral Body on the Estimation of Cement Leakage in Vertebroplasty and Kyphoplasty Operations

    Directory of Open Access Journals (Sweden)

    Hao Chen

    2015-01-01

    Conclusions: Depression of the thoracolumbar posterior vertebral body may be informative for the estimation of cement location on C-arm images. To reduce type-B leakage, DCPW should be made longer than DBCV on C-arm images for safety during PVP or PKP.

  3. Osteoporotic vertebral body fractures of the thoracolumbar spine: indications and techniques of a 360°-stabilization.

    Science.gov (United States)

    Spiegl, Ulrich; Jarvers, J-S; Heyde, C-E; Josten, C

    2017-02-01

    Unstable vertebral body fragility fractures of the thoracolumbar spine can occur with or without relevant trauma. Initially, a standardized diagnostic algorithm including magnetic resonance tomography is recommended to detect accompanied further vertebral body fractures, to interpret the individual fracture stability, and to screen for relevant traumatic intervertebral disc lesions. Aim of the therapy is to assure fast mobilization and to maintain spinal alignment. Unstable fracture morphology is defined by vertebral body fractures including a relevant defect of the posterior vertebral cortex as well as type B or C fractures. With respect of type A fractures, a combined anterior-posterior approach including a primary cement-augmented posterior stabilization and anterior spondylodesis is indicated in those patients with relevant intervertebral lesions or in those suffering from high-energy accidents resulting in unstable burst-type fractures. The others will benefit from hybrid stabilizations including cement-augmented posterior stabilizations and cement augmentation (kyphoplasty) of the fractured level to gain a ventral transosseous stability. In addition, individually adapted antiosteoporotic therapy is essential.

  4. A comparison of two techniques: Open and percutaneous biopsies of thoracolumbar vertebral body lesions

    Directory of Open Access Journals (Sweden)

    Furkan Yapici

    2015-01-01

    Full Text Available Aim: The purpose of this article is to compare the similarity of initial radiological diagnosis and pathological diagnosis between thoracal and lumbar vertebral bodies and the adequacy and the reliability of open and percutaneous biopsies performed via transpedicular approach in the lesions located in vertebral bodies. Materials and Methods: Thirty-three patients who had undergone transpedicular biopsy for vertebral body lesions were retrospectively evaluated. Seventeen patients were diagnosed by percutaneous transpedicular biopsy (11 in the lumbar vertebrae, 6 in the thoracal vertebrae. Sixteen patients were diagnosed by open transpedicular biopsy (9 in the lumbar vertebrae, 7 in the thoracal vertebrae. Results: The similarity ratio between the initial radiological diagnosis and the final pathological diagnosis was 71.4% in the open biopsy and was 69.2% in the percutaneous biopsy (P > 0.05. The similarity ratio between the initial radiological diagnosis and the final pathological diagnosis was 66.7% in the lumbar region and was 77.8% in the thoracal region (P > 0.05. For percutaneous biopsy group, the similarity ratio was 72.7% in the lumbar region and was 66.7% in the thoracal region (P > 0.05. For open biopsy group, the similarity ratio was 62.5% in the lumbar region and 83.3% in the thoracal region (P > 0.05. No complication was observed. Conclusion: Specimen adequacy of open biopsy was higher than percutaneous biopsy. Particularly, the open thoracal biopsy has provided the highest similarity ratio between the initial radiological diagnosis and the final pathological diagnosis.

  5. A new distractable implant for vertebral body replacement: biomechanical testing of four implants for the thoracolumbar spine.

    Science.gov (United States)

    Reinhold, M; Schmoelz, W; Canto, F; Krappinger, D; Blauth, M; Knop, Christian

    2009-10-01

    Expandable titanium implants for vertebral body replacement in the thoracolumbar spine have been well established in the reconstruction of the anterior spinal column. Load transfer at the bone-implant interface remains a point of concern. The purpose of the study was to compare the performance in axial load transfer from the implant to the vertebral body in four different implants, all of them in clinical use to date. We tested a second generation implant (Synex II) in comparison to three different expandable titanium cages: Synex I, Obelisc and X-Tenz. Twenty-four intact fresh frozen human lumbar vertebrae (L1-L4) were distributed into four identical groups according to bone mineral density (BMD). The BMD was determined by quantitative computed tomography (qCT). Specimens were loaded in craniocaudal direction with a material testing machine (Mini Bionix II) at a constant speed of 5 mm/min. Load displacement curves were continuously recorded for each specimen until failure (diminishment of compressive force (F) and/or obvious implant migration through the vertebral body end plate). One-way analysis of variance (ANOVA) and post-hoc tests (Bonferroni) were applied to detect differences at 1, 2, 3, and 4 mm displacement (F (1-4 mm)) between implant groups. No significant differences were observed with regard to maximum compression force (F (max)) and displacement (d (max)) until failure: Synex II (1,782.3 N/4.67 mm); Synex I (1,645.3 N/4.72 mm); Obelisc (1,314.0 N/4.24 mm); X-Tenz (1470.3 N/6.92 mm). However, the mean compression force at 1-4 mm displacement (F (1-4 mm): 300-1,600 N) was highest for Synex II. The difference at 2 mm displacement was significant (p = 0.028) between Synex II (F (2 mm) = 879 N) and X-Tenz (F (2 mm) = 339 N). The modified end plate design of Synex II was found to perform comparably at least with regard to the compressive performance at the implant-bone interface. The risk of the new implant for collapse into the vertebral body might be

  6. Vertebral stabilisation and selective decompression for the management of triple thoracolumbar disc protrusions.

    Science.gov (United States)

    McKee, W M; Downes, C J

    2008-10-01

    Triple adjacent thoracolumbar disc protrusions causing moderate to severe spinal cord compression were diagnosed by magnetic resonance imaging in two German shepherd dogs with marked paraparesis and pelvic limb ataxia. Both cases were managed by selective hemilaminectomy, partial annulectomy and bilateral quadruple vertebral body stabilisation using novel canine locking fixation plates (SOP). The stabilisation of multiple vertebrae in the thoracolumbar spine was possible because the plates could be contoured with six degrees of freedom. Spinal pain resolved and neurological function improved in both dogs. Screw breakage was evident in one dog five months following surgery.

  7. [Three-dimensional finite element model of thoracolumbar spine with osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Fei, Qi; Li, Qiu-jun; Yang, Yong; Li, Dong; Tang, Hai; Li, Jin-jun; Wang, Bing-qiang; Wang, Yi-peng

    2010-11-09

    To build a three-dimensional finite element model of thoracolumbar spine with osteoporotic vertebral compression fracture (OVCF) and analyze its biomechanical change. The T10-L2 segment data were obtained from computed tomography (CT) scans of an elderly female with a single T12 OVCF. A three-dimensional finite element model of thoracolumbar spine was constructed with the MIMICS and ABAQUS software. The model was composed of bony vertebrae, articulating facets, intervertebral disc and associated ligaments. The basic stress analysis of T10-L2 motion segment was made for different material properties of bone, ligaments and facet joints contacting frictional property. The stress on the annulus fiber, nucleus pulposus, endplate and facet joints under axial pressure (0.3 MPa, 1.0 MPa, 4.0 MPa) were analyzed. A three-dimensional finite element model of human T12-L2 motion segment had 617468 elements. And the stress was higher in vertebral body than posterior structure. The distribution of pressure stresses in intervertebral disc was asymmetrical. The stress increased with a rising axial pressure. 3D finite element model of thoracolumbar OVCF and adjacent segments are successfully established. The results of stress analysis are both feasible and reliable.

  8. Prevalence of thoracolumbar vertebral fractures on multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Bartalena, Tommaso [Department of Radiology, S. Orsola University Hospital, Via Massarenti 9 - 40138 Bologna (Italy)], E-mail: t.bartalena@email.it; Giannelli, Giovanni; Rinaldi, Maria Francesca [Department of Radiology, S. Orsola University Hospital, Via Massarenti 9 - 40138 Bologna (Italy); Rimondi, Eugenio [Department of Radiology, Rizzoli Orthopaedic Institute, Via G.C. Pupilli 1 - 40136 Bologna (Italy); Rinaldi, Giovanni [Department of Radiology, S. Orsola University Hospital, Via Massarenti 9 - 40138 Bologna (Italy); Sverzellati, Nicola [Department of Clinical Sciences, Section of Radiology, University of Parma, Via Gramsci, 14 - 43100 Parma (Italy); Gavelli, Giampaolo [Department of Radiology, S. Orsola University Hospital, Via Massarenti 9 - 40138 Bologna (Italy)

    2009-03-15

    Objective: To evaluate the prevalence of osteoporotic vertebral fractures in patients undergoing multidetector computed tomography (MDCT) of the chest and/or abdomen. Materials and methods: 323 consecutive patients (196 males, 127 females) with a mean age of 62.6 years (range 20-88) who had undergone chest and/or abdominal MDCT were evaluated. Sagittal reformats of the spine obtained from thin section datasets were reviewed by two radiologists and assessed for vertebral fractures. Morphometric analysis using electronic calipers was performed on vertebral bodies which appeared abnormal upon visual inspection. A vertebral body height loss of 15% or more was considered a fracture and graded as mild (15-24%), moderate (25-49%) or severe (more than 50%). Official radiology reports were reviewed and whether the vertebral fractures had been reported or not was noted. Results: 31 out of 323 patients (9.5%) had at least 1 vertebral fracture and 7 of those patients had multiple fractures for a total of 41 fractures. Morphometric grading revealed 10 mild, 16 moderate and 15 severe fractures. Prevalence was higher in women (14.1%) than men (6.6%) and increased with patients age with a 17.1% prevalence in post-menopausal women. Only 6 out 41 vertebral fractures (14.6%) had been noted in the radiology final report while the remaining 35 (85.45) had not. Conclusion: although vertebral fractures represent frequent incidental findings on multidetector CT studies and may be easily identified on sagittal reformats, they are often underreported by radiologists, most likely because of unawareness of their clinical importance.

  9. Effects of vertebral mobilization and manipulation on kinematics of the thoracolumbar region.

    Science.gov (United States)

    Haussler, Kevin K; Hill, Ashley E; Puttlitz, Christian M; McIlwraith, C Wayne

    2007-05-01

    To measure passive spinal movements induced during dorsoventral mobilization and evaluate effects of induced pain and spinal manipulative therapy (SMT) on passive vertebral mobility in standing horses. 10 healthy adult horses. Baseline vertical displacements, applied force, stiffness, and frequency of the oscillations were measured during dorsoventral spinal mobilization at 5 thoracolumbar intervertebral sites. As a model for back pain, fixation pins were temporarily implanted into the dorsal spinous processes of adjacent vertebrae at 2 of the intervertebral sites. Vertebral variables were recorded again after pin placement and treadmill locomotion. In a randomized crossover study, horses were allocated to control and treatment interventions, separated by a 7-day washout period. The SMT consisted of high-velocity, low-amplitude thrusts applied to the 3 non-pin-placement sites. Control horses received no treatment. The amplitudes of vertical displacement increased from cranial to caudal in the thoracolumbar portion of the vertebral column. Pin implantation caused no immediate changes at adjacent intervertebral sites, but treadmill exercise caused reductions in most variables. The SMT induced a 15% increase in displacement and a 20% increase in applied force, compared with control measurements. The passive vertical mobility of the trunk varied from cranial to caudal. At most sites, SMT increased the amplitudes of dorsoventral displacement and applied force, indicative of increased vertebral flexibility and increased tolerance to pressure in the thoracolumbar portion of the vertebral column.

  10. Vertebral body osteomyelitis in the horse

    International Nuclear Information System (INIS)

    Markel, M.D.; Madigan, J.E.; Lichtensteiger, C.A.; Large, S.M.; Hornof, W.J.

    1986-01-01

    The clinical signs, laboratory data, results of nuclear scintigraphy and radiographic examination of five horses with vertebral body osteomyelitis are described together with response to treatment. Three horses were less than five months of age. Four horses demonstrated hindlimb paresis and in three a focus of pain in the thoracolumbar region could be identified. An umbilical abscess, a caudal lobe lung abscess and a patent urachus were considered primary niduses of infection in each of three horses. Leucocytosis, neutrophilia, anaemia and elevated fibrinogen were the most consistent laboratory abnormalities. Nuclear scintigraphy was performed in three horses and identified the site of the vertebral lesion which was subsequently evaluated radiographically. In the other two horses radiographic examination in the region of areas of focal pain identified a lesion. Radiographic abnormalities included compression fractures of vertebral bodies (two), proliferative new bone (three) and soft tissue swelling ventral to a vertebral body (one). Two horses, including one with a compression fracture of the second lumbar vertebra, received parenteral antimicrobial therapy for 40 and 74 days, respectively. When re-examined six months later they showed no neurological abnormalities. The other three horses failed to respond to antimicrobial treatment and were humanely destroyed. The horse with a lung abscess also had an abscess cranial to the right tuber coxae which extended into the vertebral bodies of the third and fourth lumbar vertebrae from which Streptococcus zooepidemicus was cultured. A horse with proliferative new bone on the ventral aspect of the fifth and sixth thoracic vertebrae had a mediastinal mass associated with these vertebrae and fungal granulomas, from which Aspergillus species was cultured, in the heart and aorta, trachea, spleen and kidney. The horse with a patent urachus and soft tissue swelling ventral to the vertebral body of the 12th thoracic vertebra

  11. The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine

    OpenAIRE

    Baeesa, Saleh S.; Krueger, Antonio; Arag?n, Francisco A.; Noriega, David C.

    2015-01-01

    Objectives: To evaluate the feasibility of a minimally invasive technique using a titanium expandable device to achieve anatomical restoration of vertebral compression fractures (VCF) of the thoracolumbar spine. Methods: This prospective study included 27 patients diagnosed with VCF (Magerl classification A.1.2, A.1.3, and A.3.1) of the thoracolumbar spine treated with percutaneous cement augmentation using the SpineJack? device. The study was conducted in Valladolid University Hospital, Vall...

  12. Bilateral transtibial amputation with concomitant thoracolumbar vertebral collapse in a Sichuan earthquake survivor

    Directory of Open Access Journals (Sweden)

    Lau Herman

    2010-07-01

    Full Text Available Abstract The devastating earthquake in Sichuan, China on 12 May 2008 left thousands of survivors requiring medical care and intensive rehabilitation. In view of this great demand, the Chinese Speaking Orthopaedic Society established the "Stand Tall" project to provide voluntary services to aid amputee victims in achieving total rehabilitation and social integration. This case report highlights the multidisciplinary rehabilitation of a girl who suffered thoracolumbar vertebral collapse and underwent bilateral transtibial amputation. The rehabilitation team was involved in all stages of the care process from the pre-operative phase, through amputation, into prosthetic training, and during her life thereafter. Despite this catastrophic event, early rehabilitation and specially designed bilateral prostheses allowed her a high level of functional ability. The joint efforts of the multidisciplinary team and the advancement of new technology have revolutionized the care process for amputees.

  13. Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine

    Science.gov (United States)

    Ataka, Hiromi; Tanno, Takaaki

    2008-01-01

    Previous reports have emphasized the importance of neural decompression through either an anterior or posterior approach when reconstruction surgery is performed for neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. However, the contribution of these decompression procedures to neurological recovery has not been fully established. In the present study, we investigated 14 consecutive patients who had incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine and underwent posterior instrumented fusion without neural decompression. They were radiographically and neurologically assessed during an average follow-up period of 25 months. The mean local kyphosis angle was 14.6° at flexion and 4.1° at extension preoperatively, indicating marked instability at the collapsed vertebrae. The mean spinal canal occupation by bone fragments was 21%. After surgery, solid bony fusion was obtained in all patients. The mean local kyphosis angle became 5.8° immediately after surgery and 9.9° at the final follow-up. There was no implant dislodgement, and no additional surgery was required. In all patients, back pain was relieved, and neurological improvement was obtained by at least one modified Frankel grade. The present series demonstrate that the posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine can provide neurological improvement and relief of back pain without major complications. We suggest that neural decompression is not essential for the treatment of neurological impairment due to osteoporotic vertebral collapse with dynamic mobility. PMID:19005689

  14. Diffusion-Weighted MRI Assessment of Adjacent Disc Degeneration After Thoracolumbar Vertebral Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Noriega, David C., E-mail: dcnoriega1970@gmail.com [Valladolid University Hospital, Spine Department (Spain); Marcia, Stefano, E-mail: stemarcia@gmail.com [SS. Trinità Hospital ASL 8 Cagliari, Department of Radiology (Italy); Ardura, Francisco, E-mail: fardura@ono.com [Valladolid University Hospital, Spine Department (Spain); Lite, Israel Sanchez, E-mail: israelslite@hotmail.com [Valladolid University Hospital, Radiology Department (Spain); Marras, Mariangela, E-mail: mariangela.marrasmd@gmail.com [Azienda Ospedaliero Brotzu (A.O.B.), Department of Radiology (Italy); Saba, Luca, E-mail: lucasaba@tiscali.it [Azienda Ospedaliero Universitaria (A.O.U.), Department of Radiology (Italy)

    2016-09-15

    ObjectiveThe purpose of this study was to assess, by the mean apparent diffusion coefficient (ADC), if a relationship exists between disc ADC and MR findings of adjacent disc degeneration after thoracolumbar fractures treated by anatomic reduction using vertebral augmentation (VAP).Materials and MethodsTwenty non-consecutive patients (mean age 50.7 years; range 45–56) treated because of vertebral fractures, were included in this study. There were 10 A3.1 and 10 A1.2 fractures (AO classification). Surgical treatment using VAP was applied in 14 cases, and conservative in 6 patients. MRI T2-weighted images and mapping of apparent diffusion coefficient (ADC) of the intervertebral disc adjacent to the fractured segment were performed after a mean follow-up of 32 months. A total of 60 discs, 3 per patient, were analysed: infra-adjacent, supra-adjacent and a control disc one level above the supra-adjacent.ResultsNo differences between patients surgically treated and those following a conservative protocol regarding the average ADC values obtained in the 20 control discs analysed were found. Considering all discs, average ADC in the supra-adjacent level was lower than in the infra-adjacent (1.35 ± 0.12 vs. 1.53 ± 0.06; p < 0.001). Average ADC values of the discs used as a control were similar to those of the infra-adjacent level (1.54 ± 0.06). Compared to surgically treated patients, discs at the supra-adjacent fracture level showed statistically significant lower values in cases treated conservatively (p < 0.001). The variation in the delay of surgery had no influence on the average values of ADC at any of the measured levels.ConclusionsADC measurements of the supra-adjacent discs after a mean follow-up of 32 months following thoracolumbar fractures, showed that restoration of the vertebral collapse by minimally invasive VAP prevents posttraumatic disc degeneration.

  15. Sexual dimorphism in human vertebral body shape.

    OpenAIRE

    Taylor, J R; Twomey, L T

    1984-01-01

    This study demonstrates that the earlier growth spurt in vertebral height in females and the greater growth in vertebral transverse diameter in males, both give rise to sexual dimorphism in vertebral shape, female vertebral bodies being significantly more slender than male vertebral bodies from the age of 8 years onwards. The possible relationship of this difference to sex differences in scoliosis prevalence is discussed.

  16. Rod rotation and differential rod contouring followed by direct vertebral rotation for treatment of adolescent idiopathic scoliosis: effect on thoracic and thoracolumbar or lumbar curves assessed with intraoperative computed tomography.

    Science.gov (United States)

    Seki, Shoji; Kawaguchi, Yoshiharu; Nakano, Masato; Makino, Hiroto; Mine, Hayato; Kimura, Tomoatsu

    2016-03-01

    Although direct vertebral rotation (DVR) is now used worldwide for the surgical treatment of adolescent idiopathic scoliosis (AIS), the benefit of DVR in reducing vertebral body rotation in these patients has not been determined. We investigated a possible additive effect of DVR on further reduction of vertebral body rotation in the axial plane following intraoperative rod rotation or differential rod contouring in patients undergoing surgical treatment for AIS. The study was a prospective computed tomography (CT) image analysis. We analyzed the results of the two intraoperative procedures in 30 consecutive patients undergoing surgery for AIS (Lenke type I or II: 15; Lenke type V: 15). The angle of reduction of vertebral body rotation taken by intraoperative CT scan was measured and analyzed. Pre- and postoperative responses to the Scoliosis Research Society 22 Questionnaire (SRS-22) were also analyzed. To analyze the reduction of vertebral body rotation with rod rotation or DVR, intraoperative cone-beam CT scans of the three apical vertebrae of the major curve of the scoliosis (90 vertebrae) were taken pre-rod rotation (baseline), post-rod rotation with differential rod contouring, and post-DVR in all patients. The angle of vertebral body rotation in these apical vertebrae was measured and analyzed for statistical significance. Additionally, differences between thoracic curve scoliosis (Lenke type I or II; 45 vertebrae) and thoracolumbar or lumbar curve scoliosis (Lenke type V; 45 vertebrae) were analyzed. Pre- and postoperative SRS-22 scores were evaluated in all patients. The mean (90 vertebrae) vertebral body rotation angles at baseline, post-rod rotation or differential rod contouring, and post-rod rotation or differential rod contouring or post-DVR were 17.3°, 11.1°, and 6.9°, respectively. The mean reduction in vertebral body rotation with the rod rotation technique was 6.8° for thoracic curves and 5.7° for thoracolumbar or lumbar curves (pself

  17. Mechanisms, Predisposing Factors, and Prognosis of Intraoperative Vertebral Subluxation During Pedicle Subtraction Osteotomy in Surgical Correction of Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis.

    Science.gov (United States)

    Qian, Bang-Ping; Mao, Sai-Hu; Jiang, Jun; Wang, Bin; Qiu, Yong

    2017-08-15

    A retrospective study. To analyze the mechanisms, predisposing factors, and prognosis of the intraoperative vertebral subluxation (VS) during pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis secondary to ankylosing spondylitis (AS). VS is one of the most daunting challenges that surgeons encounter during PSO closure, especially in patients with AS with ankylosed and mostly osteoporotic spine. Unfortunately, there is a paucity of research designed to conceptualize the mechanisms, predisposing factors, and discuss the complication-avoidance strategies and prognosis. A retrospective single-center review was performed for a consecutive series of 153 patients with AS with rigid thoracolumbar kyphosis who underwent one-level PSO from April 2000 to December 2013. The incidence of the VS at the level of PSO during correction was analyzed and the potential causative factors were investigated. VS occurred in six patients with the incidence being 3.9% in this patient cohort. The predisposing factors were (1) early fracture of the anterior cortex of the osteotomized vertebra (OV); (2) excessive decancellation from vertebral body causing parallel collapse of the vertebral column with significant loss of the ability to create local lordosis; (3) improper manual osteoclasis due to insufficient decancellation of the OV; and (4) inappropriate application of cantilever technique and concomitant long instrumentation. The early surgical complication involved one patient with cerebrospinal fluid leakage at the osteotomized site, but no devastating neurological deficits. During follow-up, bone healing and adaptive vertebral remodeling with no rod breakage were observed for all these six patients. Intraoperative VS was a rare occurrence associated with inappropriate manual manipulation of osteotomy, gap closure, and rod insertion. Neurological complication was a potential risk, but could be well prevented with extensive laminectomy and emergency actions favoring partial

  18. The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine.

    Science.gov (United States)

    Baeesa, Saleh S; Krueger, Antonio; Aragón, Francisco A; Noriega, David C

    2015-01-01

    To evaluate the feasibility of a minimally invasive technique using a titanium expandable device to achieve anatomical restoration of vertebral compression fractures (VCF) of the thoracolumbar spine. This prospective study included 27 patients diagnosed with VCF (Magerl classification A.1.2, A.1.3, and A.3.1) of the thoracolumbar spine treated with percutaneous cement augmentation using the SpineJack® device. The study was conducted in Valladolid University Hospital, Valladolid, Spain from January to December 2012, with a minimum one-year follow up. Preoperative evaluation included visual analogue scale (VAS) for pain, and radiological assessment of the VCF using 3-dimensional computed tomography (3D-CT) scans for measurements of vertebral heights and angles. The patients were followed at 3, 6, and 12 months with clinical VAS and radiological assessments. The procedure was performed in 27 patients with a mean age of 55.9 ± 17.3 years, 55.6% females. All patients underwent surgery within 6 weeks from time of injury. No procedure related complications occurred. Pain measured by VAS score decreased from 7.0 preoperatively to 3.2 within 24 hours, and remained 2.2 at 3 months, 2.1 at 6 months, and 1.5 at 12-months follow-up (p<0.05). Mean height restorations for the anterior was 3.56 mm, central was 2.49, and posterior vertebral was 1.28 mm, and maintained at 12-months follow-up (p=0.001). This new percutaneous technique for VCF has shown good clinical results in pain control and the possibility to reduce both vertebral kyphosis angles and fractured endplates seen in 3D-CT scans assessment method. Further studies are needed to confirm those results on larger cohorts with long-term follow up. 

  19. Refracture of osteoporotic vertebral body after treatment by balloon kyphoplasty

    Science.gov (United States)

    Li, Xigong; Lu, Yang; Lin, Xiangjin

    2017-01-01

    Abstract Rationale: Balloon kyphoplasty is a widely accepted treatment of osteoporotic vertebral compression fractures (OVCFs) with good results and a low risk for complications. A refracture of previously treated vertebra is a relatively rare condition. Patient concerns: We reported our 3 cases and reviewed all relevant literatures of 11 cases with refracture of osteoporotic vertebral body after kyphoplasty. Diagnoses: Follow-up radiographs or magnetic resonance imaging examination confirmed refractures of previously treated vertebrae after kyphoplasty. Interventions: One patient with 1 refracture of osteoporotic vertebral body after kyphoplasty was treated conservatively, but the other 2 patients were treated surgically because of multiple vertebral fractures or neurological deficits. Outcomes: The average age of the patients was 76.8 years (range, 63–86 years). All the patients had severe osteoporosis with a mean T-score of −3.46 (range −5.0 to −3.0). The sites of refractures are in the lumbar and thoracolumbar regions. Severe osteoporosis, the presence of intravertebral cleft, and a solid lump injection pattern of polymethylmethacrylate would result in insufficient strengthening effects of cement augmentation and therefore increased the likelihood of refractures of the kyphoplasty vertibrae. Lessons: Patients with OVCFs and intravertebral cleft who did not obtain complete pain-relief at the treated vertebral level after kyphoplasty should be strictly followed up. Early finding of this condition and rapid intervention might contribute to avoiding the occurrence of the cemented vertebral refracture after kyphoplasty. Conservative treatments such as back brace and antiosteoporotic medications were strongly recommended. PMID:29245267

  20. The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine

    Science.gov (United States)

    Baeesa, Saleh S.; Krueger, Antonio; Aragón, Francisco A.; Noriega, David C.

    2015-01-01

    Objectives: To evaluate the feasibility of a minimally invasive technique using a titanium expandable device to achieve anatomical restoration of vertebral compression fractures (VCF) of the thoracolumbar spine. Methods: This prospective study included 27 patients diagnosed with VCF (Magerl classification A.1.2, A.1.3, and A.3.1) of the thoracolumbar spine treated with percutaneous cement augmentation using the SpineJack® device. The study was conducted in Valladolid University Hospital, Valladolid, Spain from January to December 2012, with a minimum one-year follow up. Preoperative evaluation included visual analogue scale (VAS) for pain, and radiological assessment of the VCF using 3-dimensional computed tomography (3D-CT) scans for measurements of vertebral heights and angles. The patients were followed at 3, 6, and 12 months with clinical VAS and radiological assessments. Results: The procedure was performed in 27 patients with a mean age of 55.9 ± 17.3 years, 55.6% females. All patients underwent surgery within 6 weeks from time of injury. No procedure related complications occurred. Pain measured by VAS score decreased from 7.0 preoperatively to 3.2 within 24 hours, and remained 2.2 at 3 months, 2.1 at 6 months, and 1.5 at 12-months follow-up (pvertebral was 1.28 mm, and maintained at 12-months follow-up (p=0.001). Conclusion: This new percutaneous technique for VCF has shown good clinical results in pain control and the possibility to reduce both vertebral kyphosis angles and fractured endplates seen in 3D-CT scans assessment method. Further studies are needed to confirm those results on larger cohorts with long-term follow up. PMID:25630005

  1. Simultaneous posterior and anterior approaches with posterior vertebral wall preserved for rigid post-traumatic kyphosis in thoracolumbar spine.

    Science.gov (United States)

    Wang, Qing; Xiu, Peng; Zhong, Dejun; Wang, Gaoju; Wang, Song

    2012-08-01

    A retrospective study. To evaluate the radiological and clinical results of simultaneous surgery with preservation of the posterior vertebral wall for rigid post-traumatic kyphosis in the thoracolumbar spine. Management of rigid post-traumatic kyphosis has been a challenge for surgeons. Current widely used posterior osteotomy procedures have the disadvantages of significant invasiveness, spinal column shortening, and instrumentation-related complications. From 2004 to 2009, 21 patients with rigid post-traumatic kyphosis in the thoracolumbar spine (T11-L2) were managed in our hospital. Average kyphotic angle was 45.2° ± 11.2° (range, 31°-67°). The surgical technique used was posterior and anterior circumferential release and anterior corpectomy with posterior vertebral wall preservation and short segmental instrumentation. Preoperative and postoperative kyphotic angle was measured to assess the degree of kyphosis correction and maintenance. Changes in low back pain were assessed by Japanese Orthopaedic Association scores. All patients were successfully managed with this procedure without major complications. Most patients (19 of 21) were instrumented with anterior-only fixation, while posterior interspinal wire was added in 2 patients with osteoporosis. The mean blood loss was 470 mL (range, 300-700 mL). Patients were followed for an average of 32 months (range, 6-70 mo) postoperatively. Back pain was relieved to some degree in all patients and the improvement in Japanese Orthopaedic Association scores was 76.9% ± 7.9. Average kyphotic angle was 6.0° ± 5.7° (range, -2 to 17) immediately after surgery and 7.2° ± 5.8° (range, -3 to 17) at final follow-up. Average of 1° of correction loss was documented and all patients obtained solid fusion uneventfully. This technique is indicated for most patients with rigid post-traumatic kyphosis in the thoracolumbar spine and can yield satisfactory clinical results not only in terms of pain relief, kyphosis

  2. Parametric modelling and segmentation of vertebral bodies in 3D CT and MR spine images.

    Science.gov (United States)

    Stern, Darko; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2011-12-07

    Accurate and objective evaluation of vertebral deformations is of significant importance in clinical diagnostics and therapy of pathological conditions affecting the spine. Although modern clinical practice is focused on three-dimensional (3D) computed tomography (CT) and magnetic resonance (MR) imaging techniques, the established methods for evaluation of vertebral deformations are limited to measuring deformations in two-dimensional (2D) x-ray images. In this paper, we propose a method for quantitative description of vertebral body deformations by efficient modelling and segmentation of vertebral bodies in 3D. The deformations are evaluated from the parameters of a 3D superquadric model, which is initialized as an elliptical cylinder and then gradually deformed by introducing transformations that yield a more detailed representation of the vertebral body shape. After modelling the vertebral body shape with 25 clinically meaningful parameters and the vertebral body pose with six rigid body parameters, the 3D model is aligned to the observed vertebral body in the 3D image. The performance of the method was evaluated on 75 vertebrae from CT and 75 vertebrae from T(2)-weighted MR spine images, extracted from the thoracolumbar part of normal and pathological spines. The results show that the proposed method can be used for 3D segmentation of vertebral bodies in CT and MR images, as the proposed 3D model is able to describe both normal and pathological vertebral body deformations. The method may therefore be used for initialization of whole vertebra segmentation or for quantitative measurement of vertebral body deformations.

  3. Joint detection and segmentation of vertebral bodies in CT images by sparse representation error minimization

    Science.gov (United States)

    Korez, Robert; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2016-03-01

    Automated detection and segmentation of vertebral bodies from spinal computed tomography (CT) images is usually a prerequisite step for numerous spine-related medical applications, such as diagnosis, surgical planning and follow-up assessment of spinal pathologies. However, automated detection and segmentation are challenging tasks due to a relatively high degree of anatomical complexity, presence of unclear boundaries and articulation of vertebrae with each other. In this paper, we describe a sparse representation error minimization (SEM) framework for joint detection and segmentation of vertebral bodies in CT images. By minimizing the sparse representation error of sampled intensity values, we are able to recover the oriented bounding box (OBB) and segmentation binary mask for each vertebral body in the CT image. The performance of the proposed SEM framework was evaluated on five CT images of the thoracolumbar spine. The resulting Euclidean distance of 1:75+/-1:02 mm, computed between the center points of recovered and corresponding reference OBBs, and Dice coefficient of 92:3+/-2:7%, computed between the resulting and corresponding reference segmentation binary masks, indicate that the proposed framework can successfully detect and segment vertebral bodies in CT images of the thoracolumbar spine.

  4. Surgical treatment of congenital thoracolumbar spondyloptosis in a 2-year-old child with vertebral column resection and posterior-only circumferential reconstruction of the spine column: case report.

    Science.gov (United States)

    Gressot, Loyola V; Mata, Javier A; Luerssen, Thomas G; Jea, Andrew

    2015-02-01

    Spondyloptosis refers to complete dislocation of a vertebral body onto another. The L5-S1 level is frequently affected. As this condition is rare, few published reports describing its clinical features and surgical outcomes exist, especially in the pediatric patient population. The authors report the presentation, pathological findings, and radiographic studies of a 2-year-old girl who presented to Texas Children's Hospital with a history since birth of progressive spastic paraparesis. Preoperative CT and MRI showed severe spinal cord compression associated with T11-12 spondyloptosis. The patient underwent a single-stage posterior approach for complete resection of the dysplastic vertebral bodies at the apex of the spinal deformity with reconstruction and stabilization of the vertebral column using a titanium expandable cage and pedicle screws. At the 12-month follow-up, the patient remained neurologically stable without any radiographic evidence of instrumentation failure or loss of alignment. To the best of the authors' knowledge, there have been only 2 other children with congenital thoracolumbar spondyloptosis treated with the above-described strategy. The authors describe their case and review the literature to discuss the aggregate clinical features, surgical strategies, and operative outcomes for congenital thoracolumbar spondyloptosis.

  5. [Biomechanical effect on adjacent vertebra after percutaneous kyphoplasty with cement leakage into disc: a finite element analysis of thoracolumbar osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Fei, Qi; Li, Qiu-Jun; Li, Dong; Yang, Yong; Tang, Hai; Li, Jin-Jun; Wang, Bing-Qiang; Wang, Yi-Peng

    2011-01-04

    To explore the biomechanical effects on adjacent vertebra of thoracolumbar osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP) with cement leakage into the disc by using finite element analysis. T10-L2 segment data were obtained from computed tomography (CT) scans of an elder female with single T12 OVCF undergoing a cement leakage into the T12-L1 disc after PKP. A three-dimensional finite element Model of thoracolumbar spine (T10-L2) was built in the Mimics and the ABAQUS software. The stress on annulus fiber, nucleus pulposus, endplate and facet joints under axial pressure (0.3, 1.0, 4.0 MPa) were analyzed. The 3D finite element after percutaneous kyphoplasty (PKP) with cement leakage into the disc may be strongly related with the changes of biomechanical effects on adjacent vertebra of thoracolumbar OVCF. Models of thoracolumbar OVCF before and after PVP with a cement leakage into the T12-L1 disc were successfully established. The stresses increased with a rising axial pressure in the model of cement leakage into the disc after PVP, the stress augmentation scope on adjacent end plates(T11 low plate & L1 top plate) and intervertebral disc (T11-12 & T12-L1) increased. The maximal Von Mises stress on adjacent vertebra (T11 & L1) increased while but the maximal Von Mises stress on end vertebra (T10 & L2) decreased. Postoperative adjacent vertebral fracture.

  6. Aquatic vertebrate locomotion : Wakes from body waves

    NARCIS (Netherlands)

    Videler, JJ; Muller, UK; Stamhuis, EJ

    1999-01-01

    Vertebrates swimming with undulations of the body and tail have inflection points where the curvature of the body changes from concave to convex or vice versa. These inflection paints travel down the body at the speed of the running wave of bending, In movements with increasing amplitudes, the body

  7. Initial non-weight-bearing therapy is important for preventing vertebral body collapse in elderly patients with clinical vertebral fractures

    Directory of Open Access Journals (Sweden)

    Kishikawa Y

    2012-04-01

    Full Text Available Yoichi KishikawaKishikawa Orthopaedic Clinic, Saga City, Saga, JapanPurpose: The aim of the present conventional observational study was to compare the clinical outcomes of initial non-weight-bearing therapy and conventional relative rest therapy among elderly patients with clinical vertebral fractures.Methods: In total, 196 consecutive patients with clinical vertebral fractures (mean age: 78 years who were hospitalized for treatment between January 1999 and March 2007 were analyzed. Initial non-weight-bearing therapy consisted of complete bed rest allowing rolling on the bed without any weight-bearing to the spine for 2 weeks, followed by rehabilitation wearing a soft brace. The indications for initial non-weight-bearing therapy were vertebral fracture involving the posterior portion of the vertebral body at the thoraco-lumbar spine, mild neurological deficit, instability of the fracture site, severe pain, multiple vertebral fractures arising from trauma, malalignment at the fracture site, and mild spinal canal stenosis caused by the fracture. Patients who met the indication criteria were treated with initial non-weight-bearing therapy (n = 103, while the other patients were treated with conventional relative rest (n = 93. All the patients were uniformly treated with intramuscular elcatonin to relieve pain. The primary endpoint was progression of the vertebral fracture. The secondary endpoints included bony union and subjective back pain. The follow-up period was 12 weeks.Results: Compared with the conventional relative rest group, the collapse rate of the anterior and posterior portions of the vertebral body was significantly smaller in the initial non-weight-bearing group. The bony union rate was 100% in the initial non-weight-bearing group and 97% in the conventional relative rest group. The number of patients who experienced back pain was significantly lower in the initial non-weight-bearing group than in the conventional relative rest

  8. Can MRI predict subsequent pseudarthrosis resulting from osteoporotic thoracolumbar vertebral fractures?

    Science.gov (United States)

    Omi, Hirotsugu; Yokoyama, Toru; Ono, Atsushi; Numasawa, Takuya; Wada, Kanichiro; Fujisawa, Yoichi

    2014-12-01

    The purpose of this study was to assess the ability of short inversion time inversion-recovery (STIR) in magnetic resonance imaging for predicting the prognosis of osteoporotic vertebral fractures. We analyzed 63 vertebrae of 56 patients who had osteoporotic vertebral fracture (Th10-L2) prospectively. Image finding of a homogeneous high signal change on a fractured vertebra was evaluated and all vertebrae were divided into "homogenous high signal change group" or "non-homogenous high signal change group". On the other hand, image finding of linear black signal area was evaluated and all vertebrae were divided into "linear black signal area group" or "non-linear black signal area group". Sixteen and 24 vertebrae were included in the homogenous high signal change group or the linear black signal area group, respectively. The 16 homogenous high signal change cases did not result in non-union, and 47 non-homogenous high signal change cases resulted in 14 non-unions, a significant difference. Twenty-four linear black signal area and 39 non-linear black signal area cases resulted in 10, and 4 non-unions, respectively, also a significant difference. The kyphosis progression rate of the linear black signal area group (mean 35%) was significantly higher than that of non-linear black signal area group (mean 23%). The visual analog scale of back pain of the linear black signal area group (mean 35 mm) was significantly higher than that of the non-linear black signal area group (mean 23 mm). STIR was useful for predicting bone union, kyphosis, and back pain in patients with osteoporotic vertebral fracture.

  9. Quantitative vertebral morphometry based on parametric modeling of vertebral bodies in 3D.

    Science.gov (United States)

    Stern, D; Njagulj, V; Likar, B; Pernuš, F; Vrtovec, T

    2013-04-01

    Quantitative vertebral morphometry (QVM) was performed by parametric modeling of vertebral bodies in three dimensions (3D). Identification of vertebral fractures in two dimensions is a challenging task due to the projective nature of radiographic images and variability in the vertebral shape. By generating detailed 3D anatomical images, computed tomography (CT) enables accurate measurement of vertebral deformations and fractures. A detailed 3D representation of the vertebral body shape is obtained by automatically aligning a parametric 3D model to vertebral bodies in CT images. The parameters of the 3D model describe clinically meaningful morphometric vertebral body features, and QVM in 3D is performed by comparing the parameters to their statistical values. Thresholds and parameters that best discriminate between normal and fractured vertebral bodies are determined by applying statistical classification analysis. The proposed QVM in 3D was applied to 454 normal and 228 fractured vertebral bodies, yielding classification sensitivity of 92.5% at 7.5% specificity, with corresponding accuracy of 92.5% and precision of 86.1%. The 3D shape parameters that provided the best separation between normal and fractured vertebral bodies were the vertebral body height and the inclination and concavity of both vertebral endplates. The described QVM in 3D is able to efficiently and objectively discriminate between normal and fractured vertebral bodies and identify morphological cases (wedge, (bi)concavity, or crush) and grades (1, 2, or 3) of vertebral body fractures. It may be therefore valuable for diagnosing and predicting vertebral fractures in patients who are at risk of osteoporosis.

  10. [Development and application of artificial vertebral body].

    Science.gov (United States)

    Liu, Jian-Tao; Zhang, Feng; Gao, Zheng-Chao; Niu, Bin-Bin; Li, Yu-Huan; He, Xi-Jing

    2017-12-25

    Artificial vertebral body has achieved good results in treating spinal tumors, tuberculosis, fracture and other diseases. Currently, artificial vertebral body with variety of kinds and pros and cons, is generally divided into two types: fusion type and movable type. The former according to whether the height could be adjusted and strength of self-stability is divided into three types: support-fixed type, adjust-fixed type and self-fixed type. Whether the height of self-fixed type could be adjusted is dependent on structure of collar thread rotation. The latter is due to mobile device of ball-and-socket joints or hollow structures instead of the disc which retains the activity of the spine to some extent. Materials of artificial vertebral body include metals, ceramics, biomaterials, polymer composites and other materials. Titanium with a dominant role in the metal has developed to the third generation, but there are still defects such as poor surface bioactivity; ceramics with the representative of hydroxyapatite composite, magnetic bioceramics, polycrystalline alumina ceramics and so on, which have the defects of processing complex and uneven mechanical properties; biological material is mainly dominated by xenogeneic bone, which is closest to human bone in structure and properties, but has defects of low toughness and complex production; polymer composites according to biological characteristics in general consists of biodegradable type and non-biodegradable type which are respectively represented by poly-lactide and polyethylene, each with advantages and disadvantages. Although the design and materials of prosthesis have made great progress, it is difficult to fully meet requirements of spinal implants and they need be further optimized. 3D printing technology makes process of the complex structure of prosthesis and individual customization possible and has broad development prospects. However, long production cycles and high cost of defect should be overcome

  11. Comparison of polymethylmethacrylate versus expandable cage in anterior vertebral column reconstruction after posterior extracavitary corpectomy in lumbar and thoraco-lumbar metastatic spine tumors.

    Science.gov (United States)

    Eleraky, Mohammed; Papanastassiou, Ioannis; Tran, Nam D; Dakwar, Elias; Vrionis, Frank D

    2011-08-01

    Single-stage posterior corpectomy for the management of spinal tumors has been well described. Anterior column reconstruction has been accomplished using polymethylmethacrylate (PMMA) or expandable cages (EC). The aim of this retrospective study was to compare PMMA versus ECs in anterior vertebral column reconstruction after posterior corpectomy for tumors in the lumbar and thoracolumbar spine. Between 2006 and 2009 we identified 32 patients that underwent a single-stage posterior extracavitary tumor resection and anterior reconstruction, 16 with PMMA and 16 with EC. There were no baseline differences in regards to age (mean: 58.2 years) or performance status. Differences between groups in terms of survival, estimated blood loss (EBL), kyphosis reduction (decrease in Cobb's angle), pain, functional outcomes, and performance status were evaluated. Mean overall survival and EBL were 17 months and 1165 ml, respectively. No differences were noted between the study groups in regards to survival (p = 0.5) or EBL (p = 0.8). There was a trend for better Kyphosis reduction in favor of the EC group (10.04 vs. 5.45, p = 0.16). No difference in performance status or VAS improvements was observed (p > 0.05). Seven patients had complications that led to reoperation (5 infections). PMMA or ECs are viable options for reconstruction of the anterior vertebral column following tumor resection and corpectomy. Both approaches allow for correction of the kyphotic deformity, and stabilization of the anterior vertebral column with similar functional and performance status outcomes in the lumbar and thoracolumbar area.

  12. Stability potential of spinal instrumentations in tumor vertebral body replacement surgery.

    Science.gov (United States)

    Vahldiek, M J; Panjabi, M M

    1998-03-01

    The multidirectional stability potential of anterior, posterior, and combined instrumentations applied at L1-L3 was studied after L2 corpectomy and replacement with a carbon-fiber implant. To evaluate the biomechanical characteristics of short-segment anterior, posterior, and combined instrumentations in lumbar spine tumor vertebral body replacement surgery. The biomechanical properties of many different spinal instrumentations have been studied in various spinal injury models. Only a few studies, however, investigate the stabilization methods in spinal tumor vertebral body replacement surgery. Eight fresh frozen human cadaveric thoracolumbar spine specimens (T12-L4) were prepared for biomechanical testing. Pure moments (2.5 Nm, 5 Nm, and 7.5 Nm) of flexion-extension, left-right axial torsion, and left-right lateral bending were applied to the top vertebra in a flexibility machine, and the motions of the L1 vertebra with respect to L3 were recorded with an optoelectronic motion measurement system after reconditioning. The L2 vertebral body was resected and replaced by a carbon-fiber cage. Different fixation methods were applied to the L1 and L3 vertebrae. One anterior, two posterior, and two combined instrumentations were tested. Load-displacement curves were recorded and neutral zone and range of motion parameters were determined. The anterior instrumentation provided less potential stability than the posterior and combined instrumentations in all motion directions. The anterior instrumentation, after vertebral body replacement, showed greater motion than the intact spine, especially in axial torsion (range of motion, 10.3 degrees vs 5.5 degrees; neutral zone, 2.9 degrees vs. 0.7 degrees; P combined instrumentation provided superior rigidity in all directions compared with all other instrumentations. Posterior and combined instrumentations provided greater rigidity than anterior instrumentation. Anterior instrumentation should not be used alone in vertebral body

  13. Minimal Invasive Circumferential Management of Thoracolumbar Spine Fractures

    Directory of Open Access Journals (Sweden)

    S. Pesenti

    2015-01-01

    Full Text Available Introduction. While thoracolumbar fractures are common lesions, no strong consensus is available at the moment. Objectives. The aim of this study was to evaluate the results of a minimal invasive strategy using percutaneous instrumentation and anterior approach in the management of thoracolumbar unstable fractures. Methods. 39 patients were included in this retrospective study. Radiologic evaluation was based on vertebral and regional kyphosis, vertebral body height restoration, and fusion rate. Clinical evaluation was based on Visual Analogic Score (VAS. All evaluations were done preoperatively and at 1-year follow-up. Results. Both vertebral and regional kyphoses were significantly improved on postoperative evaluation (13° and 7° versus −1° and −9°  P<0.05, resp. as well as vertebral body height (0.92 versus 1.16, P<0.05. At 1-year follow-up, mean loss of correction was 1°. A solid fusion was visible in all the cases, and mean VAS was significantly reduced form 8/10 preoperatively to 1/10 at the last follow-up. Conclusion. Management of thoracolumbar fractures using percutaneous osteosynthesis and minimal invasive anterior approach (telescopic vertebral body prosthesis is a valuable strategy. Results of this strategy offer satisfactory and stable results in time.

  14. The variability of vertebral body volume and pain associated with osteoporotic vertebral fractures: conservative treatment versus percutaneous transpedicular vertebroplasty.

    Science.gov (United States)

    Andrei, Diana; Popa, Iulian; Brad, Silviu; Iancu, Aida; Oprea, Manuel; Vasilian, Cristina; Poenaru, Dan V

    2017-05-01

    Osteoporotic vertebral fractures (OVF) can lead to late collapse which often causes kyphotic spinal deformity, persistent back pain, decreased lung capacity, increased fracture risk and increased mortality. The purpose of our study is to compare the efficacy and safety of vertebroplasty against conservative management of osteoporotic vertebral fractures without neurologic symptoms. A total of 66 patients with recent OVF on MRI examination were included in the study. All patients were admitted from September 2009 to September 2012. The cohort was divided into two groups. The first study group consisted of 33 prospectively followed consecutive patients who suffered 40 vertebral osteoporotic fractures treated by percutaneous vertebroplasty (group 1), and the control group consisted of 33 patients who suffered 41 vertebral osteoporotic fractures treated conservatively because they refused vertebroplasty (group 2). The data collection has been conducted in a prospective registration manner. The inclusion criteria consisted of painful OVF matched with imagistic findings. We assessed the results of pain relief and minimal sagittal area of the vertebral body on the axial CT scan at presentation, after the intervention, at six and 12 months after initial presentation. Vertebroplasty with poly(methyl methacrylate) (PMMA) was performed in 30 patients on 39 VBs, including four thoracic vertebras, 27 vertebras of the thoracolumbar jonction and eight lumbar vertebras. Group 2 included 30 patients with 39 OVFs (four thoracic vertebras, 23 vertebras of the thoracolumbar junction and 11 lumbar vertebras). There was no significant difference in VAS scores before treatment (p = 0.229). The mean VAS was 5.90 in Group 1 and 6.28 in Group 2 before the treatment. Mean VAS after vertebroplasty was 0.85 in Group 1. The mean VAS at six months was 0.92 in Group 1 and 3.00 in Group 2 (p measured on sagital CT images was 8.288 at the initial presentation, 8.554 postoperatively, 8

  15. [Stability of ventral, dorsal and combined spondylodesis in vertebral body prosthesis implantation].

    Science.gov (United States)

    Vahldiek, M; Gossè, F; Panjabi, M M

    2002-05-01

    The purpose of this study was to evaluate the biomechanical characteristics of short-segment anterior, posterior, and combined instrumentations in lumbar spine vertebral body replacement surgery. Eight fresh frozen human cadaveric thoracolumbar spine specimens (T12-L4) were prepared for biomechanical testing. Pure moments (2.5, 5, and 7.5 Nm) of flexion-extension, left-right axial torsion, and left-right lateral bending were applied to the top vertebra in a flexibility machine and the motions of L1 vertebra with respect to L3 were recorded with an optoelectronic motion measurement system after preconditioning. One anterior, two posterior pedicle screw systems, and two combined instrumentations were tested. Load-displacement curves were recorded and neutral zone (NZ) and range of motion (ROM) were determined. The anterior instrumentation, after vertebral body replacement, showed greater motion than the intact spine, especially in axial torsion. Posterior instrumentation provided greater rigidity than the anterior instrumentation, especially in flexion-extension. The combined instrumentation provided superior rigidity in all directions compared to all other instrumentations.

  16. Augmentation of anterior vertebral body screw fixation by an injectable, biodegradable calcium phosphate bone substitute.

    Science.gov (United States)

    Bai, B; Kummer, F J; Spivak, J

    2001-12-15

    A biomechanical study to evaluate the effects of a biodegradable calcium phosphate (Ca-P) bone substitute on the fixation strength and bending rigidity of vertebral body screws. To determine if an injectable, biodegradable Ca-P bone substitute provides significant augmentation of anterior vertebral screw fixation in the osteoporotic spine. Polymethylmethacrylate (PMMA) augmented screws have been used clinically; however, there is concern about thermal damage to the neural elements during polymerization of the PMMA as well as its negative effects on bone remodeling. Injectable, biodegradable Ca-P bone substitutes have shown enhanced fixation of pedicle screws. Sixteen fresh cadaveric thoracolumbar vertebrae were randomly divided into two groups: control (no augmentation) (n = 8) and Ca-P bone substitute augmentation (n = 8) groups. Bone-screw fixation rigidity in bending was determined initially and after 10(5) cycles, followed by pullout testing of the screw to failure to determine pullout strength and stiffness. The bone-screw bending rigidity for the Ca-P bone substitute group was significantly greater than the control group, initially (58%) and after cyclic loading (125%). The pullout strength for Ca-P bone substitute group (1848 +/- 166 N) was significantly greater than the control group (665 +/- 92 N) (P pullout for the Ca-P bone substitute groups (399 +/- 69 N/mm) was significantly higher than the control group (210 +/- 51 N/mm) (P screw fixation with a biodegradable Ca-P bone substitute is a potential alternative to the use of PMMA cement.

  17. Vertebral hemangiomas: their demographical characteristics, location along the spine and position within the vertebral body.

    Science.gov (United States)

    Slon, Viviane; Stein, Dan; Cohen, Haim; Sella-Tunis, Tatiana; May, Hila; Hershkovitz, Israel

    2015-10-01

    Vertebral hemangiomas (VHs) are the most common form of benign tumors in the spine. The aim of this research was to study the prevalence of VHs in the human population, their distribution along the spine and their location in the vertebral body. The presence of VHs was assessed in full spine CT scans of 196 adults. Demographic data were gathered from medical records. VHs were present in 26.0% of the individuals studied, a rate significantly higher (χ2=43.338, pvertebral body (52.8 vs. 47.2%, respectively); and at its center and periphery (50.1 and 49.9%, respectively). VHs usually appeared at mid-height of the vertebral body or slightly higher. The reported prevalence of VHs is dependent on the demographic structure of the population studied, the size of the VHs and the method used to identify them. Overall, the phenomenon is more frequent than usually reported. VHs may appear at all vertebral levels and in all areas of the vertebral body.

  18. In vitro biomechanics of an expandable vertebral body replacement with self-adjusting end plates.

    Science.gov (United States)

    Buttermann, Glenn R; Freeman, Andrew L; Beaubien, Brian P

    2010-11-01

    Unstable burst fractures of the thoracolumbar spine may be treated surgically. Vertebral body replacements (VBRs) give anterior column support and, when used with supplemental fixation, impart rigidity to the injured segments. Although some VBRs are expandable, device congruity to the vertebral end plates is imprecise and may lead to stress risers and device subsidence. The objective of this study was to compare the rigidity of a VBR that self-adjusts to the adjacent vertebral end plates versus structural bone allograft and with an unsupported anterior column in a traumatic burst fracture reconstruction model. Biomechanical flexibility testing with rod strain measurement. Twelve T11-L3 human spine segments. Range of motion, neutral zone, and posterior fixation rod stress (moments). Flexibility testing was performed to ± 6 Nm in flexion-extension, lateral bending, and axial rotation on 12 intact human T11-L3 specimens. Burst fractures were created in L1, and flexibility testing was repeated in three additional states: subtotal corpectomy with posterior instrumentation (PI) only from T12 to L2, reconstruction with a femoral strut allograft and PI, and reconstruction with a VBR (with self-adjusting end plates) and PI. The PI consisted of pedicle screws and strain gage instrumented rods that were calibrated to measure rod stress via flexion-extension bending moments. There was no statistical difference in range of motion or neutral zone between the strut graft and VBR constructs, which both had less motion than the PI-only construct in flexion/extension and torsion and were both less than the intact values in flexion/extension and lateral bending (p combined with PI. Posterior rod stress was not significantly increased with this type of VBR compared with the strut graft reconstruction. The benefits of burst fracture stabilization using a self-adjusting VBR ultimately will not be known until long-term clinical studies are performed. Copyright © 2010 Elsevier Inc. All

  19. Automatic Vertebral Column Extraction by Whole-Body Bone SPECT Scan

    Directory of Open Access Journals (Sweden)

    Sheng-Fang Huang

    2013-01-01

    Full Text Available Bone extraction and division can enhance the accuracy of diagnoses based on whole-body bone SPECT data. This study developed a method for using conventional SPECT for automatic recognition of the vertebral column. A novel feature of the proposed approach is a novel “bone graph" image description method that represents the connectivity between these image regions to facilitate manipulation of morphological relationships in the skeleton before surgery. By tracking the paths shown on the bone graph, skeletal structures can be identified by performing morphological operations. The performance of the method was evaluated quantitatively and qualitatively by two experienced nuclear medicine physicians. Datasets for whole-body bone SPECT scans in 46 lung cancer patients with bone metastasis were obtained with Tc-99m MDP. The algorithm successfully segmented vertebrae in the thoracolumbar spine. The quantitative assessment shows that the segmentation method achieved an average TP, FP, and FN rates of 95.1%, 9.1%, and 4.9%. The qualitative evaluation shows an average acceptance rate of 83%, where the data for the acceptable and unacceptable groups had a Cronbach’s alpha value of 0.718, which indicated reasonable internal consistency and reliability.

  20. Height gain of vertebral bodies and stabilization of vertebral geometry over one year after vertebroplasty of osteoporotic vertebral fractures

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, Michael B.; Morgen, Nadine; Herber, Sascha; Dueber, Christoph [University Hospital of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Drees, Philipp; Boehm, Bertram [University Hospital, Johannes Gutenberg University of Mainz, Department of Orthopedia, Mainz (Germany)

    2008-03-15

    The height gain of vertebral bodies after vertebroplasty and geometrical stability was evaluated over a one-year period. Osteoporotic fractures were treated with vertebroplasty. The vertebral geometry and disc spaces were analysed using reformatted computed tomography (CT) images: heights of the anterior, posterior, and lateral vertebral walls, disc spaces, endplate angles, and minimal endplate distances. Vertebrae were assigned to group I [severe compression (anterior height/posterior height) <0.75] and group II (moderate compression index >0.75). A total of 102 vertebral bodies in 40 patients (12 men, 28 women, age 70.3 {+-} 9.5) were treated with vertebroplasty and prospectively followed for 12 months. Group I showed a greater benefit compared with group II with respect to anterior height gain (+2.1 {+-} 1.9 vs +0.7 {+-} 1.6 mm, P < 0.001), reduction of endplate angle (-3.6 {+-} 4.2 vs -0.8 {+-} 2.3 , P < 0.001), and compression index (+0.09 {+-} 0.11 vs +0.01 {+-} 0.06, P < 0.001). At one-year follow-up, group I demonstrated preserved anterior height gain (+1.5 {+-} 2.8 mm, P < 0.015) and improved endplate angle (-3.4 {+-} 4.9 , P < 0.001). In group II, the vertebral heights returned to and were fixed at the pre-interventional levels. Vertebroplasty provided vertebral height gain over one year, particularly in cases with severe compression. Vertebrae with moderate compression were fixed and stabilized at the pre-treatment level over one year. (orig.)

  1. Micromechanics of the human vertebral body for forward flexion.

    Science.gov (United States)

    Yang, Haisheng; Nawathe, Shashank; Fields, Aaron J; Keaveny, Tony M

    2012-08-09

    To provide mechanistic insight into the etiology of osteoporotic wedge fractures, we investigated the spatial distribution of tissue at the highest risk of initial failure within the human vertebral body for both forward flexion and uniform compression loading conditions. Micro-CT-based linear elastic finite element analysis was used to virtually load 22 human T9 vertebral bodies in either 5° of forward flexion or uniform compression; we also ran analyses replacing the simulated compliant disc (E=8 MPa) with stiff polymethylmethacrylate (PMMA, E=2500 MPa). As expected, we found that, compared to uniform compression, forward flexion increased the overall endplate axial load on the anterior half of the vertebra and shifted the spatial distribution of high-risk tissue within the vertebra towards the anterior aspect of the vertebral body. However, despite that shift, the high-risk tissue remained primarily within the central regions of the trabecular bone and endplates, and forward flexion only slightly altered the ratio of cortical-to-trabecular load sharing at the mid-vertebral level (mean±SD for n=22: 41.3±7.4% compression; 44.1±8.2% forward flexion). When the compliant disc was replaced with PMMA, the anterior shift of high-risk tissue was much more severe. We conclude that, for a compliant disc, a moderate degree of forward flexion does not appreciably alter the spatial distribution of stress within the vertebral body. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Adjacent vertebral body fracture following vertebroplasty with polymethylmethacrylate or calcium phosphate cement: biomechanical evaluation of the cadaveric spine.

    Science.gov (United States)

    Nouda, Shinya; Tomita, Seiji; Kin, Akihiro; Kawahara, Kunihiko; Kinoshita, Mitsuo

    2009-11-15

    A biomechanical study using human cadaveric thoracolumbar spinal columns. To compare the effect of treatment by vertebroplasty (VP) with polymethylmethacrylate cement and VP with calcium phosphate cement on the creation of adjacent vertebral body fracture following VP. Adjacent vertebral body fractures have been reported as a complication following VP. Twenty-four spinal columns (T10-L2) from human cadavers were subjected to dual energy radiograph absorptiometry to assess bone mineral density. They were divided into the P group and C group, and experimental vertebral compression fractures were created at T12 vertebrae. T12 vertebrae were augmented with polymethylmethacrylate and calcium phosphate cement in the P group and C group, respectively. Each spinal column was compressed until a new fracture occurred at any vertebra, and the location of newly fractured vertebra and failure load was investigated. There was no significant difference in bone mineral density at each level within each group. In the P group, a new fracture occurred at T10 in 2 specimens, T11 in 8, and L1 in 2. In the C group, it occurred at T10 in 1 specimen, T11 in 2, L1 in 1, and T12 (treated vertebra) in 8. The failure loads of the spinal column were 1774.8+/-672.3 N and 1501.2+/-556.5 N in the P group and C group, respectively. There was no significant difference in the failure load of the spinal column between each group. New vertebral fractures occurred at the vertebra adjacent to augmented vertebrae in the P group and in the augmented vertebrae in the C group. The difference in the fractured site may be because of the difference in strength between the 2 bone filler materials. Therefore, the strength of bone filler materials is considered a risk factor in developing adjacent vertebral body fractures after VP.

  3. Measurement of kyphosis and vertebral body height loss in traumatic spine fractures: an international study.

    Science.gov (United States)

    Sadiqi, Said; Verlaan, Jorrit-Jan; Lehr, A Mechteld; Chapman, Jens R; Dvorak, Marcel F; Kandziora, Frank; Rajasekaran, S; Schnake, Klaus J; Vaccaro, Alexander R; Oner, F Cumhur

    2017-05-01

    To investigate whether wide variations are seen in the measurement techniques preferred by spine surgeons around the world to assess traumatic fracture kyphosis and vertebral body height loss (VBHL). An online survey was conducted at two time points among an international community of spine trauma experts from all world regions. The first survey (TL-survey) focused on the thoracic, thoracolumbar and lumbar spine, the second survey (C-survey) on the subaxial cervical spine. Participants were asked to indicate which measurement technique(s) they used for measuring kyphosis and VBHL. Descriptive statistics, frequency analysis and the Fisher exact test were used to analyze the responses. Of the 279 invited experts, 107 (38.4 %) participated in the TL-survey, and 108 (38.7 %) in the C-survey. The Cobb angle was the most frequently used for all spine regions to assess kyphosis (55.6-75.7 %), followed by the wedge angle and adjacent endplates method. Concerning VBHL, the majority of the experts used the vertebral body compression ratio in all spine regions (51.4-54.6 %). The most frequently used combination for kyphosis was the Cobb and wedge angles. Considerable differences were observed between the world regions, while fewer differences were seen between surgeons with different degrees of experience. This study identified worldwide variations in measurement techniques preferred by treating spine surgeons to assess fracture kyphosis and VBHL in spine trauma patients. These results establish the importance of standardizing assessment parameters in spine trauma care, and can be taken into account to further investigate these radiographic parameters.

  4. Substantial vertebral body osteophytes protect against severe vertebral fractures in compression

    Science.gov (United States)

    Aubin, Carl-Éric; Chaumoître, Kathia; Mac-Thiong, Jean-Marc; Ménard, Anne-Laure; Petit, Yvan; Garo, Anaïs; Arnoux, Pierre-Jean

    2017-01-01

    Recent findings suggest that vertebral osteophytes increase the resistance of the spine to compression. However, the role of vertebral osteophytes on the biomechanical response of the spine under fast dynamic compression, up to failure, is unclear. Seventeen human spine specimens composed of three vertebrae (from T5-T7 to T11-L1) and their surrounding soft tissues were harvested from nine cadavers, aged 77 to 92 years. Specimens were imaged using quantitative computer tomography (QCT) for medical observation, classification of the intervertebral disc degeneration (Thomson grade) and measurement of the vertebral trabecular density (VTD), height and cross-sectional area. Specimens were divided into two groups (with (n = 9) or without (n = 8) substantial vertebral body osteophytes) and compressed axially at a dynamic displacement rate of 1 m/s, up to failure. Normalized force-displacement curves, videos and QCT images allowed characterizing failure parameters (force, displacement and energy at failure) and fracture patterns. Results were analyzed using chi-squared tests for sampling distributions and linear regression for correlations between VTD and failure parameters. Specimens with substantial vertebral body osteophytes present higher stiffness (2.7 times on average) and force at failure (1.8 times on average) than other segments. The presence of osteophytes significantly influences the location, pattern and type of fracture. VTD was a good predictor of the dynamic force and energy at failure for specimens without substantial osteophytes. This study also showed that vertebral body osteophytes provide a protective mechanism to the underlying vertebra against severe compression fractures. PMID:29065144

  5. Robot-assisted vertebral body augmentation: a radiation reduction tool.

    Science.gov (United States)

    Barzilay, Yair; Schroeder, Josh E; Hiller, Nurith; Singer, Gordon; Hasharoni, Amir; Safran, Ori; Liebergall, Meir; Itshayek, Eyal; Kaplan, Leon

    2014-01-15

    Retrospective. To assess radiation exposure time during robot-guided vertebral body augmentation compared with other published findings. Rising incidence of vertebral compression fractures in the aging population result in widespread use of vertebral body cement augmentation with significant radiation exposure to the surgeon, operating room staff, and patient. Radiation exposure leads to higher cancer rates among orthopedic and spine surgeons and patients. Thirty-three patients with 60 vertebral compression fractures underwent robot-guided vertebral body augmentation performed by 2 surgeons simultaneously injecting cement at 2 levels under pulsed fluoroscopy. The age of patients was in the range from 29 to 92 (mean, 67 yr). One to 6 vertebrae were augmented per case (average 2). Twenty-five patients had osteoporotic fractures and 8 had pathological fractures. Robotic guidance data included execution rate, accuracy of guidance, total surgical time, and time required for robotic guidance. Radiation-related data included the average preoperative computed tomographic effective dose, radiation time for calibration, registration, placement of Kirschner wires, and total procedure radiation time. Radiation time per level and surgeon's exposure were calculated. Kyphoplasty was performed in 15 patients (1 sacroplasty), vertebroplasty in 13, and intravertebral expanding implants in 5. The average preoperative computed tomographic effective dose was 50 mSv (18-81). Average operative time was 118 minutes (49-350). Mean robotic guidance took 36 minutes. Average operative radiation time was 46.1 seconds per level (33-160). Average exposure time of the surgeons and the operating room staff per augmented level was 37.6 seconds. The execution rate was 99%, with an accuracy of 99%. Two complications (hemothorax and superficial wound infection) occurred. The radiation exposure of the surgeon and the operating room staff in a series of robot-assisted vertebral body augmentation was 74

  6. A Classification System for the Spread of Polymethyl Methacrylate in Vertebral Bodies Treated with Vertebral Augmentation.

    Science.gov (United States)

    Frankl, Joseph; Sakata, Michael P; Choudhary, Gagandeep; Hur, Seung; Peterson, Andrew; Hennemeyer, Charles T

    2016-09-01

    In this study, we develop a classification system for describing polymethyl methacrylate (PMMA) spread in vertebral bodies after kyphoplasty or vertebroplasty for vertebral compression fractures (VCFs) and for assessing whether PMMA spread varies between operators, VCF etiology, or vertebral level. Intraoperative fluoroscopic images of 198 vertebral levels were reviewed in 137 patients (women, 84; men, 53; mean age, 75.8 ± 12.5; and those with a diagnosis of osteoporosis, 63%) treated with kyphoplasty between January 01, 2015 and May 31, 2015 at a single center to create a 5-class descriptive system. PMMA spread patterns in the same images were then classified by 2 board-certified radiologists, and a third board-certified radiologist resolved conflicts. A total of 2 primary PMMA spread patterns were identified, namely, acinar and globular, with subtypes of localized acinar, diffuse globular, and mixed, to describe an equal combination of patterns. Interrater reliability using the system was moderate ( κ = 0.47). After resolving conflicts, the most common spread class was globular (n = 63), followed by mixed (n = 58), diffuse globular (n = 30), acinar (n = 27), and localized acinar (n = 20). The spread class after treatment by the 2 most frequent operators differed significantly (n 1 = 63, n 2 = 70; P < .0001). There was no difference in the spread class between VCF etiologies or vertebral levels. PMMA spread may, therefore, be a modifiable parameter that affects kyphoplasty and vertebroplasty efficacy and adverse events.

  7. Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta

    Energy Technology Data Exchange (ETDEWEB)

    Rami, Parag M.; Heatwole, Eric V.; Boorstein, Jeffrey M. [Center for Vascular and Interventional Radiology, St. Vincent Mercy Medical Center, Toledo, OH (United States); McGraw, Kevin J. [Riverside Methodist Hospital, Columbus, OH (United States)

    2002-03-01

    Percutaneous vertebroplasty, a minimally invasive interventional radiological procedure, has recently been used effectively for the treatment of symptomatic vertebral body compression fractures. Primary indications for vertebroplasty include osteoporotic compression fracture, osteolytic vertebral metastasis and myeloma, and vertebral hemangioma. We present a case and extend the indication of percutaneous vertebroplasty in a patient with a vertebral body compression fracture secondary to osteogenesis imperfecta. (orig.)

  8. Evolution of bone mineral density after percutaneous kyphoplasty in fresh osteoporotic vertebral body fractures and adjacent vertebrae along with sagittal spine alignment.

    Science.gov (United States)

    Korovessis, Panagiotis; Zacharatos, Spyridon; Repantis, Thomas; Michael, Andreas; Karachalios, Dionysios

    2008-06-01

    Prospective controlled cohort study of 27 adult osteoporotic patients who underwent kyphoplasty for fresh osteoporotic spinal fractures. To define the evolution of vertebral bone mineral density (BMD) at kyphoplasty and adjacent levels along with sagittal spinal alignment to contribute to the etiology of adjacent vertebral fractures after augmentation. Osteoporotic compression fractures can be effectively treated with methylmethacrylate vertebral augmentation. However, to the authors' knowledge the effect of vertebral augmentation on the vertebral endplate BMD of the augmented and adjacent nonaugmented levels has not as yet been described. Twenty-seven consecutive selected patients (9 men, 18 women), with an average age of 72+/-9 years underwent 1, 2, or 3-level percutaneous kyphoplasty for painful fresh osteoporotic vertebral fractures at the thoracolumbar spine. All patients were radiologically examined with plain roentgenograms, computed tomography, and magnetic resonance imaging. Lateral dual energy x-ray absorptiometry in the augmented and on the adjacent vertebrae (1 level above and below kyphoplasty) was used to measure BMD preoperatively to the last postoperative observation in the subchondral bone of the vertebral endplates. Anthropometric data, sagittal global balance (plumbline), and segmental spine reconstruction (vertebral body height, Gardner kyphotic angle) were recorded and analyzed. The patients were followed for at least 2 years. Kyphoplasty was performed between T12 and L5. A total of 48 vertebral bodies were augmented. Thirteen patients received 1 level and the remaining 14 received 2 or 3-level kyphoplasty. No significant changes in the sagittal spinal balance were shown postoperatively. Gardner kyphotic angle and posterior vertebral body height improved postoperatively, however, insignificantly. Significant [analysis of variance (ANOVA), P=0.008] increase of anterior vertebral body height in the fractured vertebra was achieved postoperatively

  9. Evolutionary allometry of the thoracolumbar centra in felids and bovids.

    Science.gov (United States)

    Jones, Katrina E

    2015-07-01

    Mammals have evolved a remarkable range of body sizes, yet their overall body plan remains unaltered. One challenge of evolutionary biology is to understand the mechanisms by which this size diversity is achieved, and how the mechanical challenges associated with changing body size are overcome. Despite the importance of the axial skeleton in body support and locomotion, and much interest in the allometry of the appendicular skeleton, little is known about vertebral allometry outside primates. This study compares evolutionary allometry of the thoracolumbar centra in two families of quadrupedal running mammals: Felidae and Bovidae. I test the hypothesis that, as size increases, the thoracolumbar region will resist increasing loads by becoming a) craniocaudally shorter, and b) larger in cross-sectional area, particularly in the sagittal plane. Length, width, and height of the thoracolumbar centra of 23 felid and 34 bovid species were taken. Thoracic, prediaphragmatic, lumbar, and postdiaphragmatic lengths were calculated, and diameters were compared at three equivalent positions: the midthoracic, the diaphragmatic and the midlumbar vertebra. Allometric slopes were calculated using a reduced major axis regression, on both raw and independent contrasts data. Slopes and elevations were compared using an ANCOVA. As size increases the thoracolumbar centra become more robust, showing preferential reinforcement in the sagittal plane. There was less allometric shortening of the thoracic than the lumbar region, perhaps reflecting constraints due to its connection with the respiratory apparatus. The thoracic region was more robust in bovids than felids, whereas the lumbar region was longer and more robust in felids than bovids. Elongation of lumbar centra increases the outlever of sagittal bending at intervertebral joints, increasing the total pelvic displacement during dorsomobile running. Both locomotor specializations and functional regionalization of the axial skeleton

  10. Percutaneous vertebroplasty in osteoporotic vertebral body compression fracture

    International Nuclear Information System (INIS)

    Kim, Hyuk Jung; Lee, Seon Kyu; Hwang, Hee Young; Kim, Hyung Sik; Ko, Joon Seok; Park Si Hyun; Park, Cheol Hee

    2001-01-01

    To determine the clinical efficacy of percutaneous vertebroplasty in cases of painful and medically intractable osteoporotic vertebral compression fracture. Ninety-eight patients (20 men and 78 women: mean age, 69 years) underwent 122 percutaneous vertebroplasty procedures for the treatment of osteoporotic vertical compression fracture. For the evaluation of bone mass, bone densitometry was performed in 45 patients, and to assess the recent evolution of the fracture, all 98 underwent MRI. Percutaneous vertebroplasty involves percutaneous transpedicular puncture of the involved verteb666rae followed by the injection of a polymethylmethacrylate(PMMA)-Barium mixture into the vertebral body. To assess leakage of the mixture into the epidural tissue, neural foramina, venous plexus and paravertebral tissue, we then immediately obtained a computerized tomographic (CT) scan, assessing the clinical efficacy of the procedure on the basis of time required for pain relief (defined as more than 60% reduction of initial pain), and time required for ambulation without significant pain. Percutaneous vertebroplasty was successful in all patients. Pain relief was accomplished within 1-5 (mean, 1.8) days and early ambulation without significant pain was possible within 2-15 (mean, 3.3) days. Post-procedural CT scanning revealed leakage of the PMMA-barium mixture into paravertebral tissue(n=41).the paravertebral venous plexus (n=34) and epidural tissue (n=4). No neural foraminal leakage was identified, and no procedure-related complication requiring surgical treatment occurred. Percutaneous vertebroplasty is an effective new interventional procedure for the treatment of osteoporotic vertebral compression fracture. It relieves pain, provides early mobilization, and strengthens involved vertebral bodies

  11. The effect of angular mismatch between vertebral endplate and vertebral body replacement endplate on implant subsidence.

    Science.gov (United States)

    Mohammad-Shahi, Mohammad H; Nikolaou, Vassilios S; Giannitsios, Demetrios; Ouellet, Jean; Jarzem, Peter F

    2013-07-01

    Comparative biomechanical study. To determine whether an angular mismatch between the vertebral body replacement (VBR) endplate and the simulated foam vertebral endplate leads to accelerated subsidence in a cyclic compression model of the VBR-vertebra interface. One of the main complications of the VBR surgery is postoperative subsidence and collapse of the VBR implant into the adjacent vertebral bodies. Although numerous factors affecting intervertebral cage subsidence have been cited, few studies have proposed factors responsible for VBR cage subsidence. Hardwood blocks at 0-30-degree angles and polyurethane foam blocs have been used as base for this experimental setting. One end of the Synex (Synthes) expandable cage was attached to a material testing machine. The endplate of the implant was placed at a similar spot on the block in such a manner that there was an exact match between the Synex endplate and the foam block at 0 degrees, subsequent angled blocks would tilt the foam endplates by the 10-, 20-, and 30-degree increments as needed. Cyclic axial loads were applied in 9 load-unload cycles. Five samples were tested at each mismatch angle (0, 10, 20, and 30 degrees), for a total of 20 trials. Implant subsidence significantly increased for each 10-degree increase in mismatch angle. This effect, however, did not follow a uniform trend at all angles. The curve appeared exponential at 0 degree of angular mismatch, became linear at 10-20 degrees of mismatch, and then demonstrated some ability to resist load at 30 degrees, leading to a plateau at the higher loads. Increasing mismatch angles are an important factor in leading to increased cage subsidence into polyurethane blocks. Consequently, the incidence of subsidence in the clinical setting could be reduced by paying careful attention to ensuring that both the prosthetic and bony endplates are well apposed at the end of surgery.

  12. The impact of direct vertebral body derotation on the lumbar prominence in Lenke Type 5C curves.

    Science.gov (United States)

    Hwang, Steven W; Dubaz, Ornella M; Ames, Robert; Rothkrug, Alex; Kimball, Jeff S; Samdani, Amer F

    2012-10-01

    The thoracic rib hump, caused by axial rotation of the spine, is one of the most dissatisfying cosmetic features associated with adolescent idiopathic scoliosis (AIS). However, advances in instrumentation and surgical techniques, such as direct vertebral body derotation (DVBD), have allowed improved correction in the axial plane and the rib hump. In cases of thoracolumbar/lumbar curves (Lenke Type 5), the lumbar prominence can be equally disfiguring and is often associated with waist asymmetry, another cosmetic concern. Although DVBD has been evaluated in the thoracic spine, little is known about its impact on the lumbar spine. The authors investigated the outcomes of DVBD on the lumbar prominence. A prospectively collected multicenter database was queried for pediatric patients with AIS and Lenke Type 5 curves. All patients who underwent thoracoplasty procedures were excluded. A total of 34 patients underwent surgical correction via a posterior-only approach using pedicle screw constructs. Nineteen patients underwent concurrent DVBD, and the remaining 15 patients served as a control group and did not undergo DVBD. All patients had a minimum of 2 years of follow-up. The mean age of the entire cohort was 14.9 ± 2.3 years, and the majority of patients were female (88%). All patients had Lenke Type 5C curves with a mean major curve of 46.0° ± 8.7°, which corrected to 13.7° ± 7.2° (70% correction). A mean of 10.7 ± 3.0 levels were fused. Only thoracic kyphosis was significantly different between the groups preoperatively. Similarly, postoperative radiographic parameters were comparable between the groups, with equivalent percentages of correction. Although improvement in the thoracic rib hump was comparable between the groups, the DVBD group had 56.2% correction of the lumbar prominence, and the control group had 76% improvement (p = 0.05). Although DVBD has been a valuable tool in the management of AIS, the authors' results suggest that its application for

  13. Three-dimensional reconstruction of entire vertebral bodies

    DEFF Research Database (Denmark)

    Odgaard, A.; Andersen, K.; Ullerup, R.

    1994-01-01

    conducting experimental and clinical studies related to cancellous bone architecture and, ultimately, to cancellous bone quality. A set of new and unbiased methods for quantification of cancellous bone has been a stimulus for the development of the technique, as the quantification methods rely on 3-D...... hour, which means that an average vertebral body can be reconstructed in about 2 h. Compared to previous implementations of the general principle of serial sectioning, this is a significant improvement both in resolution and in time efficiency....

  14. Posterior tension band wiring and instrumentation for thoracolumbar flexion-distraction injuries.

    Science.gov (United States)

    Hasankhani, E G; Omidi-Kashani, F

    2014-04-01

    To evaluate treatment outcome of tension band wiring followed by posterior spinal fusion and instrumentation for thoracolumbar flexiondistraction injury (FDI). 36 men and 12 women aged 21 to 56 (mean, 36) years underwent tension band wiring followed by posterior spinal fusion and instrumentation using pedicular screws for FDI of the thoracolumbar spine. The injured vertebral levels were T11 (n=2), T12 (n=12), T11-T12 (n=1), T12-L1 (n=1), L1 (n=28), and L2 (n=4). Anterior vertebral body height and kyphosis were measured before and after surgery. Neurologic status was assessed using the American Spinal Injury Association (ASIA) scale. The Oswestry Disability Index questionnaire and visual analogue scale for pain were also used. The mean follow-up was 38 (range, 26-72) months. At final follow-up, the mean visual analogue scale for pain was 1.7, and the median Oswestry Disability Index was 4% (range, 0-32%). The mean anterior vertebral body height improved from 20.5 to 38.8 mm (pwiring followed by posterior spinal fusion and instrumentation for thoracolumbar FDIs achieved good outcome.

  15. Vertebral Adaptations to Large Body Size in Theropod Dinosaurs.

    Directory of Open Access Journals (Sweden)

    John P Wilson

    Full Text Available Rugose projections on the anterior and posterior aspects of vertebral neural spines appear throughout Amniota and result from the mineralization of the supraspinous and interspinous ligaments via metaplasia, the process of permanent tissue-type transformation. In mammals, this metaplasia is generally pathological or stress induced, but is a normal part of development in some clades of birds. Such structures, though phylogenetically sporadic, appear throughout the fossil record of non-avian theropod dinosaurs, yet their physiological and adaptive significance has remained unexamined. Here we show novel histologic and phylogenetic evidence that neural spine projections were a physiological response to biomechanical stress in large-bodied theropod species. Metaplastic projections also appear to vary between immature and mature individuals of the same species, with immature animals either lacking them or exhibiting smaller projections, supporting the hypothesis that these structures develop through ontogeny as a result of increasing bending stress subjected to the spinal column. Metaplastic mineralization of spinal ligaments would likely affect the flexibility of the spinal column, increasing passive support for body weight. A stiff spinal column would also provide biomechanical support for the primary hip flexors and, therefore, may have played a role in locomotor efficiency and mobility in large-bodied species. This new association of interspinal ligament metaplasia in Theropoda with large body size contributes additional insight to our understanding of the diverse biomechanical coping mechanisms developed throughout Dinosauria, and stresses the significance of phylogenetic methods when testing for biological trends, evolutionary or not.

  16. Vertebral Adaptations to Large Body Size in Theropod Dinosaurs.

    Science.gov (United States)

    Wilson, John P; Woodruff, D Cary; Gardner, Jacob D; Flora, Holley M; Horner, John R; Organ, Chris L

    2016-01-01

    Rugose projections on the anterior and posterior aspects of vertebral neural spines appear throughout Amniota and result from the mineralization of the supraspinous and interspinous ligaments via metaplasia, the process of permanent tissue-type transformation. In mammals, this metaplasia is generally pathological or stress induced, but is a normal part of development in some clades of birds. Such structures, though phylogenetically sporadic, appear throughout the fossil record of non-avian theropod dinosaurs, yet their physiological and adaptive significance has remained unexamined. Here we show novel histologic and phylogenetic evidence that neural spine projections were a physiological response to biomechanical stress in large-bodied theropod species. Metaplastic projections also appear to vary between immature and mature individuals of the same species, with immature animals either lacking them or exhibiting smaller projections, supporting the hypothesis that these structures develop through ontogeny as a result of increasing bending stress subjected to the spinal column. Metaplastic mineralization of spinal ligaments would likely affect the flexibility of the spinal column, increasing passive support for body weight. A stiff spinal column would also provide biomechanical support for the primary hip flexors and, therefore, may have played a role in locomotor efficiency and mobility in large-bodied species. This new association of interspinal ligament metaplasia in Theropoda with large body size contributes additional insight to our understanding of the diverse biomechanical coping mechanisms developed throughout Dinosauria, and stresses the significance of phylogenetic methods when testing for biological trends, evolutionary or not.

  17. Fracture of posterior margin of lumbar vertebral body

    Directory of Open Access Journals (Sweden)

    Krishnan Ajay

    2005-01-01

    Full Text Available Background: Avulsion or fracture of posterior ring apophysis of lumbar vertebra is not a common clinical entity and is missed often. These fractures are mostly traumatic lesions typically seen in adolescents and young adults, because fusion in this area is not complete until the age of 18 to 25 years. These fractures are occult on plain radiographs and are frequently missed due to unfamiliarity with the entity. But, CT scanning and MR imaging shows characteristic picture. Methods: We had 21 cases of fracture of posterior margin of a lumbar vertebral body from 1991 to 2002. Fracture in all patients were classified according to CT imaging, into the three types described by Takata et al. Out of these, 8 patients were of type I, 4 patients of type II and 9 patients of type III respectively. Focal deficit / muscle weakness was present in only three patients. No fractures of type IV (Epstein et al was found. Twelve patients were treated conservatively and 9 patients were treated by posterior decompression with total laminectomy and removal of retropulsed fragment and discectomy. Results: The mean follow-up period was of 42 months. Conventional radiography could locate the fracture in only 6 cases and CT scan was required in all cases for stamping the diagnosis and classification. Though it is uncommon, high index of suspicion is required to diagnose it, in especially adolescent patients. All the 21 patients had good outcome following the management. Conclusion: Avulsion or fracture of posterior margin of lumbar vertebral body is not so rare entity. In children and young adults diagnosed as having lumbar disc herniation, this lesion may be the proper diagnosis. These fractures need to be accurately diagnosed because as compared to simple disc herniations these fractures require more extensive exposure and resection to relieve the nerve impingent.

  18. The vertebral body growth plate in scoliosis: a primary disturbance of growth?

    Directory of Open Access Journals (Sweden)

    Labrom Robert

    2008-01-01

    Full Text Available Abstract Study Design and Aims This was an observational pilot study of the vertebral body growth plates in scoliosis involving high-resolution coronal plane magnetic resonance (MR imaging and histological examination. One aim of this study was to determine whether vertebral body growth plates in scoliosis demonstrated abnormalities on MR imaging. A second aim was to determine if a relationship existed between MR and histological abnormalities in these vertebral body growth plates. Methods MR imaging sequences of 18 patients demonstrated the vertebral body growth plates well enough to detect gross abnormalities/deficient areas/zones. Histological examination of ten vertebral body growth plates removed during routine scoliosis surgery was performed. Observational histological comparison with MR images was possible in four cases. Results Four of the 18 MR images demonstrated spines with normal curvature and normal vertebral body growth plates. In 13 scoliotic spines, convex and concave side growth plate deficiencies were observed most frequently at or near the apex of the curve. One MR image demonstrated a 55° kyphosis and no convex or concave side deficiencies. The degree of vertebral body wedging was independent of the presence of vertebral body growth plate deficiency. Histological abnormalities of the vertebral body growth plates were demonstrated in four with MR imaging abnormalities. Conclusion This study demonstrated MR image abnormalities of scoliotic vertebral body growth plates compared to controls. A qualitative relationship was demonstrated between MR imaging and histological abnormalities. The finding that vertebral body growth plate deficiencies occurred both on the convex and concave sides of the spine, closest to the apical vertebra of the scoliosis curve, implied that they are less likely to be the result of adaptive changes to the physical forces involved in the scoliotic deformity. One explanation is that they represent a

  19. Operative strategy for different types of thoracolumbar stress fractures in ankylosing spondylitis.

    Science.gov (United States)

    Zhang, WenSheng; Zheng, MinQian

    2014-12-01

    There are no accurate guidelines on the operative treatment of ankylosing spondylitis (AS)-related thoracolumbar stress fractures. For this reason, we categorized such bone fractures into 2 types: vertebral body type and intervertebral space type, according to the damage mechanism, cross-section spot, and iconography, and devised a targeted surgical plan based on the characteristics of each fracture type. To investigate the types and surgical treatment of thoracolumbar stress fractures in AS. Thoracolumbar stress fractures are complications of AS. The patients with AS have a higher fracture risk that is approximately 3.5 times than the healthy. As the mechanism of injury, clinical manifestations, imaging characteristics, and principles of treatment of these fractures differ from those of general spinal fractures, the surgical approach is different from that of AS kyphosis orthopedic surgery. In this study, we summarize the clinical data of 11 AS patients with thoracolumbar fractures and discuss the clinical efficacy of the surgical approach based on the mechanism of injury and radiographic features. We reviewed the data of 11 patients who underwent surgery for AS-related thoracolumbar stress fractures. Five patients with vertebral body-type fractures underwent vertebral wedge osteotomy through the pedicle and posterior internal fixation, whereas 6 patients with intervertebral space-type fractures underwent anterior spinal decompression with strut grafting and posterior internal fixation. The follow-up period was 2-4 years. After surgery, all kyphosis deformities were corrected, low back pain was relieved immediately, and scores on the visual analog scale improved by >70%. At the final follow-up, kyphosis correction had no significant loss. In the radiographic images, neither nonunion signs of pseudarthrosis plane nor neurologic or infectious complications were observed. Choosing an anterior or posterior surgical approach based on the type of AS

  20. Monosegmental fixation for the treatment of fractures of the thoracolumbar spine

    Directory of Open Access Journals (Sweden)

    Defino Helton

    2007-01-01

    Full Text Available Background : A short vertebral arthrodesis has been one of the objectives of the surgical treatment of fractures of the thoracolumbar spine. We present here clinical, functional and radiographic outcome obtained after monosegmental fixation (single posterior or combined anterior and posterior of specific types of unstable thoracolumbar fractures. Materials and Methods : Twenty four patients with fractures of the thoracolumbar spine submitted to monosegmental surgical treatment (Group I - 18 single posterior monosegmental fixations and Group II - 6 combined anterior and posterior fixations were retrospectively evaluated according to clinical, radiographic and functional parameters. The indication for surgery was instability or neurological deficit. All the procedures were indicated and performed by the senior surgeon (Helton LA Defino. Results : The patients from group I were followed-up from 2 to 12 years (mean: 6.65±2.96. The clinical, functional and radiographic results show that a single posterior monosegmental fixation is adequate and a satisfactory procedure to be used in specific types of thoracolumbar spine fractures, The patients from group II were followed-up from 9 to 15 years (mean: 13 ± 2,09 years. On group II the results of clinical evaluation showed moderate indices of residual pain and of satisfaction with the final result. The values obtained by functional evaluation showed that 66.6% of the patients were unable to return to their previous job and presented a moderate disability index (Oswestry = 16.6 and a significant reduction of quality of life based on the SF-36 questionnaire. Radiographic evaluation showed increased kyphosis of the fixed vertebral segment during the late postoperative period, accompanied by a reduction of the height of the intervertebral disk. Conclusion : It is possible to stabilize the fractures which have an anterior good load-bearing capacity by a standalone posterior monosegmental fixation. However

  1. MDCT after balloon kyphoplasty: analysis of vertebral body architecture one year after treatment of osteoporotic fractures

    International Nuclear Information System (INIS)

    Roehrl, B.; Dueber, C.; Sadick, M.; Brocker, K.; Voggenreiter, G.; Obertacke, U.; Brade, J.

    2006-01-01

    Purpose: to evaluate the value of MDCT in the monitoring of vertebral body architecture after balloon kyphoplasty and observe morphological changes of the vertebral body. Material and methods: during a period of 26 months, 66 osteoporotic fractures of the vertebral bodies were treated with percutanous balloon kyphoplasty. The height of the vertebral body, width of spinal space, sagittal indices, kyphosis und COBB angle, and cement leakage were evaluated by computed tomography before and after treatment and in a long-term follow up. Statistical analysis was performed by calculating quantitative constant parameters of descriptive key data. In addition, parametric and distribution-free procedures were performed for all questions. Results: after kyphoplasty, the treated vertebral bodies showed a significant gain in the height of the leading edge (0.15 cm; p < 0.0001) and in the central part of the vertebral body (0.17 cm; p < 0.0001). The height of the trailing edge did not change significantly. A corresponding gain in the sagittal index was found. The index remained stable during follow-up. Treated vertebral bodies as well as untreated references showed a comparable loss of height over the period of one year. The shape of the vertebral bodies remained stable. In comparison to these findings, treated vertebral bodies showed a reduced loss of height. A significant change in kyphosis und the COBB angle was noted. In total, pallacos leakage was detected in 71% of cases. Conclusion: MDCT is an accurate method for evaluating vertebral body architecture after treatment with balloon kyphoplasty. (orig.)

  2. HISTOMORPHOLOGICAL STUDY OF THORACOLUMBAR FASCIA IN PATIENTS WITH LUMBOSACRAL DISCOPATHY

    OpenAIRE

    Z BEHDADIPOOR; SH RAISI; F BAHMANI; H MOIN

    2000-01-01

    Introduction. Thoracolumbar fascia has neural ends in normal positions. It has sensory role and by inhibitory and or excitatory reflexes helps to protect vertebral column. In this research, it has been studied neural ends in thoracolumbar fascia in 42 cases. Our aim was to compare the presence of neural ends in normal individuals and those with lumbosacral discopathy. Methods. The samples were taken from one centimeter of midline at the level of L4-L5 vertebrae, since in this region the ...

  3. Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury: its clinical and radiologic significances.

    Science.gov (United States)

    Lee, Seonjong; Park, Moon Soo; Kim, Yong-Chan; Kim, Tae-Hwan

    2016-11-01

    To assess the clinical and radiologic outcome of osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture (SPF) without posterior ligament injury. A total of 391 patients with single-level osteoporotic thoracolumbar junctional (T10-L2) fracture were selectively enrolled. The patients were divided into two groups by absence (group I) or presence (group II) of SPF. Clinical and radiologic parameters were compared between the two groups. Group I comprised of 332 patients with only vertebral body fracture, and group II comprised of 59 patients with both vertebral body and SPFs. In all cases of group II, SPFs were located just one level above the fractured vertebral body, and the injury of the posterior ligament was not found. At the time of injury, group II patients showed worse outcomes in anterior vertebral body compression percentage, kyphotic Cobb angle, cranial disk status, and the rate of the initial neurologic injury. Kyphotic alignment changes during 1-year follow-up were compared between the conservative subgroups of groups I and II. At the time of injury, there were no statistical differences in anterior vertebral body compression percentage and Cobb angle between the two conservative subgroups. However, the difference was significant after 1-year follow-up. Comparison of kyphotic alignment change at 12 months after diagnosis within group II was done according to the treatment method. Vertebroplasty subgroup in group II did not show benefit even in preventing such kyphotic alignment change, whereas instrumentation subgroup in group II showed lordotic alignment restoration despite more severe kyphotic alignment at the time of injury. Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury represented more severe injury with flexion forces on the anterior column and tensile forces on the posterior column, and was related with more severe posttraumatic kyphotic

  4. Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine: Does it Correlate With Level-specific Bone Mineral Density Scores?

    Science.gov (United States)

    Hey, Hwee Weng Dennis; Hwee Weng, Dennis Hey; Tan, Jun Hao; Jun, Hao Tan; Tan, Chuen Seng; Chuen, Seng Tan; Tan, Hsi Ming Bryan; Ming, Bryan Tan Hsi; Lau, Puang Huh Bernard; Huh, Bernard Lau Puang; Hee, Hwan Tak; Hwan, Tak Hee

    2015-12-01

    A case-control study. In this study, we investigated the correlation between level-specific preoperative bone mineral density and subsequent vertebral fractures. We also identified factors associated with subsequent vertebral fractures. Complications of cement augmentation of the spine include subsequent vertebral fractures, leading to unnecessary morbidity and more treatment. Ability to predict at-risk vertebra will help guide management. We studied all patients with osteoporotic compression fractures who underwent cement augmentation in a single institution from November 2001 to December 2010 by a single surgeon. Association between level-specific bone mineral density T-scores and subsequent fractures was assessed. Multivariable analysis was performed to identify significant factors associated with subsequent vertebral fractures. 93 patients followed up for a mean duration of 25.1 months (12-96) had a mean age of 76.8 years (47-99). Vertebroplasty was performed in 58 patients (62.4%) on 68 levels and kyphoplasty in 35 patients (37.6%) on 44 levels. Refracture was seen in 16 patients (17.2%). The time to subsequent fracture post cement augmentation was 20.5 months (2-90). For refracture cases, 43.8% (7/16) fractured in the adjacent vertebrae. Subsequently fractured vertebra had a mean T-score of -2.860 (95% confidence interval -3.268 to -2.452) and nonfractured vertebra had a mean T-score of -2.180 (95% confidence interval -2.373 to -1.986). A T-score of -2.2 or lower is predictive of refracture at that vertebra (P = 0.047). Odds ratio increases with decreasing T-scores from -2.2 or lower to -2.6 or lower. A T-score of -2.6 or lower gives no additional predictive advantage. After multivariable analysis, age (P = 0.049) and loss of preoperative anterior vertebral height (P = 0.017) are associated with refracture. Level-specific T-scores are predictive of subsequent fractures and the odds ratio increases with lower T-scores from -2.2 or less to -2.6 or less. They

  5. [MDCT after balloon kyphoplasty: analysis of vertebral body architecture one year after treatment of osteoporotic fractures].

    Science.gov (United States)

    Röhrl, B; Sadick, M; Brocker, K; Brade, J; Voggenreiter, G; Obertacke, U; Düber, C

    2006-08-01

    To evaluate the value of MDCT in the monitoring of vertebral body architecture after balloon kyphoplasty and observe morphological changes of the vertebral body. During a period of 26 months, 66 osteoporotic fractures of the vertebral bodies were treated with percutanous balloon kyphoplasty. The height of the vertebral body, width of spinal space, sagittal indices, kyphosis und COBB angle, and cement leakage were evaluated by computed tomography before and after treatment and in a long-term follow up. Statistical analysis was performed by calculating quantitative constant parameters of descriptive key data. In addition, parametric and distribution-free procedures were performed for all questions. After kyphoplasty, the treated vertebral bodies showed a significant gain in the height of the leading edge (0.15 cm; p architecture after treatment with balloon kyphoplasty. Morphological changes in the vertebral bodies, and complications such as pallacos leakage and progression of osteoprosis can be accurately documented. The significant increase in the vertebral body height after treatment is closely correlated with a gain in the sagittal index and reduced kyphosis and COBB angle.

  6. Regional disc change in segmental hypoplasia of the lumbosacral vertebral bodies: MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Kyu; Lee Seung Ro; Moon, Won Jin; Park, Dong Woo; Hahm, Chang Kok [Hanyang University Hospital, Seoul (Korea, Republic of)

    2000-07-01

    To classify types of vertebral hypoplasia and to investigate the prevalence and patterns of associated disc degeneration. Defining vertebral hypoplasia as occurring when the AP diameter of a lower vertebral body is smaller than that of an upper ones, we retrospectively reviewed the MR images obtained in 34 cases of this condition involving young adults. Two major types and two subtypes, a total of four different entities were classified as follows; type I: hypoplasia involving a single vertebral body; type II: hypoplasia involving serial lower segmental vertebral bodies; subtype a: hypoplastic body located anteriorly along the anterior spinal line; subtype b: hypoplastic body located posteriorly along the posterior spinal line. We also investigated each type of vertebral hypoplasia and patterns of associated disc changes. Three different types were observed. In type IIa (n=3D29), posterior disc occurred in 8/29 cases, diffuse degeneration in 21/29 patients, and posterior disc herniation in all. All type Ia cases (3/3) showed diffuse disc degeneration at both upper and lower disc levels, with posterior disc herniation, while both type IIb cases (2/2) showed diffuse disc degeneration, with bidirectional disc herniation. By identifying the exact patterns of vertebral hypoplasia, we were able to predict which portion of the disc was likely to degenerate. (author)

  7. Characteristic of thoracolumbar burst fracture with mid column injury and analysis of relative surgical treatment

    International Nuclear Information System (INIS)

    Yang Binhui; Zhang Bo; Ouyang Zhen; Sun Maomin; Xia Chunlin

    2010-01-01

    Objective: By analyzing the pathologic characteristics of the thoracolumbar burst fracture with mid column injury to explore the value of surgical treatment and the relationship between the spinal cord injury and the burst fracture. Methods: With the combination of X-ray film, CT, MRI examination, in 97 patients with thoracolumbar burst fracture, the rate of spinal canal stenosis was measured. For the fracture fragments morphology, translocation, and intervertebral disc, posterior longitudinal ligament injuries, a different surgical method was selected, the percentage of wound vertebral body compression, kyphosis Cobb angle and the rate of spinal canal stenosis, spinal cord nerve function recovery were compared between preoperation and postoperation. Results: After operation, all patients were reseted. Followed-up was performed from 6 to 28 months, in 88 cases bone graft fusion was obtained after 4 to 6 months, 1 ∼ 3 levels were restored in Frankel grade of spinal cord nerve function recovery. Between preoperation and postoperation, the percentage of wounded vertebral body compression, kyphosis Cobb angle and the rate of spinal canal stenosis were significantly different (P <0. 01). For the 9 cases of combined intervertebral disc injury, fusion was not achieved in the 6 cases there were loss in vertebral body height and Cobb angle in various extent. Conclusion: There is an interrelationship between thoracolumbar burst fracture caused by the reduction of spinal canal diameter and the spinal cord injury. Different forms of occupation of intraspinal bone fragments indicate different degrees of moment of violence and spinal cord primary injury. It is important to select the appropriate surgical method for clinic. The potential impact should be sufficient attention on the stability of intervertebral disc injury. (authors)

  8. Development of Guidelines for the Prophylactic Treatment of Metastatically Involved Vertebral Bodies

    National Research Council Canada - National Science Library

    Whyne, Carl

    1998-01-01

    .... Using a combination of finite element modeling, materials and mechanical testing we aim to quantify fracture risk in metastatically involved vertebral bodies in order to both understand the mechanism...

  9. Development of an experimental model of burst fracture with damage characterization of the vertebral bodies under dynamic conditions.

    Science.gov (United States)

    Germaneau, A; Vendeuvre, T; Saget, M; Doumalin, P; Dupré, J C; Brémand, F; Hesser, F; Brèque, C; Maxy, P; Roulaud, M; Monlezun, O; Rigoard, P

    2017-11-01

    Burst fractures represent a significant proportion of fractures of the thoracolumbar junction. The recent advent of minimally invasive techniques has revolutionized the surgical treatment of this type of fracture. However mechanical behaviour and primary stability offered by these solutions have to be proved from experimental validation tests on cadaveric specimens. Therefore, the aim of this study was to develop an original and reproducible model of burst fracture under dynamic impact. Experimental tests were performed on 24 cadaveric spine segments (T11-L3). A system of dynamic loading was developed using a modified Charpy pendulum. The mechanical response of the segments (strain measurement on vertebrae and discs) was obtained during the impact by using an optical method with a high-speed camera. The production of burst fracture was validated by an analysis of the segments by X-ray tomography. Burst fracture was systematically produced on L1 for each specimen. Strain analysis during impact highlighted the large deformation of L1 due to the fracture and small strains in adjacent vertebrae. The mean reduction of the vertebral body of L1 assessed for all the specimens was around 15%. No damage was observed in adjacent discs or vertebrae. With this new, reliable and replicable procedure for production and biomechanical analysis of burst fractures, comparison of different types of stabilization systems can be envisaged. The loading system was designed so as to be able to produce loads leading to other types of fractures and to provide data to validate finite element modelling. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Relationship between the small cervical vertebral body and the morbidity of cervical spondylosis.

    Science.gov (United States)

    Lu, Xin; Tian, Ye; Wang, Shu-Jie; Zhai, Ji-Liang; Zhuang, Qian-Yu; Cai, Si-Yi; Qian, Jun

    2017-08-01

    This study aimed to determine the relationship between the size of the cervical vertebral body and the morbidity of cervical spondylosis, and to examine the characteristics of spondylosis patients with small cervical vertebral bodies.The clinical data and the sagittal reconstructions of computed tomography images of 182 patients with cervical spondylosis were collected retrospectively. Patients included 74 males and 108 females, with a mean age of 31.8 years (range 20-40 years). The Torg-Pavlov ratio and the sagittal diameter of the vertebral body were measured. A Torg-Pavlov ratio above 1.2 was regarded as a small cervical vertebral body (SCVB), and below 1.2 as a nonsmall vertebral body (NSCVB).The NSCVB group was more prone to neurological symptoms than was the SCVB group (P  .05). Conservative treatment achieved similar recovery rates in the SCVB group and the NSCVB group (81.8% vs 93.6%; P > .05). The rate of symptom (eg, axial neck pain) recurrence and persistence in the SCVB group was significantly higher than in the NSCVB group (P spondylosis. Patients with smaller cervical vertebral bodies are prone to persistent axial neck pain, but not neurological symptoms.

  11. Disturbance of growth of the vertebral bodies in children and adolescents with hematogenous osteomyelitis of the vertebral column

    International Nuclear Information System (INIS)

    Sizov, V.A.

    1987-01-01

    Clinicoroentgenological changes were studied over time in 72 children and adolescents with localized hematogenous osteomyelitis of the lumbar spine. The duration of clinicoroengenological observation ranged from 1 year to 15 years. The dynamic roentgenological followup of a course of hematogenous osteomyelitis developing in the period of growth, made it possible to reveal and describe for the first time an increase in the height of the vertebral bodies which hitherto was regarded in literature as a pathognomonic sign of tuberculous spondylitis. Unlike tuberculosis, in hematogenous osteomyelitis there was an increase in the height not only of the adjacent unaffected but also of the affected vertebrae in case of their superficial or localized focal involvement

  12. Vertebral Subluxation Repair in a Pet Goat.

    Science.gov (United States)

    Nannarone, Sara; Bellezza, Enrico; Moens, Yves P; Larenza Menzies, Paula

    2017-01-01

    To describe the perioperative management, including surgery, anesthesia, metabolic derangements, and physiotherapy, in a goat referred for paraparesis secondary to a road traffic accident. Case report. 2-year-old mixed breed dwarf 44 kg female pet goat. Clinical examination showed symptoms of early compensatory stages of shock, paraparesis with hyperextension of the thoracic limbs, pain on palpation of the thoracolumbar spine, increased patellar reflexes of both pelvic limbs without superficial sensitivity, but preserved deep pain sensation. These signs suggested a spinal cord injury with upper motor neuron syndrome and an anatomic localization between the third thoracic and third lumbar vertebrae. Radiographic examination revealed a thoracolumbar vertebral subluxation. Vertebral stabilization was achieved with the application of pins in the vertebral bodies stabilized by an interconnecting bridge of polymethylmethacrylate, a technique commonly adopted in companion animals. Surgery and recovery from anesthesia were uneventful, but 3 days later ruminal atony and subsequent bloating occurred. This was associated with metabolic derangements (metabolic alkalosis), decreased mentation, and marked tachypnea that responded to medical treatment. From day 3 post-surgery, the goat underwent physiotherapy with manual and active exercises during the rehabilitation period of 21 days duration. The injury in this goat was successfully managed using vertebral stabilization similar to that used in dogs and cats. Extensive postoperative physiotherapeutic support contributed to the complete recovery of the animal. © 2016 The American College of Veterinary Surgeons.

  13. Augmentation Improves Human Cadaveric Vertebral Body Compression Mechanics For Lumbar Total Disc Replacement

    Science.gov (United States)

    Yoder, Jonathon H.; Auerbach, Joshua D.; Maurer, Philip M.; Erbe, Erik M.; Entrekin, Dean; Balderston, Richard A.; Bertagnoli, Rudolf; Elliott, Dawn M.

    2012-01-01

    Study Design Cadaveric biomechanical study. Objectives Quantify the effects of vertebral body augmentation on biomechanics under axial compression by a total disc replacement (TDR) implant. Summary of Background Data TDR is a surgical alternative to lumbar spinal fusion to treat degenerative disc disease. Osteoporosis in the adjacent vertebrae to the interposed TDR may lead to implant subsidence or vertebral body fracture. Vertebral augmentation is used to treat osteoporotic compression fracture. The study sought to evaluate whether vertebral augmentation improves biomechanics under TDR axial loading. Methods Forty-five L1-L5 lumbar vertebral body segments with intact posterior elements were used. Peripheral quantitative computed tomography scans were performed to determine bone density, block randomizing specimens by bone density into augmentation and control groups. A semi-constrained keeled lumbar disc replacement device was implanted providing 50% endplate coverage. Vertebral augmentation of 17.6 ± 0.9% vertebral volume fill with Cortoss was performed on augmentation group. All segments underwent axial compression at a rate of 0.2 mm/s to 6mm. Results The load-displacement response for all specimens was non-linear. Subfailure mechanical properties with augmentation were significantly different from control; in all cases the augmented group was 2× higher than control. At failure, the maximum load and stiffness with augmentation was not significantly different from control. The maximum apparent stress and modulus with augmentation were 2× and 1.3× greater than control, respectively. The subfailure stress and apparent modulus with augmentation was moderately correlated with bone density while the control subfailure properties were not. The augmented maximum stress was not correlated with bone density, while the control was weakly correlated. The maximum apparent modulus was moderately correlated with bone density for both the augmented and control groups

  14. Fat body, fat pad and adipose tissues in invertebrates and vertebrates: the nexus

    Science.gov (United States)

    2014-01-01

    The fat body in invertebrates was shown to participate in energy storage and homeostasis, apart from its other roles in immune mediation and protein synthesis to mention a few. Thus, sharing similar characteristics with the liver and adipose tissues in vertebrates. However, vertebrate adipose tissue or fat has been incriminated in the pathophysiology of metabolic disorders due to its role in production of pro-inflammatory cytokines. This has not been reported in the insect fat body. The link between the fat body and adipose tissue was examined in this review with the aim of determining the principal factors responsible for resistance to inflammation in the insect fat body. This could be the missing link in the prevention of metabolic disorders in vertebrates, occasioned by obesity. PMID:24758278

  15. High-resolution computed tomography evaluation of the bronchial lumen to vertebral body diameter and pulmonary artery to vertebral body diameter ratios in anesthetized ventilated normal cats.

    Science.gov (United States)

    Lee-Fowler, Tekla M; Cole, Robert C; Dillon, A Ray; Tillson, D Michael; Garbarino, Rachel; Barney, Sharron

    2017-10-01

    Objectives Bronchial lumen to pulmonary artery diameter (BA) ratio has been utilized to investigate pulmonary pathology on high-resolution CT images. Diseases affecting both the bronchi and pulmonary arteries render the BA ratio less useful. The purpose of the study was to establish bronchial lumen diameter to vertebral body diameter (BV) and pulmonary artery diameter to vertebral body diameter (AV) ratios in normal cats. Methods Using high-resolution CT images, 16 sets of measurements (sixth thoracic vertebral body [mid-body], each lobar bronchi and companion pulmonary artery diameter) were acquired from young adult female cats and 41 sets from pubertal female cats. Results Young adult and pubertal cat BV ratios were not statistically different from each other in any lung lobe. Significant differences between individual lung lobe BV ratios were noted on combined age group analysis. Caudal lung lobe AV ratios were significantly different between young adult and pubertal cats. All other lung lobe AV ratios were not significantly different. Caudal lung lobe AV ratios were significantly different from all other lung lobes but not from each other in both the young adult and pubertal cats. Conclusions and relevance BV ratio reference intervals determined for individual lung lobes could be applied to both young adult and pubertal cats. Separate AV ratios for individual lung lobes would be required for young adult and pubertal cats. These ratios should allow more accurate evaluation of cats with concurrent bronchial and pulmonary arterial disease.

  16. Mechanisms of initial endplate failure in the human vertebral body.

    Science.gov (United States)

    Fields, Aaron J; Lee, Gideon L; Keaveny, Tony M

    2010-12-01

    Endplate failure occurs frequently in osteoporotic vertebral fractures and may be related to the development of high tensile strain. To determine whether the highest tensile strains in the vertebra occur in the endplates, and whether such high tensile strains are associated with the material behavior of the intervertebral disc, we used micro-CT-based finite element analysis to assess tissue-level strains in 22 elderly human vertebrae (81.5 ± 9.6 years) that were compressed through simulated intervertebral discs. In each vertebra, we compared the highest tensile and compressive strains across the different compartments: endplates, cortical shell, and trabecular bone. The influence of Poisson-type expansion of the disc on the results was determined by compressing the vertebrae a second time in which we suppressed the Poisson expansion. We found that the highest tensile strains occurred within the endplates whereas the highest compressive strains occurred within the trabecular bone. The ratio of strain to assumed tissue-level yield strain was the highest for the endplates, indicating that the endplates had the greatest risk of initial failure. Suppressing the Poisson expansion of the disc decreased the amount of highly tensile-strained tissue in the endplates by 79.4 ± 11.3%. These results indicate that the endplates are at the greatest risk of initial failure due to the development of high tensile strains, and that such high tensile strains are associated with the Poisson expansion of the disc. We conclude that initial failure of the vertebra is associated with high tensile strains in the endplates, which in turn are influenced by the material behavior of the disc. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Fratura toracolombar explosão: correlação entre o comprometimento do canal vertebral e os resultados do tratamento conservador Fractura toralumbar por explosión: correlación entre el comprometimiento del canal vertebral y resultados del tratamiento conservador Thoracolumbar burst fracture: correlation between the spinal canal compromise and the clinical results of conservative treatment

    Directory of Open Access Journals (Sweden)

    Osmar Avanzi

    2009-03-01

    el mayor estrechamiento del canal vertebral y los peores resultados clínicos, conforme descrito en la literatura.INTRODUCTION: there has been considerable controversy regarding what constitutes the best treatment for lumbar burst fractures without neurological compromise. The percentage of spinal canal compromise has been used as a parameter of surgical indication, but its significance in patients without neurological deficit remains uncertain. OBJECTIVE: the purpose of this study was to evaluate patients with thoracolumbar burst fractures correlating the initial percentage of spinal canal compromise and the clinical results of the conservative treatment. METHODS: we have retrospectively evaluated the clinical records, radiographs and CT scans of adult patients with thoracolumbar burst fractures including the levels of T11 to L2, A3 type of Magerl's classification with less than 10 days of evolution, submitted to conservative treatment with TLSO (Jewett or hyperextension plaster. A questionnaire was also applied including the Visual Analog Pain Scale (VAS, Denis Work and Pain Scale, Oswestry Index and the Quality of Life assessment questionnaire SF-36. RESULTS: it was not found correlation between the percentage of spinal compromise and the VAS or the Denis pain scale. Negative correlation was found between the percentage of spinal canal compromise and the Denis work scale. Negative correlation was also found between the Oswestry index and the percentage of spinal canal compromise, indicating that patients with higher disability scores presented less percentage of spinal canal stenosis. In the correlation analysis between the SF-36 values and the percentage of spinal canal stenosis, significant correlation was found only with the Physical Functioning domain, suggesting that the patients with best physical function also presented higher percentage of stenosis. CONCLUSION: the obtained results confirm the absence of correlation between higher percentages of spinal

  18. Cellular automata segmentation of the boundary between the compacta of vertebral bodies and surrounding structures

    Science.gov (United States)

    Egger, Jan; Nimsky, Christopher

    2016-03-01

    Due to the aging population, spinal diseases get more and more common nowadays; e.g., lifetime risk of osteoporotic fracture is 40% for white women and 13% for white men in the United States. Thus the numbers of surgical spinal procedures are also increasing with the aging population and precise diagnosis plays a vital role in reducing complication and recurrence of symptoms. Spinal imaging of vertebral column is a tedious process subjected to interpretation errors. In this contribution, we aim to reduce time and error for vertebral interpretation by applying and studying the GrowCut - algorithm for boundary segmentation between vertebral body compacta and surrounding structures. GrowCut is a competitive region growing algorithm using cellular automata. For our study, vertebral T2-weighted Magnetic Resonance Imaging (MRI) scans were first manually outlined by neurosurgeons. Then, the vertebral bodies were segmented in the medical images by a GrowCut-trained physician using the semi-automated GrowCut-algorithm. Afterwards, results of both segmentation processes were compared using the Dice Similarity Coefficient (DSC) and the Hausdorff Distance (HD) which yielded to a DSC of 82.99+/-5.03% and a HD of 18.91+/-7.2 voxel, respectively. In addition, the times have been measured during the manual and the GrowCut segmentations, showing that a GrowCutsegmentation - with an average time of less than six minutes (5.77+/-0.73) - is significantly shorter than a pure manual outlining.

  19. MR imaging of degenerative lumbar disc disease emphasizing on signal intensity changes in vertebral body

    International Nuclear Information System (INIS)

    Toyoda, Keiko; Ida, Masahiro; Murakami, Yoshitaka; Harada, Junta; Tada, Shimpei

    1992-01-01

    Magnetic resonance imaging was performed in 400 patients with degenerative disc disease. Signal changes and their sites in the vertebral body were classified and referred to narrowing of the intervertebral disc space. MR findings were compared with those of plain roentgenograms of the lumbar spine. Signal changes in the vertebral body were noted in 83 cases (102 vertebral bodies). Low-intensity abnormality on both T1- and T2-weighted images (WI) was the most common finding, and was most frequently seen at the end plate and/or the angle. These changes were correlated with narrowing of the disc space and osteosclerosis on the plain roentgenogram of the lumbar spine. Signal changes occasionally occurred in the inner region of the vertebral body, and these lesions tended to show a high-intensity abnormality on T1-WI. We conclude that signal changes in degenerative disc disease are not specific, but are sometimes difficult to distinguish from the signal changes in other conditions such as spinal tumor or bone marrow disorder. (author)

  20. Real-time tracking of vertebral body movement with implantable reference microsensors.

    Science.gov (United States)

    Mularski, Sven; Picht, Thomas; Kuehn, Björn; Kombos, Theodoros; Brock, Mario; Suess, Olaf

    2006-05-01

    In the spine, navigation techniques serve mainly to control and accurately target insertion of implants. The main source of error is that the spine is not a rigid organ, but rather a chain of semiflexible movement segments. Any intraoperative manipulation of the patient alters the geometry and volumetry as compared to the 3D volume model created from the image data. Thus, the objective of the study was to implement the theoretical principle of microsensor referencing in a model experiment and to clarify which anatomical structures are suitable for intermittent implantation of positional sensors, as illustrated with cervical vertebral bodies. Laboratory tests were conducted using 70 models of human cervical vertebral bodies. The first experiment investigated whether arbitrary movements of vertebral bodies can be tracked with the positional information from the implanted microsensors. The accuracy of this movement monitoring was determined quantitatively on the basis of positional error measurement. In the second experiment, different ventral and dorsal surgical operations were simulated on five models of the cervical spine. Quantifiable measurement values such as the spatial extension of the intervertebral space and the relative positions of the planes of the upper plates were determined. With respect to the differing anatomy of the individual vertebral bodies of the cervical spine, the sensors could be placed securely with a 5x2 mm drill. The registration error (RE) was determined as a root mean square error. The mean value was 0.9425 mm (range: 0.57-1.2 mm; median: 0.9400 mm; SD: 0.1903 mm). The precision of the movement monitoring of the vertebral body was investigated along its three main axes. The error tolerance between post-interventional 3D reconstruction and direct measurement on the model did not exceed 1.3 mm in the distance measurements or 2.5 degrees in the angular measurements. The tomograms on the system monitor could be updated in close to real time

  1. CT in diagnosis of thoracolumbar region diseases

    International Nuclear Information System (INIS)

    Dimitrov, I.; Karadjova, M.

    2003-01-01

    The lumbalgia caused by affected thoracolumbar transition (Th 11 -L 2 ) imitates the clinical symptomatic of disc lesions in the lower lumbar segments. The syndrome is presented by a pain projected in the area of the three branchings of the spinal nerves, coming from thoracolumbar segments. The aim of this study is to determine the pathological processes, causing the clinical symptoms of this syndrome, using computer tomography. 51 patients are studied with clinically proved thoracolumbar transition syndrome: 14 men and 37 women. CT slices of 96 vertebral segments are made. Two patient are scanned at Th 11 -Th 12 and L 1 -L 2 . Only Th 12 -L 1 scans are made on 10 patients and 42 are made on two neighbouring segments (41 of them on Th 11 -Th 12 and Th 12 -L 1 and one on Th 11 -L 1 and L 1 -L 2 ). An asymmetry (facet tropism) has been found at 59 levels, 21 if them are with spondiloarthrosis. Spondiloarthrosis has been found in 24 segments - 21 of them with osteochondrosis, one with disc prolapse, and 2 with disc protrusion. It is also found osteoporotic changes osteolysis in multiple myeloma, metastasis etc. During the 3 level examination no evidence for either of the mentioned changes is obtained. The CT slices of two neighbouring segments showed an unexpected change from thoracic to lumbar type of the intervertebral joints in 34 patients. The results from this study support the hypothesis about joints origin of the clinical symptoms of the thoracolumbar transition and demonstrate the importance of the computer tomography as a diagnostic method in this disease

  2. Morphological changes of injected calcium phosphate cement in osteoporotic compressed vertebral bodies.

    Science.gov (United States)

    Heo, H D; Cho, Y J; Sheen, S H; Kuh, S U; Cho, S M; Oh, S M

    2009-12-01

    This study was undertaken to investigate the radiologic and clinical outcomes of vertebroplasty with calcium phosphate (CaP) cement in patients with osteoporotic vertebral compression fractures. The morphological changes of injected CaP cement in osteoporotic compressed vertebral bodies were variable and unpredictable. We suggest that the practice of vertebroplasty using CaP should be reconsidered. Recently, CaP, an osteoconductive filler material, has been used in the treatment of osteoporotic compression fractures. However, the clinical results of CaP-cement-augmented vertebrae are still not well established. The purpose of this study is to assess the clinical results of vertebroplasty with CaP by evaluating the morphological changes of CaP cement in compressed vertebral bodies. Fourteen patients have been followed for more than 2 years after vertebroplasty. The following parameters were reviewed: age, sex, T score, compliance with osteoporosis medications, visual analog scale score, compression ratio, subsequent compression fractures, and any morphological changes in the filler material. The morphological changes of injected CaP included reabsorption, condensation, bone formation (osteogenesis), fracture of the CaP solid hump, and heterotopic ossification. Out of 14 patients, 11 (78.6%) developed progression of the compression of the CaP-augmented vertebral bodies after vertebroplasty. The morphological changes of the injected CaP cement in the vertebral bodies were variable and unpredictable. The compression of the CaP-augmented vertebrae progressed continuously for 2 years or more. The findings of this study suggest that vertebroplasty using CaP cement should be reconsidered.

  3. Mandibular growth as related to cervical vertebral maturation and body height.

    Science.gov (United States)

    Franchi, L; Baccetti, T; McNamara, J A

    2000-09-01

    The purpose of this study was to analyze the validity of 6 stages of cervical vertebral maturation (Cvs1 through Cvs6) as a biologic indicator for skeletal maturity in 24 subjects (15 females, 9 males). The method was able to detect the greatest increment in mandibular and craniofacial growth during the interval from vertebral stage 3 to vertebral stage 4 (Cvs3 to Cvs4), when the peak in statural height also occurred. The prevalence rate of examined subjects who presented with the peak in body height at this interval was 100% for boys and 87% for girls. Statural height and total mandibular length (Co-Gn) showed significant increments during the growth interval Cvs3 to Cvs4 when compared with the growth interval Cvs2 to Cvs3, and significant growth deceleration occurred during the interval Cvs4 to Cvs5 when compared with Cvs3 to Cvs4. Ramus height (Co-Goi) and S-Gn also showed significant deceleration of growth during the interval Cvs4 to Cvs5 when compared with Cvs3 to Cvs4. Cervical vertebral maturation appears to be an appropriate method for the appraisal of mandibular skeletal maturity in individual patients on the basis of a single cephalometric observation and without additional x-ray exposure. The accuracy of the cervical vertebral method in the detection of the onset of the pubertal spurt in mandibular growth provides helpful indications concerning treatment timing of mandibular deficiencies.

  4. Thoracolumbar fracture with listhesis - an uncommon manifestation of child abuse

    Energy Technology Data Exchange (ETDEWEB)

    Levin, Terry L.; Blitman, Netta M. [Department of Radiology, Montefiore Medical Center, 111 E. 210th Street, Bronx, New York, NY 10467-2490 (United States); Berdon, Walter E. [Department of Radiology, Babies Hospital, New York Presbyterian Hospital, New York (United States); Cassell, Ian [Department of Radiology, Phoenix Children' s Hospital, Phoenix, AZ (United States)

    2003-05-01

    Thoracolumbar fracture with listhesis (FL) is an uncommon manifestation of child abuse (increasingly known as nonaccidental trauma), with only six prior reports in the literature. This article seeks to call attention to FL of the thoracolumbar spine in abused children and infants. We reviewed plain films, CT and MR images in seven new cases of FL of the thoracolumbar spine in abused children ages 6 months to 7 years, two of whom became paraplegic from their injuries. Findings varied from subtle listhesis of one vertebra on another to frank vertebral dislocation, most commonly at L1/2. Paravertebral calcification was present in all but one case. In two children, thoracolumbar FL was the only radiographic sign of abuse. Radiographic findings of FL of the thoracolumbar spine may be subtle and may be erroneously interpreted as due to a congenital or neoplastic cause. While other signs of child abuse should be sought, spinal injury may be the sole sign of abuse. Recognition of this entity is important to pursue the diagnosis of abuse. (orig.)

  5. Thoracolumbar fracture with listhesis - an uncommon manifestation of child abuse

    International Nuclear Information System (INIS)

    Levin, Terry L.; Blitman, Netta M.; Berdon, Walter E.; Cassell, Ian

    2003-01-01

    Thoracolumbar fracture with listhesis (FL) is an uncommon manifestation of child abuse (increasingly known as nonaccidental trauma), with only six prior reports in the literature. This article seeks to call attention to FL of the thoracolumbar spine in abused children and infants. We reviewed plain films, CT and MR images in seven new cases of FL of the thoracolumbar spine in abused children ages 6 months to 7 years, two of whom became paraplegic from their injuries. Findings varied from subtle listhesis of one vertebra on another to frank vertebral dislocation, most commonly at L1/2. Paravertebral calcification was present in all but one case. In two children, thoracolumbar FL was the only radiographic sign of abuse. Radiographic findings of FL of the thoracolumbar spine may be subtle and may be erroneously interpreted as due to a congenital or neoplastic cause. While other signs of child abuse should be sought, spinal injury may be the sole sign of abuse. Recognition of this entity is important to pursue the diagnosis of abuse. (orig.)

  6. Characteristic features of bone tissue regeneration in the vertebral bodies in the experiment with osteograft

    Science.gov (United States)

    Zaydman, A. M.; Predein, Yu. A.; Korel, A. V.; Shchelkunova, E. I.; Strokova, E. I.; Lastevskiy, A. D.; Rerikh, V. V.; Fomichev, N. G.; Falameeva, O. V.; Shevchenko, A. I.; Shevtcov, V. I.

    2017-09-01

    In the practice of orthopedic and trauma surgeons, there is a need to close bone tissue defects after removal of tumors or traumatic and dystrophic lesions. Currently, as cellular technologies are being developed, stem embryonic and pluripotent cells are widely introduced into practical medicine. The unpredictability of the spectrum of cell differentiations, up to oncogenesis, raised the question of creating biological structures committed toward osteogenic direction, capable of regenerating organo-specific graft at the optimal time. Such osteograft was created at the Novosibirsk Institute of Traumatology and Orthopaedics (patent RU 2574942). Its osteogenic orientation was confirmed by the morphological and immunohistochemical methods, and by the expression of bone genes. The regeneration potential of the osteograft was studied in the vertebral bodies of the mini piglet model. The study revealed that the regeneration of the vertebral body defect and the integration of the osteograft with the bed of the recipient proceeds according to the type of primary angiogenic osteogenesis within 30 days.

  7. Evaluation of changes in vertebral body density following administration of contrast medium during routine CT examination

    International Nuclear Information System (INIS)

    Janicek, M.; Bruna, J.; Stenhova, H.

    1984-01-01

    The possibility is discussed of depicting changes in the density of spongiosis of the vertebral body in normal patients after intravenous administration of a bolus of 40 ml 60% Diazetrizoate in the course of a routine CT examination. The average increase in density immediately after the administration of the contrast medium is 12 H (8%), in the course of 10 minutes is reduced to 5 H (4%) against the initial values in native examination. These average changes are statistically significant, in individual patients, however, the increase in density following the administration of a contrast medium fluctuates considerably (from 0.7% to 10%). Only systematic comparison with various pathological conditions will make it possible to assess the possibilities of the evaluation of the structure of the vertebral body in routine CT with the administration of a contrast medium into the blood flow. (author)

  8. Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis.

    Science.gov (United States)

    Ahmad, Alaaeldin A; Aker, Loai; Hanbali, Yahia; Sbaih, Aesha; Nazzal, Zaher

    2017-06-01

    The aim of this study is to evaluate the role of the non-fusion instrumented procedure with compression adjunct to lengthening by distraction in facilitating spinal modulation of the wedged peak vertebra, in patients with congenital thoracolumbar kyphosis/kyphoscoliosis according to the Hueter-Volkmann law. The authors seek to address the progressive modulation of the most wedged vertebra by analyzing the subjects' pre-operative and latest follow-up sagittal radiograph. Ongoing data collection of 14 peak wedged vertebra modulation during surgical management of 13 patients with Type I congenital thoracolumbar kyphosis (5 patients) or kyphoscoliosis (8 patients). Age at initial surgery averaged 58.6 months, with mean follow-up of 55.6 months (24-78). All were done with hybrid rib construct with clawing fashion through a single posterior approach with at least 4 lengthenings. Two vertebral bodies were selected, the peaked deformed vertebrae within the instrumentation compression level (WICL) and the vertebrae nearest but outside the instrumentation compression process (OICL). Anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) were measured in both vertebral bodies. Regarding measured vertebrae (WICL), average preoperative AVBH/PVBH ratio significantly increased from 0.54 to 0.77 in the final follow-up. Regarding measured vertebrae (OICL), the average preoperative AVBH/PVBH ratio increased from 0.76 to 0.79 in the final follow-up. Modulation can be confirmed in the most deformed vertebrae (WICL) as the difference between the change in AVBH/PVBH ratio between vertebrae (OICL) and (WICL) was statistically significant (P modulation (WICL) in comparison with the (OICL). This calls for further studies on the impact of surgical correction of EOS on modulation of the vertebrae.

  9. Static and fatigue biomechanical properties of anterior thoracolumbar instrumentation systems. A synthetic testing model.

    Science.gov (United States)

    Kotani, Y; Cunningham, B W; Parker, L M; Kanayama, M; McAfee, P C

    1999-07-15

    A mechanical testing standard for anterior thoracolumbar instrumentation systems was introduced, using a synthetic model. Twelve recent instrumentation systems were tested in static and fatigue modes. To establish the testing standard for anterior thoracolumbar instrumentation systems using a synthetic model and to evaluate the static and fatigue biomechanical properties of 12 anterior thoracolumbar instrumentation systems. Although numerous studies have been performed to evaluate the biomechanics of anterior spinal instrumentation using a cadaveric or animal tissue, problems of specimen variation, lack of reproducibility, and inability to perform fatigue testing have been pointed out. In no studies has a precise synthetic testing standard for anterior thoracolumbar instrumentation systems been described. An ultra-high-molecular-weight polyethylene cylinder was designed according to the anatomic dimensions of the vertebral body. Two cylinders spanned by spinal instrumentation simulated a total corpectomy defect, and a compressive lateral bending load was applied. The instrumentation assembly was precisely standardized. The static destructive and fatigue tests up to 2 million cycles at three load levels were conducted, followed by the failure mode analysis. Twelve anterior instrumentation systems, consisting of five plate and seven rod systems were compared in stiffness, bending strength, and cycles to failure. Static and fatigue test parameters both demonstrated highly significant differences between devices. The stiffness ranged from 280.5 kN/m in the Synthes plate (Synthes, Paoli, PA) to 67.9 kN/m in the Z-plate ATL (SofamorDanek, Memphis, TN). The Synthes plate and Kaneda SR titanium (AcroMed, Cleveland, OH) formed the highest subset in bending strength of 1516.1 N and 1209.9 N, respectively, whereas the Z-plate showed the lowest value of 407.3 N. There were no substantial differences between plate and rod devices. In fatigue, only three systems: Synthes plate

  10. Reconstruction of Vertebral Body After Radiofrequency Ablation and Augmentation in Dorsolumbar Metastatic Vertebral Fracture: Analysis of Clinical and Radiological Outcome in a Clinical Series of 18 Patients.

    Science.gov (United States)

    Maugeri, Rosario; Graziano, Francesca; Basile, Luigi; Gulì, Carlo; Giugno, Antonella; Giammalva, Giuseppe Roberto; Visocchi, Massimiliano; Iacopino, Domenico Gerardo

    2017-01-01

    Painful spinal metastases usually occur in malignant neoplastic disease. Treatment for bone metastases has been largely conservative, and it includes the use of high doses of analgesics, radiotherapy, chemotherapy, hormone therapy, and bisphosphonates; however, results are sometimes transient and ineffective. In the presence of neurological involvement a surgical strategy should be considered. Recently, percutaneous procedures such as radiofrequency ablation, vertebroplasty, and kyphoplasty have been introduced as palliative techniques to treat painful vertebral metastases [3, 11, 25]. In our study we combined the use of radiofrequency ablation with vertebroplasty in the treatment of dorsolumbar metastatic vertebral fractures in order to examine the relationship between restoration of the vertebral structure and decrease in pain. From January 2014 to March 2015 we retrospectively analyzed 18 patients with malignant vertebral lesions who underwent radiofrequency ablation with vertebroplasty followed by cementoplasty, with posterior transpedicle fixation on levels near the lesions. The parameters examined were: demographics, pain relief, and the distribution of polymethylmethacrylate (PMMA) determined by the mean Saliou filling score; all complications were recorded. The mean age of the patients was 55.72 years (range 34-69); average operative time was 60.4 min (range, 51-72). The average pain index score (visual analog score; VAS) decreased significantly from 8.05 at baseline to 3.0 (p < 0.05) after 6 months. The Saliou filling score revealed a distribution of PMMA in the vertebral body that was satisfactory (12-18) in eight patients, mediocre (6-12) in seven patients, and inadequate (0-6) in the remaining three patients. In two vertebrae, minimal asymptomatic cement leakage occurred in the lateral recess without neurological damage. No pulmonary embolism and no visceral or neural damage was recorded. Radiofrequency ablation combined with vertebroplasty seems to

  11. MRI Evaluation of Spinal Length and Vertebral Body Angle During Loading with a Spinal Compression Harness

    Science.gov (United States)

    Campbell, James A.; Hargens, Alan R.; Murthy, G.; Ballard, R. E.; Watenpaugh, D. E.; Hargens, Alan, R.; Sanchez, E.; Yang, C.; Mitsui, I.; Schwandt, D.; hide

    1998-01-01

    Weight bearing by the spinal column during upright posture often plays a role in the common problem of low back pain. Therefore, we developed a non-ferromagnetic spinal compression harness to enable MRI investigations of the spinal column during axial loading. Human subjects were fitted with a Nest and a footplate which were connected by adjustable straps to an analog load cell. MRI scans of human subjects (5 males and 1 female with age range of 27-53 yrs) during loaded and unloaded conditions were accomplished with a 1.5 Tesla GE Signa scanner. Studies of two subjects undergoing sequentially increasing spinal loads revealed significant decreases (r(sup 2) = 0.852) in spinal length between T4 and L5 culminating in a 1.5 to 2% length decrease during loading with 75% body weight. Sagittal vertebral body angles of four subjects placed under a constant 50% body weight load for one hour demonstrated increased lordotic and kyphotic curvatures. In the lumbar spine, the L2 vertebral body experienced the greatest angular change (-3 deg. to -5 deg.) in most subjects while in the thoracic spine, T4 angles increased from the unloaded state by +2 deg. to +9 deg. Overall, our studies demonstrate: 1) a progressive, although surprisingly small, decrease in spinal length with increasing load and 2) relatively large changes in spinal column angulation with 50% body weight.

  12. Deep learning for automatic localization, identification, and segmentation of vertebral bodies in volumetric MR images

    Science.gov (United States)

    Suzani, Amin; Rasoulian, Abtin; Seitel, Alexander; Fels, Sidney; Rohling, Robert N.; Abolmaesumi, Purang

    2015-03-01

    This paper proposes an automatic method for vertebra localization, labeling, and segmentation in multi-slice Magnetic Resonance (MR) images. Prior work in this area on MR images mostly requires user interaction while our method is fully automatic. Cubic intensity-based features are extracted from image voxels. A deep learning approach is used for simultaneous localization and identification of vertebrae. The localized points are refined by local thresholding in the region of the detected vertebral column. Thereafter, a statistical multi-vertebrae model is initialized on the localized vertebrae. An iterative Expectation Maximization technique is used to register the vertebral body of the model to the image edges and obtain a segmentation of the lumbar vertebral bodies. The method is evaluated by applying to nine volumetric MR images of the spine. The results demonstrate 100% vertebra identification and a mean surface error of below 2.8 mm for 3D segmentation. Computation time is less than three minutes per high-resolution volumetric image.

  13. The Optimal Volume Fraction in Percutaneous Vertebroplasty Evaluated by Pain Relief, Cement Dispersion, and Cement Leakage: A Prospective Cohort Study of 130 Patients with Painful Osteoporotic Vertebral Compression Fracture in the Thoracolumbar Vertebra.

    Science.gov (United States)

    Sun, Hai-Bo; Jing, Xiao-Shan; Liu, Yu-Zeng; Qi, Ming; Wang, Xin-Kuan; Hai, Yong

    2018-03-16

    To probe the relationship among cement volume/fraction, imaging features of cement distribution, and pain relief and then to evaluate the optimal volume during percutaneous vertebroplasty. From January 2014 to January 2017, a total of 130 patients eligible for inclusion criteria were enrolled in this prospective cohort study. According to the different degrees of pain relief, cement leakage, and cement distribution, all patients were allocated to 2 groups. Clinical and radiologic characteristics were assessed to identify independent factors influencing pain relief, cement leakage, and cement distribution, including age, sex, fracture age, bone mineral density, operation time, fracture level, fracture type, modified semiquantitative severity grade, intravertebral cleft, cortical disruption in the vertebral wall, endplate disruption, type of nutrient foramen, fractured vertebral body volume, intravertebral cement volume, and volume fraction. A receiver operating characteristic curve was used to analyze the diagnostic value of the cement volume/fraction and then to obtain the optional cut-off value. The preoperative visual analog scale scores in the responders versus nonresponders patient groups were 7.37 ± 0.61 versus 7.87 ± 0.92 and the postoperative VAS scores in the responders versus nonresponders were 2.04 ± 0.61 versus 4.33 ± 0.49 at 1 week. There were no independent factors influencing pain relief. There were 95 (73.08%) patients who experienced cement leakage, and cortical disruption in the vertebral wall and cement fraction percentage were identified as independent risk factors by binary logistic regression analysis (adjusted odds ratio [OR] 2.935, 95% confidence interval [95% CI] 1.214-7.092, P = 0.017); (adjusted OR 1.134, 95% CI 1.026-1.254, P = 0.014). The area under the receiver-operating characteristic curve of volume fraction (VF%) was 0.658 (95% CI 0.549-0.768, P = 0.006 pain rapidly. The optimal VF% was 19.78%, which could achieve

  14. [Computer-aided discectomy and corpectomy in anterior reconstruction of the injured thoracolumbar spine. A prospective, controlled clinical trial].

    Science.gov (United States)

    Blattert, T R; Springwald, J; Glasmacher, S; Siekmann, H; Josten, C

    2008-11-01

    In anterior reconstruction of the unstable thoracolumbar spine, discectomy and corpectomy are technically demanding steps requiring maximal surgical precision. This study investigated the feasibility of computer-aided guidance for discectomy and corpectomy. It also analysed the precision, advantages, and disadvantages of the procedure. Vertebral body fractures of the non-osteoporotic thoracolumbar spine addressed by discectomy/corpectomy and subsequent implant interposition (cage, tricortical strut graft) for anterior reconstruction were included. All surgical steps were done under endoscopic assistance. In the trial group, discectomy and corpectomy were performed with computer-aided guidance; in the control group, no computer navigation was used. The time required for surgery was noted. To assess surgical precision, decentralization of the implant in the frontal plane was measured in postoperative x-rays and computed tomography. Additionally, parallel alignment of vertebral body end plates with the implant was evaluated. The trial group (TG) consisted of 16 patients, and the control group (CG) of 10 patients. Fractures were localized between T10 and L1 in TG, and between T9 and L1 in CG. Operating time was significantly shorter in CG: 104+/-28 min compared with 229+/-64 min in TG (pComputer-aided guidance for anterior reconstruction of the thoracolumbar spine is a technically feasible option that may help in performing discectomy and corpectomy. However, this technique significantly prolongs the operating time. There were no differences in the precision of implant positioning between the groups. However, during discectomy the use of computer navigation may possibly add to the protection of adjacent end plates.

  15. Monostotic fibrous dysplasia of a lumbar vertebral body with secondary aneurysmal bone cyst formation: a case report

    Directory of Open Access Journals (Sweden)

    Snieders Marieke N

    2009-06-01

    Full Text Available Abstract We report the case of a 25-year-old Caucasian woman with symptomatic monostotic fibrous dysplasia of the fourth lumbar vertebral body. The patient suffered from a five-week history of progressive low back pain, radiating continuously to the left leg. Her medical history and physical and neurological examination did not demonstrate any significant abnormalities. Radiographs, computed tomography and magnetic resonance imaging revealed an osteolytic expansive lesion with a cystic component of the fourth lumbar vertebral body. Percutaneous transpedicular biopsy showed histological characteristics of fibrous dysplasia superimposed by the formation of aneurysmal bone cyst components. The patient was treated by subtotal vertebrectomy of the L4 vertebral body with anterior reconstruction and her postoperative course was uncomplicated. To our knowledge, this is the first reported case of a monostotic fibrous dysplasia with superimposed secondary aneurysmal bone cysts of a lumbar vertebral body.

  16. Host body size and the diversity of tick assemblages on Neotropical vertebrates

    Directory of Open Access Journals (Sweden)

    Helen J. Esser

    2016-12-01

    Full Text Available Identifying the factors that influence the species diversity and distribution of ticks (Acari: Ixodida across vertebrate host taxa is of fundamental ecological and medical importance. Host body size is considered one of the most important determinants of tick abundance, with larger hosts having higher tick burdens. The species diversity of tick assemblages should also be greater on larger-bodied host species, but empirical studies testing this hypothesis are lacking. Here, we evaluate this relationship using a comparative dataset of feeding associations from Panama between 45 tick species and 171 host species that range in body size by three orders of magnitude. We found that tick species diversity increased with host body size for adult ticks but not for immature ticks. We also found that closely related host species tended to have similar tick species diversity, but correcting for host phylogeny did not alter the relationships between host body size and tick species diversity. The distribution of tick species was highly aggregated, with approximately 20% of the host species harboring 80% of all tick species, following the Pareto principle or 20/80 Rule. Thus, the aggregated pattern commonly observed for tick burdens and disease transmission also holds for patterns of tick species richness. Our finding that the adult ticks in this system preferentially parasitize large-bodied host species suggests that the ongoing anthropogenic loss of large-bodied vertebrates is likely to result in host-tick coextinction events, even when immature stages feed opportunistically. As parasites play critical roles in ecological and evolutionary processes, such losses may profoundly affect ecosystem functioning and services.

  17. Classificação de McCormack e colapso sagital na fratura toracolombar explosão McCormack classification and kyphotic deformity in thoracolumbar burst fractures

    Directory of Open Access Journals (Sweden)

    Osmar Avanzi

    2007-01-01

    Full Text Available O aumento da cifose toracolombar após tratamento conservador da fratura tipo explosão é complicação constatada por vários autores. Realizamos estudo retrospectivo com 33 portadores de fratura toracolombar do tipo explosão submetidos ao tratamento conservador entre 1992 a 2004 para verificar a correlação entre a cifose toracolombar e a Classificação de McCormack, que pontua a gravidade da fratura conforme a cominuição do corpo, o deslocamento dos fragmentos no corpo vertebral e a quantidade de correção da deformidade em cifose após o tratamento. Após 30 meses de seguimento médio, verificamos correlação entre a pontuação da Classificação de McCormack, conhecida na literatura como load sharing classification, e o colapso vertebral sagital nestes pacientes (pThe increasing incidence of thoracolumbar kyphosis after conservative treatment of burst fractures is a complication reported by several authors. We performed a retrospective study on a consecutive series of 33 patients with thoracolumbar burst fractures treated with cast or brace immobilization between 1992 and 2004 to check for a correlation between thoracolumbar kyphosis and Load Sharing Classification, which provides fracture severity scores according to body comminution, vertebral body fragments displacement and the amount of kyphosis correction delivered after treatment. After an average of 30 months of follow-up we found a correlation between Load Sharing Classification scores (also known as McCormack's Classification, and the sagittal kyphotic deformity on these patients (p<0.05;r=0.65. Despite of being described for assessing sagittal deformity after surgical treatment, the applicability of this Classification can be considered for patients with thoracolumbar burst fractures submitted to conservative treatment.

  18. Vertebral body segmentation in wide range clinical routine spine MRI data.

    Science.gov (United States)

    Hille, Georg; Saalfeld, Sylvia; Serowy, Steffen; Tönnies, Klaus

    2018-03-01

    In this work we propose a 3D vertebral body segmentation approach for clinical magnetic resonance (MR) spine imaging. So far, vertebrae segmentation approaches in MR spine imaging are either limited to particular MR imaging sequences or require minutes to compute, which can be hindering in clinical routine. The major contribution of our work is a reasonably precise segmentation result, within seconds and with minimal user interaction, for spine MR imaging commonly used in clinical routine. Our focus lies on the applicability towards a large variety of clinical MR imaging sequences, dealing with low image quality, high anisotropy and spine pathologies. Our method starts with a intensity correction step to deal with bias field artifacts and a minimal user-assisted initialization. Next, appearance-based vertebral body probability maps guide a subsequent hybrid level-set segmentation. We tested our method on different MR imaging sequences from 48 subjects. Overall, our evaluation set contains 63 datasets including 419 vertebral bodies, which differ in age, sex and presence of spine pathologies. This is the largest set of reference segmentations of clinical routine spine MR imaging so far. We achieved a Dice coefficient of 86.0%, a mean Euclidean surface distance error of 1.59 ± 0.24 mm and a Hausdorff distance of 6.86 mm. These results illustrate the robustness of our segmentation approach towards the variety of MR image data, which is a pivotal aspect for clinical usefulness and reliable diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Vertebral body bone mineral density in patients with lumbar spondylolysis: a quantitative CT study.

    Science.gov (United States)

    Gezer, Naciye Sinem; Balcı, Ali; Kalemci, Orhan; Köremezli, Nevin; Başara Akın, Işıl; Ur, Koray

    2017-01-01

    Spondylolysis is known to be a part of a disease process, which describes a defect in the pars interarticularis of vertebra. We aimed to use quantitative computed tomography (QCT) to measure vertebral body bone mineral density (BMD) in patients with lumbar spondylolysis and compare it with readings in controls. Forty symptomatic patients with lumbar spondylolysis aged 18-52 years and 40 matched controls of same sex and approximate age (±2 years) were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5 and mean BMD was calculated for each case. Of 40 patients, 22 (55%) demonstrated L5 spondylolysis, 14 (35%) L4 spondylolysis, three (7.5%) L3 spondylolysis, and one (2.5%) L2 spondylolysis. Spondylolisthesis was found in 29 patients (73%). Patients with spondylolisthesis were significantly older than patients without spondylolisthesis (42±6.9 vs. 37.2±5.4, P = 0.024). Mean BMD value of the patient group was significantly lower than that of the controls (105±24 mg/cm³ vs. 118.7±25.6 mg/cm³, P = 0.015). Subgroup analysis of 19 patients and 19 controls under the age of 40 revealed that the mean BMD value of the patients was significantly lower than that of the controls in the younger age group as well (108.7±23.5 mg/cm³ vs. 130±25.8 mg/cm³, P = 0.009). This study demonstrated that patients with spondylolysis had significantly lower mean vertebral body BMD compared with controls.

  20. The Role of Minimally Invasive Vertebral Body Stent on Reduction of the Deflation Effect After Kyphoplasty: A Biomechanical Study.

    Science.gov (United States)

    Wang, Dalin; Zheng, Shengnai; Liu, An; Xu, Jie; Du, Xiaotao; Wang, Yijin; Wang, Liming

    2018-03-15

    Biomechanical investigation using cadaver spines. The aim of the present study was to assess the magnitude of the deflation effect after balloon kyphoplasty (BKP) or use of minimally invasive vertebral body stent (MIVBS) in in vitro biomechanical condition. BKP is a well-established minimally invasive treatment option for osteoporotic vertebral compression fractures. However, this technique can lead to a secondary height loss-known as the "deflation effect"-causing intrasegmental kyphosis and an overall alignment failure. The study was conducted on 24 human cadaveric vertebral bodies (T12-L5). After creating a compression fracture model, the fractured vertebral bodies were reduced by BKP (n = 12) or by MIVBS (n = 12) and then augmented with polymethyl methacrylate bone cement. Each step of the procedure was performed under fluoroscopic guidance and the results were analyzed quantitatively. Finally, the strength and stiffness of augmented vertebral bodies were measured by biomechanical tests. Complete initial reduction of the fractured vertebral body height was achieved by both systems. Secondary loss of reduction after balloon deflation was significantly greater in the BKP group (2.36 ± 0.63 mm vs. 0.34 ± 0.43 mm in the MIVBS group; P deflation effect after BKP can be significantly decreased with the use of the MIVBS technique. N/A.

  1. Treatment of osteoid osteoma in the vertebral body of the lumbar spine by radiofrequency ablation

    International Nuclear Information System (INIS)

    Cristante, Alexandre Fogaca; Barros Filho, Tarcisio; Oliveira, Reginaldo Perilo de; Babrabrini, Almir F.; Teixeira, William G.J.

    2007-01-01

    A case of Osteoid osteoma, a rare bone tumor, is studied in a 44-year-old female patient. Scintigraphy using Tc 99m demonstrated increased uptake on the left side of the vertebral body of the fourth vertebra. Computed tomography of the lumbar spine revealed an area of hypoattenuation surrounded by an area of hyperattenuation (bone sclerosis), suggestive of an osteogenic tumor . Complementary examination using MRI demonstrated a signal alteration of 1 cm diameter in the vertebral body of the fourth lumbar vertebra, surrounded by an area of signal compatible with bone edema. The anamnesis data, physical evaluation, and complementary examinations suggested the presence of osteoid osteoma in the vertical body of the fourth lumbar vertebra. A tomography-guided biopsy was performed, and material was collected for cultures, pathological studies in paraffin, and fast freezing (in print). Pathological study of frozen sections ruled out the presence of neoplastic cells. At the same time, minimally invasive destruction of the tumor was performed through a pedicullar approach, via a radiofrequency probe. One year after the procedure, computed tomography did not demonstrate any tumor, and the patient did not report any lumbar pain. (MAC)

  2. Supraphysiologic glucocorticoid administration increased biomechanical bone strength of rats' vertebral body

    OpenAIRE

    Najar, Azam; Fridoni, Mohammadjavad; Rezaei, Fatemesadat; Bayat, Saba; Bayat, Mohammad

    2015-01-01

    The aim of this study is to assess the effects of different glucocorticoid administration protocols on biomechanical properties of the first lumbar vertebral body in rats. We divided 40 male rats into the following groups: control, dexamethasone (7 mg/week), dexamethasone (0.7 mg/week), methylprednisolone (7 mg/kg/week), methylprednisolone (5 mg/kg twice weekly), dexamethasone (7 mg/kg three times per week), dexamethasone (0.7 mg/kg three times per week, and low-level laser treated rats. Lumb...

  3. Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion.

    Science.gov (United States)

    Corniola, Marco V; Jägersberg, Max; Stienen, Martin N; Gautschi, Oliver P

    2015-03-01

    A variety of implant-related short and long-term complications after lumbar fusion surgery are recognized. Mid to long-term complications due to cage migration and/or cage subsidence are less frequently reported. Here, we report a patient with a complete cage migration into the superior adjacent vertebral body almost 20 years after the initial posterior lumbar interbody fusion procedure. In this patient, the cage migration/subsidence was clinically silent, but a selective decompression for adjacent segment degenerative lumbar spinal stenosis was performed. We discuss the risk factors for cage migration/subsidence in view of the current literature. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. HISTOMORPHOLOGICAL STUDY OF THORACOLUMBAR FASCIA IN PATIENTS WITH LUMBOSACRAL DISCOPATHY

    Directory of Open Access Journals (Sweden)

    Z BEHDADIPOOR

    2000-03-01

    Full Text Available Introduction. Thoracolumbar fascia has neural ends in normal positions. It has sensory role and by inhibitory and or excitatory reflexes helps to protect vertebral column. In this research, it has been studied neural ends in thoracolumbar fascia in 42 cases. Our aim was to compare the presence of neural ends in normal individuals and those with lumbosacral discopathy. Methods. The samples were taken from one centimeter of midline at the level of L4-L5 vertebrae, since in this region the posterior layer of thoracolumbar fascia is thicker. Seven of the cases were normal and 35 were patients with lumbosacral discopathy. The samples were processed and serial sections were prepared. Six hundred and thirty sections from the serial sections were selected and 90 percent of these were stained with H&E and the rest of them were stained with Bielschowsky method. The sections were studied by light microscopy. Findings. Unlike the normal individuals, nerve corpuscles were not seen in none of our patients with lumbosacraldiscopathy.UsingBielschowsky,nerveendingswerepresentin normal individuals but they were not visible in patients with discopathy. Conclusion. It is concluded that thoracolumbar fascia in patients with discopathy had insufficient neural ends. Loss of these neural ends may be cause of decreasing proprioceptive information to nervous system and can be an initiating factor to damage the bones, ligaments and muscles.

  5. Automatic vertebral bodies detection of x-ray images using invariant multiscale template matching

    Science.gov (United States)

    Sharifi Sarabi, Mona; Villaroman, Diane; Beckett, Joel; Attiah, Mark; Marcus, Logan; Ahn, Christine; Babayan, Diana; Gaonkar, Bilwaj; Macyszyn, Luke; Raghavendra, Cauligi

    2017-03-01

    Lower back pain and pathologies related to it are one of the most common results for a referral to a neurosurgical clinic in the developed and the developing world. Quantitative evaluation of these pathologies is a challenge. Image based measurements of angles/vertebral heights and disks could provide a potential quantitative biomarker for tracking and measuring these pathologies. Detection of vertebral bodies is a key element and is the focus of the current work. From the variety of medical imaging techniques, MRI and CT scans have been typically used for developing image segmentation methods. However, CT scans are known to give a large dose of x-rays, increasing cancer risk [8]. MRI can be substituted for CTs when the risk is high [8] but are difficult to obtain in smaller facilities due to cost and lack of expertise in the field [2]. X-rays provide another option with its ability to control the x-ray dosage, especially for young people, and its accessibility for smaller facilities. Hence, the ability to create quantitative biomarkers from x-ray data is especially valuable. Here, we develop a multiscale template matching, inspired by [9], to detect centers of vertebral bodies from x-ray data. The immediate application of such detection lies in developing quantitative biomarkers and in querying similar images in a database. Previously, shape similarity classification methods have been used to address this problem, but these are challenging to use in the presence of variation due to gross pathology and even subtle effects [1].

  6. YAP is essential for tissue tension to ensure vertebrate 3D body shape.

    Science.gov (United States)

    Porazinski, Sean; Wang, Huijia; Asaoka, Yoichi; Behrndt, Martin; Miyamoto, Tatsuo; Morita, Hitoshi; Hata, Shoji; Sasaki, Takashi; Krens, S F Gabriel; Osada, Yumi; Asaka, Satoshi; Momoi, Akihiro; Linton, Sarah; Miesfeld, Joel B; Link, Brian A; Senga, Takeshi; Shimizu, Nobuyoshi; Nagase, Hideaki; Matsuura, Shinya; Bagby, Stefan; Kondoh, Hisato; Nishina, Hiroshi; Heisenberg, Carl-Philipp; Furutani-Seiki, Makoto

    2015-05-14

    Vertebrates have a unique 3D body shape in which correct tissue and organ shape and alignment are essential for function. For example, vision requires the lens to be centred in the eye cup which must in turn be correctly positioned in the head. Tissue morphogenesis depends on force generation, force transmission through the tissue, and response of tissues and extracellular matrix to force. Although a century ago D'Arcy Thompson postulated that terrestrial animal body shapes are conditioned by gravity, there has been no animal model directly demonstrating how the aforementioned mechano-morphogenetic processes are coordinated to generate a body shape that withstands gravity. Here we report a unique medaka fish (Oryzias latipes) mutant, hirame (hir), which is sensitive to deformation by gravity. hir embryos display a markedly flattened body caused by mutation of YAP, a nuclear executor of Hippo signalling that regulates organ size. We show that actomyosin-mediated tissue tension is reduced in hir embryos, leading to tissue flattening and tissue misalignment, both of which contribute to body flattening. By analysing YAP function in 3D spheroids of human cells, we identify the Rho GTPase activating protein ARHGAP18 as an effector of YAP in controlling tissue tension. Together, these findings reveal a previously unrecognised function of YAP in regulating tissue shape and alignment required for proper 3D body shape. Understanding this morphogenetic function of YAP could facilitate the use of embryonic stem cells to generate complex organs requiring correct alignment of multiple tissues.

  7. Congenital Vertebral Malformations In French Bulldogs: X-Ray Vs Computed Tomography

    Directory of Open Access Journals (Sweden)

    Lucia Madalina CORLAT

    2017-05-01

    Full Text Available Congenital vertebral malformations of the thoracolumbar area can have an important impact in the clinical evolution of French Bulldogs due to the instability it creates at the spinal level. The aim of this study is to show the differences between x-ray and CT scans in vertebral malformations of the French Bulldog. CT scans can offer a higher degree of certainty in the diagnosis of congenital vertebral malformations of the dogs. The VR model can offer a more thorough evaluation of the existing modifications of the vertebral body, allowing the examiner to circumvent the superposition effect than can be observed in the x-ray views and offering the chance to evaluate whether there is scoliosis or kyphosis present.

  8. CT volumetry of lumbar vertebral bodies in patients with hypoplasia L5 and bilateral spondylolysis and in normal controls

    International Nuclear Information System (INIS)

    Wilms, Guido E.; Demaerel, Philippe; Keyzer, Frederik de; Willems, Endry

    2012-01-01

    To examine the feasibility and results of calculating the volume of lumbar vertebral bodies in normal patients and patients with suspected hypoplasia of L5. Lumbar multi-detector CT was performed in 38 patients with bilateral spondylolysis and hypoplasia of L5 and in 38 normal patients. Lumbar vertebral body volume of L3, L4 and L5 was measured by CT volumetry with a semi-automated program, created with MeVisLab. In the control group, the average vertebral body volume (in cubic centimeters) of L3 was 35.93 (±7.33), 36.34 (±7.13) for L4 and 34.63 (±6.88) for L5. In patients with suspected hypoplasia L5 the average body volume (in cubic centimeters) of L3 was 36.85 (±7.37), 36.90 (±6.99) for L4 and 33.14 (±6.57) for L5. The difference in mean vertebral body volume for L3, L4 and L5 between both groups was statistically not significant. However, there was a statistically significant difference of the ratio L5/L4 (P < 0.001) between both groups: the mean ratio L5/L4 in the control group was 95.3 ± 3.9%, the ratio for the hypoplastic L5 group was 89.9 ± 6.3%. There was no significant difference in the vertebral body volume for L3, L4 and L5 between both groups due to inter-patient variability. However, the relation between the body volume of L5 and L4 is significantly different between both groups. The volume of the vertebral body of L5 proved to be on average 10.2% smaller than the volume of L4 in the group with hypoplasia L5 versus 4.7% in the control group. (orig.)

  9. CT volumetry of lumbar vertebral bodies in patients with hypoplasia L5 and bilateral spondylolysis and in normal controls

    Energy Technology Data Exchange (ETDEWEB)

    Wilms, Guido E.; Demaerel, Philippe; Keyzer, Frederik de [UZ Leuven, Campus Gasthuisberg, Department of Radiology, Leuven (Belgium); Willems, Endry [ZOL, Department of Radiology, Genk (Belgium)

    2012-08-15

    To examine the feasibility and results of calculating the volume of lumbar vertebral bodies in normal patients and patients with suspected hypoplasia of L5. Lumbar multi-detector CT was performed in 38 patients with bilateral spondylolysis and hypoplasia of L5 and in 38 normal patients. Lumbar vertebral body volume of L3, L4 and L5 was measured by CT volumetry with a semi-automated program, created with MeVisLab. In the control group, the average vertebral body volume (in cubic centimeters) of L3 was 35.93 ({+-}7.33), 36.34 ({+-}7.13) for L4 and 34.63 ({+-}6.88) for L5. In patients with suspected hypoplasia L5 the average body volume (in cubic centimeters) of L3 was 36.85 ({+-}7.37), 36.90 ({+-}6.99) for L4 and 33.14 ({+-}6.57) for L5. The difference in mean vertebral body volume for L3, L4 and L5 between both groups was statistically not significant. However, there was a statistically significant difference of the ratio L5/L4 (P < 0.001) between both groups: the mean ratio L5/L4 in the control group was 95.3 {+-} 3.9%, the ratio for the hypoplastic L5 group was 89.9 {+-} 6.3%. There was no significant difference in the vertebral body volume for L3, L4 and L5 between both groups due to inter-patient variability. However, the relation between the body volume of L5 and L4 is significantly different between both groups. The volume of the vertebral body of L5 proved to be on average 10.2% smaller than the volume of L4 in the group with hypoplasia L5 versus 4.7% in the control group. (orig.)

  10. An expandable prosthesis with dual cage-and-plate function in a single device for vertebral body replacement: the clinical experience on 14 consecutive cases with vertebral tumors.

    Science.gov (United States)

    Ramírez, J J; Ramírez, J J; Chiquete, E; Gómez-Limón, E

    2011-09-01

    The aim of this paper was to test the hypothesis that an expandable prosthesis with dual cage-and-plate function can provide immediate and durable spine stabilization after corpectomy. We designed an expandable vertebral body prosthesis with dual cage-and-plate function in a single device (JR-prosthesis). Anatomical studies were performed to design a titanium-made prosthesis. Cadaver assays were done with a stainless steal device to test fixation and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors (8 metastatic) underwent corpectomy and vertebral body replacement with the JR-prosthesis. All patients had neurological deficit, severe pain and spine instability (mean follow-up: 25.4 months). Mean pain score before surgery in a visual analog scale improved from 7.6 to 3.0 points after operation (P=0.002). All patients achieved at least one grade of improvement in the Frankel score (P=0.003), excepting the 3 patients with Frankel grade A presurgery. Two patients with renal cell carcinoma died during the following 4 days after surgery (renal failure and massive bleeding), the rest attained a painless and stable spine immediately and maintained for long periods. No significant infections or implant failures were registered. A non-fatal case of inferior vena cava surgical injury was observed (repaired during surgery without further complications). The JR-prosthesis stabilizes the spine immediately after surgery and for the rest of the patients' life. To our knowledge, this is the first report on the clinical experience of any expandable vertebral body prosthesis with dual cage-and-plate function in a single device. These observations await confirmation in different scenarios.

  11. Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures

    Directory of Open Access Journals (Sweden)

    Zhang L

    2017-02-01

    Full Text Available Liang Zhang, Qiang Wang, Lin Wang, Jian Shen, Qiwei Zhang, Changtai Sun Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People’s Republic of China Objective: Percutaneous vertebroplasty (PVP is a surgical procedure that has been widely used to treat patients suffering from osteoporotic vertebral compression fractures (OVCFs. The procedure involves injection of bone cement into a fractured vertebra. In this study, we investigated whether the distribution of the cement in the vertebral body is related to the occurrence of recompression after surgery. Patients and methods: A total of 172 patients diagnosed with OVCF, from January 2008 to June 2013, were retrospectively reviewed. Fifty of these patients experienced recompression after surgery during the follow-up period (recompression group, and 122 patients had no recompression observed during the follow-up period (control group. Statistical analysis was performed to compare clinical and operative parameters between these two groups. Results: Differences were found in bone cement distribution between the recompression group and control group (P=0.001. Patients with bone cement distributed around both upper and lower endplates had a significantly less incidence of recompression (4/50 patients, when compared to other patterns of cement distribution (eg, below upper endplate, above lower endplate, and in the middle of vertebral body. The logistic multiple regression analysis also indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared to patients with bone cement distributed in the middle of vertebral body (odds ratio =0.223, P=0.003. Conclusion: We herein suggest that the control of bone cement distribution during surgery provides beneficial effects on reducing the risks of recompression after PVP treatment in patients with OVCF. Keywords: elderly, OVCF, PVP, bone cement

  12. Incidence and mechanism of neurological deficit after thoracolumbar fractures sustained in motor vehicle collisions.

    Science.gov (United States)

    Mukherjee, Sourabh; Beck, Chad; Yoganandan, Narayan; Rao, Raj D

    2015-10-09

    OBJECT To determine the incidence of and assess the risk factors associated with neurological injury in motor vehicle occupants who sustain fractures of the thoracolumbar spine. METHODS In this study, the authors queried medical, vehicle, and crash data elements from the Crash Injury Research and Engineering Network (CIREN), a prospectively gathered multicenter database compiled from Level I trauma centers. Subjects had fractures involving the T1-L5 vertebral segments, an Abbreviated Injury Scale (AIS) score of ≥ 3, or injury to 2 body regions with an AIS score of ≥ 2 in each region. Demographic parameters obtained for all subjects included age, sex, height, body weight, and body mass index. Clinical parameters obtained included the level of the injured vertebra and the level and type of spinal cord injury. Vehicular crash data included vehicle make, seatbelt type, and usage and appropriate use of the seatbelt. Crash data parameters included the principal direction of force, change in velocity on impact (ΔV), airbag deployment, and vehicle rollover. The authors performed a univariate analysis of the incidence and the odds of sustaining spinal neurological injury associated with major thoracolumbar fractures with respect to the demographic, clinical, and crash parameters. RESULTS Neurological deficit associated with thoracolumbar fracture was most frequent at extremes of age; the highest rates were in the 0- to 10-year (26.7% [4 of 15]) and 70- to 80-year (18.4% [7 of 38]) age groups. Underweight occupants (OR 3.52 [CI 1.055-11.7]) and obese occupants (OR 3.27 [CI 1.28-8.31]) both had higher odds of sustaining spinal cord injury than occupants with a normal body mass index. The highest risk of neurological injury existed in crashes in which airbags deployed and the occupant was not restrained by a seatbelt (OR 2.35 [CI 0.087-1.62]). Reduction in the risk of neurological injuries occurred when 3-point seatbelts were used correctly in conjunction with the

  13. Anterior column reconstruction in thoracolumbar injuries utilizing a computer-assisted navigation system.

    Science.gov (United States)

    Blattert, T R; Jarvers, J-S; Schmidt, C; Riesner, H-J; Josten, C

    2011-04-01

    Discectomy, corpectomy, and resection of isolated posterior wall fragments are technically demanding steps requiring maximum surgical precision during anterior reconstruction of the unstable thoracolumbar spine. This study investigates the feasibility of computer-aided guidance for these steps. It also analyzes the precision, advantages, and disadvantages of the procedure. Controlled clinical trial. 21 patients were included in the trial group; the control group consisted of 10 patients. Total time for surgery was noted. To assess surgical precision, decentralization of the cage was measured in postoperative X-rays. Additionally, parallel alignment of vertebral body endplates with the cage was evaluated in postoperative CT scans. Vertebral body fractures of the thoracolumbar spine addressed by disc-/corpectomy and subsequent cage interposition for anterior reconstruction were included. All surgical steps were performed under endoscopic assistance. In the trial group, disc- and corpectomy were performed under computer-aided guidance; in the control group, no computer navigation was utilized. In cases of initial neurological deficit after trauma, the patients underwent emergency laminectomy during the initial posterior stabilization procedure. During the second-stage anterior procedure, resection of the posterior wall fragment with the aid of computer-aided navigation was performed. Fractures were localized between Th9 and L1 in the trial group, and Th10 and L1 in the control group. Time for surgery was significantly shorter in the control group: 1.7 h ± 0.5, as opposed to 3.8 h ± 1.0 in the trial group (p Computer-aided guidance in anterior reconstruction of the thoracolumbar spine is a technically feasible option that may aid in the performance of disc- and corpectomy, as well as the resection of isolated posterior wall fragments in cases with initial neurological compromise. However, total time for surgery is significantly prolongated by this technique

  14. Changes in Spinal Canal Diameter and Vertebral Body Height with Age

    Science.gov (United States)

    Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2013-01-01

    Purpose All structures of the spine, including the spinal canal, change continuously with age. The purpose of this study was to determine how the spinal canal of the lumbar spine changes with age. The L4/5 is the most common site of spinal stenosis and has the largest flexion-extension motion, whereas the T5/6 has the least motion. Therefore, we measured the spinal canal diameter and vertebral body height at T5, T6, L4, and L5 with age. Materials and Methods This was a retrospective study of aged 40 to 77 years. We reviewed whole spine sagittal MRIs of 370 patients with lumbar spinal stenosis (LSS) (Group 2) and 166 herniated cervical disc (HCD) (Group 1). Each group was divided into four age groups, and demographic parameters (age, gender, height, weight, BMI), the mid-spinal canal diameter, and mid-vertebrae height at T5, T6, L4, L5 were compared. Within- and between-group comparisons were made to evaluate changes by age and correlations were carried out to evaluate the relationships between all parameters. Results Height, weight, and all radiologic parameters were significantly lower in Group 2 than Group 1. Group 1 did not show any differences, when based on age, but in Group 2, height, weight, and T6, L4, and L5 height were significantly decreased in patients in their 70's than patients in their 40's, except for spinal canal diameter. Age was associated with all parameters except spinal canal diameter. Conclusion Vertebral height decreased with age, but spinal canal diameter did not change in patients with either LSS or HCD. Mid-spinal canal diameter was not affected by aging. PMID:24142657

  15. Traumatic expulsion of T4 vertebral body into the spinal canal treated by vertebrectomy and spine shortening.

    Science.gov (United States)

    Cappuccio, Michele; Corghi, Alessandro; De Iure, Federico; Amendola, Luca

    2014-05-20

    A case report. To describe an exceptional case of traumatic 2-level adjacent disk disruption with expulsion of the vertebral body into the spinal canal treated by vertebrectomy and spine shortening. Traumatic spondyloptosis is a very rare injury caused by high-energy trauma. Vertebral body expulsion is mostly the result of tremendous flexion-extension shearing forces causing a double contiguous disk disruption. A 49-year-old male was admitted to the emergency department of another hospital because of a high-speed car crash. He was conscious and collaborating and showed a complete paraplegia. Spinal computed tomographic scan showed a posterior expulsion of the T4 vertebral body and dislocation into the spinal canal. Magnetic resonance imaging of the spine confirmed the presence of a 2-level adjacent T3-T4 and T4-T5 disk disruption and severe compression of the spinal cord by the T4 vertebral body. We performed a posterior stabilization from T1 to T8 with T4 vertebrectomy and spine shortening. A postoperative computed tomographic scan showed a tolerable sagittal and frontal alignment and apposition of the endplates of T3 and T5. At present, 12 months after surgery, the patient is neurologically unchanged, but he can keep the sitting position without support. Total vertebrectomy and spinal shortening are safe and replicable procedures applicable in few patients with paraplegia. A surgical procedure after 3 weeks makes a complete reduction and a perfect sagittal alignment of the spine difficult to be obtained.

  16. Monostotic fibrous dysplasia of a lumbar vertebral body with secondary aneurysmal bone cyst formation: a case report

    NARCIS (Netherlands)

    Snieders, N.M.E.; Kemenade, van F.J.; Royen, van B.J.

    2009-01-01

    We report the case of a 25-year-old Caucasian woman with symptomatic monostotic fibrous dysplasia of the fourth lumbar vertebral body. The patient suffered from a five-week history of progressive low back pain, radiating continuously to the left leg. Her medical history and physical and neurological

  17. Effects of vertebral-body-sparing proton craniospinal irradiation on the spine of young pediatric patients with medulloblastoma

    Directory of Open Access Journals (Sweden)

    Iain MacEwan, MD

    2017-04-01

    Conclusion: Vertebral-body-sparing CSI with proton beam did not appear to cause increased severe spinal abnormalities in patients treated at our institution. This approach could be considered in future clinical trials in an effort to reduce toxicity and the risk of secondary malignancy and to improve adult height.

  18. [Correlative factor analysis of complications resulting from cement leakage after percutaneous kyphoplasty in treatment of osteoporotic vertebral body compression].

    Science.gov (United States)

    Shen, Yong; Ren, Hu; Zhang, Yingze; Zhi, Xinli; Ding, Wenyuan; Xu, Jiaxin; Yang, Dalong

    2010-01-01

    To explore the correlative factors affecting the complications resulting from cement leakage after percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral body compression fractures (OVCF). From February 2005 to October 2008, 71 patients with OVCF were treated by PKP and were retrospectively analyzed. There were 16 males and 55 females, and the average age was 71.5 years (range, 52-91 years). The average duration of disease was 5.7 months (range, 1-11 months). A total of 171 vertebra were involved in fracture including 19 cases of single vertebral fractures, 21 cases of double vertebral fractures, 20 cases of three vertebral fractures, and 11 cases of more than three vertebral fractures. All the treated vertebra were divided into acute (86 vertebra) or subacute (85 vertebra) state based on changes in MRI signal intensity. There was no radiculopathy or myelopathy. The average injected cement volume was 4.6 mL (range, 1.5-6.5 mL). The treatment efficacy was assessed by observing the change in anterior and middle vertebral column height, Cobb angle, visual analogue scale (VAS) and Oswestry functional score at preoperation, 3 days after operation and last follow-up. The patients were divided into cement leakage group and no cement leakage group. All the complications were recorded, and then the correlative factors affecting the complications were analyzed. All the cases had rapid and significant improvement in back pain following PKP. All patients were followed up for 14 months (range, 7-18 months). There was no cement extravasation resulting in radiculopathy or myelopathy. Four patients (5.63%) had lung-related complications. During the follow-up, 9 recurrence vertebral fractures were observed in 6 patients (8.45%). The anterior and middle vertebral column height, Cobb angle, VAS and Oswestry score were significantly improved when compared with preoperation (P 0.05) in preoperative Cobb angle, freshness of vertebral fracture, location of operative

  19. Biomechanical simulations of costo-vertebral and anterior vertebral body tethers for the fusionless treatment of pediatric scoliosis.

    Science.gov (United States)

    Aubin, Carl-Éric; Clin, Julien; Rawlinson, Jeremy

    2018-01-01

    Compression-based fusionless tethers are an alternative to conventional surgical treatments of pediatric scoliosis. Anterior approaches place an anterior (ANT) tether on the anterolateral convexity of the deformed spine to modify growth. Posterior, or costo-vertebral (CV), approaches have not been assessed for biomechanical and corrective effectiveness. The objective was to biomechanically assess CV and ANT tethers using six patient-specific, finite element models of adolescent scoliotic patients (11.9 ± 0.7 years, Cobb 34° ± 10°). A validated algorithm simulated the growth and Hueter-Volkmann growth modulation over a period of 2 years with the CV and ANT tethers at two initial tensions (100, 200 N). The models without tethering also simulated deformity progression with Cobb angle increasing from 34° to 56°, axial rotation 11° to 13°, and kyphosis 28° to 32° (mean values). With the CV tether, the Cobb angle was reduced to 27° and 20° for tensions of 100 and 200 N, respectively, kyphosis to 21° and 19°, and no change in axial rotation. With the ANT tether, Cobb was reduced to 32° and 9° for 100 and 200 N, respectively, kyphosis unchanged, and axial rotation to 3° and 0°. While the CV tether mildly corrected the coronal curve over a 2-year growth period, it had sagittal lordosing effect, particularly with increasing initial axial rotation (>15°). The ANT tether achieved coronal correction, maintained kyphosis, and reduced the axial rotation, but over-correction was simulated at higher initial tensions. This biomechanical study captured the differences between a CV and ANT tether and indicated the variability arising from the patient-specific characteristics. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:254-264, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  20. Quantitative morphology of the vertebral body cortex; Quantitative Morphologie der Wirbelkoerperkortikalis

    Energy Technology Data Exchange (ETDEWEB)

    Ritzel, H.; Amling, M.; Hahn, M.; Delling, G. [Hamburg Univ. (Germany). Abt. Osteopathologie; Maas, R. [Hamburg Univ. (Germany). Radiologische Klinik

    1998-04-01

    The vertebral bodies consist of two main structures, trabecular and cortical bone. The histological changes within the spine, especially in cortical bone, leading to osteoporotic fractures remain, however, poorly understood. Therefore, the complete front column of the spine was removed in 26 autopsy cases without skeletal diseases and in 11 cases with proven osteoporosis. A sagittal segment prepared through the center of all vertebral bodies was undecalcified embedded in plastic, ground to a 1-mm-thick block and stained using a modification of the von Kossa method. The analysis included measurement of the mean cortical thickness of both ventral and dorsal shell (from C3 to L5). The qualitative investigation of the structure of the cortical ring completed the analysis. The skeletally intact specimens had high cortical thickness values in the cervical spine (285{+-}22 {mu}m), a decrease in the thoracic spine (244{+-}14 {mu}) and an increase in the lumbar spine (290{+-}15 {mu}m). The mean thickness of the ventral shell is in general higher than the thickness of the dorsal shell. The cortical thickness of the spine showed no gender-specific differences (P=n.s.). There was a slight decrease in cortical thickness with age; however, this decrease and the correlation of cortical thickness to age was only significant below vertebral body T8 (r=0.225 to 0.574; P{sub r}<0.05 to P{sub t}<0.005). Most interestingly, osteoporosis is characterized by a significant decrease in cortical thickness throughout the whole spine. This decrease in cortical thickness was more marked in the dorsal shell (P<0.05) than in the ventral shell (ventral from C3 to T6 (P<0.05)) below T6 (P=n.s.). (orig./AJ) [Deutsch] Zielsetzung: Wirbelkoerper bestehen aus den beiden Hauptkomponenten Spongiosa und Kortikalis. Trotz kontroverser Meinungen zur biomechanischen Bedeutung dieser Strukturen fuer die Stabilitaet der Knochen liegen ueber die Dicke der Kortikalis in der Literatur allerdings nur wenige

  1. Effects of vertebral-body-sparing proton craniospinal irradiation on the spine of young pediatric patients with medulloblastoma.

    Science.gov (United States)

    MacEwan, Iain; Chou, Brian; Moretz, Jeremy; Loredo, Lilia; Bush, David; Slater, Jerry D

    2017-01-01

    To investigate the long-term effects of vertebral-body-sparing proton craniospinal irradiation (CSI) on the spine of young patients with medulloblastoma. Six children between the ages of 3 and 5 years with medulloblastoma were treated with vertebral-body-sparing proton CSI after maximal safe resection. Radiation therapy was delivered in the supine position with posterior beams targeting the craniospinal axis, and the proton beam was stopped anterior to the thecal sac. Patients were treated with a dose of either 23.4 Gy or 36 Gy to the craniospinal axis followed by a boost to the posterior fossa and any metastatic lesions. Chemotherapy varied by protocol. Radiographic effects on the spine were evaluated with serial imaging, either with magnetic resonance imaging scans or plain film using Cobb angle calculations, the presence of thoracic lordosis, lumbar vertebral body-to-disc height ratios, and anterior-posterior height ratios. Clinical outcomes were evaluated by patient/family interview and medical chart review. Overall survival and disease free survival were 83% (5/6) at follow-up. Median clinical and radiographic follow-up were 13.6 years and 12.3 years, respectively. Two patients were clinically diagnosed with scoliosis and treated conservatively. At the time of follow-up, no patients had experienced chronic back pain or required spine surgery. No patients were identified to have thoracic lordosis. Diminished growth of the posterior portions of vertebral bodies was identified in all patients, with an average posterior to anterior ratio of 0.88, which was accompanied by compensatory hypertrophy of the posterior intervertebral discs. Vertebral-body-sparing CSI with proton beam did not appear to cause increased severe spinal abnormalities in patients treated at our institution. This approach could be considered in future clinical trials in an effort to reduce toxicity and the risk of secondary malignancy and to improve adult height.

  2. Semi-automatic segmentation of vertebral bodies in volumetric MR images using a statistical shape+pose model

    Science.gov (United States)

    Suzani, Amin; Rasoulian, Abtin; Fels, Sidney; Rohling, Robert N.; Abolmaesumi, Purang

    2014-03-01

    Segmentation of vertebral structures in magnetic resonance (MR) images is challenging because of poor con­trast between bone surfaces and surrounding soft tissue. This paper describes a semi-automatic method for segmenting vertebral bodies in multi-slice MR images. In order to achieve a fast and reliable segmentation, the method takes advantage of the correlation between shape and pose of different vertebrae in the same patient by using a statistical multi-vertebrae anatomical shape+pose model. Given a set of MR images of the spine, we initially reduce the intensity inhomogeneity in the images by using an intensity-correction algorithm. Then a 3D anisotropic diffusion filter smooths the images. Afterwards, we extract edges from a relatively small region of the pre-processed image with a simple user interaction. Subsequently, an iterative Expectation Maximization tech­nique is used to register the statistical multi-vertebrae anatomical model to the extracted edge points in order to achieve a fast and reliable segmentation for lumbar vertebral bodies. We evaluate our method in terms of speed and accuracy by applying it to volumetric MR images of the spine acquired from nine patients. Quantitative and visual results demonstrate that the method is promising for segmentation of vertebral bodies in volumetric MR images.

  3. Radiologic abnormalities of the thoraco-lumbar spine in athletes

    Energy Technology Data Exchange (ETDEWEB)

    Hellstroem, M.; Jacobsson, B.; Swaerd, L.; Peterson, L. (Sahlgrenska Sjukhuset, Goeteborg (Sweden). Dept. of Radiology Oestra Sjukhuset, Goeteborg (Sweden). Dept. of Orthopedics King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia). Dept. of Radiology)

    1990-03-01

    A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male nonathletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occured in both athletes and non-athletes but were more common among athletes, especially male-gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers. (orig.).

  4. Epithelioid hemangioendothelioma and multiple thoraco-lumbar lateral meningoceles: two rare pathological entities in a patient with NF-1

    International Nuclear Information System (INIS)

    Reis, C.; Carneiro, E.; Fonseca, J.; Salgado, A.; Pereira, P.; Vaz, R.; Pinto, R.; Capelinha, A.F.; Lopes, J.M.

    2005-01-01

    Epithelioid hemangioendothelioma (EHE) is a rare vascular soft-tissue tumour of intermediate malignancy. Neurofibromatosis type I (NF-1) is a genetic syndrome associated with soft tissue sarcoma and higher risk of developing neoplasia. Lateral meningoceles are uncommon entities, being mostly associated with NF-1. We report a case of a 31-year-old woman, with NF-1 and past history of right thalamic/peduncular astrocytoma WHO grade II, admitted to the Neurosurgery Department in December 2003 due to severe low back pain, irradiating to the left leg without a radicular pattern. Thoraco-lumbar magnetic resonance imaging (MRI) showed a large left posterior paravertebral expansive lesion, bilateral and multiple thoraco-lumbar lateral meningoceles and dural ectasias with scalloping of the vertebral bodies. Biopsy of the paravertebral mass lesion disclosed EHE. We present this case because of the novel association between NF-1 and EHE, and the unusual aggressiveness of the neoplasia. Additionally, we highlight the co-existence of bilateral and multiple lateral meningoceles. (orig.)

  5. Epithelioid hemangioendothelioma and multiple thoraco-lumbar lateral meningoceles: two rare pathological entities in a patient with NF-1

    Energy Technology Data Exchange (ETDEWEB)

    Reis, C.; Carneiro, E.; Fonseca, J.; Salgado, A. [Hospital S. Joao, Departments of Neuroradiology, Porto (Portugal); Pereira, P.; Vaz, R. [Hospital S. Joao, Department of Neurosurgery, Porto (Portugal); Pinto, R. [Hospital S. Joao, Department of Orthopaedics, Porto (Portugal); Capelinha, A.F.; Lopes, J.M. [Hospital S. Joao, Department of Pathology, Porto (Portugal)

    2005-02-01

    Epithelioid hemangioendothelioma (EHE) is a rare vascular soft-tissue tumour of intermediate malignancy. Neurofibromatosis type I (NF-1) is a genetic syndrome associated with soft tissue sarcoma and higher risk of developing neoplasia. Lateral meningoceles are uncommon entities, being mostly associated with NF-1. We report a case of a 31-year-old woman, with NF-1 and past history of right thalamic/peduncular astrocytoma WHO grade II, admitted to the Neurosurgery Department in December 2003 due to severe low back pain, irradiating to the left leg without a radicular pattern. Thoraco-lumbar magnetic resonance imaging (MRI) showed a large left posterior paravertebral expansive lesion, bilateral and multiple thoraco-lumbar lateral meningoceles and dural ectasias with scalloping of the vertebral bodies. Biopsy of the paravertebral mass lesion disclosed EHE. We present this case because of the novel association between NF-1 and EHE, and the unusual aggressiveness of the neoplasia. Additionally, we highlight the co-existence of bilateral and multiple lateral meningoceles. (orig.)

  6. Vertebral Body Stapling versus Bracing for Patients with High-Risk Moderate Idiopathic Scoliosis

    Science.gov (United States)

    Cuddihy, Laury; Danielsson, Aina J.; Cahill, Patrick J.; Samdani, Amer F.; Grewal, Harsh; Richmond, John M.; Mulcahey, M. J.; Gaughan, John P.; Antonacci, M. Darryl; Betz, Randal R.

    2015-01-01

    Purpose. We report a comparison study of vertebral body stapling (VBS) versus a matched bracing cohort for immature patients with moderate (25 to 44°) idiopathic scoliosis (IS). Methods. 42 of 49 consecutive patients (86%) with IS were treated with VBS and followed for a minimum of 2 years. They were compared to 121 braced patients meeting identical inclusion criteria. 52 patients (66 curves) were matched according to age at start of treatment (10.6 years versus 11.1 years, resp. [P = 0.07]) and gender. Results. For thoracic curves 25–34°, VBS had a success rate (defined as curve progression <10°) of 81% versus 61% for bracing (P = 0.16). In thoracic curves 35–44°, VBS and bracing both had a poor success rate. For lumbar curves, success rates were similar in both groups for curves measuring 25–34°. Conclusion. In this comparison of two cohorts of patients with high-risk (Risser 0-1) moderate IS (25–44°), in smaller thoracic curves (25–34°) VBS provided better results as a clinical trend as compared to bracing. VBS was found not to be effective for thoracic curves ≥35°. For lumbar curves measuring 25–34°, results appear to be similar for both VBS and bracing, at 80% success. PMID:26618169

  7. Radiological outcome of transpedicular screws fixation in the management of thoracolumbar spine injury

    International Nuclear Information System (INIS)

    Haq, M.I.U.

    2015-01-01

    Traumatic fracture of the spine is a serious neurosurgical condition that has serious impact on the patient's quality of life. Thoracolumbar junction is the most common site of spinal injuries. The aims of management of thoracolumbar spinal fractures are to restore vertebral column stability, and to obtain spinal canal decompression. This ultimately leads to early mobilization of the patients. This study was conducted to compare preoperative and post-operative vertebral height, kyphotic angle and sagittal index in patients treated with pedicle screws and rods in thoracolumbar spine fractures. Methods: This cross-sectional study was conducted in the department of Neurosurgery, Hayatabad Medical Complex, Peshawar from 1st February 2010 to 31st July 2011. A total 161 patients with unstable thoracolumber spine fracture were included in this study. In these patients fixation was done through transpedicle screws with rods. Anteroposterior and lateral views X-rays of thoraco-lumbar spine were done pre and post operatively. Results: Out of 161 patients, 109 (67.7%) were males and 52 (32.3%) females. The age of patients ranged from 20 to 70 years (mean 42.2 years) with 71 (44.1%) in the age range of 31-40 years. Preoperative average vertebral height was 9.4194 mm while postoperative average was 19.642 mm. The mean kyphosis was 23.06 degree preoperatively. Immediately after surgery the average correction of kyphosis was 9.45 degree. The pre-operative average sagittal index was 19.38 degree, which was reduced to an average 5.41 degree post operatively. Conclusions: Transpedicular fixation for unstable thoraco-lumbar spinal fractures achieves a stable fracture segment with improvement of vertebral height, kyphotic angle and sagittal index. Hence, preventing the secondary spinal deformities. (author)

  8. Vertebral compression fractures after stereotactic body radiation therapy: a large, multi-institutional, multinational evaluation.

    Science.gov (United States)

    Jawad, Maha Saada; Fahim, Daniel K; Gerszten, Peter C; Flickinger, John C; Sahgal, Arjun; Grills, Inga S; Sheehan, Jason; Kersh, Ronald; Shin, John; Oh, Kevin; Mantel, Frederick; Guckenberger, Matthias

    2016-06-01

    OBJECTIVE The purpose of this study was to identify factors contributing to an increased risk for vertebral compression fracture (VCF) following stereotactic body radiation therapy (SBRT) for spinal tumors. METHODS A total of 594 tumors were treated with spinal SBRT as primary treatment or re-irradiation at 8 different institutions as part of a multi-institutional research consortium. Patients underwent LINAC-based, image-guided SBRT to a median dose of 20 Gy (range 8-40 Gy) in a median of 1 fraction (range 1-5 fractions). Median patient age was 62 years. Seventy-one percent of tumors were osteolytic, and a preexisting vertebral compression fracture (VCF) was present in 24% of cases. Toxicity was assessed following treatment. Univariate and multivariate analyses were performed using a logistic regression method to determine parameters predictive for post-SBRT VCF. RESULTS At a median follow-up of 10.1 months (range 0.03-57 months), 80% of patients had local tumor control. At the time of last imaging follow-up, at a median of 8.8 months after SBRT, 3% had a new VCF, and 2.7% had a progressive VCF. For development of any (new or progressive) VCF following SBRT, the following factors were predictive for VCF on univariate analysis: short interval from primary diagnosis to SBRT (less than 36.8 days), solitary metastasis, no additional bone metastases, no prior chemotherapy, preexisting VCF, no MRI used for target delineation, tumor volume of 37.3 cm(3) or larger, equivalent 2-Gy-dose (EQD2) tumor of 41.8 Gy or more, and EQD2 spinal cord Dmax of 46.1 Gy or more. Preexisting VCF, solitary metastasis, and prescription dose of 38.4 Gy or more were predictive on multivariate analysis. The following factors were predictive of a new VCF on univariate analysis: solitary metastasis, no additional bone metastases, and no MRI used for target delineation. Presence of a solitary metastasis and lack of MRI for target delineation remained significant on multivariate analysis

  9. A calibration methodology of QCT BMD for human vertebral body with registered micro-CT images.

    Science.gov (United States)

    Dall'Ara, E; Varga, P; Pahr, D; Zysset, P

    2011-05-01

    The accuracy of QCT-based homogenized finite element (FE) models is strongly related to the accuracy of the prediction of bone volume fraction (BV/TV) from bone mineral density (BMD). The goal of this study was to establish a calibration methodology to relate the BMD computed with QCT with the BV/TV computed with micro-CT (microCT) over a wide range of bone mineral densities and to investigate the effect of region size in which BMD and BV/TV are computed. Six human vertebral bodies were dissected from the spine of six donors and scanned submerged in water with QCT (voxel size: 0.391 x 0.391 x 0.450 mm3) and microCT (isotropic voxel size: 0.018(3) mm3). The microCT images were segmented with a single level threshold. Afterward, QCT-grayscale, microCT-grayscale, and microCT-segmented images were registered. Two isotropic grids of 1.230 mm (small) and 4.920 mm (large) were superimposed on every image, and QCT(BMD) was compared both with microCT(BMD) and microCT(BV/TV) for each grid cell. The ranges of QCT(BMD) for large and small regions were 9-559 mg/cm3 and -90 to 1006 mg/cm3, respectively. QCT(BMD) was found to overestimate microCT(BMD). No significant differences were found between the QCT(BMD)-microCT(BV/TV) regression parameters of the two grid sizes. However, the R2 was higher, and the standard error of the estimate (SEE) was lower for large regions when compared to small regions. For the pooled data, an extrapolated QCTBMD value equal to 1062 mg/ cm3 was found to correspond to 100% microCT(BV/TV). A calibration method was defined to evaluate BV/TV from QCTBMD values for cortical and trabecular bone in vitro. The QCT(BMD-microCT(BV/TV) calibration was found to be dependent on the scanned vertebral section but not on the size of the regions. However, the higher SEE computed for small regions suggests that the deleterious effect of QCT image noise on FE modelling increases with decreasing voxel size.

  10. Vertebral Body Compression Fractures and Bone Density: Automated Detection and Classification on CT Images.

    Science.gov (United States)

    Burns, Joseph E; Yao, Jianhua; Summers, Ronald M

    2017-09-01

    Purpose To create and validate a computer system with which to detect, localize, and classify compression fractures and measure bone density of thoracic and lumbar vertebral bodies on computed tomographic (CT) images. Materials and Methods Institutional review board approval was obtained, and informed consent was waived in this HIPAA-compliant retrospective study. A CT study set of 150 patients (mean age, 73 years; age range, 55-96 years; 92 women, 58 men) with (n = 75) and without (n = 75) compression fractures was assembled. All case patients were age and sex matched with control subjects. A total of 210 thoracic and lumbar vertebrae showed compression fractures and were electronically marked and classified by a radiologist. Prototype fully automated spinal segmentation and fracture detection software were then used to analyze the study set. System performance was evaluated with free-response receiver operating characteristic analysis. Results Sensitivity for detection or localization of compression fractures was 95.7% (201 of 210; 95% confidence interval [CI]: 87.0%, 98.9%), with a false-positive rate of 0.29 per patient. Additionally, sensitivity was 98.7% and specificity was 77.3% at case-based receiver operating characteristic curve analysis. Accuracy for classification by Genant type (anterior, middle, or posterior height loss) was 0.95 (107 of 113; 95% CI: 0.89, 0.98), with weighted κ of 0.90 (95% CI: 0.81, 0.99). Accuracy for categorization by Genant height loss grade was 0.68 (77 of 113; 95% CI: 0.59, 0.76), with a weighted κ of 0.59 (95% CI: 0.47, 0.71). The average bone attenuation for T12-L4 vertebrae was 146 HU ± 29 (standard deviation) in case patients and 173 HU ± 42 in control patients; this difference was statistically significant (P high sensitivity and with a low false-positive rate, as well as to calculate vertebral bone density, on CT images. © RSNA, 2017 Online supplemental material is available for this article.

  11. Geometry of the vertebral bodies and the intervertebral discs in lumbar segments adjacent to spondylolysis and spondylolisthesis: pilot study.

    Science.gov (United States)

    Been, Ella; Li, Ling; Hunter, David J; Kalichman, Leonid

    2011-07-01

    The objective is to evaluate the geometric parameters of vertebral bodies and intervertebral discs in spinal segments adjacent to spondylolysis and spondylolisthesis. This pilot cross-sectional study was an ancillary project to the Framingham Heart Study. The presence of spondylolysis and spondylolisthesis as well as measurements of spinal geometry were identified on CT imaging of 188 individuals. Spinal geometry measurements included lordosis angle, wedging of each lumbar vertebra and intervertebral disc. Last measurements were used to calculate ΣB, the sum of the lumbar L1-L5 body wedge angles; and ΣD, the sum of the lumbar L1-L5 intervertebral disc angles. Using Wilcoxon-Mann-Whitney test we compared the geometric parameters between individuals with no pathology and ones with spondylolysis (with no listhesis) at L5 vertebra, ones with isthmic spondylolisthesis at L5-S1 level, and ones with degenerative spondylolisthesis at L5-S1 level. Spinal geometry in individuals with spondylolysis or listhesis at L5 shows three major patterns: In spondylolysis without listhesis, spinal morphology is similar to that of healthy individuals; In isthmic spondylolisthesis there is high lordosis angle, high L5 vertebral body wedging and very high L4-5 disc wedging; In degenerative spondylolisthesis, spinal morphology shows more lordotic wedging of the L5 vertebral body, and less lordotic wedging of intervertebral discs. In conclusion, there are unique geometrical features of the vertebrae and discs in spondylolysis or listhesis. These findings need to be reproduced in larger scale study.

  12. Changes in body temperature pattern in vertebrates do not influence the codon usages of alpha-globin genes.

    Science.gov (United States)

    Hamada, Kazuo; Horiike, Tokumasa; Kanaya, Shigehiko; Nakamura, Hiroshi; Ota, Hidetoshi; Yatogo, Takayuki; Okada, Kazuhisa; Nakamura, Hiroshi; Shinozawa, Takao

    2002-06-01

    Codon usages are known to vary among vertebrates chiefly due to variations in isochore structure. Under the assumption that marked differences exist in isochore structure between warm-blooded and cold-blooded animals, the variations among vertebrates were previously attributed to an adaptation to homeothermy. However, based on data from a turtle species and a crocodile (Archosauromorpha), it was recently proposed that the common ancestors of mammals, birds and extent reptiles already had the "warm-blooded" isochore structure. We determined the nucleotide sequences of alpha-globin genes from two species of heterotherms, cuckoo (Cuculus canorus) and bat (Pipistrellus abramus), and three species of snakes (Lepidosauromorpha), Naja kaouthia from a tropical terrestrial habitat, Elaphe climacophora from a temperate terrestrial habitat, and Hydrophis melanocephalus from a tropical marine habitat. Our purposes were to assess the influence of differential body temperature patterns on codon usage and GC content at the third position of a codon (GC3), and to test the hypothesis concerning the phylogenetic position at which GC contents had increased in vertebrates. The results of principal component analysis (PCA) using the present data and data for other taxa from GenBank indicate that the primary difference in codon usage in globin genes among amniotes and other vertebrates lies in GC3. The codon usages (and GC3) in alpha-globin genes from two heterotherms and three snakes are similar to those in alpha-globin genes from warm-blooded vertebrates. These results refute the influence of body temperature pattern upon codon usages (and GC3) in alpha-globin genes, and support the hypothesis that the increase in GC content in the genome occurred in the common ancestor of amniotes.

  13. The combination of mesenchymal stem cells and a bone scaffold in the treatment of vertebral body defects

    Czech Academy of Sciences Publication Activity Database

    Vaněček, Václav; Klíma, K.; Kohout, A.; Foltán, R.; Jiroušek, Ondřej; Šedý, Jiří; Štulík, J.; Syková, Eva; Jendelová, Pavla

    2013-01-01

    Roč. 22, č. 12 (2013), s. 2777-2786 ISSN 0940-6719 R&D Projects: GA ČR GAP304/10/0320; GA MZd(CZ) NT13477 Institutional support: RVO:68378041 ; RVO:68378297 ; RVO:67985823 Keywords : vertebral body defect * mesenchymal stem cells * hydroxyapatite scaffold Subject RIV: FH - Neurology ; FI - Traumatology, Orthopedics (UTAM-F); FI - Traumatology, Orthopedics (FGU-C) Impact factor: 2.473, year: 2013

  14. Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, Adam N., E-mail: wallacea@mir.wustl.edu; Pacheco, Rafael A., E-mail: pachecor@mir.wustl.edu; Tomasian, Anderanik, E-mail: tomasiana@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Hsi, Andy C., E-mail: hsia@path.wustl.edu [Washington University School of Medicine, Division of Anatomic Pathology, Department of Pathology & Immunology (United States); Long, Jeremiah, E-mail: longj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Chang, Randy O., E-mail: changr@wusm.wustl.edu [Washington University School of Medicine (United States); Jennings, Jack W., E-mail: jenningsj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

    2016-02-15

    BackgroundA novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance.MethodsMedical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reports were reviewed to determine the histologic adequacy of specimens obtained with drill assistance.ResultsTwenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86 % (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28 weeks; range 5–115 weeks). The median total length of bone core obtained from drill-assisted biopsies was 28 mm (range 8–120 mm). This was longer than that obtained from manual biopsies (median, 20 mm; range 5–45 mm; P = 0.03). Crush artifact was present in 11 % (3/28) of drill-assisted biopsy specimens, which in one case (3.6 %; 1/28) precluded definitive diagnosis.ConclusionsA drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact.

  15. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients.

    Science.gov (United States)

    Wu, Zi-xiang; Gao, Ming-xuan; Sang, Hong-xun; Ma, Zhen-sheng; Cui, Geng; Zhang, Yang; Lei, Wei

    2012-03-01

    The incidence of screw loosening increases significantly in elderly patients with severe osteoporosis. Open vertebral cement augmentation of expandable pedicle screw fixation may improve fixation strength in the osteoporotic vertebrae. Twenty cadaveric vertebrae (L1-L5) were harvested from six osteoporotic lumbar spines. Axial pullout tests were performed to compare the maximum pullout strength (Fmax) of four methods: 1. Conventional pedicle screws (CPS), 2. Expandable pedicle screws (EPS), 3. Cement augmentation of CPS (cemented-CPS), 4. Cement augmentation of EPS (cemented-EPS). Thirty-six consecutive patients with single-vertebral osteoporotic compressive fractures received posterior decompression and spinal fusion with cemented-CPS (16 cases) or cemented-EPS (20 cases). Plain film and/or CT scan were conducted to evaluate the spinal fusion and fixation effectiveness. The Fmax and energy absorption of cemented-EPS were significantly greater than three control groups. The mean BMD in the severe osteoporosis group was significantly lower than that in the osteoporosis group (t = 2.04, P = 0.036). In the osteoporosis group, cemented-EPS improved the Fmax by 43% and 21% over CPS and cemented-CPS group. In the severe osteoporosis group, cemented-EPS increased the Fmax by 59%, 22%, and 26% over CPS, EPS, and cemented-CPS, respectively. The clinical results showed that all patients suffered from severe osteoporosis. Six months after operation, the JOA and VAS scores in cemented-EPS group improved from 11.4 ± 2.6 and 7.0 ± 1.4 mm to 24.9 ± 1.6 and 2.1 ± 1.3 mm, respectively. No screw loosening occurred in the cemented-EPS group and spinal fusion was achieved. In the cemented-CPS group, four screws loosened (4.2%) according to the radiolucency. Six months after operation, the JOA and VAS scores improved from 13.1 ± 1.9 and 7.6 ± 1.5 mm to 22.8 ± 2.2 and 2.5 ± 1.6 mm, respectively. No cement leaked into the spinal canal in both groups. Cemented-EPS could increase

  16. Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions

    Directory of Open Access Journals (Sweden)

    Jain Anil

    2010-01-01

    Full Text Available Background: Anterior decompression with posterior instrumentation when indicated in thoracolumbar spinal lesions if performed simultaneously in single-stage expedites rehabilitation and recovery. Transthoracic, transdiaphragmatic approach to access the thoracolumbar junction is associated with significant morbidity, as it violates thoracic cavity; requires cutting of diaphragm and a separate approach, for posterior instrumentation. We evaluated the clinical outcome morbidity and feasibility of extrapleural retroperitoneal approach to perform anterior decompression and posterior instrumentation simultaneously by single "T" incision outcome in thoracolumbar spinal trauma and tuberculosis. Patients and Methods: Forty-eight cases of tubercular spine (n = 25 and fracture of the spine (n = 23 were included in the study of which 29 were male and 19 female. The mean age of patients was 29.1 years. All patients underwent single-stage anterior decompression, fusion, and posterior instrumentation (except two old traumatic cases via extrapleural retroperitoneal approach by single "T" incision. Tuberculosis cases were operated in lateral position as they were stabilized with Hartshill instrumentation. For traumatic spine initially posterior pedicle screw fixation was performed in prone position and then turned to right lateral position for anterior decompression by same incision and approach. They were evaluated for blood loss, duration of surgery, superficial and deep infection of incision site, flap necrosis, correction of the kyphotic deformity, and restoration of anterior and posterior vertebral body height. Results: In traumatic spine group the mean duration of surgery was 269 minutes (range 215-315 minutes including the change over time from prone to lateral position. The mean intraoperative blood loss was 918 ml (range 550-1100 ml. The preoperative mean ASIA motor, pin prick and light touch score improved from 63.3 to 74.4, 86 to 94.4 and 86 to 96 at

  17. Does the correlation between Schmorl's nodes and vertebral morphology extend into the lumbar spine?

    Science.gov (United States)

    Plomp, Kimberly; Roberts, Charlotte; Strand Vidarsdottir, Una

    2015-07-01

    Schmorl's nodes are depressions on vertebrae due to herniation of the nucleus pulposus of the intervertebral disc into the vertebral body. This study provides an extension of our previous study which analyzed the shape of the lower thoracic spine and found that vertebral morphology was associated with the presence of Schmorl's nodes. Ninety adult individuals from the late Medieval site of Fishergate House, York, and the Post-Medieval site of Coach Lane, North Shields, Tyne and Wear, England, were analysed using 2D geometric morphometrics to identify possible relationships between vertebral morphology and Schmorl's nodes at the thoraco-lumbar junction and in the lumbar spine. A significant correlation was found between vertebral shape and the presence of Schmorl's nodes in the twelfth thoracic vertebrae and the first to third lumbar vertebrae. The findings corroborate previous studies and suggest that vertebral shape may be an important factor in spinal health. It is hypothesized that the pedicle shape of affected vertebrae may not provide adequate structural support for the vertebral bodies, resulting in vertical disc herniation. © 2015 Wiley Periodicals, Inc.

  18. The correlation between vertebral wedge-shaped changes in X-ray imaging at supine and standing positions and the efficacy of operative treatment of thoracolumbar spinal fracture in the elderly.

    Science.gov (United States)

    Qian, L; Pan, J; Liu, Z D; Li, L J; Tan, J; Cheng, L M; Zeng, Z L; Jia, Y W; Li, X F; Wang, H T

    2013-12-01

    By analyzing a large number of surgical patients, we identified the roles of wedge-shaped changes in related surgeries. To illustrate the relevance of vertebral wedge-shaped changes in X-ray imaging at supine and standing positions in patients with percutaneous kyphoplasty as well as the postoperative effect. All patient data were collected from a hospital in China. Between June 2006 and May 2010, 77 surgical patients (9 men and 68 women) with wedge-shaped compression fractures were retrospectively analyzed. Patients were divided into group A (ΔWR2.5%) and group B (ΔWRvariable ratio (WR) at supine and standing positions. The intensity of back pain in different positions pre- and postoperatively was evaluated with a visual analog pain scale (VAS). The WRs in both standing and supine positions were significantly reduced by kyphoplasty in both groups A and B. In agreement with the improvement in WRs, the VAS was significantly decreased in three positions for patients in group A and in turning over and standing position for patients in group B. With respect to ΔWR changes, group B revealed significantly lower values compared with group A preoperatively (P<0.001), but there was no significant difference between groups A and B postoperatively and at 1-month follow-up (P=0.179 and P=0.558, respectively). Improvement in symptoms after kyphoplasty is better in patients with wedge-shaped changes in supine and standing positions, and the efficacy of height restoration of the spine would be better in unstable vertebrae by balloon dilatation.

  19. Is kyphoplasty better than vertebroplasty at restoring form and function after severe vertebral wedge fractures?

    Science.gov (United States)

    Landham, Priyan R; Baker-Rand, Holly L A; Gilbert, Samuel J; Pollintine, Phillip; Annesley-Williams, Deborah J; Adams, Michael A; Dolan, Patricia

    2015-04-01

    The vertebral augmentation procedures, vertebroplasty and kyphoplasty, can relieve pain and facilitate mobilization of patients with osteoporotic vertebral fractures. Kyphoplasty also aims to restore vertebral body height before cement injection and so may be advantageous for more severe fractures. The purpose of this study was to compare the ability of vertebroplasty and kyphoplasty to restore vertebral height, shape, and mechanical function after severe vertebral wedge fractures. This is a biomechanical and radiographic study using human cadaveric spines. Seventeen pairs of thoracolumbar "motion segments" from cadavers aged 70-98 years were injured, in a two-stage process involving flexion and compression, to create severe anterior wedge fractures. One of each pair underwent vertebroplasty and the other kyphoplasty. Specimens were then compressed at 1 kN for 1 hour to allow consolidation. Radiographs were taken before and after injury, after treatment, and after consolidation. At these same time points, motion segment compressive stiffness was assessed, and intervertebral disc "stress profiles" were obtained to characterize the distribution of compressive stress on the vertebral body and neural arch. On average, injury reduced anterior vertebral body height by 34%, increased its anterior wedge angle from 5.0° to 11.4°, reduced intradiscal (nucleus) pressure and motion segment stiffness by 96% and 44%, respectively, and increased neural arch load bearing by 57%. Kyphoplasty caused 97% of the anterior height loss to be regained immediately, although this reduced to 79% after consolidation. Equivalent gains after vertebroplasty were significantly lower: 59% and 47%, respectively (pconsolidation, but these mechanical effects were similar for kyphoplasty and vertebroplasty. After severe vertebral wedge fractures, vertebroplasty and kyphoplasty were equally effective in restoring mechanical function. However, kyphoplasty was better able to restore vertebral height

  20. Injuries Associated with Thoracolumbar Fractures | Montshiwa | East ...

    African Journals Online (AJOL)

    Results: A total of 32 cases had been admitted with fractures of the thoracolumbar spine over the study period. Neurologic injury was associated with a thoracolumbar fracture in two-thirds of cases. An associated non-spinal injury was found in 37.5% of cases. Most of these injuries (77%) involved the extremities. The

  1. Role of major revision spine surgery in recurrent adjacent segment osteoporotic vertebral body fracture: a case report.

    Science.gov (United States)

    Ghani, Imtiaz; Kroeber, Markus

    2012-08-01

    Case report. To report the beneficial effects of kyphoplasty, cement augmentation and extension of posterior instrumentation in a patient with recurrent adjacent segment osteoporotic vertebral body fracture. A 72-year-old lady underwent multiple revision spine surgeries for recurrent adjacent segment osteoporotic vertebral body fracture. The patient underwent four surgeries in 6 years: (1) in 2005, posterior lumbar interbody fusion with stabilization (L4-S1) was done; (2) in August 2010, implants from L4-S1 were removed and revised, transforaminal lumbar interbody fusion was done at L2/L3 and L3/L4 along with pedicle screw stabilization from T12-S1; (3) in September 2011, revision surgery was attempted, wherein a kyphoplasty was done at T12 and the stabilization was extended to T4; (4) again in October 2011, a revision surgery was attempted, wherein a kyphoplasty was done at T5 along with stabilization using pedicular screws in the T2 and T3 vertebrae and lateral mass screws in the C6 vertebra. To current date, the patient is stable with good sagittal and coronal balance and walking pain free without support. The current case demonstrates the need for posterior spinal reconstruction in osteoporotic vertebral collapse. Cement augmentation and extension of posterior instrumentation are both viable techniques that could be used to improve stabilization in the elderly spine.

  2. Automated Detection, Localization, and Classification of Traumatic Vertebral Body Fractures in the Thoracic and Lumbar Spine at CT.

    Science.gov (United States)

    Burns, Joseph E; Yao, Jianhua; Muñoz, Hector; Summers, Ronald M

    2016-01-01

    To design and validate a fully automated computer system for the detection and anatomic localization of traumatic thoracic and lumbar vertebral body fractures at computed tomography (CT). This retrospective study was HIPAA compliant. Institutional review board approval was obtained, and informed consent was waived. CT examinations in 104 patients (mean age, 34.4 years; range, 14-88 years; 32 women, 72 men), consisting of 94 examinations with positive findings for fractures (59 with vertebral body fractures) and 10 control examinations (without vertebral fractures), were performed. There were 141 thoracic and lumbar vertebral body fractures in the case set. The locations of fractures were marked and classified by a radiologist according to Denis column involvement. The CT data set was divided into training and testing subsets (37 and 67 subsets, respectively) for analysis by means of prototype software for fully automated spinal segmentation and fracture detection. Free-response receiver operating characteristic analysis was performed. Training set sensitivity for detection and localization of fractures within each vertebra was 0.82 (28 of 34 findings; 95% confidence interval [CI]: 0.68, 0.90), with a false-positive rate of 2.5 findings per patient. The sensitivity for fracture localization to the correct vertebra was 0.88 (23 of 26 findings; 95% CI: 0.72, 0.96), with a false-positive rate of 1.3. Testing set sensitivity for the detection and localization of fractures within each vertebra was 0.81 (87 of 107 findings; 95% CI: 0.75, 0.87), with a false-positive rate of 2.7. The sensitivity for fracture localization to the correct vertebra was 0.92 (55 of 60 findings; 95% CI: 0.79, 0.94), with a false-positive rate of 1.6. The most common cause of false-positive findings was nutrient foramina (106 of 272 findings [39%]). The fully automated computer system detects and anatomically localizes vertebral body fractures in the thoracic and lumbar spine on CT images with a

  3. Lumbar Disc Herniation in a Patient With Congenital Vertebral Body Anomaly: A Case Report

    Science.gov (United States)

    Atabey, Cem; Topuz, Ali Kivanc; Velioğlu, Murat; Demircan, Mehmet Nusret

    2014-01-01

    Lumbar disc herniation is characterized with low back and leg pain resulting from the degenerated lumbar disc compressing the spinal nerve root. The etiology of degenerative spine is related to age, smoking, microtrauma, obesity, disorders of familial collagen structure, occupational and sports-related physical activity. However, disc herniations induced by congenital lumbar vertebral anomalies are rarely seen. Vertebral fusion defect is one of the causes of congenital anomalies. The pathogenesis of embryological corpus vertebral fusion anomaly is not fully known. In this paper, a 30-year-old patient who had the complaints of low back and right leg pain after falling from a height is presented. She had right L5-S1 disc herniation that had developed on the basis of S1 vertebra corpus fusion anomaly in Lumbar computed tomography. This case has been discussed in the light of literature based on evaluations of Lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This case is unique in that it is the first case with development of lumbar disc herniation associated with S1 vertebral corpus fusion anomaly. Congenital malformations with unusual clinical presentation after trauma should be evaluated through advanced radiological imaging techniques. PMID:25620987

  4. Importance of mechanics and kinematics in determining the stiffness contribution of the vertebral column during body-caudal-fin swimming in fishes.

    Science.gov (United States)

    Nowroozi, Bryan N; Brainerd, Elizabeth L

    2014-02-01

    Whole-body stiffness in fishes has important consequences for swimming mode, speed and efficiency, but the contribution of vertebral column stiffness to whole-body stiffness is unclear. In our opinion, this lack of clarity is due in part to the lack of studies that have measured both in vitro mechanical properties of the vertebral column as well as in vivo vertebral kinematics in the same species. Some lack of clarity may also come from real variation in the mechanical role of the vertebral column across species. Previous studies, based on either mechanics or kinematics alone, suggest species-specific variation in vertebral column locomotor function that ranges from highly stiff regimes that contribute greatly to whole-body stiffness, and potentially act as a spring, to highly compliant regimes that only prohibit excessive flexion of the intervertebral joints. We review data collected in combined investigations of both mechanics and kinematics of three species, Myxine glutinosa, Acipenser transmontanus, and Morone saxatilis, to illustrate how mechanical testing within the context of the in vivo kinematics more clearly distinguishes the role of the vertebral column in each species. In addition, we identify species for which kinematic data are available, but mechanical data are lacking. We encourage further investigation of these species to fill these mechanical data gaps. Finally, we hope these future combined analyses will identify certain morphological, mechanical, or kinematic parameters that might be associated with certain vertebral column functional regimes with respect to body stiffness. Copyright © 2013 Elsevier GmbH. All rights reserved.

  5. A Levering Technique Using Small Parallel Rods for Open Reduction of High-Grade Thoracolumbar Dislocation

    OpenAIRE

    Hadgaonkar, Shailesh; Shah, Kunal; Khurjekar, Ketan; Krishnan, Vibhu; Shyam, Ashok; Sancheti, Parag

    2017-01-01

    Study Design: Technical report. Objective: Dorsolumbar vertebral dislocations, with or without associated fractures, occur secondary to very high velocity trauma. The reduction procedures and techniques, which may be adopted in these situations, have been multifariously discussed in the literature. Our objective was to assess the outcome of a novel reduction maneuver, using parallel rods which we have employed in reduction of high-grade thoracolumbar fractures to achieve precise sagittal bala...

  6. Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

    International Nuclear Information System (INIS)

    Jagt-Willems, H.C. van der; Munster, B.C. van; Leeflang, M.; Beuerle, E.; Tulner, C.R.; Lems, W.F.

    2014-01-01

    Highlights: • (Lateral) chest X-ray's are often performed in older individuals for various reasons. • Vertebral fractures are visualized on lateral chest X-ray, but the diagnosis of vertebral fractures is until now only validated on (lateral) spine X-ray's. • This study shows that a (lateral) chest X-ray is sufficient for the diagnosis of vertebral fractures. • Older individuals with a vertebral fracture on a (lateral) chest X-ray do not need further radiography with thoracic spine X-ray or vertebral fracture assessment with DXA. - Abstract: Background: In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine X-rays. Methods: To evaluate the agreement and intraobserver reliability of the semi-quantitative method for vertebral fractures on the lateral chest X-ray (X-chest) in comparison to the lateral thoracic spine X-ray (X-Tspine), two observers scored vertebral fractures on X-Tspine and twice on X-chest, separately, blinded and in different time periods. Agreement and Cohens’ kappa were calculated for a diagnosis of any fracture on patient level and on vertebral body level. The study was done in patients visiting an outpatient geriatric day clinic, with a high prevalence of vertebral fractures. Results: 109 patients were included. The intraobserver agreement for X-chest versus X-Tspine was 95–98% for the two levels of fracturing, with a Cohen's kappa of 0.88–0.91. The intraobserver agreement and reliability of the re-test on the X-chest showed an agreement between 91 and 98% with a Cohen's kappa of 0.81–0.93. More vertebrae were visible on the X-chest, mean 10.2, SD 0.66 versus mean 9.8, SD 0.73 on the X-Tspine (p < 0.001). Conclusion: The results show good agreement and intraobserver reliability on

  7. Proximal instrumented vertebral body chance fracture after pedicle screw instrumentation in a thoracic kyphosis patient with osteoporosis.

    Science.gov (United States)

    Hu, Xiaobang; Lieberman, Isador H

    2015-02-01

    We present a case of proximal vertebral body chance fracture after pedicle screw instrumentation and fusion in a 67-year-old woman with osteoporosis and thoracic kyphosis. To report the rare and unique complication of proximal vertebral body chance fracture after pedicle screw instrumentation and fusion in a kyphosis patient. Pedicle screw instrumentation has been associated with complications not limited to neurological or vascular injury, loss of curve correction, intraoperative pedicle fracture or loosening, dural laceration, deep infection, and pseudarthrosis. To the best of our knowledge, there are no previous reports describing a chance-type fracture generated by a pedicle screw fixation at the proximal end of a construct. A 67-year-old woman suffered from progressive thoracic kyphosis and mid thoracic pain presented 2 weeks after pedicle screw instrumentation and correction. She developed a vertebral body fracture at the proximal end of the instrumentation construct. Surgical intervention, including removal of the screws in the fractured vertebrae and extension of the instrumented fusion across the cervicothoracic junction, effectively restored the physiological sagittal alignment. Postoperatively, at 12-month follow-up, the patient is doing exceptionally well with near-complete relief of back pain and an excellent maintenance of correction. Chance fracture in osteoporotic bone at the proximal end of a construct due to a pedicle screw is a rare complication but it may result in catastrophic consequences. Early recognition of this complication, reduction of the fraction-dislocation, and an extension of the instrumentation can be utilized for realignment and long-term stabilization.

  8. CT-findings in pain syndromes originated from thoraco-lumbar junction

    International Nuclear Information System (INIS)

    Dimitrov, I.; Karadjova, M.; Malchanova, V.

    2007-01-01

    The thoraco-lumbar junction syndrome imitates, as far as clinical symptoms are concerned, low back pain, caused by disc protrusion in the lower lumbar vertebral segments. It is manifested by referred pain in the area, innervated by posterior and anterior primary rami (dorsal and ventral rami), belonging to thoraco-lumbar junction vertebral segments (Th11-L2). Eighty one patients with clinically diagnosed thoraco-lumbar junction syndrome underwent CT-investigations, that aimed establishing pathological processes, leading to this clinical symptomatology. 148 vertebral levels were examined. In 67 patients we scanned two consecutive levels to find the type of change of the zygapophyseal joints. We found facet tropism (asymmetry) in 72 patients (88.8%) or in 117 levels (79.6%), degenerated faced joints in 63 patients (77.8%), pathology of the intervertebral disc - in 33 patients (43.1%) including 5 patients (6.2%) with disc prolapse. When investigating on two subsequent segments (Th11-Th12 and Th12-L1) sudden anatomical change in orientation of facets occurred in 55 patients (82%). Our findings support the hypothesis of the facet-joint origin of this ailment. (authors)

  9. Biomechanical comparison of mono-segment transpedicular fixation with short-segment fixation for treatment of thoracolumbar fractures: a finite element analysis.

    Science.gov (United States)

    Xu, Guijun; Fu, Xin; Du, Changling; Ma, Jianxiong; Li, Zhijun; Tian, Peng; Zhang, Tao; Ma, Xinlong

    2014-10-01

    Mono-segment transpedicular fixation is a method for the treatment of certain types of thoracolumbar spinal fracture. Finite element models were constructed to evaluate the biomechanics of mono-segment transpedicular fixation of thoracolumbar fracture. Spinal motion (T10-L2) was scanned and used to establish the models. The superior half of the cortical bone of T12 was removed and the superior half of the cancellous bone of the T12 body was assigned the material properties of injured bone to mimic vertebral fracture. Transpedicular fixation of T11 and T12 was performed to produce a mono-segment fixation model; T11 and L1 were fixed to produce a short-segment fixation model. Motion differences between functional units and von Mises stress on the spine and implants were measured under axial compression, anterior bending, extensional bending, lateral bending and axial rotation. We found no significant difference between mono- and short-segment fixations in the motion of any functional unit. Stress on the T10/T11 nucleus pulposus and T10/T11 and L1/L2 annulus fibrosus increased significantly by about 75% on anterior bending, extensional bending and lateral bending. In the fracture model, stress was increased by 24% at the inferior endplate of T10 and by 43% at the superior endplate of L2. All increased stresses were reduced after fixation and lower stress was observed with mono-segment fixation. In summary, the biomechanics of mono-segment pedicle screw instrumentation was similar to that of conventional short-segment fixation. As a minimally invasive treatment, mono-segment fixation would be appropriate for the treatment of selected thoracolumbar spinal fractures. © IMechE 2014.

  10. Vertebral osteomyelitis without disc involvement

    Energy Technology Data Exchange (ETDEWEB)

    Kamani, I.; Syed, I.; Saifuddin, A. E-mail: asaifuddin@aol.com; Green, R.; MacSweeney, F

    2004-10-01

    Vertebral osteomyelitis is most commonly due to pyogenic or granulomatous infection and typically results in the combined involvement of the intervertebral disc and adjacent vertebral bodies. Non-infective causes include the related conditions of chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Occasionally, these conditions may present purely within the vertebral body, resulting in various combinations of vertebral marrow oedema and sclerosis, destructive lesions of the vertebral body and pathological vertebral collapse, thus mimicking neoplastic disease. This review illustrates the imaging features of vertebral osteomyelitis without disc involvement, with emphasis on magnetic resonance imaging (MRI) findings.

  11. Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

    International Nuclear Information System (INIS)

    Knirsch, Walter; Kurtz, Claudia; Langer, Mathias; Haeffner, Nicole; Kececioglu, Deniz

    2005-01-01

    The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

  12. Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Knirsch, Walter [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany); University Children' s Hospital Zurich, Division of Paediatric Cardiology, Zurich (Switzerland); Kurtz, Claudia; Langer, Mathias [University Hospital Freiburg, Department of Radiology, Freiburg (Germany); Haeffner, Nicole; Kececioglu, Deniz [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany)

    2005-04-01

    The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

  13. Development of a multi-scale finite element model of the osteoporotic lumbar vertebral body for the investigation of apparent level vertebra mechanics and micro-level trabecular mechanics.

    Science.gov (United States)

    McDonald, K; Little, J; Pearcy, M; Adam, C

    2010-07-01

    Osteoporotic spinal fractures are a major concern in ageing Western societies. This study develops a multi-scale finite element (FE) model of the osteoporotic lumbar vertebral body to study the mechanics of vertebral compression fracture at both the apparent (whole vertebral body) and micro-structural (internal trabecular bone core) levels. Model predictions were verified against experimental data, and found to provide a reasonably good representation of the mechanics of the osteoporotic vertebral body. This novel modelling methodology will allow detailed investigation of how trabecular bone loss in osteoporosis affects vertebral stiffness and strength in the lumbar spine. Copyright 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

  14. Volume of Lytic Vertebral Body Metastatic Disease Quantified Using Computed Tomography–Based Image Segmentation Predicts Fracture Risk After Spine Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Thibault, Isabelle [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Centre Hospitalier de L' Universite de Québec–Université Laval, Quebec, Quebec (Canada); Whyne, Cari M. [Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Department of Surgery, University of Toronto, Toronto, Ontario (Canada); Zhou, Stephanie; Campbell, Mikki [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Atenafu, Eshetu G. [Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario (Canada); Myrehaug, Sten; Soliman, Hany; Lee, Young K. [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Ebrahimi, Hamid [Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Department of Surgery, University of Toronto, Toronto, Ontario (Canada); Yee, Albert J.M. [Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)

    2017-01-01

    Purpose: To determine a threshold of vertebral body (VB) osteolytic or osteoblastic tumor involvement that would predict vertebral compression fracture (VCF) risk after stereotactic body radiation therapy (SBRT), using volumetric image-segmentation software. Methods and Materials: A computational semiautomated skeletal metastasis segmentation process refined in our laboratory was applied to the pretreatment planning CT scan of 100 vertebral segments in 55 patients treated with spine SBRT. Each VB was segmented and the percentage of lytic and/or blastic disease by volume determined. Results: The cumulative incidence of VCF at 3 and 12 months was 14.1% and 17.3%, respectively. The median follow-up was 7.3 months (range, 0.6-67.6 months). In all, 56% of segments were determined lytic, 23% blastic, and 21% mixed, according to clinical radiologic determination. Within these 3 clinical cohorts, the segmentation-determined mean percentages of lytic and blastic tumor were 8.9% and 6.0%, 0.2% and 26.9%, and 3.4% and 15.8% by volume, respectively. On the basis of the entire cohort (n=100), a significant association was observed for the osteolytic percentage measures and the occurrence of VCF (P<.001) but not for the osteoblastic measures. The most significant lytic disease threshold was observed at ≥11.6% (odds ratio 37.4, 95% confidence interval 9.4-148.9). On multivariable analysis, ≥11.6% lytic disease (P<.001), baseline VCF (P<.001), and SBRT with ≥20 Gy per fraction (P=.014) were predictive. Conclusions: Pretreatment lytic VB disease volumetric measures, independent of the blastic component, predict for SBRT-induced VCF. Larger-scale trials evaluating our software are planned to validate the results.

  15. Walking Out of the Curve: Thoracolumbar Kyphosis in Achondroplasia.

    Science.gov (United States)

    Margalit, Adam; McKean, Greg; Lawing, Cheryl; Galey, Scott; Ain, Michael C

    2016-09-15

    Thoracolumbar kyphosis (TLK) is common in infants with achondroplasia. Our goals were to examine the natural history of TLK and identify factors associated with persistent TLK. We reviewed records of patients with achondroplasia seen by a board-certified orthopaedic surgeon at a tertiary care medical center between 1997 and 2013. Inclusion criteria were minimum 2-year follow-up and radiographs taken at time of presentation, within 6 months of walking age, and within 6 months of the first anniversary of walking age. We defined TLK as kyphosis of ≥20 degrees centered at T12 and L1. We assessed patient demographic characteristics, radiographic parameters (Cobb angle, apical vertebral translation, and apical vertebral wedging for vertebral height and width), and clinical parameters (developmental motor delay, hydrocephalus, presence of a ventriculoperitoneal shunt, and foramen magnum decompression). Developmental motor delay was defined as the inability to sit or ambulate independently by age 14 or 30 months, respectively. Associations between these factors and persistent TLK (ie, unresolved at final follow-up) were evaluated using logistic regression and χ, Fisher exact, and independent t tests. Significance was set at Pachondroplasia, TLK resolved at walking age in 15% of patients and after a year of walking in 58% of patients. Earlier bracing may slow TLK progression in patients with achondroplasia and developmental motor delay. Patients with kyphotic curves between 20 and 40 degrees should be examined intermittently for progressive deformity or worsening symptoms of spinal cord compression. Level II.

  16. Microscale Material Properties of Bone and the Mineralized Tissues of the Intervertebral Disc-Vertebral Body Interface

    Science.gov (United States)

    Paietta, Rachel C.

    The objective of this dissertation is to understand the influences of material structure on the properties, function and failure of biological connective tissues. Biological interfaces are becoming an increasingly studied system within mechanics and tissue engineering as a model for attaching dissimilar materials. The elastic modulus of bone (≈ 20 GPa) and cartilage (≈ 0.1-1 MPa) differ over orders of magnitude, which should intuitively create high stress concentrations and failure at the interface. Yet, these natural interface systems rarely fail in vivo, and the mechanism by which loads are transferred between tissues has not yet been established. Tissue quality is one major contributor to the mechanical behavior of bone and cartilage, and is defined by properties such as collagen orientation, mineral volume fraction, porosity and tissue geometry. These properties have yet to be established at the bone-cartilage interface in the spine, and the lack of quantitative data on material microstructure and behavior limits treatments and tissue engineering construct design. In this dissertation, second harmonic generation imaging, quantitative backscattered scanning electron imaging and nanoindentation are combined to characterize micrometer scale tissue quality and modulus in both bone and calcified cartilage. These techniques are utilized to: 1) determine the hierarchical micrometer to millimeter scale properties of lamellar bone, 2) quantify changes throughout development and aging at the human intervertebral disc-vertebral body junction, and 3) explore compressive fractures at this interface. This work is the first to provide quantitative data on the mineral volume fraction, collagen orientation and modulus from the same, undecalcified sections of tissue to corroborate tissue structure and mineralization and describe quantitative parameters of the interface. The principal findings from this work indicate that the underlying matrix, or collagen, organization in

  17. A fully automated level-set based segmentation method of thoracic and lumbar vertebral bodies in Computed Tomography images.

    Science.gov (United States)

    Ruiz-España, Silvia; Díaz-Parra, Antonio; Arana, Estanislao; Moratal, David

    2015-01-01

    Spine is a structure commonly involved in several diseases. Identification and segmentation of the vertebral structures are of relevance to many medical applications related to the spine such as diagnosis, therapy or surgical intervention. However, the development of automatic and reliable methods are an unmet need. This work presents a fully automatic segmentation method of thoracic and lumbar vertebral bodies from Computed Tomography images. The procedure can be divided into four main stages: firstly, seed points were detected in the spinal canal in order to generate initial contours in the segmentation process, automating the whole process. Secondly, a processing step is performed to improve image quality. Third step was to carry out the segmentation using the Selective Binary Gaussian Filtering Regularized Level Set method and, finally, two morphological operations were applied in order to refine the segmentation result. The method was tested in clinical data coming from 10 trauma patients. To evaluate the result the average value of the DICE coefficient was calculated, obtaining a 90.86 ± 1.87% in the whole spine (thoracic and lumbar regions), a 86.08 ± 1.73% in the thoracic region and a 95,61 ±2,25% in the lumbar region. The results are highly competitive when compared to the results obtained in previous methods, especially for the lumbar region.

  18. A Levering Technique Using Small Parallel Rods for Open Reduction of High-Grade Thoracolumbar Dislocation.

    Science.gov (United States)

    Hadgaonkar, Shailesh; Shah, Kunal; Khurjekar, Ketan; Krishnan, Vibhu; Shyam, Ashok; Sancheti, Parag

    2017-06-01

    Technical report. Dorsolumbar vertebral dislocations, with or without associated fractures, occur secondary to very high velocity trauma. The reduction procedures and techniques, which may be adopted in these situations, have been multifariously discussed in the literature. Our objective was to assess the outcome of a novel reduction maneuver, using parallel rods which we have employed in reduction of high-grade thoracolumbar fractures to achieve precise sagittal balance as well as accurate vertebral alignment with minimal soft tissue damage. The study included a total of 11 cases of thoracolumbar dislocations, who had presented to our emergency spine services following high-velocity trauma. After appropriate systemic stabilization and necessary investigations, all patients were surgically treated using the described technique. There were no surgical complications at 2-year follow-up. Radiographs showed good reduction and maintained sagittal balance. We believe that this technique is an excellent means of achieving safer, easier, and accurate reduction for restoration of sagittal/coronal balance and alignment in high-grade thoracolumbar dislocations. It is easily reproducible and predictable.

  19. Direct medical costs of traumatic thoracolumbar spine fractures.

    NARCIS (Netherlands)

    van der Roer, N.; de Bruyne, M.C.; Bakker, F.C.; van Tulder, M.; Boers, M.

    2005-01-01

    Background: The costs and cost-effectiveness of treatment of thoracolumbar fractures are poorly known. Methods: We estimated the costs of hospital care and outpatient visits for patients with traumatic thoracolumbar spine fractures. Results: Stable fractures without neurological deficits were

  20. Direct medical costs of traumatic thoracolumbar spine fractures

    NARCIS (Netherlands)

    van der Roer, N.; de Bruyne, M.C.; Bakker, F.C.; van Tulder, M.; Boers, M.

    2005-01-01

    Background: The costs and cost-effectiveness of treatment of thoracolumbar fractures are poorly known. Methods: We estimated the costs of hospital care and outpatient visits for patients with traumatic thoracolumbar spine fractures. Results: Stable fractures without neurological deficits were

  1. Value of polydirectional tomography in the assessment of the postoperative spine after anterior decompression and vertebral body autografting

    Energy Technology Data Exchange (ETDEWEB)

    Karasick, D.; Huettl, E.A.; Cotler, J.M. (Jefferson Medical Coll., Philadelphia, PA (United States) Thomas Jefferson Univ. Hospital, Philadelphia, PA (United States))

    1992-08-01

    With the growing number of orthopedic reconstructive spinal procedure, the use of bone grafting has steadily increased in the past decade. An understanding of the biology of bone grafting is essential for both the clinician and radiologist. Despite the advent of computed tomography and magnetic resonance imaging, conventional polydirectional tomography remains an important tool in the evaluation of vertebral body autografs. Trispiral or hypocycloidal tomography plays a valuable role in the assessment of bone graft fusion and possible complications, especially in the presence of metallic fixation devices. We present our imaging experient derived from 375 patients with cervical, thoracic, or lumbar anterior spinal fusion. True graft complications occurred in 27 patients (7%) and consisted of fracture (4%), malpositioning (3%), and infection (< 1%). (orig.).

  2. Clinical characterization of thoracolumbar and lumbar intervertebral disk extrusions in English Cocker Spaniels.

    Science.gov (United States)

    Cardy, Thomas J A; Tzounos, Caitlin E; Volk, Holger A; De Decker, Steven

    2016-02-15

    To assess the anatomic distribution of thoracolumbar and lumbar intervertebral disk extrusions (IVDEs) in English Cocker Spaniels as compared with findings in Dachshunds and to characterize clinical findings in English Cocker Spaniels with thoracolumbar or lumbar IVDEs affecting various regions of the vertebral column. Retrospective observational study. 81 English Cocker Spaniels and 81 Dachshunds with IVDEs. Signalment, clinical signs, neurologic examination findings, and affected intervertebral disk spaces (IVDSs) were recorded for both breeds. Management methods and outcomes were recorded for English Cocker Spaniels. Lesions were categorized as thoracolumbar (IVDSs T9-10 through L1-2), midlumbar (L2-3 through L4-5), or caudal lumbar (L5-6 through L7-S1). Midlumbar and caudal lumbar IVDEs were significantly more common in English Cocker Spaniels than in Dachshunds. English Cocker Spaniels with caudal lumbar IVDEs had a longer median duration of clinical signs before evaluation and more commonly had unilateral pelvic limb lameness or spinal hyperesthesia as the predominant clinical sign than did those with IVDEs at other sites. Those with caudal lumbar IVDEs less commonly had neurologic deficits and had a higher median neurologic grade (indicating lesser severity), shorter mean postoperative hospitalization time, and faster mean time to ambulation after surgery than those with other sites affected. These variables did not differ between English Cocker Spaniels with thoracolumbar and midlumbar IVDEs. Caudal and midlumbar IVDEs were more common in English Cocker Spaniels than in Dachshunds. English Cocker Spaniels with caudal lumbar IVDE had clinical signs and posttreatment responses that differed from those in dogs with midlumbar or thoracolumbar IVDE.

  3. Spread of dye after single thoracolumbar paravertebral injection in infants. A cadaveric study.

    Science.gov (United States)

    Albokrinov, Andrew A; Fesenko, Ulbolgan A

    2014-06-01

    Thoracolumbar paravertebral block (PVB) is one method of providing regional anaesthesia for abdominal wall surgery in children. It is common practice when performing a PVB for abdominal wall anaesthesia to inject a certain volume of local anaesthetic solution in the paravertebral space at several levels. This increases the duration of the procedure and makes it more invasive. To determine the character of dye spread in infants' paravertebral space, to check the feasibility of single injection PVB and to determine the optimal volume of injectate necessary to cover the paravertebral segments responsible for sensation of the lower abdomen. Experimental study. Single centre, University Hospital, April 2013 to August 2013. Twenty infant cadavers. Ultrasound-guided, single thoracolumbar paravertebral injections were performed on infant cadavers. The total number of paravertebral segments stained after dye injection and specific vertebral levels of cephalad and caudad spread of dye in the paravertebral space. Dye was present in the paravertebral spaces of all cadavers. Spread of dye within the paravertebral space was different depending on dye volume. Strong correlation was found between the volume of injectate and the number of paravertebral segments involved. The number of spinal nerve roots surrounded with dye corresponded with the number of paravertebral segments involved. T11, T12 and L1 nerve roots were stained in all cadavers. The optimal injectate volume to involve T10-L1 segments was defined as 0.2 to 0.3  ml  kg(-1). Single thoracolumbar paravertebral injection at T12-L1 level leads to caudad and cephalad spread of injectate in a dose-dependent manner. Single injection thoracolumbar paravertebral injections could be performed for lower abdomen anaesthesia in infants. We suggest that a single injection of 0.2 to 0.3  ml  kg(-1) of local anaesthetic in the thoracolumbar paravertebral space could provide adequate coverage of the dermatomes of the lower

  4. A Novel Anterior Transpedicular Screw Artificial Vertebral Body System for Lower Cervical Spine Fixation: A Finite Element Study.

    Science.gov (United States)

    Wu, Weidong; Chen, Chun; Ning, Jinpei; Sun, Peidong; Zhang, Jinyuan; Wu, Changfu; Bi, Zhenyu; Fan, Jihong; Lai, Xianliang; Ouyang, Jun

    2017-06-01

    A finite element model was used to compare the biomechanical properties of a novel anterior transpedicular screw artificial vertebral body system (AVBS) with a conventional anterior screw plate system (ASPS) for fixation in the lower cervical spine. A model of the intact cervical spine (C3-C7) was established. AVBS or ASPS constructs were implanted between C4 and C6. The models were loaded in three-dimensional (3D) motion. The Von Mises stress distribution in the internal fixators was evaluated, as well as the range of motion (ROM) and facet joint force. The models were generated and analyzed by mimics, geomagic studio, and ansys software. The intact model of the lower cervical spine consisted of 286,382 elements. The model was validated against previously reported cadaveric experimental data. In the ASPS model, stress was concentrated at the connection between the screw and plate and the connection between the titanium mesh and adjacent vertebral body. In the AVBS model, stress was evenly distributed. Compared to the intact cervical spine model, the ROM of the whole specimen after fixation with both constructs is decreased by approximately 3 deg. ROM of adjacent segments is increased by approximately 5 deg. Facet joint force of the ASPS and AVBS models was higher than those of the intact cervical spine model, especially in extension and lateral bending. AVBS fixation represents a novel reconstruction approach for the lower cervical spine. AVBS provides better stability and lower risk for internal fixator failure compared with traditional ASPS fixation.

  5. Vertebral Compression Fracture After Spine Stereotactic Body Radiation Therapy: A Review of the Pathophysiology and Risk Factors.

    Science.gov (United States)

    Faruqi, Salman; Tseng, Chia-Lin; Whyne, Cari; Alghamdi, Majed; Wilson, Jefferson; Myrehaug, Sten; Soliman, Hany; Lee, Young; Maralani, Pejman; Yang, Victor; Fisher, Charles; Sahgal, Arjun

    2017-10-18

    Vertebral compression fracture (VCF) is a challenging and not infrequent complication observed following spine stereotactic body radiation therapy (SBRT). To summarize the data from the multiple studies that have been published, addressing the risk and predictive factors for VCF post-SBRT. A systematic literature review was conducted. Studies were selected if they specifically addressed risk factors for post-SBRT VCF in their analyses. A total of 11 studies were identified, reporting both the risk of VCF post-SBRT and an analysis of risk factors based on univariate and multivariate analysis. A total of 2911 spinal segments were treated with a crude VCF rate of 13.9%. The most frequently identified risk factors on multivariate analysis were: lytic disease (hazard ratio [HR] range, 2.76-12.2), baseline VCF prior to SBRT (HR range, 1.69-9.25), higher dose per fraction SBRT (HR range, 5.03-6.82), spinal deformity (HR range, 2.99-11.1), older age (HR range, 2.15-5.67), and more than 40% to 50% of vertebral body involved by tumor (HR range, 3.9-4.46). In the 9 studies that specifically reported on the use of post-SBRT surgical procedures, 37% of VCF had undergone an intervention (range, 11%-60%). VCF is an important adverse effect following SBRT. Risk factors have been identified to guide the selection of high-risk patients. Evidence-based algorithms with respect to patient selection and intervention are needed. Copyright © 2017 by the Congress of Neurological Surgeons

  6. Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

    NARCIS (Netherlands)

    van der Jagt-Willems, H. C.; van Munster, B. C.; Leeflang, M.; Beuerle, E.; Tulner, C. R.; Lems, W. F.

    2014-01-01

    Background: In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine

  7. Vertebral lesion distribution in multiple myeloma - assessed by reduced-dose whole-body MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Bier, Georg; Kloth, Christopher; Schabel, Christoph; Bongers, Malte; Nikolaou, Konstantin; Horger, Marius [Eberhard-Karls-University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2016-01-15

    To observe the distribution and potential distribution patterns of osteolytic and sclerotic vertebral involvement in a representative collective of multiple myeloma patients. A total of 66 consecutive patients with a diagnosis of multiple myeloma at initial diagnosis or during follow-up were examined by multidetector reduced-dose computed tomography to evaluate the distribution of bone lesions along the spine with focus on size, location, and lesion character. Confirmation of diagnosis was performed by comparison to follow-up computed tomography or magnetic resonance tomography. If >50 % of all detected malignant lesions occurred in one spinal segment, the distribution pattern was called cervical, thoracic, lumbar, or sacral, otherwise a ''mixed'' pattern was classified. Of a total number of 933 osseous spine lesions, 632 (67.7 %) were classified as malignant (98.9 % of them osteolytic) and 293 (31.5 %) as benign. The distribution pattern analysis yielded two patients (3.8 %) with a cervical, 26 (50 %) with a thoracic, 4 (7.7 %) with a lumbar, one (1.9 %) with a sacral pattern, and 19 cases (36.6 %) showed a mixed distribution pattern. Segment-wise, the mean lesion size was 6.52 ± 2.76 mm (cervical), 8.97 ± 5.43 mm (thoracic), 11.97 ± 7.11 mm (lumbar), and 17.5 ± 16.465 (sacral), whilst, related to the vertebra size, the lesion/vertebra size ratio is decreasing through the whole spine beginning from the top. Multiple myeloma bone lesions occur preferably and are larger in the thoracic and lumbar spine. Moreover, a specific distribution pattern is present in about 60 %. (orig.)

  8. Genetic factors are associated with modic changes in endplates of lumbar vertebral bodies.

    Science.gov (United States)

    Karppinen, Jaro; Daavittila, Iita; Solovieva, Svetlana; Kuisma, Mari; Taimela, Simo; Natri, Antero; Haapea, Marianne; Korpelainen, Raija; Niinimäki, Jaakko; Tervonen, Osmo; Ala-Kokko, Leena; Männikkö, Minna

    2008-05-15

    A cross-sectional genotype-phenotype evaluation. To evaluate the genetic background to Modic changes in an occupational cohort. Modic changes are vertebral endplate changes visible in magnetic resonance imaging. Twin studies suggest that intervertebral disc degeneration may be primarily explained by genetic factors, but no data exist on genetic factors of Modic changes. Thirteen variations in 8 genes (COL9A2, COL9A3, COL11A2, IL1A, IL1B, IL6, MMP3, and VDR) were genotyped in an occupational cohort of 159 male train engineers and 69 male paper mill workers. All the subjects were scanned by magnetic resonance imaging and evaluated for Modic changes. Out of the 228 subjects, 128 (56%) were found to have Modic changes at one or more disc levels, exclusively of type I in 15%, of type II in 32%, and of both type I and type II in 10%. None of the single nucleotide polymorphisms was significantly associated with Modic changes when analyzed independently, but when gene-gene interactions were evaluated, interleukin-1A (IL1A) and matrix metalloproteinase-3 (MMP3) polymorphisms together were associated with type II Modic changes (OR = 3.2, 95% CI = 1.2-8.5; P = 0.038), as was the IL1 gene cluster together with the MMP3 polymorphism (OR = 8.14, 95% CI = 1.72-38.44; P = 0.008). This is the first study evaluating the role of genetic factors in relation to Modic changes. Genetic variations in the IL1 cluster and the MMP3 gene together were found to be significantly associated with type II Modic changes.

  9. Osteoporotic vertebral fracture simulating a spinal tumor: a case report

    Directory of Open Access Journals (Sweden)

    Moscote-Salazar Luis Rafael

    2015-06-01

    Full Text Available Vertebral fractures are a frequent entity, mainly in the thoracolumbar and lumbar spine. In some circumstances the differential diagnosis of vertebral injuries can confuse the physician, since the difference between an osteoporotic vertebral fracture and a fracture secondary to a tumor is not clear. We report the case of a patient with osteoporotic vertebral fracture simulating a spinal tumor, handled by our department of neurosurgery as illustrative experience to guide the approach in those cases, in which the definitive diagnosis is crucial for therapeutic decision making

  10. Combined posteroanterior fusion versus transforaminal lumbar interbody fusion (TLIF) in thoracolumbar burst fractures.

    Science.gov (United States)

    Schmid, Rene; Lindtner, Richard Andreas; Lill, Markus; Blauth, Michael; Krappinger, Dietmar; Kammerlander, Christian

    2012-04-01

    The optimal treatment strategy for burst fractures of the thoracolumbar junction is discussed controversially in the literature. Whilst 360° fusion has shown to result in better radiological outcome, recent studies have failed to show its superiority concerning clinical outcome. The morbidity associated with the additional anterior approach may account for these findings. The aim of this prospective observational study was therefore to compare two different techniques for 360° fusion in thoracolumbar burst fractures using either thoracoscopy or a transforaminal approach (transforaminal lumbar interbody fusion (TLIF)) to support the anterior column. Posterior reduction and short-segmental fixation using angular stable pedicle screw systems were performed in all patients as a first step. Monocortical strut grafts were used for the anterior support in the TLIF group, whilst tricortical grafts or titanium vertebral body replacing implants of adjustable height were used in the combined posteroanterior group. At final follow-up, the radiological outcome was assessed by performing X-rays in a standing position. The clinical outcome was measured using five validated outcome scores. The morbidity associated with the approaches and the donor site was assessed as well. There were 21 patients in the TLIF group and 14 patients in the posteroanterior group included. The postoperative loss of correction was higher in the TLIF group (4.9°±8.3° versus 3.4°±6.4°, p>0.05). There were no significant differences regarding the outcome scores between the two groups. There were no differences in terms of return to employment, leisure activities and back function either. More patients suffered from donor-site morbidity in the TLIF group, whilst the morbidity associated with the surgical approach was higher in the posteroanterior group. The smaller donor-site morbidity in the posteroanterior group is counterbalanced by an additional morbidity associated with the anterior approach

  11. Morphometric analysis of the relationships between intervertebral disc and vertebral body heights: an anatomical and radiographic study of the human thoracic spine

    Science.gov (United States)

    Kunkel, Maria E; Herkommer, Andrea; Reinehr, Michael; Böckers, Tobias M; Wilke, Hans-Joachim

    2011-01-01

    The main aim of this study was to provide anatomical data on the heights of the human intervertebral discs for all levels of the thoracic spine by direct and radiographic measurements. Additionally, the heights of the neighboring vertebral bodies were measured, and the prediction of the disc heights based only on the size of the vertebral bodies was investigated. The anterior (ADH), middle (MDH) and posterior heights (PDH) of the discs were measured directly and on radiographs of 72 spine segments from 30 donors (age 57.43 ± 11.27 years). The radiographic measurement error and the reliability of the measurements were calculated. Linear and non-linear regression analyses were employed for investigation of statistical correlations between the heights of the thoracic disc and vertebrae. Radiographic measurements displayed lower repeatability and were shorter than the anatomical ones (approximately 9% for ADH and 37% for PDH). The thickness of the discs varied from 4.5 to 7.2 mm, with the MDH approximately 22.7% greater. The disc heights showed good correlations with the vertebral body heights (R2, 0.659–0.835, P-values vertebral body height posterior. For the creation of parameterized models of the human thoracic discs, the use of the prediction equations could eliminate the need for direct measurement on intervertebral discs. Moreover, the error produced by radiographic measurements could be reduced at least for the PDH. PMID:21615399

  12. Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3-4 fixation.

    Science.gov (United States)

    Kwon, Yoon-Kwang; Jang, Ju-Hee; Lee, Choon-Dae; Lee, Sang-Ho

    2014-06-01

    Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3-4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3-4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3-4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3-4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.

  13. UV radiation impacts body weight, oxygen consumption, and shelter selection in the intertidal vertebrate Girella laevifrons.

    Science.gov (United States)

    Pulgar, José; Waldisperg, Melany; Galbán-Malagón, Cristóbal; Maturana, Diego; Pulgar, Victor M; Aldana, Marcela

    2017-02-01

    The amount of ultraviolet (UV) radiation reaching the earth's surface has increased due to ozone layer depletion, and this fact represents an opportunity to evaluate the physiological and behavioral responses of animals to this global-scale stressor. The transitory fish Girella laevifrons inhabits pools in the upper intertidal zone, which is characterized by exposure to a wide range of stressors, including UV radiation. We documented the field magnitude and the impact of UV radiation on oxygen consumption, body mass variations, and shelter (rocky and algae) selection by G. laevifrons. UV-exposed animals showed increased oxygen consumption, slower body weight increase, and active rocky shelter selection. Control fish showed increased body weight and no evident shelter selection. The results indicated that UV exposure affects fish energetic balance and habitat selection to favor greater protection against radiation. Increased UV exposure in transitory intertidal animals at levels observed in upper intertidal pools may alter the residency time of fish before leaving for the subtidal zone. Therefore, UV-induced energetic changes may determine animal performance and ontogenetic physiological itineraries, whereas shelter quality might determine habitat use. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Fully Automatic Localization and Segmentation of 3D Vertebral Bodies from CT/MR Images via a Learning-Based Method.

    Directory of Open Access Journals (Sweden)

    Chengwen Chu

    Full Text Available In this paper, we address the problems of fully automatic localization and segmentation of 3D vertebral bodies from CT/MR images. We propose a learning-based, unified random forest regression and classification framework to tackle these two problems. More specifically, in the first stage, the localization of 3D vertebral bodies is solved with random forest regression where we aggregate the votes from a set of randomly sampled image patches to get a probability map of the center of a target vertebral body in a given image. The resultant probability map is then further regularized by Hidden Markov Model (HMM to eliminate potential ambiguity caused by the neighboring vertebral bodies. The output from the first stage allows us to define a region of interest (ROI for the segmentation step, where we use random forest classification to estimate the likelihood of a voxel in the ROI being foreground or background. The estimated likelihood is combined with the prior probability, which is learned from a set of training data, to get the posterior probability of the voxel. The segmentation of the target vertebral body is then done by a binary thresholding of the estimated probability. We evaluated the present approach on two openly available datasets: 1 3D T2-weighted spine MR images from 23 patients and 2 3D spine CT images from 10 patients. Taking manual segmentation as the ground truth (each MR image contains at least 7 vertebral bodies from T11 to L5 and each CT image contains 5 vertebral bodies from L1 to L5, we evaluated the present approach with leave-one-out experiments. Specifically, for the T2-weighted MR images, we achieved for localization a mean error of 1.6 mm, and for segmentation a mean Dice metric of 88.7% and a mean surface distance of 1.5 mm, respectively. For the CT images we achieved for localization a mean error of 1.9 mm, and for segmentation a mean Dice metric of 91.0% and a mean surface distance of 0.9 mm, respectively.

  15. Fully Automatic Localization and Segmentation of 3D Vertebral Bodies from CT/MR Images via a Learning-Based Method.

    Science.gov (United States)

    Chu, Chengwen; Belavý, Daniel L; Armbrecht, Gabriele; Bansmann, Martin; Felsenberg, Dieter; Zheng, Guoyan

    2015-01-01

    In this paper, we address the problems of fully automatic localization and segmentation of 3D vertebral bodies from CT/MR images. We propose a learning-based, unified random forest regression and classification framework to tackle these two problems. More specifically, in the first stage, the localization of 3D vertebral bodies is solved with random forest regression where we aggregate the votes from a set of randomly sampled image patches to get a probability map of the center of a target vertebral body in a given image. The resultant probability map is then further regularized by Hidden Markov Model (HMM) to eliminate potential ambiguity caused by the neighboring vertebral bodies. The output from the first stage allows us to define a region of interest (ROI) for the segmentation step, where we use random forest classification to estimate the likelihood of a voxel in the ROI being foreground or background. The estimated likelihood is combined with the prior probability, which is learned from a set of training data, to get the posterior probability of the voxel. The segmentation of the target vertebral body is then done by a binary thresholding of the estimated probability. We evaluated the present approach on two openly available datasets: 1) 3D T2-weighted spine MR images from 23 patients and 2) 3D spine CT images from 10 patients. Taking manual segmentation as the ground truth (each MR image contains at least 7 vertebral bodies from T11 to L5 and each CT image contains 5 vertebral bodies from L1 to L5), we evaluated the present approach with leave-one-out experiments. Specifically, for the T2-weighted MR images, we achieved for localization a mean error of 1.6 mm, and for segmentation a mean Dice metric of 88.7% and a mean surface distance of 1.5 mm, respectively. For the CT images we achieved for localization a mean error of 1.9 mm, and for segmentation a mean Dice metric of 91.0% and a mean surface distance of 0.9 mm, respectively.

  16. 6-Year follow-up of ventral monosegmental spondylodesis of incomplete burst fractures of the thoracolumbar spine using three cortical iliac crest bone grafts.

    Science.gov (United States)

    Spiegl, Ulrich; Hauck, Stefan; Merkel, Patricia; Bühren, Volker; Gonschorek, Oliver

    2012-10-01

    Autologous bone graft is the gold standard for vertebral body replacement. Currently, after modern implants for vertebral body replacement are available, controversies exist regarding the optimal implant strategy. Between 2002 and 2003, 17 patients were included in this study, all suffering from incomplete burst fractures of the thoracolumbar spine. All of them were treated by ventral monosegmental spondylodesis using iliac crest bone graft. The individual treatment strategy depended on the fracture situation and patient's condition. After an average of 74 months (range 66-84) a clinical and computer tomographic follow-up examination was performed in 14 patients (average age, 35.2 years) including VAS spine score and SF 36 score. Nine patients were treated ventral only five patients dorsoventrally. Complete osseous consolidation was visible in nine, partial consolidation (>30 %) in four, and lysis in one patient, without any significant differences between ventral only or dorsoventral approach. After removal of the fixateur interne the level of consolidation improved in all patients, treated dorsoventrally. There was no significant correlation between percentage of osseous consolidation and the clinical follow-up parameters. After 6 years, 71 % of the patients suffered from persistent pain associated with the approach to the iliac crest. Two revision surgeries have been necessary. High rates of osseous consolidation are visible 6 years after ventral spondylodesis by iliac crest bone grafts. A further improvement of consolidation can be expected after dorsal implant removal. But the surgical approach to the iliac crest is accompanied with a relevant complication rate.

  17. Effect of Ex Vivo Ionizing Radiation on Static and Fatigue Properties of Mouse Vertebral Bodies

    Science.gov (United States)

    Emerzian, Shannon R.; Pendleton, Megan M.; Li, Alfred; Liu, Jennifer W.; Alwood, Joshua S.; O’Connell, Grace D.; Keaveny, Tony M.

    2018-01-01

    For a variety of medical and scientific reasons, human bones can be exposed to a wide range of ionizing radiation levels. In vivo radiation therapy (0.05 kGy) is used in cancer treatment, and ex vivo irradiation (25-35 kGy) is used to sterilize bone allografts. Ionizing radiation in these applications has been shown to increase risk of fracture, decrease bone quality and degrade collagen integrity. Past studies have investigated the deleterious effects of radiation on cortical or trabecular bone specimens individually, but to date no studies have examined whole bones containing both cortical and trabecular tissue. Furthermore, a clear relationship between the dose and the mechanical and biochemical response of bone's extracellular matrix has yet to be established for doses ranging from cancer therapy to allograft sterilization (0.05-35 kGy). To gain insight into these issues, we conducted an ex vivo radiation study to investigate non-cellular (i.e. matrix) effects of ionizing radiation dose on vertebral whole bone mechanical properties, over a range of radiation doses (0.05-35 kGy), with a focus on any radiation-induced changes in collagen. With underlying mechanisms of action in mind, we hypothesized that any induced reductions in mechanical properties would be associated with changes in collagen integrity. METHODS: 20-week old female mice were euthanized and the lumbar spine was dissected using IACUC approved protocols. The lumbar vertebrae (L1- S1) were extracted from the spine via cuts through adjacent intervertebral discs, and the endplates, posterior processes, surrounding musculature, and soft tissues were removed (approx. 1.5mm diameter, approx. 2mm height). Specimens were randomly assigned to one of five groups for ex vivo radiation exposure: x-ray irradiation at 0.05, 1, 17, or 35 kGy, or a 0 kGy control. Following irradiation, the vertebrae were imaged using microcomputed tomography (micro-CT) and then subjected to either monotonic compressive loading to

  18. Radiographic damage and progression of the cervical spine in ankylosing spondylitis patients treated with TNF-α inhibitors: Facet joints vs. vertebral bodies.

    Science.gov (United States)

    Maas, Fiona; Spoorenberg, Anneke; Brouwer, Elisabeth; van der Veer, Eveline; Bootsma, Hendrika; Bos, Reinhard; Wink, Freke R; Arends, Suzanne

    2017-04-01

    To investigate radiographic damage and 4-year progression of the cervical facet joints in a prospective observational cohort of AS patients treated with TNF-α inhibitors, to compare this with damage and progression of the cervical vertebral bodies, and to study the relation with patient characteristics and clinical outcome. Patients from the Groningen Leeuwarden AS (GLAS) cohort starting TNF-α inhibitors with baseline and 4-year radiographs were included. Cervical facet joints and vertebral bodies were scored by two independent readers according to the method of de Vlam and mSASSS, respectively. At baseline, 25 of 99 (25%) AS patients had partial or complete ankylosis of the cervical facet joints, whereas 51 (52%) patients had non-bridging or bridging syndesmophytes of cervical vertebral bodies. During 4 years, 13 (13%) patients developed new (partial) ankylosis of the facet joints, whereas 26 (26%) developed new (bridging) syndesmophytes. Facet joint damage and progression without involvement of the vertebral bodies were seen in 5 (5%) and 8 (8%) patients, respectively. Damage of facet joints was associated with longer disease duration, history of IBD/uveitis/psoriasis, higher disease activity, larger occiput-to-wall distance, higher mSASSS, and presence of syndesmophytes. Progression of the facet joints was associated with larger occiput-to-wall distance and more facet joint damage at baseline. Cervical facet joints were frequently involved in AS. During 4 years of TNF-α blocking therapy, 13% of the patients showed radiographic progression of cervical facet joints of which the majority did not show progression of vertebral bodies. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. 1980 Volvo award in biomechanics. Measurement of the distribution of axial stress on the end-plate of the vertebral body.

    Science.gov (United States)

    Horst, M; Brinckmann, P

    1981-01-01

    The distribution of axial stress on the end-plate of the vertebral body has been measured by the aid of miniature piezoelectric pressure transducers in specimens of motion segments of the human vertebral column. The results indicate that the stress distribution depends essentially on the state of degeneration of the intervertebral disc and on the relative position of the adjacent end-plates. Furthermore lumbar and thoracic motion segments show a different behaviour. The measured results relate to the problem of the stress dependent deformation of the growing vertebra, the codfish shape of the osteoporotic vertebra and to the mechanism of degeneration of the intervertebral disc.

  20. MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF MORPHOLOGICAL AND STRUCTURAL CHANGES OF THE VERTEBRAL BODIES OF THE LUMBAR SPINE WITH BONE MINERAL DENSITY REDUCTION

    Directory of Open Access Journals (Sweden)

    S. A. Myagkov

    2018-02-01

    Full Text Available The aim of the study was to study the morphological and structural changes of the vertebral bodies in patients with different bone mineral density by MRI. Materials and methods. 81 patients with different bone mineral density (BMD of the vertebral bodies of the lumbar spine (LS had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group, 56,5 ± 9,8 years (patients with osteopenia, 66,0 ± 9,4 years (with osteoporosis. All patients underwent dual-energy X-ray absorptiometry (DXA and magnetic resonance imaging (MRI. DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40 manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994. In this case, average bone mineral density BMD (g/cm2 in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear

  1. Vertebral chondroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Ilaslan, Hakan; Sundaram, Murali [Department of Radiology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 (United States); Unni, Krishnan K. [Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 (United States)

    2003-02-01

    To determine the age distribution, gender, incidence, and imaging findings of vertebral chondroblastoma, and to compare our series with findings from case reports in the world literature.Design and patients Case records and imaging findings of nine histologically documented vertebral chondroblastomas were retrospectively reviewed for patient age, gender, vertebral column location and level, morphology, matrix, edema, soft tissue mass, spinal canal invasion, and metastases. Our findings were compared with a total of nine patients identified from previous publications in the world literature. The histologic findings in our cases was re-reviewed for diagnosis and specifically for features of calcification and secondary aneurysmal bone cyst (ABC). Clinical follow-up was requested from referring institutions. Nine of 856 chondroblastomas arose in vertebrae (incidence 1.4%; thoracic 5, lumbar 1, cervical 2, sacral 1). There were six males and three females ranging in age from 5 to 41 years (mean 28 years). Satisfactory imaging from seven patients revealed the tumor to arise from the posterior elements in four and the body in three. All tumors were expansive, six of seven were aggressive, and the spinal canal was significantly narrowed by bone or soft tissue mass in six. In one patient canal invasion was minimal. Calcification was pronounced in two and subtle in four. The sole nonaggressive-appearing tumor was heavily mineralized. Bony edema and secondary ABC were not seen on MR imaging. None of the cases had microscopic features of significant secondary ABC. Calcification, and specifically ''chicken wire'' calcification, was identified in two patients. Pulmonary metastases occurred in none. Vertebral chondroblastoma is a rare neoplasm that presents later in life than its appendicular counterpart. On imaging it is aggressive in appearance with bone destruction, soft tissue mass, and spinal canal invasion. The lesions contain variable amounts of mineral

  2. Vertebral chondroblastoma

    International Nuclear Information System (INIS)

    Ilaslan, Hakan; Sundaram, Murali; Unni, Krishnan K.

    2003-01-01

    To determine the age distribution, gender, incidence, and imaging findings of vertebral chondroblastoma, and to compare our series with findings from case reports in the world literature.Design and patients Case records and imaging findings of nine histologically documented vertebral chondroblastomas were retrospectively reviewed for patient age, gender, vertebral column location and level, morphology, matrix, edema, soft tissue mass, spinal canal invasion, and metastases. Our findings were compared with a total of nine patients identified from previous publications in the world literature. The histologic findings in our cases was re-reviewed for diagnosis and specifically for features of calcification and secondary aneurysmal bone cyst (ABC). Clinical follow-up was requested from referring institutions. Nine of 856 chondroblastomas arose in vertebrae (incidence 1.4%; thoracic 5, lumbar 1, cervical 2, sacral 1). There were six males and three females ranging in age from 5 to 41 years (mean 28 years). Satisfactory imaging from seven patients revealed the tumor to arise from the posterior elements in four and the body in three. All tumors were expansive, six of seven were aggressive, and the spinal canal was significantly narrowed by bone or soft tissue mass in six. In one patient canal invasion was minimal. Calcification was pronounced in two and subtle in four. The sole nonaggressive-appearing tumor was heavily mineralized. Bony edema and secondary ABC were not seen on MR imaging. None of the cases had microscopic features of significant secondary ABC. Calcification, and specifically ''chicken wire'' calcification, was identified in two patients. Pulmonary metastases occurred in none. Vertebral chondroblastoma is a rare neoplasm that presents later in life than its appendicular counterpart. On imaging it is aggressive in appearance with bone destruction, soft tissue mass, and spinal canal invasion. The lesions contain variable amounts of mineral. Secondary

  3. IL-6 Contributes to the Defective Osteogenesis of Bone Marrow Stromal Cells from the Vertebral Body of the Glucocorticoid-Induced Osteoporotic Mouse

    Science.gov (United States)

    Zhang, Yuan-yuan; Yang, Hui-lin

    2016-01-01

    Osteoporosis is one of the most prevalent skeletal system diseases. It is characterized by a decrease in bone mass and microarchitectural changes in bone tissue that lead to an attenuation of bone resistance and susceptibility to fracture. Vertebral fracture is by far the most prevalent osteoporotic fracture. In the musculoskeletal system, osteoblasts, originated from bone marrow stromal cells (BMSC), are responsible for osteoid synthesis and mineralization. In osteoporosis, BMSC osteogenic differentiation is defective. However, to date, what leads to the defective BMSC osteogenesis in osteoporosis remains an open question. In the current study, we made attempts to answer this question. A mouse model of glucocorticoid-induced osteoporosis (GIO) was established and BMSC were isolated from vertebral body. The impairment of osteogenesis was observed in BMSC of osteoporotic vertebral body. The expression profiles of thirty-six factors, which play important roles in bone metabolisms, were compared through antibody array between normal and osteoporotic BMSC. Significantly higher secretion level of IL-6 was observed in osteoporotic BMSCs compared with normal control. We provided evidences that IL-6 over-secretion impaired osteogenesis of osteoporotic BMSC. Further, it was observed that β-catenin activity was inhibited in response to IL-6 over-secretion. More importantly, in vivo administration of IL-6 neutralizing antibody was found to be helpful to rescue the osteoporotic phenotype of mouse vertebral body. Our study provides a deeper insight into the pathophysiology of osteoporosis and identifies IL-6 as a promising target for osteoporosis therapy. PMID:27128729

  4. Minimum cement volume required in vertebral body augmentation--A biomechanical study comparing the permanent SpineJack device and balloon kyphoplasty in traumatic fracture.

    Science.gov (United States)

    Rotter, Robert; Schmitt, Lena; Gierer, Philip; Schmitz, Klaus-Peter; Noriega, David; Mittlmeier, Thomas; Meeder, Peter-J; Martin, Heiner

    2015-08-01

    Minimally invasive treatment of vertebral fractures is basically characterized by cement augmentation. Using the combination of a permanent implant plus cement, it is now conceivable that the amount of cement can be reduced and so this augmentation could be an attractive opportunity for use in traumatic fractures in young and middle-aged patients. The objective of this study was to determine the smallest volume of cement necessary to stabilize fractured vertebrae comparing the SpineJack system to the gold standard, balloon kyphoplasty. 36 fresh frozen human cadaveric vertebral bodies (T11-L3) were utilized. After creating typical compression wedge fractures (AO A1.2.1), the vertebral bodies were reduced by SpineJack (n=18) or kyphoplasty (n=18) under preload (100N). Subsequently, different amounts of bone cement (10%, 16% or 30% of the vertebral body volume) were inserted. Finally, static and dynamic biomechanical tests were performed. Following augmentation and fatigue tests, vertebrae treated with SpineJack did not show any significant loss of intraoperative height gain, in contrast to kyphoplasty. In the 10% and 16%-group the height restoration expressed as a percentage of the initial height was significantly increased with the SpineJack (>300%). Intraoperative SpineJack could preserve the maximum height gain (mean 1% height loss) better than kyphoplasty (mean 16% height loss). In traumatic wedge fractures it is possible to reduce the amount of cement to 10% of the vertebral body volume when SpineJack is used without compromising the reposition height after reduction, in contrast to kyphoplasty that needs a 30% cement volume. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Cervical Vertebral Body's Volume as a New Parameter for Predicting the Skeletal Maturation Stages.

    Science.gov (United States)

    Choi, Youn-Kyung; Kim, Jinmi; Yamaguchi, Tetsutaro; Maki, Koutaro; Ko, Ching-Chang; Kim, Yong-Il

    2016-01-01

    This study aimed to determine the correlation between the volumetric parameters derived from the images of the second, third, and fourth cervical vertebrae by using cone beam computed tomography with skeletal maturation stages and to propose a new formula for predicting skeletal maturation by using regression analysis. We obtained the estimation of skeletal maturation levels from hand-wrist radiographs and volume parameters derived from the second, third, and fourth cervical vertebrae bodies from 102 Japanese patients (54 women and 48 men, 5-18 years of age). We performed Pearson's correlation coefficient analysis and simple regression analysis. All volume parameters derived from the second, third, and fourth cervical vertebrae exhibited statistically significant correlations (P cervical-vertebra volume as an independent variable with a variance inflation factor less than ten. The explanation power was 81.76%. Volumetric parameters of cervical vertebrae using cone beam computed tomography are useful in regression models. The derived regression model has the potential for clinical application as it enables a simple and quantitative analysis to evaluate skeletal maturation level.

  6. The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit

    Directory of Open Access Journals (Sweden)

    Zhouming Deng

    2014-01-01

    Full Text Available This study aims to investigate the efficacy of posterior short-segment pedicle instrumentation without fusion in curing thoracolumbar burst fracture. All of the 53 patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments was conducted by a novel custom-designed repositor (RRBF. The mean operation time and blood loss during surgery were analyzed; the radiological index and neurological status were compared before and after the operation. The mean operation time was 93 min (range: 62–110 min and the mean intraoperative blood loss was 452 mL in all cases. The average canal encroachment was 50.04% and 10.92% prior to the surgery and at last followup, respectively (P<0.01. The preoperative kyphotic angle was 17.2 degree (±6.87 degrees, whereas it decreased to 8.42 degree (±4.99 degrees at last followup (P<0.01. Besides, the mean vertebral body height increased from 40.15% (±9.40% before surgery to 72.34% (±12.32% at last followup (P<0.01. 45 patients showed 1-2 grades improvement in Frankel’s scale at last followup. This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and it may promote the recovery of neurological function. However, further research is still necessary to confirm the efficacy of this treatment.

  7. CT-Based Anatomical Evaluation of Pre-Vertebral Structures With Respect to Vertebral Body Using a Clock-Face Analogy.

    Science.gov (United States)

    Sarwahi, Vishal; Gecelter, Rachel C; Wendolowski, Stephen F; Kulkarni, Preethi M; Wang, Dan; Amaral, Terry D; Thornhill, Beverly

    2015-12-01

    Retrospective Chart and CT Scan Review. To define the relationship of the pre-vertebral structures for each level to assist in easier intraoperative visualization. Vascular and visceral injuries from pedicle screws are well-known. This study will define the relationship of the pre-vertebral structures for each level to assist in avoiding potential complications. Pre- and post-operative CT scans were reviewed to define the pre-vertebral structures in relation to a clock-face. On reformatted axial slices, a clock-face was superimposed so that the left transverse process (TP) represented 8 o'clock and the right TP represented 4 o'clock. The positions of the TP on the clock-face did not change with rotation of the vertebra. 108 patients had pre-operative CT scans. 78 had post-operative CT scans. Median age was 15 years, median Cobb angle was 50°, fused were 12, with 21 fixation points. 6324 axial CT slices were reformatted and analyzed. The trachea was located at 12 o'clock at T1, 1 o'clock at T2-T4, and between 12 and 1 o'clock at T5. The esophagus starts as a midline structure at 12 o'clock from T1-T2, moves to 11 o'clock from T3-T6, and further to 10 o'clock from T7-T9. The aorta starts at 10 o'clock at T5-T6, moves left at T7-T8 to 9 o'clock, and returns to 10 o'clock from T9-T11. It appears at 11'clock at T12, and at 12 o'clock from L1-L4. In about a third of cases, it is at 1 o'clock from L1 to L4, where it bifurcates. This CT-based anatomical study provides a simple reference frame to help surgeons visualize the vital structures at each level. This three-dimensional visualization is facilitated by fixing the position of TP on the clock-face. Knowledge of this anatomical relationship can help avoid direct injury, and is easier to recall intra-operatively. 3.

  8. Clinical detectable tension in the growing body: new and revisited signs in clinical examination in children with postural problems and spinal deformities. Restoration of lordosis on the thoracolumbar junction can correct sagittal and coronal plane deformity; a new (revisited) linked approach on the treatment and etiology of adolescent spinal deformities.

    Science.gov (United States)

    van Loon, P J M

    2008-01-01

    . By recognising positive effects of creating lordosis at the thoracolumbar junction of the spine and consistent clinical findings in early deformations scientific support was found by earlier experimental work of Roth. With a leading role of the central nervous system in growth of the spine of standing and sitting vertebrates by steering a tension based system, deformation can be understand as adaptations. Consequences for new preventive measures and therapeutic strategies in deformities seems possible.

  9. Paraspinal approach for thoracolumbar fracture

    Directory of Open Access Journals (Sweden)

    JIANG Rui

    2011-02-01

    pedicle screws. As a minimally invasive approach, it can be widely used in thoracolumbar spine surgery. Key words: Fractures, bone; Lumbar vertebrae; Thoracic vertebrae; Surgical procedures, operative

  10. Surgical outcome of posterior decompression, posterolateral fusion and stabilization by pedicle screw and rod in thoracolumbar tuberculosis

    Directory of Open Access Journals (Sweden)

    Md. Anowarul Islam

    2017-05-01

    Full Text Available Spinal tuberculosis causes severe complications like neurological and spinal deformity which may lead to respiratory distress, costo-pelvic impingement, paraplegia and consequent reduction in the quality and longevity of life. The aim of the present treatment is to avoid the consequence of neural complications and gain near-normal spine. Mechanical factor causes pathological fracture or dislocation of an affected vertebral body. Surgical decompression ensues further instability. Reconstruction of spinal column by pedicle screw and rod provide stability and prevents secondary neural damage and deformity thereby helps in early mobilization. Prospective study was done to evaluate the results in 20 cases of spinal tuberculosis in thoracolumbar region associated with neurological deficit. We operated our cases (12 males and 8 females by posterolateral decompression, fusion and stabilization by pedicle screw and rod along with antitubercular drug treatment. All patients were with neurological deficit, single level involvement and 10 to 30 degree of mild kyphosis. After surgery, kyphosis improved from 20.7 ± 5.5 degrees to 12.5 ± 3.9 degree. Bony fusion was in 65.0% cases. Neurological improvement and pain subsided in all the patients.

  11. 78 FR 68906 - Agency Information Collection (Back (Thoracolumbar Spine) Conditions Disability Benefits...

    Science.gov (United States)

    2013-11-15

    ... (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire). Type of Review: New data collection... (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire) Under OMB Review AGENCY: Veterans Benefits... Control No. 2900- NEW (Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire)'' in any...

  12. Radiological Results and Clinical Patient Outcome After Implantation of a Hydraulic Expandable Vertebral Body Replacement following Traumatic Vertebral Fractures in the Thoracic and Lumbar Spine: A 3-Year Follow-Up.

    Science.gov (United States)

    Kreinest, Michael; Schmahl, Dorothee; Grützner, Paul A; Matschke, Stefan

    2017-04-15

    A prospective monocentric study. The aim of the current study was the analysis of patient outcome and radiological results 3 years after implantation of a hydraulic expandable vertebral body replacement (VBR) system. Around 70% to 90% of all traumatic spinal fractures are located in the thoracic and lumbar spine. Dorso-ventral stabilization is a frequently used procedure in traumatic vertebral body fracture treatment. VBR systems can be used to bridge bony defects. In the current study, a new VBR expanded by water pressure with adjustable endplates is used. All patients who suffered a singular traumatic fracture to a thoracic or lumbar vertebral body (Th 5-L 5) in the period from November 2009 to December 2010 and (i) underwent dorsal instrumentation and (ii) afterwards received the implantation of a hydraulic VBR were included in this study. The clinical outcome (visual analogue scale [VAS] spine score, questionnaire) and radiological findings (sagittal angle, implant subsidence, and implant position) 3 years after implantation were analyzed. The follow-up was successful for n = 47 patients (follow-up rate: 89%). Most of the patients (n = 40) were "generally/very satisfied" with their outcome. The mean rating of the VAS spine score was 65.2 ± 23.1 (range: 20.5-100.0). The analysis of the radiological data showed an average subsidence of the implants of 1.1 ± 1.2 mm (range 0.0-5.0 mm). After the initial operation, the local sagittal angle remained stable in the follow-up 3 years later both for the thoracic spine and lumbar spine. Furthermore, no change in the implant's position was observed. The implantation of a hydraulically expandable VBR allows a permanent stable fixation after traumatic fractures of the thoracic and lumbar spine. 2.

  13. Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia

    Science.gov (United States)

    Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

    2017-01-01

    Abstract Rationale: Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. Patient concerns: A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Diagnoses: Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. Interventions: We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. Outcomes: No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Lessons: Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia. PMID:29245270

  14. Differential diagnosis of the anterior cartiliqinous nodes of the lumber vertebral bodies with tuberculosis and hematogenic osteomyelitis of the vertebrae in children and adolescents

    International Nuclear Information System (INIS)

    Sizov, V.A.

    1982-01-01

    The clinico-radiologic alterations were studied over time in 292 children and adolescents with degenerative and limited destructive inflammatory lesion of the lumbar section of the spine. Of these, 140 patients had the anterior catilaginous nodes of the vertebral bodies, 80 tuberculosis and 72 hematogenic osteomyelitis. The clinico-radiological observation period ranged from several months to 10-15 years. An analysis of clinical symptoms of the disease under examination indicated their striking resemblance. Radiological methods of examination (multiposition radiography, functional spondylography) are of decisive importance in differential diagnosis. Based on comparative assessment and correlation of X-ra anifestations, both similar and distinctive features of the disease were distinguished. As a result, criteria of differential diagnosis between the anterior cartilaginous nodes of the vertebral bodies and limited destructive forms of tuberculosis and hematogenic osteomyelitis of the spinal lumbar section were developed for various stages of pathologic process

  15. Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws.

    Directory of Open Access Journals (Sweden)

    Anica Eschler

    Full Text Available There is a high incidence of vertebral burst fractures following low velocity trauma in the elderly. Treatment of unstable vertebral burst fractures using the same principles like in stable vertebral burst fractures may show less favourable results in terms of fracture reduction, maintenance of reduction and cement leakage. In order to address these shortcomings this study introduces cementless fixation of unstable vertebral burst fractures using internal fixators and expandable intravertebral titanium mesh cages in a one-stage procedure via minimum-invasive techniques.A total of 16 consecutive patients (median age 76 years, range 58-94 with unstable thoracolumbar burst fractures and concomitant osteoporosis were treated by an internal fixator inserted via minimum invasive technique one level above and below the fractured vertebra. Fracture reduction was achieved and maintained by transpedicular placement of two titanium mesh cages into the fractured vertebral body during the same procedure. Intra- and postoperative safety of the procedure as well as analysis of reduction quality was analysed by 3D C-arm imaging or CT, respectively. Clinical and radiographic follow-up averaged 10.4 months (range 4.5-24.5.Stabilization of the collapsed vertebral body was achieved in all 16 cases without any intraoperative complication. Surgical time averaged 102 ± 6.6 minutes (71-194. The postoperative kyphotic angle (KA and Cobb angle revealed significant improvements (KA 13.7° to 7.4°, p < 0.001; Cobb 9.6° to 6.0°, p < 0.002 with partial loss of reduction at final follow-up (KA 8.3°, Cobb 8.7°. VAS (Visual Analogue Scale improved from 7.6 to 2.6 (p < 0.001. Adjacent fractures were not observed. One minor (malposition of pedicle screw complication was encountered.Cementless fixation of osteoporotic burst fractures revealed substantial pain relief, adequate maintenance of reduction and a low complication rate. Bony healing after unstable osteoporotic burst

  16. [Unilateral Wiltse intermuscular approach and contralateral decompression for the treatment of thoracolumbar burst fracture].

    Science.gov (United States)

    Li, Chi; Wang, Jing; Teng, Hong-Lin; Zhu, Ming-Yu; Zhou, Yang

    2017-05-25

    To compare the clinical effects and multifidus muscle injury of different approaches, including unilateral Wiltse intermuscular approach and intramuscular approach combined with contralateral decompression, in treating thoracolumbar burst fracture. Forty-three patients with thoracolumbar burst fracture were enrolled in the study from January 2010 to December 2014, including 29 males and 14 females with an average age of 42.3 years old(ranged from 21 to 64 years old). The patients were treated with posterior pedicle screw fixation and unilateral decompression and were divided into Wiltse intermuscular approach group (group A) and intramuscular approach group (group B) according to surgical approach. Operation time and intraoperative bleeding were recorded for all patients; visual analogue scale(VAS) was compared 1 d preoperatively, 1 week, 12 months postoperatively between two groups; preoperation and 12 months postoperatively, the fractured vertebral canal and two-sides multifidus muscle of the same section were observed and compared by CT measure between two groups. All the patients were follow-up for 14 to 21 months with an average of 16.3 months. Partial wound non-healing occurred in 3 patients and the wound ultimately healing after debridgement suture and change dressings. No screw breakage was found. There was significant difference in operation and intraoperative bleeding operation between two groups ( P groups( P >0.05). As for CT measurement results, postoperative vertebral canal narrow ratio was significant decreased in all patients( P group A ( P group B ( P >0.05). Neurologic status of all patients got recovery at final follow-up. The method of unilateral Wiltse intermuscular approach combined with contralateral decompression for the treatment of thoracolumbar burst fracture has good clinical effects, also it is less invasive and less damage to multifidus muscle compared with intramuscular approach.

  17. EFFECT OF OXIDATIVE STRESS ON HISTOARCHITECTONICS AND ELEMENTAL COMPOSITION OF BONE TISSUE OF THE VERTEBRAL BODY RATS

    Directory of Open Access Journals (Sweden)

    S. N. Lukanina

    2015-01-01

    Full Text Available This paper is concerned with study an influence of the oxidative stress on morphofunctional characteris-tics and elemental composition of bone tissue of the vertebral body rats.Material and methods. The research carried out on male rats of the Wistar line with weight 250–300 g. All rats were categorized into 4 groups with 10 ones in each: 1 – intact group; 2 and 3 – experimental groups; 4 – control group. Rats from groups 2–4 were under the development of oxidized stress which caused by daily stomach-pump injection (during fortnight with aqua suspension of synthetic glucocorticoid “Prednisolone” in dose 50 mg/kg. Through three hours after “Prednisolone” the antioxidant “Tiophan” was injected by stomach-pump (dose 100 mg/kg, which was dissolved in 0.2 ml of vegetation oil to laboratory animals from the group 2. Rats from control group got only solvent (vegetative oil 0.2 ml according the same scheme. Three hours after “Prednisolone” to rats from group 3 were injected of 0.2 ml aquaFontana. It was made for purity the experiment and standartization of manipulations, which are connected with injections into rats’ organisms. The peculiarities of structure of bone tissue of vertebra have been studied by methods of morphohystochemical analysis. The elemental composition of bone tissue was defined by atom-emission analysis method with inductive coupled plasma (spectrometer OPTIMA, code of methodics KHA: MUK.4.1.1482-03.Results. A development of glucocorticoid-induced oxidative stress results to infraction the histoarchitectonics of bone tissue of vertebra and decreasing the content of cations, which are included to the composition of active centres of pherments of antioxidant protection and prosthetic groups of proteins with an antioxidant activity. Using the antioxidant “Tiophan” proved an existence of its expressed osteoprotective properties. This can be seen from decreasing a level of resorbtion of bone tissue of

  18. Direct vertebral body derotation, thoracoplasty, or both: which is better with respect to inclinometer and scoliosis research society-22 scores?

    Science.gov (United States)

    Samdani, Amer F; Hwang, Steven W; Miyanji, Firoz; Lonner, Baron; Marks, Michelle C; Sponseller, Paul D; Newton, Peter O; Cahill, Patrick J; Shufflebarger, Harry L; Betz, Randal R

    2012-06-15

    Prospective, longitudinal cohort (nonrandomized). To compare thoracoplasty (Th), direct vertebral body derotation (DVBD), and Th and DVBD with respect to correction of the rib prominence and Scoliosis Research Society (SRS) self-image scores in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Rib prominence correction is one of the main goals of AIS surgery. Th and DVBD are powerful tools for correction of the rib prominence; however, a paucity of literature exists comparing Th, DVBD, and Th and DVBD. A prospective longitudinal database was queried to identify patients with AIS who underwent a posterior spinal fusion with pedicle screws and 2 years of follow-up. A total of 326 patients were identified and divided into 3 groups: (1) Th alone (N = 47), (2) DVBD alone (N = 196), and (3) both Th and DVBD (N = 83). Patients were subdivided into categories on the basis of their preoperative inclinometer reading: (1) ≤9° (mild), (2) 10 to 15° (moderate), and (3) ≥ 16° (severe). Pre- and postoperative inclinometer readings and SRS self-image scores were compared using analysis of variance. Overall, the groups were similar preoperatively except for the DVBD group having higher percentage of thoracic flexibility. The preoperative rib prominence values were Th = 13.2, DVBD = 14.0, and Th and DVBD = 12.9 (P = 0.27). Taken collectively, the postoperative 2-year inclinometer readings were similar for all 3 groups (Th = 5.2, DVBD = 7.0, Th and DVBD = 5.6; P = 0.66). However, the SRS-22 self-image scores were significantly better for patients having both Th and DVBD (Th = 3.37, DVBD = 3.44, Th and DVBD = 3.76; P self-image scores were highest in the Th and DVBD group. In patients with larger rib prominences, the addition of Th was necessary for optimal rib prominence correction, but there was no difference in SRS-22 self-image scores. Our results suggest that Th alone, DVBD alone, or both Th and DVBD provide equivalent inclinometer results in patients

  19. Pan-regional (cervico-thoraco-lumbo-sacral spinal epidural abscess with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis: complete resolution with non-operative management

    Directory of Open Access Journals (Sweden)

    Appukutty Manickam, MRCS

    2014-12-01

    Conclusion: Even pan-regional CTLS SEA with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis can be managed non-operatively. A complete clinical and radiological resolution can be achieved with antibiotics alone.

  20. Percutaneous cement augmentation for osteoporotic vertebral fractures.

    Science.gov (United States)

    Sebaaly, Amer; Rizkallah, Maroun; Bachour, Falah; Atallah, Firas; Moreau, Pierre Emmanuel; Maalouf, Ghassan

    2017-06-01

    Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.Percutaneous fixation by 'vertebroplasty' is a tempting alternative for open surgical management of these fractures.Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment.Early intervention is also gaining ground recently.Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak.Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes.In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed. Cite this article: EFORT Open Rev 2017;2:293-299. DOI: 10.1302/2058-5241.2.160057.

  1. Prediction of Human Vertebral Compressive Strength Using Quantitative Computed Tomography Based Nonlinear Finite Element Method

    Directory of Open Access Journals (Sweden)

    Ahad Zeinali

    2007-12-01

    Full Text Available Introduction: Because of the importance of vertebral compressive fracture (VCF role in increasing the patients’ death rate and reducing their quality of life, many studies have been conducted for a noninvasive prediction of vertebral compressive strength based on bone mineral density (BMD determination and recently finite element analysis. In this study, QCT-voxel based nonlinear finite element method is used for predicting vertebral compressive strength. Material and Methods: Four thoracolumbar vertebrae were excised from 3 cadavers with an average age of 42 years. They were then put in a water phantom and were scanned using the QCT. Using a computer program prepared in MATLAB, detailed voxel based geometry and mechanical characteristics of the vertebra were extracted from the CT images. The three dimensional finite element models of the samples were created using ANSYS computer program. The compressive strength of each vertebra body was calculated based on a linearly elastic-linearly plastic model and large deformation analysis in ANSYS and was compared to the value measured experimentally for that sample. Results: Based on the obtained results the QCT-voxel based nonlinear finite element method (FEM can predict vertebral compressive strength more effectively and accurately than the common QCT-voxel based linear FEM. The difference between the predicted strength values using this method and the measured ones was less than 1 kN for all the samples. Discussion and Conclusion: It seems that the QCT-voxel based nonlinear FEM used in this study can predict more effectively and accurately the vertebral strengths based on every vertebrae specification by considering their detailed geometric and densitometric characteristics.

  2. Does pedicle screw fixation of the subaxial cervical spine provide adequate stabilization in a multilevel vertebral body fracture model? An in vitro biomechanical study.

    Science.gov (United States)

    Duff, John; Hussain, Mir M; Klocke, Noelle; Harris, Jonathan A; Yandamuri, Soumya S; Bobinski, Lukas; Daniel, Roy T; Bucklen, Brandon S

    2018-03-01

    Cervical vertebral body fractures generally are treated through an anterior-posterior approach. Cervical pedicle screws offer an alternative to circumferential fixation. This biomechanical study quantifies whether cervical pedicle screws alone can restore the stability of a three-column vertebral body fracture, making standard 360° reconstruction unnecessary. Range of motion (2.0 Nm) in flexion-extension, lateral bending, and axial rotation was tested on 10 cadaveric specimens (five/group) at C2-T1 with a spine kinematics simulator. Specimens were tested for flexibility of intact when a fatigue protocol with instrumentation was used to evaluate construct longevity. For a C4-6 fracture, spines were instrumented with 360° reconstruction (corpectomy spacer + plate + lateral mass screws) (Group 1) or cervical pedicle screw reconstruction (C3 and C7 only) (Group 2). Results are expressed as percentage of intact (100%). In Group 1, 360° reconstruction resulted in decreased motion during flexion-extension, lateral bending, and axial rotation, to 21.5%, 14.1%, and 48.6%, respectively, following 18,000 cycles of flexion-extension testing. In Group 2, cervical pedicle screw reconstruction led to reduced motion after cyclic flexion-extension testing, to 38.4%, 12.3%, and 51.1% during flexion-extension, lateral bending, and axial rotation, respectively. The 360° stabilization procedure provided the greatest initial stability. Cervical pedicle screw reconstruction resulted in less change in motion following cyclic loading with less variation from specimen to specimen, possibly caused by loosening of the shorter lateral mass screws. Cervical pedicle screw stabilization may be a viable alternative to 360° reconstruction for restoring multilevel vertebral body fracture. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. A comparison of the accuracy and safety of vertebral body pin placement using a fluoroscopically guided versus an open surgical approach: an in vitro study.

    Science.gov (United States)

    Wheeler, Jason L; Cross, Alan R; Rapoff, Andrew J

    2002-01-01

    To compare the safety and accuracy of Steinmann pin placement in vertebral bodies T10 through L7 using either an open or closed fluoroscopic method. In vitro radiographic and anatomic study. Ten medium-sized canine cadavers. Cadavers were randomly assigned to 2 groups: open and closed. Steinmann pins were placed in vertebral bodies through a standard dorsal incision in the open group and percutaneously with the aid of fluoroscopy in the closed group. Pins were placed bilaterally in vertebral bodies T10 through L7 at approximately 30 degrees from horizontal and driven to a uniform depth. Necropsies were performed to examine potential pulmonary, vascular, or neurological trauma as a result of pin placement. Spines were cross-sectioned through intervertebral disc spaces, and radiographs were performed to evaluate accuracy of pin placement. Descriptive statistics were determined for pin angle, percentage of bone purchase, and penetration length. Means of interest between groups were compared using a Student t test. Complication incidence was compared using Chi;(2) analysis. Significance was P thoracic and lumbar vertebrae and for the closed group in thoracic vertebrae. Mean pin insertion angle for all vertebrae was significantly greater than 30 degrees for the open group. Mean pin penetration distance in each vertebra was significantly different between groups with the closed group having less penetration and lower variance. Both groups were significantly different from the ideal penetration distance. The mean percentage of bone purchase was greater in the closed group for all vertebrae except T10 and T11. The complication incidence was significantly greater in the open group for thoracic vertebrae. The results of this study suggest that a closed technique for placement of Steinmann pins in lumbar vertebrae for use in external skeletal fixation is a reasonable and safer alternative to the traditional open technique. Use of either technique in thoracic vertebrae should

  4. Morphological changes of lumbar vertebral bodies and intervertebral discs associated with decrease in bone mineral density of the spine: a cross-sectional study in elderly subjects.

    Science.gov (United States)

    Kwok, Anthony W L; Wang, Yi-Xiang J; Griffith, James F; Deng, Min; Leung, Jason C S; Ahuja, Anil T; Leung, Ping Chung

    2012-11-01

    Cross-sectional study. To investigate changes in the morphology of the lumbar vertebrae and intervertebral discs associated with osteoporosis of the spine in elderly subjects. Osteoporosis is a common condition that primarily affects the elderly with significant impact on quality of life. How exactly osteopenia and osteoporosis influence vertebral and intervertebral disc morphology remains unknown and needs exploration. A total of 395 community-dwelling ambulatory adults from 67 to 89 years of age were studied. The lumbar bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry. T2-weighted sagittal images of the lumbar spine were obtained using a 1.5-T magnet. For each subject, the anterior height (Ha), middle height (Hm), posterior height (Hp), and anterior-posterior (AP) dimension of the 5 lumbar vertebrae (L1-L5) and 6 intervertebral discs (T12-L1 to L5-S1) were measured. To minimize the age effect, volume of these vertebrae and discs was measured in subgroups of 47 men (mean age = 74 yr, range: 73-75 yr) and 67 women (mean age = 72 yr, range: 71-73 yr). Continuous variables were examined by analysis of covariance after adjustment of height and age. There was no significant age difference between the groups of normal BMD, osteopenia, and osteoporosis. For the vertebral bodies, lower BMD was associated with a decrease of Ha, Hm, and Hp but not AP in both sexes, leading to an increased biconcavity index. For the discs, lower BMD was associated with a decrease of Ha and Hp, as well as AP, and an increase in Hm in both men and women. The disc biconvexity index was increased. Lower BMD is associated with an overall decrease in both vertebral volume and disc volume. Lower BMD is associated with a decreasing trend in both lumbar vertebral and disc volumes in elderly subjects but an increase in the Hm of the intervertebral discs.

  5. Predicting vertebral bone strength by vertebral static histomorphometry

    DEFF Research Database (Denmark)

    Thomsen, Jesper Skovhus; Ebbesen, Ebbe Nils; Mosekilde, Lis

    2002-01-01

    of the entire vertebral bodies (L-2) were used for histomorphometry. The other iliac crest biopsies and the L-3 were destructively tested by compression. High correlation was found between BV/TV or Tb.Sp and vertebral bone strength (absolute value of r = 0.86 in both cases). Addition of Tb.Th significantly....... No gender-related differences were found in any of the relationships. Neither static histomorphometry nor biomechanical testing of iliac crest bone biopsies is a good predictor of vertebral bone strength.......The study investigates the relationship between static histomorphometry and bone strength of human lumbar vertebral bone. The ability of vertebral histomorphometry to predict vertebral bone strength was compared with that of vertebral densitometry, and also with histomorphometry and bone strength...

  6. Location of Vertebral Fractures is Associated with Bone Mineral Density and History of Traumatic Injury.

    Science.gov (United States)

    Watt, Jennifer; Crilly, Richard

    2017-04-01

    The upper and lower thoracolumbar spine have been associated with different biomechanical outcomes. This concept, as it applies to osteoporotic fracture risk, has not been well documented. This was a case-control study of 120 patients seen in an osteoporosis clinic. Vertebral fractures were identified from lateral radiographs using Genant's semi-quantitative assessment method. An association between bone mineral density (BMD) T-scores and vertebral fracture location was assessed. In an additional analysis, the association between a history of any traumatic injury and possible predictor variables was also explored. The median age of patients was 75 (IQR 67-80), and 84.2% of patients were female. A history of trauma was reported by 46.7% of patients. A vertebral fracture in the lower thoracolumbar spine (T11-L4) was associated with significantly higher femoral neck (p trochanteric (p = 0.002), intertrochanteric (p fractures in the lower thoracolumbar spine. A fracture in the upper thoracolumbar spine (T4-T10) decreased the odds of having a history of traumatic injury (OR 0.32, 95% CI 0.14-0.76, p = 0.01), while a non-vertebral fracture increased the odds of such an injury (OR 2.41, 95% CI 1.10-5.32, p = 0.03). Vertebral fractures in the lower thoracolumbar spine are associated with higher BMD T-scores. This should be studied further to understand possible correlations with patients' future fracture risk.

  7. Evaluation of a Novel HA/ZrO2-Based Porous Bioceramic Artificial Vertebral Body Combined with a rhBMP-2/Chitosan Slow-Release Hydrogel.

    Directory of Open Access Journals (Sweden)

    Yihui Shi

    Full Text Available A new HA/ZrO2-based porous bioceramic artificial vertebral body (AVB, carried a recombinant human bone morphogenetic protein-2 (rhBMP-2/chitosan slow-release hydrogel was prepared to repair vertebral bone defect in beagles. An ionic cross-linking was used to prepare the chitosan hydrogel (CS gel as the rhBMP-2 slow-release carrier. The vertebral body defects were implanted with the rhBMP-2-loaded AVB in group A, or a non-drug-loaded AVB in group B, or autologous iliac in group C. The encapsulation rate of rhBMP-2 in rhBMP-2-loaded CS gel was 91.88±1.53%, with a drug load of 39.84±2.34 ng/mg. At 6, 12, 24 weeks postoperatively, radiography showed that the bone calluses gradually increased with time in group A, where the artificial vertebral body had completely fused with host-bone at 24 weeks after surgery. In group C, an apparent bone remodeling was occurred in the early stages, and the graft-bone and host-bone had also fused completely at 24 weeks postoperatively. In group B, fusion occurred less than in groups A and C. At 24 weeks after surgery, micro-computed tomography (Micro-CT revealed that the volume of newly-formed bone in group A was significantly more than in group B (p<0.05. At 24 weeks after surgery, ultra-compressive strengths of the operated segments were 14.03±1.66 MPa in group A, 8.62±1.24 MPa in group B, and 13.78±1.43 MPa in group C. Groups A and C were both significantly higher than group B (p < 0.05. At 24 weeks postoperatively, the hard tissue sections showed that the AVB of group A had tightly fused with host bone, and that pores of the AVB had been filled with abundant nearly mature bone, and that the new bone structured similarly to a trabecular framework, which was similar to that in group C. In contrast, implant fusion of the AVB in group B was not as apparent as group A. In conclusion, the novel HA/ZrO2-based porous bioceramic AVB carried the rhBMP-2-loaded CS gel can promote the repair of bony defect, and induce

  8. Validity of the three-column theory of thoracolumbar fractures. A biomechanic investigation.

    Science.gov (United States)

    Panjabi, M M; Oxland, T R; Kifune, M; Arand, M; Wen, L; Chen, A

    1995-05-15

    This study validated the three-column theory of fractures by correlating the multidirectional instabilities and the vertebral injuries to each of the three columns, using a biomechanic trauma model. The objective was to validate the three-column theory as applied to the thoracolumbar fractures. The widely used three-column theory of fractures for classification and evaluation was based on retrospective analysis of radiographs. No biomechanic study, using realistic spinal fractures and multidirectional instability measurements, was available. Using 16 fresh cadaveric thoracolumbar human spine specimens, two groups of burst fractures were produced by either simple axial compression or flexion-compression, using a high-speed trauma model. Multidirectional flexibility was measured before and after the trauma, thus quantifying the instability of the burst fracture. Computed tomography scans were taken after the fracture, and a newly developed injury scoring scheme quantified the injuries to the anterior, middle, and posterior columns. Statistical correlations were obtained between the flexibility parameters and injuries to each of the three columns. In the axial compression group, the middle column injury, compared with the other two columns, showed the highest correlations to eight of the nine flexibility parameters (average R2 = 0.77). In the flexion-compression group, again the middle column injury showed the highest correlations to eight of the nine flexibility parameters (average R2 = 0.85). The results of this study supported the three-column theory of the thoracolumbar fractures and bolstered the concept of the middle column being the primary determinant of mechanical stability of this region of the spine.

  9. Motion in the unstable thoracolumbar spine when spine boarding a prone patient

    Science.gov (United States)

    Conrad, Bryan P.; Marchese, Diana L.; Rechtine, Glenn R.; Horodyski, MaryBeth

    2012-01-01

    Introduction Previous research has found that the log roll (LR) technique produces significant motion in the spinal column while transferring a supine patient onto a spine board. The purpose of this project was to determine whether log rolling a patient with an unstable spine from prone to supine with a pulling motion provides better thoracolumbar immobilization compared to log rolling with a push technique. Methods A global instability was surgically created at the L1 level in five cadavers. Two spine-boarding protocols were tested (LR Push and LR Pull). Both techniques entailed performing a 180° LR rotation of the prone patient from the ground to the supine position on the spine board. An electromagnetic tracking device registered motion between the T12 and L2 vertebral segments. Six motion parameters were tracked. Repeated-measures statistical analysis was performed to evaluate angular and translational motion. Results Less motion was produced during the LR Push compared to the LR Pull for all six motion parameters. The difference was statistically significant for three of the six parameters (flexion–extension, axial translation, and anterior–posterior (A–P) translation). Conclusions Both the LR Push and LR Pull generated significant motion in the thoracolumbar spine during the prone to supine LR. The LR Push technique produced statistically less motion than the LR Pull, and should be considered when a prone patient with a suspected thoracolumbar injury needs to be transferred to a long spine board. More research is needed to identify techniques to further reduce the motion in the unstable spine during prone to supine LR. PMID:22330191

  10. CT diagnosis in the evaluation of vertebral trauma

    International Nuclear Information System (INIS)

    Emori, Takumi; Kadoya, Satoru; Nakamura, Tsutomu; Ito, Shotaro; Kwak, Ryungchan

    1984-01-01

    The diagnostic capability of the CT scan of the vertebral trauma and a comparison with the results of a routine roentgenogram and tomogram were studied in 11 patients. In total, there were 15 fractured vertebrae: 3 in the upper cervical, 3 in the lower cervical, and 9 in the thoracic and thoraco-lumbar vertebrae. In the detailed evaluation of the vertebral fractures, CT provided more information than plain films in all 15 fractured vertebrae, with a better visualization of the spinal bony details, particularly at the upper cervical, thoracic, and thoraco-lumbar levels, where the interpretation of the spinal abnormalities is usually difficult because of adjacent structures such as the skull and thorax. Only CT was able to demonstrate impingements on the vertebral canal by bony fragments. Post-traumatic syringomyelia was incidentally demonstrated in one patient on a plain CT. In 6 patients, conventional tomography was done, but no additional information with regard to spinal instability and spinal-cord compression was obtained. The usage of sagittal tomography was also limited, because it required a change in the patient's position, which might worsen the neurological deficits. On the other hand, a plain roentgenogram and conventional tomography were superior in the evaluation of spinal malalignment and fractures running horizontally. In summary, both plain roentgenograms and CT images provided detailed information about vertebral injury, whereas conventional tomography is judged to be inferior and not always necessary. Based on these results, our new diagnostic and therapeutic approaches using CT for the vertebral injuries were presented. (author)

  11. Spondylectomy and lateral lumbar interbody fusion for thoracolumbar kyphosis in an adult with achondroplasia: A case report.

    Science.gov (United States)

    Miyazaki, Masashi; Kanezaki, Shozo; Notani, Naoki; Ishihara, Toshinobu; Tsumura, Hiroshi

    2017-12-01

    Fixed thoracolumbar kyphosis with spinal stenosis in adult patients with achondroplasia presents a challenging issue. We describe the first case in which spondylectomy and minimally invasive lateral access interbody arthrodesis were used for the treatment of fixed severe thoracolumbar kyphosis and lumbar spinal canal stenosis in an adult with achondroplasia. A 61-year-old man with a history of achondroplastic dwarfism presented with low back pain and radiculopathy and neurogenic claudication. Plain radiographs revealed a high-grade thoracolumbar kyphotic deformity with diffuse degenerative changes in the lumbar spine. The apex was located at L2, the local kyphotic angle from L1 to L3 was 105°, and the anterior area was fused from the L1 to L3 vertebrae. MRI revealed significant canal and lateral recess stenosis secondary to facet hypertrophy. We planned a front-back correction of the anterior and posterior spinal elements. We first performed anterior release at the fused part from L1 to L3 and XLIF at L3/4 and L4/5. Next, the patient was placed in the prone position. Spondylectomy at the L2 vertebra and posterior fusion from T10 to L5 were performed. Postoperative radiographs revealed L1 to L3 kyphosis of 32°. No complications occurred during or after surgery. Postoperatively, the patient's low back pain and neurological claudication were resolved. No worsening of kyphosis was observed 24 months postoperatively. Circumferential decompression of the spinal cord at the apical vertebral level and decompression of lumbar canal stenosis were necessary. Front-back correction of the anterior and posterior spinal elements via spondylectomy and lateral lumbar interbody fusion is a reasonable surgical option for thoracolumbar kyphosis and developmental canal stenosis in patients with achondroplasia.

  12. [Intra-operative myelography in treatment of fractures of thoracolumbar spine].

    Science.gov (United States)

    Tomčovčík, L; Cuha, R; Raši, R

    2010-08-01

    The aim of this retrospective study was to evaluate the results of intra-operative myelography as the method used to assess the reduction of bone fragments from the posterior margin of the vertebral body. Forty patients with 42 comminuted fractures of the thoracolumbar spine were included in the study. The pre-operative spinal stenosis caused by bone fragments from the posterior margin of the vertebral body, as detected by CT scanning, ranged from 25 % to 85 %. Neurological deficit was due to injury in 19 patients and in one it developed post-operatively after the patient stood and walked. After ligamentotaxis and internal fixation, intra-operative myelography was used to show decompression of the spinal canal. A spinal block or severe constriction of contrast flow was an indication for hemilaminectomy (laminectomy) and direct decompression of the spinal canal. In the patients with neurological deficit and severe spinal stenosis persisting after ligamentotaxis and detectable by skiascopy, hemilaminectomy (laminectomy) and direct spinal decompression followed by intra-operative myelography were carried out. Intra-operative myelography was used 46 -times (20-times in 20 patients free from neurological deficit and 26-times in 20 patients with neurological deficit). In 38 cases (82.6 %) dural sac compression was not present (patients with neurological deficit, 13-times after ligamentotaxis, eight-times after ligamentotaxis and hemilaminectomy with direct decompression, twi- ce at repeat surgeryúúú patients without neurological deficit, 15-times). On two occasions (4.4 %) the contrast agent injected into the dural sac did not make the interior body part visible, on three occasions (6.5 %) contrast medium was injected extradurally, and dural sac compression following ligamentotaxis requiring hemilaminectomy (laminectomy) and direct decompression occurred in three cases (6.5 %). In the patients without neurological deficit, dural sac compression was not recorded. No

  13. Range of motion after thoracolumbar corpectomy

    DEFF Research Database (Denmark)

    Gehrchen, Martin; Hegde, Sajan K; Moldavsky, Mark

    2017-01-01

    STUDY DESIGN: An in vitro biomechanical study. OBJECTIVES: To compare the biomechanical stability of traditional and low-profile thorocolumbar anterior instrumentation after a corpectomy with cross-connectors. Dual-rod anterior thoracolumbar lateral plates (ATLP) have been used clinically...... to stabilize the thorocolumbar spine. METHODS: The stability of a low-profile dual-rod system (LP DRS) and a traditional dual-rod system (DRS) was compared using a calf spine model. Two groups of seven specimens were tested intact and then in the following order: (1) ATLP with two cross-connectors and spacer......; (2) ATLP with one cross-connector and spacer; (3) ATLP with spacer. Data were normalized to intact (100 %) and statistical analysis was used to determine between-group significances. RESULTS: Both constructs reduced motion compared to intact in flexion-extension and lateral bending. Axial rotation...

  14. Congenital abnormalities of the vertebral column in ferrets.

    Science.gov (United States)

    Proks, Pavel; Stehlik, Ladislav; Paninarova, Michaela; Irova, Katarina; Hauptman, Karel; Jekl, Vladimir

    2015-01-01

    Vertebral column pathologies requiring surgical intervention have been described in pet ferrets, however little information is available on the normal vertebral formula and congenital variants in this species. The purpose of this retrospective study was to describe vertebral formulas and prevalence of congenital vertebral anomalies in a sample of pet ferrets. Radiographs of 172 pet ferrets (96 males and 76 females) were included in this retrospective study. In 143 ferrets (83.14%), five different formulas of the vertebral column were recorded with normal morphology of vertebrae (rib attachment included) but with a variable number of thoracic (Th), lumbar (L), and sacral (S) vertebrae. The number of cervical (C) vertebrae was constant in all examined animals. Observed vertebral formulas were C7/Th14/L6/S3 (51.74%), C7/Th14/L6/S4 (22.10%), C7/Th14/L7/S3 (6.98%), C7/Th15/L6/S3 (1.74%), and C7/Th15/L6/S4 (0.58%). Formula C7/Th14/L6/S4 was significantly more common in males than in females (P < 0.05). Congenital spinal abnormalities were found in 29 ferrets (16.86%), mostly localized in the thoracolumbar and lumbosacral regions. The cervical region was affected in only one case. Transitional vertebrae represented the most common congenital abnormalities (26 ferrets) in the thoracolumbar (13 ferrets) and lumbosacral regions (10 ferrets) or simultaneously in both regions (three ferrets). Other vertebral anomalies included block (two ferrets) and wedge vertebra (one ferret). Spina bifida was not detected. Findings from the current study indicated that vertebral formulas may vary in ferrets and congenital abnormalities are common. This should be taken into consideration for surgical planning. © 2014 American College of Veterinary Radiology.

  15. What's new in vertebral cementoplasty?

    Science.gov (United States)

    Guarnieri, Gianluigi; Giurazza, Francesco; Manfrè, Luigi

    2016-01-01

    Vertebral cementoplasty is a well-known mini-invasive treatment to obtain pain relief in patients affected by vertebral porotic fractures, primary or secondary spine lesions and spine trauma through intrametameric cement injection. Two major categories of treatment are included within the term vertebral cementoplasty: the first is vertebroplasty in which a simple cement injection in the vertebral body is performed; the second is assisted technique in which a device is positioned inside the metamer before the cement injection to restore vertebral height and allow a better cement distribution, reducing the kyphotic deformity of the spine, trying to obtain an almost normal spine biomechanics. We will describe the most advanced techniques and indications of vertebral cementoplasty, having recently expanded the field of applications to not only patients with porotic fractures but also spine tumours and trauma. PMID:26728798

  16. The influence of dietary and whole-body nutrient content on the excretion of a vertebrate consumer.

    Directory of Open Access Journals (Sweden)

    Christopher M Dalton

    Full Text Available In many contexts, nutrient excretion by consumers can impact ecosystems by altering the availability of limiting nutrients. Variation in nutrient excretion can be predicted by mass balance models, most of which are premised on two key ideas: (1 consumers maintain fixed whole-body nutrient content (i.e., %N and %P, so-called fixed homeostasis; (2 if dietary nutrients are not matched to whole-body nutrients, excesses of any nutrient are released as excretion to maintain fixed homeostasis. Mass balance models thus predict that consumer excretion should be positively correlated with diet nutrients and negatively correlated with whole-body nutrients. Recent meta-analyses and field studies, however, have often failed to find these expected patterns, potentially because of a confounding influence-flexibility in whole-body nutrient content with diet quality (flexible homeostasis. Here, we explore the impact of flexible homeostasis on nutrient excretion by comparing the N and P excretion of four genetically diverged Trinidadian guppy (Poecilia reticulata populations when reared on diets of variable P content. As predicted by mass balance, P excretion increased on the high-P diet, but, contrary to the notion of fixed homeostasis, guppy whole-body %P also increased on the high-P diet. While there was no overall correlation between excretion nutrients and whole-body nutrients, when the effect of diet on both whole-body and excretion nutrients was included, we detected the expected negative correlation between whole-body N:P and excretion N:P. This last result suggests that mass balance can predict excretion rates within species, but only if dietary effects on whole-body nutrient content are controlled. Flexible homeostasis can obscure patterns predicted by mass balance, creating an imperative to accurately capture an organism's diet quality in predicting its excretion rate.

  17. Effect of soft tissue thickness over the posterior border of the vertebral body and disc space on cage placement during posterior lumbar interbody fusion: a cadaveric study.

    Science.gov (United States)

    Yang, Jae Hyuk; Kasat, Niraj Sharad; Whang, Jin Ho; Kim, Min Keun; Min, Kyueng-Whan; Hong, Jae Young; Modi, Hitesh N; Suh, Seung Woo

    2012-11-01

    In the present study, we investigated whether there is a difference between visual depth (VD) and radiological image depth (RD) of cages (i.e., structural interbody support devices) placed in disc spaces during posterior lumbar interbody fusion and whether soft tissues covering the posterior border of the vertebral body and associated disc space are the cause of any observed differences. Using digital calipers, cages were inserted at a depth of 5 mm from the soft tissues covering the posterior border of the vertebral body and disc space under direct vision; this depth was defined as VD. After insertion, RD was measured in triplicate. The reliability of RD measurements was evaluated using an intraclass coefficient test. To identify the cause of differences between VD and RD, the thicknesses of soft tissues were measured microscopically. A total of 40 lumbar intervertebral disc spaces with cages were evaluated. The mean RD of cages was 3.12 mm, while the mean difference between the VD and RD of cages (DVRD) was 1.91 mm. On histological examination, the mean thickness of the soft tissue was 2.02 mm. Comparative analysis between histological values and DVRD showed no statistical difference (P = 1.14, 1.55, 0.06). There was a significant difference between VD and RD during cage placement, and soft tissue structure appeared to be responsible for the DVRD of inserted cages. Therefore, cages should be inserted deeper to account for differences between visual and radiological image depths. Copyright © 2012 Wiley Periodicals, Inc.

  18. Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent With Ewing Sarcoma.

    Science.gov (United States)

    Xu, Nanfang; Wei, Feng; Liu, Xiaoguang; Jiang, Liang; Cai, Hong; Li, Zihe; Yu, Miao; Wu, Fengliang; Liu, Zhongjun

    2016-01-01

    Case report. To describe a three-dimensional (3D) printed axial vertebral body used in upper cervical spine reconstruction after a C2 Ewing sarcoma resection in an adolescent boy. Ewing sarcoma is a malignant musculoskeletal neoplasm with a peak incidence in adolescents. Cervical spine as the primary site of the tumor has been related to a worse prognosis. Tumor resection is particularly challenging in the atlantoaxial region due to complexity of the anatomy, necessity for extensive resection according to oncological principles, and a lack of specialized implants for reconstruction. 3D printing refers to a process where 3D objects are created through successive layering of material under computer control. Although this technology potentially enables accurate fabrication of patient-specific orthopedic implants, literature on its utilization in this regard is rare. A 12-year-old boy with a C2 Ewing sarcoma underwent a staged spondylectomy. Wide resection of the posterior elements was first performed. Two weeks later, a high anterior retropharyngeal approach was taken to remove the remains of the C2 vertebra. A customized artificial vertebral body fabricated according to a computer model using titanium alloy powder was inserted to replace the defect between C1 and C3. The microstructure of the implant was optimized for better biomechanical stability and enhanced bone healing. Patient had an uneventful recovery and began to ambulate on postoperative day 7. Adjuvant treatment commenced 3 weeks after the surgery. He was tumor-free at the 1-year follow-up. Computed tomography studies revealed evidence of implant osseointegration and no subsidence or displacement of the construct. This is a case example on the concept of personalized precision medicine in a surgical setting and demonstrates how 3D-printed, patient-specific implants may bring individualized solutions to rare problems wherein restoration of the specific anatomy of each patient is a key prognostic factor.

  19. Initial experience with the use of an expandable titanium cage as a vertebral body replacement in patients with tumors of the spinal column: a report of 95 patients.

    Science.gov (United States)

    Viswanathan, Ashwin; Abd-El-Barr, Muhammad M; Doppenberg, Egon; Suki, Dima; Gokaslan, Ziya; Mendel, Ehud; Rao, Ganesh; Rhines, Laurence D

    2012-01-01

    Vertebral body resection to treat spine tumors necessitates reconstruction to maintain spinal stability. The durability of reconstruction may be a challenge in cancer patients as treatment with chemotherapy and/or radiation coupled with poor nutritional status may compromise bone quality. We present a series of patients who underwent implantation of an expandable titanium cage (ETC) for reconstruction after vertebral body resection for primary or metastatic spine tumors. We report the functional outcome, assess the durability of reconstruction, and describe complications associated with this procedure. A retrospective review of patients undergoing placement of ETC after vertebrectomy for spinal tumor at our institution was performed. From September 2001 to August 2006, 95 patients underwent implantation of an ETC for reconstruction of the anterior spinal column following vertebrectomy for tumor (75 one-level, 19 two-level, 1 three-level). All patients underwent spinal stabilization as well. The median survival after surgery was 13.7 months; 23 patients had primary spinal tumors and 72 had metastatic tumors. Numerical pain scores were significantly improved postoperatively indicating a palliative benefit. No new neurological deficits were noted postoperatively, except when intentional neurological sacrifice was performed for oncologic reasons. Median height correction of 14% (range 0-118%) and median improvement in sagittal alignment of 6° (range 0-28°) were demonstrated on immediate postoperative imaging. Three patients experienced hardware related complications, one of which had posterior migration of the ETC. On postoperative imaging, 12 patients demonstrated subsidence of greater than 1 mm, but none required operative revision. Use of an ETC for spinal reconstruction in patients with spinal tumors is safe, decreases pain associated with pathologic fracture, protects neurologic function, and is durable. We found a very low incidence of cage-related construct

  20. Spreading epidural hematoma and deep subcutaneous edema: indirect MRI signs of posterior ligamentous complex injury in thoracolumbar burst fractures

    International Nuclear Information System (INIS)

    Kim, Na Ra; Hong, Sung Hwan; Choi, Ja-Young; Myung, Jae Sung; Chang, Bong-Soon; Lee, Joon Woo; Kang, Heung Sik; Moon, Sung Gyu

    2010-01-01

    The purpose of this study was to evaluate the diagnostic value of a spreading epidural hematoma (SEH) and deep subcutaneous edema (DSE) as indirect signs of posterior ligamentous complex (PLC) injuries on MR imaging of thoracolumbar burst fractures. We retrospectively reviewed spinal MR images of 43 patients with thoracolumbar burst fractures: 17 patients with PLC injuries (study group) and 26 without PLC injuries (control group). An SEH was defined as a hemorrhagic infiltration into the anterior or posterior epidural space that spread along more than three vertebrae including the level of the fracture. A DSE was regarded as a fluid-like signal lesion in the deep subcutaneous layer of the back, and its epicenter was at the burst fracture level. The frequency of the SEH/DSE in the two groups was analyzed. In addition, the association between each sign and the degree of vertebral collapse, the severity of central canal compromise, and surgical decisions were analyzed. Magnetic resonance images showed an SEH in 20 out of 43 patients (46%) and a DSE in 17 (40%). The SEH and DSE were more commonly seen in the study group with PLC injuries (SEH, 15 out of 17 patients, 80%; DSE, 16 out of 17 patients, 94%) than in the control group without PLC injuries (SEH, 5 out of 26, 19%; DSE, 1 out of 26, 4%) (P <0.0001). The SEH and DSE were significantly associated with surgical management decisions (17 out of 20 patients with SEH, 85%, vs 8 out of the 23 without SEH, 35%, P =0.002; 15 out of 17 with DSE, 88%, vs 10 out of 26 without DSE, 38%, P =0.002). The SEH and DSE did not correlate with the degree of vertebral collapse or the severity of central canal compromise. The SEH and DSE may be useful secondary MR signs of posterior ligamentous complex injury in thoracolumbar burst fractures. (orig.)

  1. 78 FR 36308 - Proposed Information Collection: (Back (Thoracolumbar Spine) Conditions Disability Benefits...

    Science.gov (United States)

    2013-06-17

    ...-NEW (Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire). Type of Review: New... (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire) Activity: Comment Request AGENCY: Veterans... comments on information needed to adjudicate the claim for VA disability benefits related to a claimant's...

  2. Thoracic Vertebral Body Irradiation Contributes to Acute Hematologic Toxicity During Chemoradiation Therapy for Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Deek, Matthew P.; Benenati, Brian [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey (United States); Kim, Sinae [Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, New Jersey (United States); Biometrics Division, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey (United States); Chen, Ting; Ahmed, Inaya; Zou, Wei [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey (United States); Aisner, Joseph [Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey (United States); Jabbour, Salma K., E-mail: jabbousk@cinj.rutgers.edu [Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey (United States)

    2016-01-01

    Purpose: To determine the relationships between radiation doses to the thoracic bone marrow and declines in blood cell counts in non-small cell lung cancer (NSCLC) patients treated with chemoradiation therapy (CRT). Methods and Materials: We included 52 patients with NSCLC treated with definitive concurrent carboplatin–paclitaxel and RT. Dose-volume histogram (DVH) parameters for the thoracic vertebrae (TV), sternum, scapulae, clavicles, and ribs were assessed for associations with changes in blood counts during the course of CRT. Linear and logistic regression analyses were performed to identify associations between hematologic nadirs and DVH parameters. A DVH parameter of Vx was the percentage of the total organ volume exceeding x radiation dose. Results: Grade ≥3 hematologic toxicity including neutropenia developed in 21% (n=11), leukopenia in 42% (n=22), anemia in 6% (n=3), and throbocytopenia in 2% (n=1) of patients. Greater RT dose to the TV was associated with higher risk of grade ≥3 leukopenia across multiple DVH parameters, including TV V{sub 20} (TVV) (odds ratio [OR] 1.06; P=.025), TVV{sub 30} (OR 1.07; P=.013), and mean vertebral dose (MVD) (OR 1.13; P=.026). On multiple regression analysis, TVV{sub 30} (β = −0.004; P=.018) and TVV{sub 20} (β = −0.003; P=.048) were associated with white blood cell nadir. Additional bone marrow sites (scapulae, clavicles, and ribs) did not affect hematologic toxicity. A 20% chance of grade ≥3 leukopenia was associated with a MVD of 13.5 Gy and a TTV{sub 30} of 28%. Cutoff values to avoid grade ≥3 leukopenia were MVD ≤23.9 Gy, TVV{sub 20} ≤56.0%, and TVV{sub 30} ≤52.1%. Conclusions: Hematologic toxicity is associated with greater RT doses to the TV during CRT for NSCLC. Sparing of the TV using advanced radiation techniques may improve tolerance of CRT and result in improved tolerance of concurrent chemotherapy.

  3. Deformable registration for image-guided spine surgery: preserving rigid body vertebral morphology in free-form transformations

    Science.gov (United States)

    Reaungamornrat, S.; Wang, A. S.; Uneri, A.; Otake, Y.; Zhao, Z.; Khanna, A. J.; Siewerdsen, J. H.

    2014-03-01

    Purpose: Deformable registration of preoperative and intraoperative images facilitates accurate localization of target and critical anatomy in image-guided spine surgery. However, conventional deformable registration fails to preserve the morphology of rigid bone anatomy and can impart distortions that confound high-precision intervention. We propose a constrained registration method that preserves rigid morphology while allowing deformation of surrounding soft tissues. Method: The registration method aligns preoperative 3D CT to intraoperative cone-beam CT (CBCT) using free-form deformation (FFD) with penalties on rigid body motion imposed according to a simple intensity threshold. The penalties enforced 3 properties of a rigid transformation - namely, constraints on affinity (AC), orthogonality (OC), and properness (PC). The method also incorporated an injectivity constraint (IC) to preserve topology. Physical experiments (involving phantoms, an ovine spine, and a human cadaver) as well as digital simulations were performed to evaluate the sensitivity to registration parameters, preservation of rigid body morphology, and overall registration accuracy of constrained FFD in comparison to conventional unconstrained FFD (denoted uFFD) and Demons registration. Result: FFD with orthogonality and injectivity constraints (denoted FFD+OC+IC) demonstrated improved performance compared to uFFD and Demons. Affinity and properness constraints offered little or no additional improvement. The FFD+OC+IC method preserved rigid body morphology at near-ideal values of zero dilatation (D = 0.05, compared to 0.39 and 0.56 for uFFD and Demons, respectively) and shear (S = 0.08, compared to 0.36 and 0.44 for uFFD and Demons, respectively). Target registration error (TRE) was similarly improved for FFD+OC+IC (0.7 mm), compared to 1.4 and 1.8 mm for uFFD and Demons. Results were validated in human cadaver studies using CT and CBCT images, with FFD+OC+IC providing excellent preservation

  4. Variation in the management of thoracolumbar trauma and postoperative infection.

    Science.gov (United States)

    Kepler, Christopher K; Vroome, Colin; Goldfarb, Matthew; Nyirjesy, Sarah; Millhouse, Paul; Lonjon, Guillaume; Koerner, John D; Harrop, James; Vialle, Luiz R; Vaccaro, Alexander R

    2015-05-01

    Multinational survey of spine trauma surgeons. To survey spine trauma surgeons, examine the variety of management practices for thoracolumbar fractures, and investigate the need for future areas of study. Attempts to develop a universal thoracolumbar classification system represent the first step in standardizing treatment of thoracolumbar injuries, but there is little consensus regarding diagnosis and management of these injuries. A survey questionnaire regarding a fictional neurologically intact patient with a burst fracture was administered to 46 spine surgeons. The questionnaire consisted of 2 domains: management of thoracolumbar fractures and management of postoperative infection. Survey results were compiled and evaluated and consensus arbitrarily assumed when the majority of surgeons agreed on a single question answer. Although majority consensus was reached on most questions, the interobserver reliability was poor. Consensus was achieved that magnetic resonance imaging should be performed during initial imaging. The majority would also operate regardless of magnetic resonance imaging findings, and would not operate at night. The favored technique was a posterior approach with decompression. Percutaneous fusion was considered a viable option by the majority of surgeons. No consensus was reached regarding instrumentation levels or construct length. The majority would use posterolateral bone grafting, and would not remove instrumentation nor perform an anterior reconstruction. Consensus was reached that postoperative bracing is unnecessary. Regarding management of infection, consensus was reached to use intraoperative vancomycin powder but not culture the nares before surgery. The majority used a set time period for antibiotic treatment when a drain was required, and would not apply supplementary bone graft at the time of final debridement and closure. There is lack of consensus regarding the appropriate management of thoracolumbar fractures. In the future

  5. Residual herniated disc material following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease.

    Science.gov (United States)

    Roach, W J; Thomas, M; Weh, J M; Bleedorn, J; Wells, K

    2012-01-01

    To evaluate the presence of residual disc material within the vertebral canal following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease. Forty dogs were treated by hemilaminectomy. Computed tomography was performed preoperatively and immediately postoperatively. The vertebral canal height, width, area, and herniated disc material area were measured. Maximum filling percentage (MFP), residual disc percentage (RDP), maximum residual filling percentage (MRFP), and residual filling percentage (RFP) were calculated. Clinical outcome was determined by telephone interviews. Residual disc material was present in 100% of the dogs. Mean MFP = 55.4% (range 25.9-82.3%; median 56.9%). Mean RDP = 50.3% (range 2.6-155.8%; median 47.9%). Mean MRFP = 30.8% (range 4.9-60%; median 30.1%). Mean RFP = 19.8% (range 4.8-45%; median 19.0%). All dogs were ambulatory with voluntary urination at the long-term follow-up (range: 88-735 days). Residual disc was present in all dogs following hemilaminectomy for intervertebral disc disease. Residual disc was not associated with failure to achieve functional recovery in these cases.

  6. Comparison of three different surgical approaches for treatment of thoracolumbar burst fracture

    Directory of Open Access Journals (Sweden)

    WU Han

    2013-02-01

    Full Text Available 【Abstract】Objective: The main treatment method used for thoracolumbar fractures is open reduction and in-ternal fixation. Commonly there are three surgical approaches: anterior, posterior and paraspinal. We attempt to compare the three approaches based on our clinical data analysis. Methods: A group of 94 patients with Denis type A or B thoracolumbar burst fracture between March 2008 and September 2010 were recruited in this study. These patients were treated by anterior-, posterior- or paraspinal-approach reduction with or without decompression. The fracture was fixed with titanium mesh and Z-plate via anterior approach (24 patients, screw and rod system via posterior approach (38 patients or paraspinal approach (32 patients. Clinical evaluations included operation duration, blood loss, inci-sion length, preoperative and postoperative Oswestry dis-ability index (ODI. Results: The average operation duration (94.1 min±13.7 min, blood loss (86.7 ml±20.0 ml, length of incision (9.3 mm± 0.7 mm and postoperative ODI (6±0.5 were signifi-cantly lower (P<0.05 in paraspinal approach group than in traditional posterior approach group (operation duration 94.1 min±13.7 min, blood loss 143.3 ml±28.3 ml, length of incision 15.4 cm±2.1 cm and ODI 12±0.7 and anterior approach group (operation duration 176.3 min±20.7 min, blood loss 255.1 ml±38.4 ml, length of incision 18.6 cm±2.4 cm and ODI 13±2.4. There was not statistical difference in terms of Cobb angle on radiographs among the three approaches. Conclusion: The anterior approach surgery is conve-nient for resection of the vertebrae and reconstruction of vertebral height, but it is more complicated and traumatic. Hence it is mostly used for severe Denis type B fracture. The posterior approach is commonly applied to most thora-columbar fractures and has fewer complications compared with the anterior approach, but it has some shortcomings as well. The paraspinal approach has great advantages

  7. [Building an effective nonlinear three-dimensional finite-element model of human thoracolumbar spine].

    Science.gov (United States)

    Zeng, Zhi-Li; Cheng, Li-Ming; Zhu, Rui; Wang, Jian-Jie; Yu, Yan

    2011-08-23

    intervertebral disc load-displacement curve were similar to those of in vitro test. The stress distribution results of vertebral cortical bone, posterior complex and cancellous bone were similar to those of other static experiments in a dynamic impact test under the observation of stress cloud. With the advantages of high geometric and mechanical similarity and complete thoracolumbar, hexahedral meshes, nonlinear finite element model may facilitate the impact loading test for a further dynamic analysis of injury mechanism for thoracolumbar burst fracture.

  8. [Comparison of effectiveness between two surgical methods in treatment of thoracolumbar brucella spondylitis].

    Science.gov (United States)

    Yang, Xinming; Zuo, Xianhong; Jia, Yongli; Chang, Yuefei; Zhang, Peng; Ren, Yixing

    2014-10-01

    To compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment. A retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed. Incision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and

  9. [The un-healing cause of its management after operation of thoracolumbar tuberculosis].

    Science.gov (United States)

    Fei, Jun; Lai, Zhen; Bi, Dawei; Shen, Jian; Wei, Wei

    2013-06-01

    To analyze the un-healing cause and management after operation of thoracolumbar tuberculosis. From January 2008 to December 2011, the data of 12 patients with postoperative un-healing thoracolumbar tuberculosis were retrospectively analyzed. There were 5 males and 7 females, with an average age of 51.3 years old (ranged, 42 to 65). All the patients occurred different degree of vertebral destruction, abscess-formation, kyphosis and nerve functional injury at the first operation. Among them, 11 patients underwent debridement and fusion with autogenous iliac bone grafting and internal fixation, 1 patient underwent debridement and fusion with autogenous iliac bone grafting. At 2-6 months after operation, internal fixation loosening, fusion failure, abscess-ormation, or erythrocyte sedimentation rate increasing occurred in the patients. For the patients to adjust anti-tuberculosis scheme, 2 patients were treated with puncture to multiple abscess combining with rifampicin local injection; 10 patients were reoperated with debridement and internal fixation adjusting. At 1-2.5 years (mean 1.8 years) after follow-up, 9 cases were cured finally. Re-admission had 3 cases because of re-occurred erythrocyte sedimentation rate increasing and abscess-formation at the 2-4 months after operation, whose bacterial culture showed more than 2 kinds of drug fast, and the treatment effect was still not ideal after adjusting anti-tuberculosis scheme. Insufficient anti-tuberculosis and bad nutritional status before operation,incomplete debridement and unreasonable fixation style during operation, inadequate drainage, irregular anti-tuberculosis and drug fast of Bacillus tuberculosis after operation are main reasons leading to un-healing of tuberculosis. Therefore, actively improving malnutrition, making individual operation plan before operation, ensuring complete debridement, rebuilding spinal stability, removing the compression of spinal cord, combining with postoperative effective

  10. Evaluation of the Results of Posterior Decompression, Corpectomy and Instrumentation in Traumatic Unstable Thoraco-Lumbar Burst Fractures

    Directory of Open Access Journals (Sweden)

    Md. Anowarul Islam

    2012-06-01

    Full Text Available Background: Thoraco-lumbar burst fractures occur as a result of axial load which often causes displacement of the middle column into the vertebral canal. Posterior surgery reduces the morbid outcomes of different other approaches. Objective: To evaluate the clinical and radiological success of posterior corpectomy and instrumentation in the management of traumatic unstable thoraco-lumbar burst fractures. Methods: It is a prospective interventional study carried out in Bangabandhu Sheikh Mujib Medical University and different private hospitals in Dhaka from July 2008 to December 2011. Total 18 patients; 13 male and 05 female within an age range of 21-40 years were selected. Total 09 cases involved L1, 05 cases at D12, 02 cases at D11 and at L2 each. Neurological status was assessed by Frankel‘s grading and pain status by Visual Analogue Score (VAS. Paired t-test was used for statistical analysis. Results: All the patients were followed up for minimum 1 year. Eleven out of 12 patients with Frankel grade-B and 04 patients out of 06 with Frankel grade-C recovered fully and could walk without support (p<0.05. Overall 03 patients ended with some degrees of persistant neurological deficit. The mean postoperative pain improvement and kyphotic angle correction was significant  (p<0.05. Conclusion: Decompression through posterior approach by laminectomy, corpectomy and fusion by cage with bone graft and stabilization by pedicle screw and rod significantly improves the clinical and radiological outcome in management of traumatic unstable thoraco-lumbar burst fractures.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10998 BSMMU J 2012; 5(1:35-41 

  11. Reconstruction of Thoracic Spine Using a Personalized 3D-Printed Vertebral Body in Adolescent with T9 Primary Bone Tumor.

    Science.gov (United States)

    Choy, Wen Jie; Mobbs, Ralph J; Wilcox, Ben; Phan, Steven; Phan, Kevin; Sutterlin, Chester E

    2017-09-01

    Neurosurgery and spine surgery have the potential to benefit from the use of 3-dimensional printing (3DP) technology due to complex anatomic considerations and the delicate nature of surrounding structures. We report a procedure that uses a 3D-printed titanium T9 vertebral body implant post T9 vertebrectomy for a primary bone tumor. A 14-year-old female presented with progressive kyphoscoliosis and a pathologic fracture of the T9 vertebra with sagittal and coronal deformity due to a destructive primary bone tumor. Surgical resection and reconstruction was performed in combination with a 3D-printed, patient-specific implant. Custom design features included porous titanium end plates, corrective angulation of the implant to restore sagittal balance, and pedicle screw holes in the 3D implant to assist with insertion of the device. In addition, attachment of the anterior column construct to the posterior pedicle screw construct was possible due to the customized features of the patient-specific implant. An advantage of 3DP is the ability to manufacture patient-specific implants, as in the current case example. Additionally, the use of 3DP has been able to reduce operative time significantly. Surgical procedures can be preplanned using 3DP patient-specific models. Surgeons can train before performing complex procedures, which enhances their presurgical planning in order to maximize patient outcomes. When considering implants and prostheses, the use of 3DP allows a superior anatomic fit for the patient, with the potential to improve restoration of anatomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Variability and constraint of vertebral formulae and proportions in colugos, tree shrews, and rodents, with special reference to vertebral modification by aerodynamic adaptation.

    Science.gov (United States)

    Kawashima, Tomokazu; Thorington, Richard W; Bohaska, Paula W; Sato, Fumi

    2017-07-13

    The aim of the present study is to provide the first large data set on vertebral formulae and proportions, and examine their relationship with different locomotive modes in colugos (Dermoptera), tree shrews (Scandentia), and rodents (Rodentia), which have been considered less variable because they were thought to have a plesiomorphic number of 19 thoracolumbar vertebrae. The data included 33 colugos and 112 tree shrews, which are phylogenetically sister taxa, and 288 additional skeletons from 29 other mammalian species adapted to different locomotive modes, flying, gliding, arboreal, terrestrial, digging, and semi-aquatic habitats. The following results were obtained: (1) intra-/interspecies variability and geographical variation in thoracic, lumbar, and thoracolumbar counts were present in two gliding colugo species and 12 terrestrial/arboreal tree shrew species; (2) in our examined mammals, some aerodynamic mammals, such as colugos, southern flying squirrels, scaly-tailed squirrels, and bats, showed exceptionally high amounts of intraspecific variation of thoracic, lumbar, and thoracolumbar counts, and sugar gliders and some semi-aquatic rodents also showed some variation; (3) longer thoracic and shorter lumbar vertebrae were typically shared traits among the examined mammals, except for flying squirrels (Pteromyini) and scaly-tailed squirrels (Anomaluridae). Our study reveals that aerodynamic adaptation could potentially lead to strong selection and modification of vertebral formulae and/or proportions based on locomotive mode despite evolutionary and developmental constraints.

  13. CIRSE Guidelines on Percutaneous Vertebral Augmentation

    Energy Technology Data Exchange (ETDEWEB)

    Tsoumakidou, Georgia, E-mail: gtsoumakidou@yahoo.com; Too, Chow Wei, E-mail: spyder55@gmail.com; Koch, Guillaume, E-mail: guillaume.koch@gmail.com; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr; Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Garnon, Julien, E-mail: juliengarnon@gmail.com; Gangi, Afshin, E-mail: gangi@unistra.fr [Strasbourg University Hospital, Interventional Radiology Department (France)

    2017-03-15

    Vertebral compression fracture (VCF) is an important cause of severe debilitating back pain, adversely affecting quality of life, physical function, psychosocial performance, mental health and survival. Different vertebral augmentation procedures (VAPs) are used in order to consolidate the VCFs, relief pain,and whenever posible achieve vertebral body height restoration. In the present review we give the indications, contraindications, safety profile and outcomes of the existing percutaneous VAPs.

  14. The epidemiology of thoracolumbar trauma: A meta-analysis.

    Science.gov (United States)

    Katsuura, Yoshihiro; Osborn, James Michael; Cason, Garrick Wayne

    2016-12-01

    To describe the epidemiology of thoracolumbar fractures and associated injuries in blunt trauma patients. A systematic review and metaanalysis was performed based on a MEDLINE database search using MeSH terms for studies matching our inclusion criteria. The search yielded 21 full-length articles, each sub-grouped according to content. Data extraction and multiple analyses were performed on descriptive data. The rate of thoracolumbar fracture in blunt trauma patients was 6.90% (±3.77, 95% CI). The rate of spinal cord injury was 26.56% (±10.70), and non-contiguous cervical spine fracture occurred in 10.49% (±4.17). Associated injury was as follows: abdominal trauma 7.63% (±9.74), thoracic trauma 22.64% (±13.94), pelvic trauma 9.39% (±6.45), extremity trauma 18.26% (±5.95), and head trauma 12.96% (±2.01). Studies that included cervical spine fracture with thoracolumbar fracture had the following rates of associated trauma: 3.78% (±5.94) abdominal trauma, 21.65% (±16.79) thoracic trauma, 3.62% (±1.07) pelvic trauma, 18.36% (±4.94) extremity trauma, and 15.45% (±11.70) head trauma. A subgroup of flexion distraction injuries showed an associated intra-abdominal injury rate of 38.70% (±13.30). The most common vertebra injured was L1 at a rate of 34.40% (±15.90). T7 was the most common non-junctional vertebra injured at 3.90% (±1.09). Burst/AO type A3 fractures were the most common morphology 39.50% (±16.30) followed by 33.60% (±15.10) compression/AO type A1, 14.20% (±8.08) fracture dislocation/AO type C, and 6.96% (±3.50) flexion distraction/AO type B. The most common etiology for a thoracolumbar fracture was motor vehicle collision 36.70% (±5.35), followed by high-energy fall 31.70% (±6.70). Here we report the incidence of thoracolumbar fracture in blunt trauma and the spectrum of associated injuries. To our knowledge, this paper provides the first epidemiological road map for blunt trauma thoracolumbar injuries.

  15. Building the Vertebrate Spine

    Science.gov (United States)

    Pourquié, Olivier

    2008-03-01

    The vertebrate body can be subdivided along the antero-posterior (AP) axis into repeated structures called segments. This periodic pattern is established during embryogenesis by the somitogenesis process. Somites are generated in a rhythmic fashion from the paraxial mesoderm and subsequently differentiate to give rise to the vertebrae and skeletal muscles of the body. Somite formation involves an oscillator-the segmentation clock-whose periodic signal is converted into the periodic array of somite boundaries. This clock drives the dynamic expression of cyclic genes in the presomitic mesoderm and requires Notch and Wnt signaling. Microarray studies of the mouse presomitic mesoderm transcriptome reveal that the segmentation clock drives the periodic expression of a large network of cyclic genes involved in cell signaling. Mutually exclusive activation of the Notch/FGF and Wnt pathways during each cycle suggests that coordinated regulation of these three pathways underlies the clock oscillator. In humans, mutations in the genes associated to the function of this oscillator such as Dll3 or Lunatic Fringe result in abnormal segmentation of the vertebral column such as those seen in congenital scoliosis. Whereas the segmentation clock is thought to set the pace of vertebrate segmentation, the translation of this pulsation into the reiterated arrangement of segment boundaries along the AP axis involves dynamic gradients of FGF and Wnt signaling. The FGF signaling gradient is established based on an unusual mechanism involving mRNA decay which provides an efficient means to couple the spatio-temporal activation of segmentation to the posterior elongation of the embryo. Another striking aspect of somite production is the strict bilateral symmetry of the process. Retinoic acid was shown to control aspects of this coordination by buffering destabilizing effects from the embryonic left-right machinery. Defects in this embryonic program controlling vertebral symmetry might lead

  16. Third-generation percutaneous vertebral augmentation systems

    Science.gov (United States)

    Galzio, Renato; Kazakova, Anna; Pantalone, Andrea; Grillea, Giovanni; Bartolo, Marcello; Salini, Vincenzo; Magliani, Vincenzo

    2016-01-01

    Currently, there is no general consensus about the management of osteoporotic vertebral fractures (OVF). In the past, conservative treatment for at least one month was deemed appropriate for the majority of vertebral fractures. When pain persisted after conservative treatment, it was necessary to consider surgical interventions including: vertebroplasty for vertebral fractures with less than 30% loss of height of the affected vertebral body and kyphoplasty for vertebral fractures with greater than 30% loss of height. Currently, this type of treatment is not feasible. Herein we review the characteristics and methods of operation of three of the most common percutaneous vertebral augmentation systems (PVAS) for the treatment of OVF: Vertebral Body Stenting® (VBS), OsseoFix® and Spine Jack®. VBS is a titanium device accompanied by a hydraulic (as opposed to mechanical) working system which allows a partial and not immediate possibility to control the opening of the device. On the other hand, OsseoFix® and Spine Jack® are accompanied by a mechanical working system which allows a progressive and controlled reduction of the vertebral fracture. Another important aspect to consider is the vertebral body height recovery. OsseoFix® has an indirect mechanism of action: the compaction of the trabecular bone causes an increase in the vertebral body height. Unlike the Vertebral Body Stenting® and Spine Jack®, the OsseoFix® has no direct lift mechanism. Therefore, for these characteristics and for the force that this device is able to provide. In our opinion, Spine Jack® is the only device also suitable for the treatment OVF, traumatic fracture (recent, old or inveterate) and primary or secondary bone tumors. PMID:27683690

  17. Prediction of Deformity Correction by Pedicle Screw Instrumentation in Thoracolumbar Scoliosis Surgery

    Science.gov (United States)

    Kiriyama, Yoshimori; Yamazaki, Nobutoshi; Nagura, Takeo; Matsumoto, Morio; Chiba, Kazuhiro; Toyama, Yoshiaki

    In segmental pedicle screw instrumentation, the relationship between the combinations of pedicle screw placements and the degree of deformity correction was investigated with a three-dimensional rigid body and spring model. The virtual thoracolumbar scoliosis (Cobb’s angle of 47 deg.) was corrected using six different combinations of pedicle-screw placements. As a result, better correction in the axial rotation was obtained with the pedicle screws placed at or close to the apical vertebra than with the screws placed close to the end vertebrae, while the correction in the frontal plane was better with the screws close to the end vertebrae than with those close to the apical vertebra. Additionally, two screws placed in the convex side above and below the apical vertebra provided better correction than two screws placed in the concave side. Effective deformity corrections of scoliosis were obtained with the proper combinations of pedicle screw placements.

  18. Posterior Vertebral Column Resection Through Unilateral Osteotomy Approach for Old Lumbar Fracture Combined with Kummell Disease.

    Science.gov (United States)

    Wang, Hui; Ding, Wenyuan

    2018-01-01

    Kummell disease is a clinical syndrome characterized by minor spinal trauma with a symptom-free period from months to years, followed by progressive painful kyphosis. Many surgical options for Kummell disease have been reported in the previous literature; however, no study has mentioned the surgical strategy for patients whose fractured vertebrae were severely compressed and only a slice of superior and inferior end plate was left. Here we report the case of a 69-year-old woman who suffered persistent severe back pain since she slipped and fell 1 year before medical consult. The patient presented with constrained body posture and pressure pain on the thoracolumbar region. Visual analog scale pain under weight bearing was 90/100, and her Oswestry Disability Index score was 74%. Kummell disease was diagnosed on the basis of clinical presentation, trauma history, radiograph, computed tomography, and magnetic resonance imaging. We performed the posterior vertebral column resection through the unilateral osteotomy approach for the patient, and the clinical outcome and radiologic restoration were recorded. One year after the surgery, outpatient follow-up review revealed that the visual analog scale reduced to 10/100 and Oswestry Disability Index reduced to 13%. The posteroanterior and lateral radiograph in the standing position showed bony fusion was achieved at the osteotomy site. No pseudarthrosis or instrumentation-related failure occurred. Posterior vertebral column resection through unilateral osteotomy approach is an effective method for patients with Kummell disease, especially when the fractured vertebrae compressed severely and only a slice of superior and inferior end plate was left. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Percutaneous vertebroplasty in osteoporotic vertebral compression fractures

    NARCIS (Netherlands)

    Voormolen, Maurits Hendrik Joannes

    2006-01-01

    Percutaneous vertebroplasty (PV) literary means augmentation of the vertebral body through the skin. The main goal is partial or complete pain relief. Nowadays, the most frequent indication for treatment is a painful invalidating osteoporotic vertebral compression fracture (VCF), not responding to

  20. Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers.

    Science.gov (United States)

    Kuisma, Mari; Karppinen, Jaro; Niinimäki, Jaakko; Ojala, Risto; Haapea, Marianne; Heliövaara, Markku; Korpelainen, Raija; Taimela, Simo; Natri, Antero; Tervonen, Osmo

    2007-05-01

    Cross-sectional comparison of self-reported low back pain (LBP) symptoms and Modic findings on magnetic resonance imaging (MRI). To investigate associations of frequency and intensity of LBP and sciatic pain with Modic changes in a sample of middle-aged male workers with or without whole-body vibration exposure. Vertebral endplate changes are bone marrow lesions visible on MRI and are assumed to be associated with degenerative intervertebral disc disease. Associations of these so-called Modic changes with clinical symptoms are controversial. Furthermore, most of these studies have been performed in selected series of patients. A total of 228 middle-aged male workers (159 train engineers and 69 sedentary controls) from northern Finland underwent sagittal T1 and T2-weighted MRI. Both endplates of 1140 lumbar interspaces were graded for type and extent of Modic changes. Logistic regression was used to analyze associations of pain variables with Modic changes. Train engineers had on the average higher sciatic pain scores than the sedentary controls, but the prevalence of Modic changes was similar in both occupational groups. Altogether, 178 Modic changes in 128 subjects were recorded: 30% were type I, 66% type II, and 4% both types I and II. Eighty percent of changes occurred at L4-L5 or L5-S1. Modic changes at L5-S1 showed significant association with pain symptoms with increased frequency of LBP (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.44-3.15) and sciatica episodes (OR 1.44; 95% CI 1.01-1.89), and with higher LBP visual analog scores during the past week (OR 1.36; 95% CI 1.06-1.70). Type I lesions and extensive lesions in particular were closely associated with pain. Modic changes at L5-S1 and Modic type I lesions are more likely to be associated with pain symptoms than other types of Modic changes or changes located at other lumbar levels.

  1. Concordance in the radiological diagnosis of thoracolumbar spine fractures.

    Science.gov (United States)

    Hirschfeld, M; Rodriguez, M; Cerván, A M; Ortega, J A; Rivas-Ruiz, F; Guerado, E

    2015-01-01

    Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment to obtain good clinical results is essential, with many classifications being proposed for this purpose. To determine the external validity of radiographic and computed tomography (CT) measurements for the most used classifications, and decide on the type of treatment required. The working hypothesis is the existence of external validity of radiographic measurements. A sample of patients with thoracolumbar fracture was selected. Three spine specialists and a resident performed measurements on anteroposterior and lateral radiographic images as well as coronal, sagittal and axial CT slices. Fractures were classified as stable or unstable, evaluating the degree of intra-and interobserver agreement based on a standard observer. Sagittal index of Farcy, lateral wedging, Beck Index, traumatic regional angulation and channel occupancy were studied. All indicators studied, except the lateral wedging, showed a high degree of concordance. Instability determinants studied with radiographs and CT, which had obtained statistical significance, are reliable and accurate for the classification of thoracolumbar fractures and, therefore, to indicate an appropriate treatment. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  2. Prevalence of Scoliosis and Thoracolumbar Kyphosis in Patients With Achondroplasia.

    Science.gov (United States)

    Khan, Bilal I; Yost, Mary T; Badkoobehi, Haleh; Ain, Michael C

    2016-03-01

    Retrospective chart review, case series. To determine the prevalence of scoliosis and kyphosis in patients with achondroplasia. There is little published research on the prevalence of scoliosis and thoracolumbar kyphosis in patients with achondroplasia. The authors retrospectively reviewed charts of 459 patients with achondroplasia who were seen by the senior author, an orthopedic surgeon, from 1999 through 2013, at a tertiary referral center. After excluding patients who presented after spinal surgery and those who were referred for specific non-spinal issues, 326 patients were included (71%). Cobb angles were measured on lateral and posteroanterior radiographs. Scoliosis was defined as curvature on posteroanterior radiographs greater than 10°; thoracolumbar kyphosis was defined as any kyphotic curvature with an apex between T11 and L2. These data were then stratified by sex, age group (0-2, 3-12, 13-19, 20-40, and >40 years), and severity: within normal limits (≤10°), mild (>10°-25°), moderate (26°-50°), and severe (>50°). The study population consisted of 176 males and 150 females with a mean age of 18 years. Scoliosis was observed in 60%. Thoracolumbar kyphosis was observed in 79%, with 52% exhibiting moderate to severe curvature. In these patients, the rates of scoliosis and kyphosis were 60% and 79%, respectively, which are much higher than the rates reported in the literature for the general population of children. Level 3 or 4. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  3. Which is the ideal point of time to perform intraoperative 3D imaging in dorsal stabilisation of thoracolumbar spine fractures? A matched pair analysis.

    Science.gov (United States)

    Beck, M; Mittlmeier, T; Gierer, P; Rotter, R; Harms, C; Gradl, G

    2010-10-01

    After dorsal stabilisation of vertebral fractures by an internal fixateur the postoperative computed tomography is a standard procedure to control the positions of the pedicle screws, the success of the reposition, the clearance of the spinal canal and to plane an additive secondary ventral stabilisation. An intraoperative scan with a 3D image intensifier may clarify these questions directly after the implantation with the possibility of an immediate correction of the implants. The aim of this study was to find out the optimal point of time to perform an intraoperative 3D scan and if a postoperative computed tomography is dispensable. Intraoperative 3D scans were carried out on 33 patients with thoracolumbar spine fractures (T11-L5) after bi-segmental fixateur interne montage (Group 1). A matched pair group of 33 patients (Group 2) with a 3D scan after implantation of pedicle screws was built. A postoperative computed tomography of the instrumented spinal section was done in all patients. The following measurements were done in sagittal and axial reconstruction planes and were compared: classification of screw positions, maximal axial diameter of pedicles, cortical perforation of the screws. Additionally in Group 1 the distance between the upper and lower end plates of the injured section, the height of posterior vertebral body wall, the dislocation of the posterior wall and the minimal diameter of the spinal canal were measured. The intraoperative scoring of pedicle screws positions and the measurement of pedicle width showed in both groups a significant accordance with the computed tomography determinations. The measurements "posterior wall dislocation" and "diameter of spinal canal" were only possible in 24 3D scans and showed a significant difference compared with the CT data. The picture quality in Group 2 was scored significantly better than for Group 1 with the complete assembly of the fixateur. The ideal point of time for an intraoperative 3D imaging with

  4. Proximal junctional vertebral fracture-subluxation after adult spine deformity surgery. Does vertebral augmentation avoid this complication? A case report

    Directory of Open Access Journals (Sweden)

    Fernández-Baíllo Nicomedes

    2012-09-01

    Full Text Available Abstract Background To report to the orthopedic community a case of vertebral fracture and adjacent vertebral subluxation through the upper instrumented vertebra after thoracolumbar fusion with augmentation of the cranial level. Methods This report reviewed the patient`s medical record, her imaging studies and related literature. The possible factors contributing to this fracture are hypothesized. Results A 70-year-old woman underwent decompressive surgery and posterolateral fusion for adult lumbar scoliosis. We used pedicular screws from T10 to S1 and iliac screw at the right side, augmented with cement at T10, T11, L1, L5 and S1; and prophylactic vertebroplasty at T9 to avoid the "topping-off syndrome". Thirty days after discharge, without recognizable inciting trauma, the patient complained of pain in the lower thoracic area. The exam revealed overall neurological deficit below the level of fracture. CT scan and MRI demonstrated a T10 vertebral collapse and T9 vertebral subluxation with morphologic features of flexion-distraction fracture through the upper edge of the screw. At this point, the authors performed posterior decompression at T9 to T10 and extended posterolateral arthrodesis from T2 to T10. To our knowledge, this is an unreported fracture. Conclusions Augmentation of the cranial level in a long thoracolumbar fusion has been developed to avoid the junctional kyphosis and compression fractures at that level. We alert the orthopedic community that this augmentation may lead to further and more severe fractures, although this opinion requires investigation for confirmation.

  5. Consequences of intraoperative spinal cord manipulation in dogs with thoracolumbar intervertebral disc extrusion

    Directory of Open Access Journals (Sweden)

    C.C. Diogo

    Full Text Available ABSTRACT The objective of the present study was to evaluate if extradural contact during hemilaminectomy would cause neurological deterioration in the early and/or late postoperative period in dogs with intervertebral disc extrusion. Nineteen dogs with thoracolumbar intervertebral disc extrusion underwent hemilaminectomy for spinal cord decompression and removal of extruded disc material. Meningeal contacts during surgery were quantified. Paraplegia (with nociception and paraparesis were observed in 11/19 and 8/19 of dogs, respectively, before surgery. At the end of our study, only two (2/19 had paraplegia and one (1/19, paraparesis. There were more extradural contacts when extruded intervertebral disc material was at a ventrolateral position. Extradural contacts during surgery had no influence on neurological progression nor on time to recovery of motor function. Immediately (24 and 48 hours after surgery, 13/19 dogs had the same neurological stage before surgery. At 7 and 90 days, 13/19 and 17/19 dogs, respectively, showed neurological improvement, compared with their preoperative stage. There was no influence of the number of extradural contacts on neurological recovery. These findings indicate that a careful inspection of the vertebral canal for removal of as much extruded disc material as possible does not cause neurologic deterioration.

  6. Vertebral cross-sectional growth: A predictor of vertebral wedging in the immature skeleton.

    Science.gov (United States)

    Poorghasamians, Ervin; Aggabao, Patricia C; Wren, Tishya A L; Ponrartana, Skorn; Gilsanz, Vicente

    2017-01-01

    The degree of vertebral wedging, a key structural characteristic of spinal curvatures, has recently been found to be negatively related to vertebral cross-sectional area (CSA). The purpose of this longitudinal study was to examine the relation between vertebral cross-sectional growth and vertebral wedging progression within the immature lumbar spine. Using magnetic resonance imaging (MRI), we analyzed the potential association between increases in lumbar vertebral CSA and changes in L5 vertebral wedging in 27 healthy adolescent girls (ages 9-13 years) twice within a two-year period. Vertebral CSA growth was negatively associated with changes in posteroanterior vertebral wedging (r = -0.61; p = 0.001). Multiple regression analysis showed that this relation was independent of gains in age, height, and weight. When compared to the 14 girls whose vertebral wedging progressed, the 13 subjects whose vertebral wedging decreased had significantly greater vertebral cross-sectional growth (0.39 ± 0.25 vs. 0.75 ± 0.23 cm2; p = 0.001); in contrast, there were no significant differences in increases in age, height, or weight between the two groups. Changes in posteroanterior vertebral wedging and the degree of lumbar lordosis (LL) positively correlated (r = 0.56, p = 0.002)-an association that persisted even after adjusting for gains in age, height, and weight. We concluded that in the immature skeleton, vertebral cross-sectional growth is an important determinant of the plasticity of the vertebral body; regression of L5 vertebral wedging is associated with greater lumbar vertebral cross-sectional growth, while progression is the consequence of lesser cross-sectional growth.

  7. Thoracolumbar spine model with articulated ribcage for the prediction of dynamic spinal loading.

    Science.gov (United States)

    Ignasiak, Dominika; Dendorfer, Sebastian; Ferguson, Stephen J

    2016-04-11

    Musculoskeletal modeling offers an invaluable insight into the spine biomechanics. A better understanding of thoracic spine kinetics is essential for understanding disease processes and developing new prevention and treatment methods. Current models of the thoracic region are not designed for segmental load estimation, or do not include the complex construct of the ribcage, despite its potentially important role in load transmission. In this paper, we describe a numerical musculoskeletal model of the thoracolumbar spine with articulated ribcage, modeled as a system of individual vertebral segments, elastic elements and thoracic muscles, based on a previously established lumbar spine model and data from the literature. The inverse dynamics simulations of the model allow the prediction of spinal loading as well as costal joints kinetics and kinematics. The intradiscal pressure predicted by the model correlated well (R(2)=0.89) with reported intradiscal pressure measurements, providing a first validation of the model. The inclusion of the ribcage did not affect segmental force predictions when the thoracic spine did not perform motion. During thoracic motion tasks, the ribcage had an important influence on the predicted compressive forces and muscle activation patterns. The compressive forces were reduced by up to 32%, or distributed more evenly between thoracic vertebrae, when compared to the predictions of the model without ribcage, for mild thoracic flexion and hyperextension tasks, respectively. The presented musculoskeletal model provides a tool for investigating thoracic spine loading and load sharing between vertebral column and ribcage during dynamic activities. Further validation for specific applications is still necessary. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Correlation between thoracolumbar curvatures and respiratory function in older adults

    Directory of Open Access Journals (Sweden)

    Rahman NNAA

    2017-03-01

    Full Text Available Nor Najwatul Akmal Ab Rahman,1 Devinder Kaur Ajit Singh,1 Raymond Lee2 1Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia; 2School of Applied Sciences, London South Bank University, London, UK Abstract: Aging is associated with alterations in thoracolumbar curvatures and respiratory function. Research information regarding the correlation between thoracolumbar curvatures and a comprehensive examination of respiratory function parameters in older adults is limited. The aim of the present study was to examine the correlation between thoracolumbar curvatures and respiratory function in community-dwelling older adults. Thoracolumbar curvatures (thoracic and lumbar were measured using a motion tracker. Respiratory function parameters such as lung function, respiratory rate, respiratory muscle strength and respiratory muscle thickness (diaphragm and intercostal were measured using a spirometer, triaxial accelerometer, respiratory pressure meter and ultrasound imaging, respectively. Sixty-eight community-dwelling older males and females from Kuala Lumpur, Malaysia, with mean (standard deviation age of 66.63 (5.16 years participated in this cross-sectional study. The results showed that mean (standard deviation thoracic curvature angle and lumbar curvature angles were -46.30° (14.66° and 14.10° (10.58°, respectively. There was a significant negative correlation between thoracic curvature angle and lung function (forced expiratory volume in 1 second: r=-0.23, P<0.05; forced vital capacity: r=-0.32, P<0.05, quiet expiration intercostal thickness (r=-0.22, P<0.05 and deep expiration diaphragm muscle thickness (r=-0.21, P<0.05. The lumbar curvature angle had a significant negative correlation with respiratory muscle strength (r=-0.29, P<0.05 and diaphragm muscle thickness at deep inspiration (r=-0.22, P<0.05. However, respiratory rate

  9. Ergotropic effect of bone cement on pedicle screw fixation in treatment of osteoporotic thoracolumbar fracture

    Directory of Open Access Journals (Sweden)

    Da LIU

    2017-02-01

    Full Text Available Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo¬rotic thoracolumbar fracture. Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob¬served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi¬sual analogue scale (VAS and neurological function score (ASIA of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured. Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P0.05. Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo¬porosis, restore the

  10. [Neural crest and vertebrate evolution].

    Science.gov (United States)

    Le Douarin, Nicole M; Creuzet, Sophie

    2011-01-01

    The neural crest (NC) is a remarkable structure of the Vertebrate embryo, which forms from the lateral borders of the neural plate (designated as neural folds) during neural tube closure. As soon as the NC is formed, its constitutive cells detach and migrate away from the neural primordium along definite pathways and at precise periods of time according to a rostro-caudal progression. The NC cells aggregate in definite places in the developing embryo, where they differentiate into a large variety of cell types including the neurons and glial cells of the peripheral nervous system, the pigment cells dispersed throughout the body and endocrine cells such as the adrenal medulla and the calcitonin producing cells. At the cephalic level only, in higher Vertebrates (but along the whole neural axis in Fishes and Amphibians), the NC is also at the origin of mesenchymal cells differentiating into connective tissue chondrogenic and osteogenic cells. Vertebrates belong to the larger group of Cordates which includes also the Protocordates (Cephalocordates and the Urocordates). All Cordates are characterized by the same body plan with a dorsal neural tube and a notochord which, in Vertebrates, exists only at embryonic stages. The main difference between Protocordates and Vertebrates is the very rudimentary development of cephalic structures in the former. As a result, the process of cephalization is one of the most obvious characteristics of Vertebrates. It was accompanied by the apparition of the NC which can therefore be considered as an innovation of Vertebrates during evolution. The application of a cell marking technique which consists in constructing chimeric embryos between two species of birds, the quail and the chicken, has led to show that the vertebrate head is mainly formed by cells originating from the NC, meaning that this structure was an important asset in Vertebrate evolution. Recent studies, described in this article, have strengthened this view by showing

  11. Closure of the vertebral canal in human embryos and fetuses

    NARCIS (Netherlands)

    Mekonen, Hayelom K.; Hikspoors, Jill P. J. M.; Mommen, Greet; Kruepunga, Nutmethee; Köhler, S. Eleonore; Lamers, Wouter H.

    2017-01-01

    The vertebral column is the paradigm of the metameric architecture of the vertebrate body. Because the number of somites is a convenient parameter to stage early human embryos, we explored whether the closure of the vertebral canal could be used similarly for staging embryos between 7 and 10weeks of

  12. The development of a clinical decision making algorithm for detection of osteoporotic vertebral compression fracture or wedge deformity.

    Science.gov (United States)

    Roman, Matthew; Brown, Christopher; Richardson, William; Isaacs, Robert; Howes, Cameron; Cook, Chad

    2010-03-01

    The clinical diagnosis of an osteoporotic vertebral compression fracture (OVCF) is challenging and requires detailed assessment using comprehensive imaging methods. Further complicating matter is that the clinical sequelae associated with OVCF typically involves asymptomatic findings and variable pain patterns. The purpose of this study was to identify clinical characteristics and assessment findings that were associated with a diagnosis of OVCF. The study evaluated routine clinical findings in over 1400 subjects seen at an adult spine surgery clinic for thoracolumbar spine-related conditions within the years 2005-2009. All patients underwent a standardized clinical examination that included a self-report, observational, physical examination and imaging assessment. The diagnosis of OVCF was made after assessment of radiographic findings in sagittal alignment, vertebral body compression, and spinal canal dimensions. Data from the patient history and observational findings were then statistically analyzed and compared between those patients with a diagnosis of OVCF and those with an alternative diagnosis. Based on the results, a diagnostic support tool was created to predict the likelihood of OVCF. The most diagnostic combination included a cluster of: (1) age > 52 years; (2) no presence of leg pain; (3) body mass index ⩽ 22; (4) does not exercise regularly; and (5) female gender. A finding of two of five positive tests or less demonstrated high sensitivity of 0.95 (95% CI  =  0.83-0.99) and low negative likelihood ratio of 0.16 (95% CI  =  0.04-0.51), providing moderate value to rule out OVCF. Four of five yielded a positive likelihood ratio (LR+) of 9.6 (95% CI  =  3.7-14.9) providing moderate value in ruling in the diagnosis of OVCF. Further validation is necessary prospectively to determine the value of these findings on a disparate sample of patients in other unique environments.

  13. Varied overstrain injuries of the vertebral column conditioned by evolution

    International Nuclear Information System (INIS)

    Kohlbach, W.

    1983-01-01

    During physiological growth of the juvenile vertebral column, various stages of stability occur which are characterized by the condition of the marginal rim of the vertebral bodies. If the vertebral juvenile column is overstrained, these variations in stability results in a variety of damage to vertebral bodies and vertebral disks. One of these lesions corresponds to Scheuermann's disease (osteochondrosis of vertebral epiphyses in juveniles). Damage of the vertebral column due to overstrain can occur only if the overstrain is applied in upright position. Since Man alone can damage his vertebral column in upright position (as a result of his evolutionary development), Scheuermann's thesis is confirmed that Scheuermann's disease is confined to Man. Spondylolysis/spondylolisthesis is also a damage caused by overstrain. Here, too, the damage can occur only if the load is exercised in upright position, with the exception of a slanted positioning of the intervertebral components. (orig.) [de

  14. Varied overstrain injuries of the vertebral column conditioned by evolution

    Energy Technology Data Exchange (ETDEWEB)

    Kohlbach, W.

    1983-08-01

    During physiological growth of the juvenile vertebral column, various stages of stability occur which are characterized by the condition of the marginal rim of the vertebral bodies. If the vertebral juvenile column is overstrained, these variations in stability results in a variety of damage to vertebral bodies and vertebral disks. One of these lesions corresponds to Scheuermann's disease (osteochondrosis of vertebral epiphyses in juveniles). Damage of the vertebral column due to overstrain can occur only if the overstrain is applied in upright position. Since Man alone can damage his vertebral column in upright position (as a result of his evolutionary development), Scheuermann's thesis is confirmed that Scheuermann's disease is confined to Man. Spondylolysis/spondylolisthesis is also a damage caused by overstrain. Here, too, the damage can occur only if the load is exercised in upright position, with the exception of a slanted positioning of the intervertebral components.

  15. Lordose lombar: estudo dos valores angulares e da participação dos corpos vertebrais e discos intervertebrais Lumbar lordosis: a study of angle values and of vertebral bodies and intervertebral discs role

    Directory of Open Access Journals (Sweden)

    Luiz Henrique Fonseca Damasceno

    2006-01-01

    Full Text Available Foi estudado, em indivíduos normais, o valor angular da lordose lombar e a participação dos corpos vertebrais e discos intervertebrais na sua composição. Foram avaliadas as radiografias da coluna lombar de 350 indivíduos normais e assintomáticos com a idade variando de 18 a 50 anos (média 29,0 anos ± 8,24, sendo 143 homens e 207 mulheres. Foram medidas a curvatura lombossacra (L1S1 e a curvatura lombolombar (L1L5. As medidas das curvaturas lombares e dos seus componentes apresentaram grande variabilidade. Foram observados valores médios de -61° para a curvatura lombossacra e de -45° para a curvatura lombolombar. As medidas dos corpos vertebrais apresentaram valores cifóticos para L1, neutros para L2, e progressivamente lordóticos de L3 a L5. Os discos intervertebrais apresentaram angulação lordótica progressiva desde L1-L2. Os elementos caudais da curvatura, discos intervertebrais L4-L5 e L5-S1 e o corpo vertebral L5 corresponderam a quase 60% medida angular da curvatura lombossacra. Foi observada diferença significante entre os sexos masculino e feminino para as medidas das curvaturas lombares, e dos corpos vertebrais L2 e L4, tendo sido observados valores maiores no sexo feminino. Foram observadas diferenças relacionadas à idade na medida das curvaturas lombares e dos corpos vertebrais.The angular value of lumbar lordosis and the role of vertebral bodies and intervertebral discs in its constitution were studied in normal individuals. X-Ray images of lumbar spine were studied in 350 normal and asymptomatic individuals, ages ranging from 18 to 50 years old (average 29.0 years old ± 8.24, being 143 males and 207 females. The lumbosacral (L1S1 and the lumbolumbar (L1L5 curves were measured. Measurements for lumbar curves and their components presented a large variation. Average values of -61º were seen for lumbosacral curve and of -45º for lumbolumbar curve. Vertebral bodies measurements presented kyphotic values for L1

  16. MR imaging of tuberculous vertebral osteomyelitis: pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Gouliamos, A.D.; Kehagias, D.T.; Lahanis, S.; Moulopoulou, E.S.; Kalovidouris, A.A.; Trakadas, S.J.; Vlahos, L.j. [Dept. of Radiology, University of Athens (Greece); Athanassopoulou, A.A. [Dept. of Radiology, Asklipiion Hospital, Athens (Greece)

    2001-04-01

    Vertebral osteomyelitis is one of the most common manifestations of tuberculosis. Magnetic resonance imaging is considered the main imaging modality for the diagnosis, the demonstration of the extent of the disease, and follow-up studies. Vertebral destruction involving two consecutive levels with sparing of the intervertebral disc, disc herniation into the vertebral body, epidural involvement, and paraspinal abscess are the most common MRI findings suggestive of tuberculous vertebral osteomyelitis. (orig.)

  17. Reliability of smartphone-based teleradiology for evaluating thoracolumbar spine fractures.

    Science.gov (United States)

    Stahl, Ido; Dreyfuss, Daniel; Ofir, Dror; Merom, Lior; Raichel, Michael; Hous, Nir; Norman, Doron; Haddad, Elias

    2017-02-01

    Timely interpretation of computed tomography (CT) scans is of paramount importance in diagnosing and managing spinal column fractures, which can be devastating. Out-of-hospital, on-call spine surgeons are often asked to evaluate CT scans of patients who have sustained trauma to the thoracolumbar spine to make diagnosis and to determine the appropriate course of urgent treatment. Capturing radiographic scans and video clips from computer screens and sending them as instant messages have become common means of communication between physicians, aiding in triaging and transfer decision-making in orthopedic and neurosurgical emergencies. The present study aimed to compare the reliability of interpreting CT scans viewed by orthopedic surgeons in two ways for diagnosing, classifying, and treatment planning for thoracolumbar spine fractures: (1) captured as video clips from standard workstation-based picture archiving and communication system (PACS) and sent via a smartphone-based instant messaging application for viewing on a smartphone; and (2) viewed directly on a PACS. Reliability and agreement study. Thirty adults with thoracolumbar spine fractures who had been consecutively admitted to the Division of Orthopedic Surgery of a Level I trauma center during 2014. Intraobserver agreement. CT scans were captured by use of an iPhone 6 smartphone from a computer screen displaying PACS. Then by use of the WhatsApp instant messaging application, video clips of the scans were sent to the personal smartphones of five spine surgeons. These evaluators were asked to diagnose, classify, and determine the course of treatment for each case. Evaluation of the cases was repeated 4 weeks later, this time using the standard method of workstation-based PACS. Intraobserver agreement was interpreted based on the value of Cohen's kappa statistic. The study did not receive any outside funding. Intraobserver agreement for determining fracture level was near perfect (κ=0.94). Intraobserver

  18. Reliability assessment of AOSpine thoracolumbar spine injury classification system and Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries: results of a multicentre study.

    Science.gov (United States)

    Kaul, Rahul; Chhabra, Harvinder Singh; Vaccaro, Alexander R; Abel, Rainer; Tuli, Sagun; Shetty, Ajoy Prasad; Das, Kali Dutta; Mohapatra, Bibhudendu; Nanda, Ankur; Sangondimath, Gururaj M; Bansal, Murari Lal; Patel, Nishit

    2017-05-01

    The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries. Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation. Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems. Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not

  19. Identifying osteoporotic vertebral endplate and cortex fractures.

    Science.gov (United States)

    Wáng, Yì Xiáng J; Santiago, Fernando Ruiz; Deng, Min; Nogueira-Barbosa, Marcello H

    2017-10-01

    Osteoporosis is the most common metabolic bone disease, and vertebral fractures (VFs) are the most common osteoporotic fracture. A single atraumatic VF may lead to the diagnosis of osteoporosis. Prevalent VFs increase the risk of future vertebral and non-vertebral osteoporotic fracture independent of bone mineral density (BMD). The accurate and clear reporting of VF is essential to ensure patients with osteoporosis receive appropriate treatment. Radiologist has a vital role in the diagnosis of this disease. Several morphometrical and radiological methods for detecting osteoporotic VF have been proposed, but there is no consensus regarding the definition of osteoporotic VF. A vertebra may fracture yet not ever result in measurable changes in radiographic height or area. To overcome these difficulties, algorithm-based qualitative approach (ABQ) was developed with a focus on the identification of change in the vertebral endplate. Evidence of endplate fracture (rather than variation in vertebral shape) is the primary indicator of osteoporotic fracture according to ABQ criteria. Other changes that may mimic osteoporotic fractures should be systemically excluded. It is also possible that vertebral cortex fracture may not initially occur in endplate. Particularly, vertebral cortex fracture can occur in anterior vertebral cortex without gross vertebral deformity (VD), or fractures deform the anterior vertebral cortex without endplate disruption. This article aims to serve as a teaching material for physicians or researchers to identify vertebral endplate/cortex fracture (ECF). Emphasis is particularly dedicated to identifying ECF which may not be associated apparent vertebral body collapse. We believe a combined approach based on standardized radiologic evaluation by experts and morphometry measurement is the most appropriate approach to detect and classify VFs.

  20. Identifying osteoporotic vertebral endplate and cortex fractures

    Science.gov (United States)

    Santiago, Fernando Ruiz; Deng, Min; Nogueira-Barbosa, Marcello H.

    2017-01-01

    Osteoporosis is the most common metabolic bone disease, and vertebral fractures (VFs) are the most common osteoporotic fracture. A single atraumatic VF may lead to the diagnosis of osteoporosis. Prevalent VFs increase the risk of future vertebral and non-vertebral osteoporotic fracture independent of bone mineral density (BMD). The accurate and clear reporting of VF is essential to ensure patients with osteoporosis receive appropriate treatment. Radiologist has a vital role in the diagnosis of this disease. Several morphometrical and radiological methods for detecting osteoporotic VF have been proposed, but there is no consensus regarding the definition of osteoporotic VF. A vertebra may fracture yet not ever result in measurable changes in radiographic height or area. To overcome these difficulties, algorithm-based qualitative approach (ABQ) was developed with a focus on the identification of change in the vertebral endplate. Evidence of endplate fracture (rather than variation in vertebral shape) is the primary indicator of osteoporotic fracture according to ABQ criteria. Other changes that may mimic osteoporotic fractures should be systemically excluded. It is also possible that vertebral cortex fracture may not initially occur in endplate. Particularly, vertebral cortex fracture can occur in anterior vertebral cortex without gross vertebral deformity (VD), or fractures deform the anterior vertebral cortex without endplate disruption. This article aims to serve as a teaching material for physicians or researchers to identify vertebral endplate/cortex fracture (ECF). Emphasis is particularly dedicated to identifying ECF which may not be associated apparent vertebral body collapse. We believe a combined approach based on standardized radiologic evaluation by experts and morphometry measurement is the most appropriate approach to detect and classify VFs. PMID:29184768

  1. Stature estimation based on vertebral morphometry by dual energy X-rays absorptiometry imaging in Italian females

    Directory of Open Access Journals (Sweden)

    Chantal Milani

    2017-02-01

    Full Text Available Anthropological profile in forensic context includes the assessment of parameters as ancestry, sex, age and stature of an individual by the analysis of skeletal remains. Stature can be estimated from decomposed and fully or partially skeletonized remains by means of anatomical or mathematical methods applied on the whole skeleton or single bones. Many authors calculated regression formulae for the living stature estimation by these methods, in particular based on a population similar to the remains recovered. Long bones are commonly used for stature estimation, but, when they are missing, methods involving different parts of the skeleton are needed. In this preliminary study we measured heights of the vertebral bodies in a female Caucasian Italian population, evaluated by images of morphometric X-ray absorptiometry based on dual-energy X-ray absorptiometry in living subjects investigated for routine diagnostic purposes. Thoracic and lumbar segments of the spine were measured and statistical analysis was performed, thus obtaining regression formulae for estimated living stature from thoraco-lumbar spine segments (T6-T12, L1-L4 and T6-L4. We propose this method for stature evaluation in physical or forensic anthropology when the spine is available and long bones are missing.

  2. Correlation between thoracolumbar curvatures and respiratory function in older adults.

    Science.gov (United States)

    Rahman, Nor Najwatul Akmal Ab; Singh, Devinder Kaur Ajit; Lee, Raymond

    2017-01-01

    Aging is associated with alterations in thoracolumbar curvatures and respiratory function. Research information regarding the correlation between thoracolumbar curvatures and a comprehensive examination of respiratory function parameters in older adults is limited. The aim of the present study was to examine the correlation between thoracolumbar curvatures and respiratory function in community-dwelling older adults. Thoracolumbar curvatures (thoracic and lumbar) were measured using a motion tracker. Respiratory function parameters such as lung function, respiratory rate, respiratory muscle strength and respiratory muscle thickness (diaphragm and intercostal) were measured using a spirometer, triaxial accelerometer, respiratory pressure meter and ultrasound imaging, respectively. Sixty-eight community-dwelling older males and females from Kuala Lumpur, Malaysia, with mean (standard deviation) age of 66.63 (5.16) years participated in this cross-sectional study. The results showed that mean (standard deviation) thoracic curvature angle and lumbar curvature angles were -46.30° (14.66°) and 14.10° (10.58°), respectively. There was a significant negative correlation between thoracic curvature angle and lung function (forced expiratory volume in 1 second: r =-0.23, P <0.05; forced vital capacity: r =-0.32, P <0.05), quiet expiration intercostal thickness ( r =-0.22, P <0.05) and deep expiration diaphragm muscle thickness ( r =-0.21, P <0.05). The lumbar curvature angle had a significant negative correlation with respiratory muscle strength ( r =-0.29, P <0.05) and diaphragm muscle thickness at deep inspiration ( r =-0.22, P <0.05). However, respiratory rate was correlated neither with thoracic nor with lumbar curvatures. The findings of this study suggest that increase in both thoracic and lumbar curvatures is correlated with decrease in respiratory muscle strength, respiratory muscle thickness and some parameters of lung function. Clinically, both thoracic and

  3. Vertebral contour in spondylolisthesis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J. S.; Rho, J. C.; Park, J. H.; Choi, H. Y.; Kim, B. K. [Wallace memorial Baptist Hospital, Busan (Korea, Republic of)

    1981-09-15

    The defect in the pars interarticularis of spondylolisthesis may be dependent on contributing factors related to trauma and stress to which the neural arch is subjected, superimposed on a hereditary diasthesis. Posterior wedging of 5th lumber vertebral body in lumbosacral spondylolisthesis together with the degree of slip have been measured. The average wedging in spondylolisthesis is significantly greater than patient without this condition, and forms a characteristic radiological sign. The degree of wedging and slip show a statistically valid correlation. The diagnosis of spondylolisthesis is becoming more prevalent as the complexity of our society result in the increasing use of roentgenography of the lumbar spine. Isolated lateral deviation and rotation of spinous process seen in anteroposterior radiographs of the lumbar spine seems to be associated with pathology in the pars interarticularis.

  4. Comparison of qualitative and quantitative evaluation of diffusion-weighted MRI and chemical-shift imaging in the differentiation of benign and malignant vertebral body fractures.

    Science.gov (United States)

    Geith, Tobias; Schmidt, Gerwin; Biffar, Andreas; Dietrich, Olaf; Dürr, Hans Roland; Reiser, Maximilian; Baur-Melnyk, Andrea

    2012-11-01

    The objective of our study was to compare the diagnostic value of qualitative diffusion-weighted imaging (DWI), quantitative DWI, and chemical-shift imaging in a single prospective cohort of patients with acute osteoporotic and malignant vertebral fractures. The study group was composed of patients with 26 osteoporotic vertebral fractures (18 women, eight men; mean age, 69 years; age range, 31 years 6 months to 86 years 2 months) and 20 malignant vertebral fractures (nine women, 11 men; mean age, 63.4 years; age range, 24 years 8 months to 86 years 4 months). T1-weighted, STIR, and T2-weighted sequences were acquired at 1.5 T. A DW reverse fast imaging with steady-state free precession (PSIF) sequence at different delta values was evaluated qualitatively. A DW echo-planar imaging (EPI) sequence and a DW single-shot turbo spin-echo (TSE) sequence at different b values were evaluated qualitatively and quantitatively using the apparent diffusion coefficient. Opposed-phase sequences were used to assess signal intensity qualitatively. The signal loss between in- and opposed-phase images was determined quantitatively. Two-tailed Fisher exact test, Mann-Whitney test, and receiver operating characteristic analysis were performed. Sensitivities, specificities, and accuracies were determined. Qualitative DW-PSIF imaging (delta = 3 ms) showed the best performance for distinguishing between benign and malignant fractures (sensitivity, 100%; specificity, 88.5%; accuracy, 93.5%). Qualitative DW-EPI (b = 50 s/mm(2) [p = 1.00]; b = 250 s/mm(2) [p = 0.50]) and DW single-shot TSE imaging (b = 100 s/mm(2) [p = 1.00]; b = 250 s/mm(2) [p = 0.18]; b = 400 s/mm(2) [p = 0.18]; b = 600 s/mm(2) [p = 0.39]) did not indicate significant differences between benign and malignant fractures. DW-EPI using a b value of 500 s/mm(2) (p = 0.01) indicated significant differences between benign and malignant vertebral fractures. Quantitative DW-EPI (p = 0.09) and qualitative opposed-phase imaging (p = 0

  5. The increased prevalence of cervical spondylosis in patients with adult thoracolumbar spinal deformity.

    Science.gov (United States)

    Schairer, William W; Carrer, Alexandra; Lu, Michael; Hu, Serena S

    2014-12-01

    Retrospective cohort study. To assess the concomitance of cervical spondylosis and thoracolumbar spinal deformity. Patients with degenerative cervical spine disease have higher rates of degeneration in the lumbar spine. In addition, degenerative cervical spine changes have been observed in adult patients with thoracolumbar spinal deformities. However, to the best of our knowledge, there have been no studies quantifying the association between cervical spondylosis and thoracolumbar spinal deformity in adult patients. Patients seen by a spine surgeon or spine specialist at a single institution were assessed for cervical spondylosis and/or thoracolumbar spinal deformity using an administrative claims database. Spinal radiographic utilization and surgical intervention were used to infer severity of spinal disease. The relative prevalence of each spinal diagnosis was assessed in patients with and without the other diagnosis. A total of 47,560 patients were included in this study. Cervical spondylosis occurred in 13.1% overall, but was found in 31.0% of patients with thoracolumbar spinal deformity (OR=3.27, Pspondylosis (OR=3.26, Pspondylosis or thoracolumbar spinal deformity had significantly higher rates of the other spinal diagnosis. This correlation was increased with increased severity of disease. Patients with both diagnoses were significantly more likely to have received a spine fusion. Further research is warranted to establish the cause of this correlation. Clinicians should use this information to both screen and counsel patients who present for cervical spondylosis or thoracolumbar spinal deformity.

  6. Is the Thoracolumbar Injury Classification and Severity Score (TLICS) Superior to the AO Thoracolumbar Injury Classification System for Guiding the Surgical Management of Unstable Thoracolumbar Burst Fractures without Neurological Deficit?

    Science.gov (United States)

    Yuksel, Mehmet Onur; Gurbuz, Mehmet Sabri; Is, Merih; Somay, Hakan

    2018-01-01

    To determine whether the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine Thoracolumbar Injury Classification System have any superiority to each other regarding the reliability of their recommendations in the surgical management of unstable thoracolumbar burst fractures. Fifty-five consecutive patients with thoracolumbar burst fractures undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. TLICS and AO systems were compared based on patients" American Spinal Injury Association (ASIA) scores and they were analyzed for their safety and reliability. A total of 55 patients were studied. Neurological deficits were detected in 18 patients and the remaining 37 patients had normal neurological functions. All the patients with neurological deficits received > 4 points according to TLICS. There were 14 patients with incomplete spinal cord injury and all of them received > 4 points according to TLICS (p AO system. None of the 37 patients without neurological deficit received AO points, to whom AO recommends conservative treatment despite the fact that they had unstable burst fractures (p AO particularly for guiding the surgical management of unstable thoracolumbar burst fractures without neurological deficit. However, this conclusion needs to be verified with further multicenter prospective studies.

  7. Vertebral Artery Stump Syndrome.

    Science.gov (United States)

    Suzuki, Masato; Dembo, Tomohisa; Hara, Wataru; Tajima, Takashi; Yamashita, Minako; Oji, Satoru; Nomura, Kyoichi

    2018-03-01

    Carotid stump syndrome is a well-documented embolic source for ischemic stroke. However, few cases have been reported of a similar condition - termed vertebral artery stump syndrome - which affects the posterior circulation after vertebral artery origin occlusion. We herein report a case of infarction of the right superior cerebellar artery and left posterior inferior cerebellar artery territories due to vertebral artery stump syndrome. In this interesting case, a turbulent flow at the distal side of the vertebral artery occlusion was captured on ultrasonography, and was identified as the probable mechanism of vertebral artery stump syndrome.

  8. Thoracolumbar spine trauma: Evaluation and surgical decision-making

    Directory of Open Access Journals (Sweden)

    Andrei F Joaquim

    2013-01-01

    Full Text Available Introduction: Thoracolumbar spine trauma is the most common site of spinal cord injury, with clinical and epidemiological importance. Materials and Methods: We performed a comprehensive literature review on the management and treatment of TLST. Results: Currently, computed tomography is frequently used as the primary diagnostic test in TLST, with magnetic resonance imaging used in addition to assess disc, ligamentous, and neurological injury. The Thoracolumbar Injury Classification System is a new injury severity score created to help the decision-making process between conservative versus surgical treatment. When decision for surgery is made, early procedures are feasible, safe, can improve outcomes, and reduce healthcare costs. Surgical treatment is individualized based on the injury characteristics and surgeon′s experience, as there is no evidence-based for the superiority of one technique over the other. Conclusions: The correct management of TLST involves multiple steps, such as a precise diagnosis, classification, and treatment. The TLICS can improve care and communication between spine surgeons, resulting in a more standardized treatment.

  9. Imaging of vertebral fractures

    Directory of Open Access Journals (Sweden)

    Ananya Panda

    2014-01-01

    Full Text Available Vertebral fracture is a common clinical problem. Osteoporosis is the leading cause of non-traumatic vertebral fracture. Often, vertebral fractures are not clinically suspected due to nonspecific presentation and are overlooked during routine interpretation of radiologic investigations. Moreover, once detected, many a times the radiologist fails to convey to the clinician in a meaningful way. Hence, vertebral fractures are a constant cause of morbidity and mortality. Presence of vertebral fracture increases the chance of fracture in another vertebra and also increases the risk of subsequent hip fracture. Early detection can lead to immediate therapeutic intervention improving further the quality of life. So, in this review, we wish to present a comprehensive overview of vertebral fracture imaging along with an algorithm of evaluation of vertebral fractures.

  10. The vertebral biomechanic previous and after kyphoplasty.

    Science.gov (United States)

    Pesce, V; Piazzolla, Andrea; Moretti, L; Carlucci, S; Parato, C; Maxy, P; Moretti, B

    2013-10-01

    The biomechanical understanding of increasing anterior column load with progressing kyphosis leading to subsequent vertebral compression fracture (VCF) established the basic rationale for kyphoplasty. The lumbar spine can support an effort of 500 kg in the axis of the vertebral body, and a bending moment of 20 Nm in flexion. Consequently, if this effort is forward deviated of only 10 cm, the acceptable effort will be reduced to 20 kg so it is important to restore the vertebral anterior wall after a VCF: the authors describe the biomechanical modifications in the spine after kyphoplasty.

  11. Vertebrate Embryonic Cleavage Pattern Determination.

    Science.gov (United States)

    Hasley, Andrew; Chavez, Shawn; Danilchik, Michael; Wühr, Martin; Pelegri, Francisco

    2017-01-01

    The pattern of the earliest cell divisions in a vertebrate embryo lays the groundwork for later developmental events such as gastrulation, organogenesis, and overall body plan establishment. Understanding these early cleavage patterns and the mechanisms that create them is thus crucial for the study of vertebrate development. This chapter describes the early cleavage stages for species representing ray-finned fish, amphibians, birds, reptiles, mammals, and proto-vertebrate ascidians and summarizes current understanding of the mechanisms that govern these patterns. The nearly universal influence of cell shape on orientation and positioning of spindles and cleavage furrows and the mechanisms that mediate this influence are discussed. We discuss in particular models of aster and spindle centering and orientation in large embryonic blastomeres that rely on asymmetric internal pulling forces generated by the cleavage furrow for the previous cell cycle. Also explored are mechanisms that integrate cell division given the limited supply of cellular building blocks in the egg and several-fold changes of cell size during early development, as well as cytoskeletal specializations specific to early blastomeres including processes leading to blastomere cohesion. Finally, we discuss evolutionary conclusions beginning to emerge from the contemporary analysis of the phylogenetic distributions of cleavage patterns. In sum, this chapter seeks to summarize our current understanding of vertebrate early embryonic cleavage patterns and their control and evolution.

  12. Unusual manifestation of vertebral osteoid osteoma: case report

    International Nuclear Information System (INIS)

    Scuotto, A.; Accardo, C.; Rotondo, M.; Natale, M.; Lus, G.; La Marca, P.; Cotrufo, R.; Agozzino, L.

    2002-01-01

    We report the case of a 64 year-old man with a clinical history suggesting a low thoracic-cord involvement, in which an unexpected vertebral osteoid osteoma was discovered. The patient underwent MRI of the thoraco-lumbar spine, which included sagittal and axial T1-weighted images, and sagittal double-echo T2-weighted images. Subsequently, CT scan was carried out with 2-mm-thick axial sections, aimed at T10 vertebra. Magnetic resonance imaging disclosed an extra-axial mass at T10 level. Computed tomography scan suggested an osteoid osteoma of the tenth thoracic vertebra, involving the lamina with marked sclerosis and prevalently endocanalar extension. Histology following surgical resection confirmed the diagnosis. In the reported case CT scan provided the correct pre-operative diagnosis of osteoid osteoma despite its unusual clinical-anamnestic presentation. Magnetic resonance imaging was useful in establishing the relationship of the neoplasm with the spinal cord. (orig.)

  13. Evaluation of the predictors of postoperative aggravation of shoulder imbalance in severe and rigid thoracic or thoracolumbar scoliosis.

    Science.gov (United States)

    Zang, Lei; Fan, Ning; Hai, Yong; Lu, S B; Su, Q J; Yang, J C; Guan, Li; Kang, Nan; Meng, X L; Liu, Y Z

    2016-10-01

    To study the predictors of postoperative aggravation of shoulder imbalance in severe and rigid thoracic or thoracolumbar scoliosis. In this study, 49 patients with severe and rigid thoracic or thoracolumbar scoliosis were analyzed retrospectively. The patients underwent whole-spine anteroposterior and lateral radiography preoperatively and postoperatively. On the radiographs, we measured parameters, including T1 tilt, radiographic shoulder height (RSH), proximal curve, middle curve, distal curve, apical vertebral translation (AVT) of the middle curve, thoracic trunk shift (TTS), coronal balance, and sagittal balance. We regarded RSH and T1 tilt as postoperative shoulder balance parameters and divided the patients into improved and aggravated groups of shoulder imbalance. Univariate analysis, receiver operating characteristic (ROC) curve, and multivariate logistic regression analyses were used in the statistical analyses. The RSH was -17.01 ± 21.85 mm before surgery and 4.76 ± 18.11 mm at follow-up. The T1 tilt angle was -10.20° ± 19.53° before surgery and -2.72° ± 13.48° at follow-up. The results of the univariate analysis suggest that preoperative RSH and proximal to middle curve change ratio were significantly higher in the patients in the improved RSH group (p < 0.01). In addition, preoperative RSH, preoperative T1 tilt, and apical vertebral translation of the middle curve were significantly higher, and preoperative proximal curve, postoperative proximal curve, and preoperative distal curve were significantly lower in the patients with improved T1 tilt group (p < 0.01). In a binary logistic regression analysis, preoperative RSH [B = -0.120, odds ratio (OR) = 0.887, p = 0.006] was found to be an independent predictor of postoperative aggravation of RSH. Similarly, preoperative T1 tilt (B = -0.488, OR = 0.614, p = 0.001) was found to be an independent predictor of postoperative aggravation of T1 tilt. Moreover, the relationship

  14. THORACOLUMBAR BURST FRACTURE: STRUCTURAL CHANGES AND CLINICAL OUTCOME OF TREATMENT

    Directory of Open Access Journals (Sweden)

    Rodrigo Arnold Tisot

    2016-03-01

    Full Text Available ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05 between initial collapse and SF-36 domains in both groups (operated and non-operated. Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

  15. First performance evaluation of software for automatic segmentation, labeling and reformation of anatomical aligned axial images of the thoracolumbar spine at CT

    Energy Technology Data Exchange (ETDEWEB)

    Scholtz, Jan-Erik, E-mail: janerikscholtz@gmail.com; Wichmann, Julian L.; Kaup, Moritz; Fischer, Sebastian; Kerl, J. Matthias; Lehnert, Thomas; Vogl, Thomas J.; Bauer, Ralf W.

    2015-03-15

    Highlights: •Automatic segmentation and labeling of the thoracolumbar spine. •Automatically generated double-angulated and aligned axial images of spine segments. •High grade of accurateness for the symmetric depiction of anatomical structures. •Time-saving and may improve workflow in daily practice. -- Abstract: Objectives: To evaluate software for automatic segmentation, labeling and reformation of anatomical aligned axial images of the thoracolumbar spine on CT in terms of accuracy, potential for time savings and workflow improvement. Material and methods: 77 patients (28 women, 49 men, mean age 65.3 ± 14.4 years) with known or suspected spinal disorders (degenerative spine disease n = 32; disc herniation n = 36; traumatic vertebral fractures n = 9) underwent 64-slice MDCT with thin-slab reconstruction. Time for automatic labeling of the thoracolumbar spine and reconstruction of double-angulated axial images of the pathological vertebrae was compared with manually performed reconstruction of anatomical aligned axial images. Reformatted images of both reconstruction methods were assessed by two observers regarding accuracy of symmetric depiction of anatomical structures. Results: In 33 cases double-angulated axial images were created in 1 vertebra, in 28 cases in 2 vertebrae and in 16 cases in 3 vertebrae. Correct automatic labeling was achieved in 72 of 77 patients (93.5%). Errors could be manually corrected in 4 cases. Automatic labeling required 1 min in average. In cases where anatomical aligned axial images of 1 vertebra were created, reconstructions made by hand were significantly faster (p < 0.05). Automatic reconstruction was time-saving in cases of 2 and more vertebrae (p < 0.05). Both reconstruction methods revealed good image quality with excellent inter-observer agreement. Conclusion: The evaluated software for automatic labeling and anatomically aligned, double-angulated axial image reconstruction of the thoracolumbar spine on CT is time

  16. Development of an Animal Model of Thoracolumbar Burst Fracture-Induced Acute Spinal Cord Injury

    Science.gov (United States)

    2016-07-01

    spinal cord impactor and sustained balloon compression. 2. Keywords Spinal cord injury, spine trauma , burst fracture, large animal model 3...AWARD NUMBER: W81XWH-14-2-0013 TITLE: DEVELOPMENT OF AN ANIMAL MODEL OF THORACOLUMBAR BURST FRACTURE-INDUCED ACUTE SPINAL CORD INJURY...4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER DEVELOPMENT OF AN ANIMAL MODEL OF THORACOLUMBAR BURST FRACTURE-INDUCED ACUTE SPINAL CORD INJURY 5b. GRANT

  17. Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis.

    Science.gov (United States)

    Zhao, Wen-Tao; Qin, Da-Ping; Zhang, Xiao-Gang; Wang, Zhi-Peng; Tong, Zun

    2018-02-08

    Clinical results have shown that different vertebral heights have been restored post-augmentation of osteoporotic vertebral compression fractures (OVCFs) and the treatment results are consistent. However, no significant results regarding biomechanical effects post-augmentation have been found with different types of vertebral deformity or vertebral heights by biomechanical analysis. Therefore, the present study aimed to investigate the biomechanical effects between different vertebral heights of OVCFs before and after augmentation using three-dimensional finite element analysis. Four patients with OVCFs of T12 underwent computed tomography (CT) of the T11-L1 levels. The CT images were reconstructed as simulated three-dimensional finite-element models of the T11-L1 levels (before and after the T12 vertebra was augmented with cement). Four different kinds of vertebral height models included Genant semi-quantitative grades 0, 1, 2, and 3, which simulated unilateral augmentation. These models were assumed to represent vertical compression and flexion, left flexion, and right flexion loads, and the von Mises stresses of the T12 vertebral body were assessed under different vertebral heights before and after bone cement augmentation. Data showed that the von Mises stresses significantly increased under four loads of OVCFs of the T12 vertebral body before the operation from grade 0 to grade 3 vertebral heights. The maximum stress of grade 3 vertebral height pre-augmentation was produced at approximately 200%, and at more than 200% for grade 0. The von Mises stresses were significantly different between different vertebral heights preoperatively. The von Mises stresses of the T12 vertebral body significantly decreased in four different loads and at different vertebral body heights (grades 0-3) after augmentation. There was no significant difference between the von Mises stresses of grade 0, 1, and 3 vertebral heights postoperatively. The von Mises stress significantly

  18. The radiological diagnosis of thoracolumbar disc disease in the Dachshund

    International Nuclear Information System (INIS)

    Kirberger, R.M.; Roos, C.J.; Lubbe, A.M.

    1992-01-01

    The accuracy of survey radiographs in the diagnosis of acute thoracolumbar disc disease in 36 Dachshunds was determined by comparison with lumbar myelographic findings using iohexol. The value of making radiographs immediately after injection of contrast medium and the effectiveness of oblique radiographs in determining the exact circumferential distribution of extruding or protruding disc material were assessed. The presence of a double contrast medium column, resistance to injection and the presence of cerebrospinal fluid flow during needle placement was also evaluated. The location of the affected disc was accurately determined on survey radiographs in only 26 dogs. The myelographic technique used in this study resulted in the correct intervertebral space being identified, together with the exact circumferential distribution of disc material, in 35 dogs. Survey radiographs alone are inadequate for localization of protruding or extruding disc material

  19. Temporary Percutaneous Instrumentation and Selective Anterior Fusion for Thoracolumbar Fractures.

    Science.gov (United States)

    Charles, Yann Philippe; Walter, Axel; Schuller, Sébastien; Steib, Jean-Paul

    2017-05-01

    Prospective clinical trial in thoracolumbar trauma with 5-year follow-up. To analyze clinical and radiographic outcomes of minimal invasive surgery, and the rational of circumferential fracture treatment with regard to age, degenerative changes, bone mineral density, and global sagittal balance. Non-neurologic fractures with anterior column defect can be treated by posterior percutaneous instrumentation and selective anterior fusion. After consolidation, instrumentation can be removed at 1 year to provide mobility in non-fused segments. Fifty-one patients, 47 (18-75) years, were operated for A2, A3, or B-type fractures. Visual analog scale (VAS) for back pain and Oswestry Disability Index (ODI) were assessed. Radiographic measurements were: sagittal index, regional kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, and T9 tilt. Anterior fusion and facet joints were analyzed on computed tomography (CT) at 1 year. The ODI was 8.8 before accident, 35.4 at 3 months, 17.8 at 2 years, 14.4 at 5 years. The VAS was 2.0 at 3 months and 1.0 at 5 years. The sagittal index was 18.0° preoperatively and 1.0° at 3 months (P fractured vertebra fused regularly. Spontaneous facet joint fusions were observed in two patients at the fracture level in B-type injuries. Percutaneous instrumentation and selective anterior fusion using autologous bone and mesh cages lead to high fusion rates, which provided good long-term clinical results in younger patients with thoracolumbar fractures. Sagittal alignment was maintained after instrumentation removal without damaging paravertebral muscles. Outcomes were worse in elderly patients presenting osteopenia or osteoporosis. 3.

  20. Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis.

    Science.gov (United States)

    Qureshi, Muhammad Asad; Khalique, Ahmed Bilal; Afzal, Waseem; Pasha, Ibrahim Farooq; Aebi, Max

    2013-06-01

    Tuberculous spondylitis (TBS) is the most common form of extra-pulmonary tuberculosis. The mainstay of TBS management is anti-tuberculous chemotherapy. Most of the patients with TBS are treated conservatively; however in some patients surgery is indicated. Most common indications for surgery include neurological deficit, deformity, instability, large abscesses and necrotic tissue mass or inadequate response to anti-tuberculous chemotherapy. The most common form of TBS involves a single motion segment of spine (two adjoining vertebrae and their intervening disc). Sometimes TBS involves more than two adjoining vertebrae, when it is called multilevel TBS. Indications for correct surgical management of multilevel TBS is not clear from literature. We have retrospectively reviewed 87 patients operated in 10 years for multilevel TBS involving the thoracolumbar spine at our spine unit. Two types of surgeries were performed on these patients. In 57 patients, modified Hong Kong operation was performed with radical debridement, strut grafting and anterior instrumentation. In 30 patients this operation was combined with pedicle screw fixation with or without correction of kyphosis by osteotomy. Patients were followed up for correction of kyphosis, improvement in neurological deficit, pain and function. Complications were noted. On long-term follow-up (average 64 months), there was 9.34 % improvement in kyphosis angle in the modified Hong Kong group and 47.58 % improvement in the group with pedicle screw fixation and osteotomy in addition to anterior surgery (p multilevel thoracolumbar tuberculous spondylitis undergoing radical debridement and anterior column reconstruction.

  1. Freqüencia de extrusões de núcleos pulposos cervicais e toracolombares, em cadáveres caninos submetidos à técnica de fenestração Frequency of cervical e thoracolumbar nucleus pulposus extrusions in cadavers submitted to fenestration technique

    Directory of Open Access Journals (Sweden)

    Eduardo Alberto Tudury

    2004-08-01

    potential for damage to the spinal cord during ventral cervical and lateral thoracolumbar fenestration procedures. Fourty five cadavers of stray dogs of both sexes and various breeds, were used. All dogs were young adults, neurologically normal and with body weight ranging from 7 to 13kg. From 25 dogs, the cervical spinal segment comprehending C1-C7 was freshly collected after death, while from the remaining 20 dogs, the thoracolumbar segment T11-L4 was equally freshly harvest. The spinal canal was opened (all the dogs were free of intervertebral disc disease and a dorsal incision was performed through the annulus fibrosus of the intervertebral disc until the nucleus pulposus was reached. A either ventral or lateral fenestration, with and without window openening was immediately performed. From a total of 100 fenestrated cervical intervertebral discs, 78 dorsal extrusions of disc material were observed, being 55% in the window group and 45% in the non-windowed group. From the 120 thoracolumbar fenestrated discs, 68 (56.6% presented dorsal extrusion of nucleus pulposus material into the spinal canal. Fourty-seven of these occurred in the window group, whereas 53% of the extrusions occurred in the non-window group. It was verified that intervertebral disc fenestration, with or without the opening of a window in the annulus fibrosus can result in disc material extrusion towards the vertebral canal. The incidence of extrusion was significantly higher in the cervical region when compared to the thoracolumbar area (p< 0.01, but there were no differences in disc extrusion rates between the window and non-window techniques in either cervical or thoracolumbar areas.

  2. An evaluation of the effect of pulsed wave low-level laser therapy on the biomechanical properties of the vertebral body in two experimental osteoporosis rat models.

    Science.gov (United States)

    Bayat, Mohammad; Fridoni, Mohammadjavad; Nejati, Hossein; Mostafavinia, Atarodalsadat; Salimi, Maryam; Ghatrehsamani, Mahdi; Abdollahifar, Mohammad-Amin; Najar, Azam; Bayat, Saba; Rezaei, Fatemesadat

    2016-02-01

    Osteoporosis (OP) increases vertebral fragility as a result of the biomechanical effects of diminished bone structure and composition. This study has aimed to assess the effects of pulsed wave low-level laser therapy (PW LLLT) on cancellous bone strength of an ovariectomized (OVX-d) experimental rat model and a glucocorticoid-induced OP (GIOP) experimental rat model. There were four OVX-d groups and four dexamethasone-treated groups. A group of healthy rats was used for baseline evaluations. The OVX-d rats were further subdivided into the following groups: control rats with OP, OVX-d rats that received alendronate, OVX-d rats treated with PW LLLT, and OVX-d rats treated with alendronate and PW LLLT. The remaining rats received dexamethasone and were divided into four groups: control, alendronate-treated rats, laser-treated rats, and laser-treated rats with concomitant administration of alendronate. PW LLLT (890 nm, 80 Hz, 0.972 J/cm(2)) was performed on the spinal processes of the T12, L1, L2, and L3 vertebras. We extracted the L1 vertebrae and submitted them to a mechanical compression test. Biomechanical test findings showed positive effects of the PW LLLT and alendronate administration on increasing bending stiffness and maximum force of the osteoporotic bones compared to the healthy group. However, laser treatment of OVA-d rats significantly increased stress high load compared to OVA-d control rats. PW LLLT preserved the cancellous (trabecular) bone of vertebra against the detrimental effects of OV-induced OP on bone strength in rats compared to control OV rats.

  3. [[Durable persistence of a biocompatible foreign body in a vertebral channel in open penetrating trauma of a spinal cord: clinico-experimental and pathomorphological peculiarities].

    Science.gov (United States)

    Tsymbalyuk, V I; Medvedyev, V V; Semenova, V M; Grydina, N Ya; Yaminskyi, Yu Ya; Senchyk, Yu Yu; Draguntsova, N G; Rybachuk, O A; Dychko, S M; Petriv, T I

    2016-08-01

    Simulation model of open penetrating wound of a spinal cord (SC) with its durable com- pression by biocompatible foreign body, was tasted. Experimental animals - mature male rats (inbred line, descendent from a Wistar breed); the trauma simulation model - a left- sided transsection of the SC half on the Txi level; experimental groups: the main (a SC trau- ma + homotopic implantation of microporous hydrogel fragment - foreign body [n=10]), groups of comparison (the SC trauma [n=16]; the SC trauma + homotopic implantation of chemically identical analogue of hydrogel - NeuroGelTM [n=20]). A SC compression by a foreign body worsens the regeneration process course essentially: during first 2 mo the function index of a hind ipsilateral extremity in experimental animals of the main group was the lowest in the experiment - (1.30 ? 0.94) points in accordance to BBB scale, during 3 - 4 mo - the function index had enhanced trustworthy - up to (2.35 ? 0.95) points in accor- dance to BBB scale, what is connected with lowering of a local pressure on a SC tissue due to change of the foreign body form and volume. In 24 weeks the function index of hind ipsi- lateral extremity had constituted (8.45 ? 0.92) points - while application of NeuroGeTM and (2.35 ? 0.95) points - of the foreign body; the tissue processes in the implants localization zone had differed essentially. The tasted simulation model reproduces satisfactory a mechanical component of the foreign body impact on a SC tissue. The SC compression reduction, even in a late follow-up period, had improved the conditions and results of recenerative process essentially.

  4. Endplates Changes Related to Age and Vertebral Segment

    Directory of Open Access Journals (Sweden)

    Carlos Fernando P. S. Herrero

    2014-01-01

    Full Text Available Endplate separations are defined as the presence of a space between the hyaline cartilage and the cortical bone of the adjacent vertebral body. This study evaluates endplate separations from the vertebral body and intervertebral discs and verifies if endplate separation is related to age and the spinal level. Groups were formed based on age (20–40 and 41–85 years old and the vertebral segment (T7-T8 and L4-L5 segments. Histological analysis included assessment of the length of the vertebral endplates, the number and dimensions of the separations, and orientation of the collagen fibers, in the mid-sagittal slice. Two indexes were created: the separation index (number of separations/vertebral length and separation extension index (sum of all separations/vertebral length. The results of the study demonstrated a direct relationship between the density of separations in the endplate and two variables: age and spinal level.

  5. Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hayeon, E-mail: kimh2@upmc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Rajagopalan, Malolan S.; Beriwal, Sushil; Huq, M. Saiful [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Smith, Kenneth J. [Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States)

    2015-03-01

    Purpose: Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods and Materials: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction) with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. Conclusion: SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100

  6. Reduced thoracolumbar fascia shear strain in human chronic low back pain

    Directory of Open Access Journals (Sweden)

    Konofagou Elisa E

    2011-09-01

    Full Text Available Abstract Background The role played by the thoracolumbar fascia in chronic low back pain (LBP is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP. Methods We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity. Results Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p Conclusion Thoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function.

  7. Lumbo-costo-vertebral syndrome with posterior spinal dysraphism.

    Science.gov (United States)

    Kumar, G Samson Sujit; Kulkarni, Vaijayantee; Haran, R P

    2005-09-01

    Lumbo-costo-vertebral syndrome, which includes abnormalities of the vertebral bodies, ribs and trunk musculature, is very rare and only few cases have been reported. We report a case of 18-month-old female child with absent ribs, hemivertebrae, superior lumbar hernia (features of lumbo-costo-vertebral syndrome) and posterior spinal dysraphism, which to our knowledge is the first case in the English literature with such a combination of defects. Embryology and management of the case is discussed.

  8. Assisted techniques for vertebral cementoplasty: Why should we do it?

    Energy Technology Data Exchange (ETDEWEB)

    Muto, M., E-mail: mutomar@tiscali.it [Department of Diagnostic Imaging, Section of Neuroradiology—“A. Cardarelli” Hospital, Naples (Italy); Marcia, S. [Section of Radiology—Santissima Trinità Hospital, Cagliari (Italy); Guarnieri, G. [Department of Diagnostic Imaging, Section of Neuroradiology—“A. Cardarelli” Hospital, Naples (Italy); Pereira, V. [Unit of Interventional Neuroradiology–HUG, Geneva (Switzerland)

    2015-05-15

    Assisted techniques (AT) for vertebral cementoplasty include multiple mini-invasive percutaneous systems in which vertebral augmentation is obtained through mechanical devices with the aim to reach the best vertebral height restoration. As an evolution of the vertebroplasty, the rationale of the AT-treatment is to combine the analgesic and stability effect of cement injection with the restoration of a physiological height for the collapsed vertebral body. Reduction of the vertebral body kyphotic deformity, considering the target of normal spine biomechanics, could improve all systemic potential complications evident in patient with vertebral compression fracture (VCF). Main indications for AT are related to fractures in fragile vertebral osseous matrix and non-osteoporotic vertebral lesions due to spine metastasis or trauma. Many companies developed different systems for AT having the same target but different working cannula, different vertebral height restoration system and costs. Aim of this review is to discuss about vertebral cementoplasty procedures and techniques, considering patient inclusion and exclusion criteria as well as all related minor and/or major interventional complications.

  9. Kyphoplasty for severe osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Bao Zhaohua; Wang Genlin; Yang Huilin; Meng Bin; Chen Kangwu; Jiang Weimin

    2010-01-01

    Objective: To evaluate the clininal efficacy of kyphoplasty for severe osteoporotic vertebral compression fractures. Methods: Forty-five patients with severe osteoporotic compressive fractures were treated by kyphoplasty from Jan 2005 to Jan 2009. The compressive rate of the fractured vertebral bodies was more than 75%. According to the morphology of the vertebral compression fracture bodies the unilateral or bilateral balloon kyphoplasty were selected. The anterior vertebral height was measured on a standing lateral radiograph at pre-operative, post-operative (one day after operation) and final follow-up time. A visual analog scale(VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain status and functional activity. Results: The mean follow-up was for 21.7 months (in range from 18 to 48 months). The anterior vertebral body height of fracture vertebra was restored from preoperative (18.7 ± 3.1)% to postoperative (51.4 ± 2.3)%, the follow-up period (50.2 ± 2.7)%. There was a significant improvement between preoperative and postoperative values (P 0.05). The VAS was 8.1 ± 1.4 at preoperative, 2.6 ± 0.9 at postoperative, 2.1 ± 0.5 at final follow-up time; and the ODI was preoperative 91.1 ± 2.3, postoperative 30.7 ± 7.1, follow-up period 26.1 ± 5.1. There was statistically significant improvement in the VAS and ODI in the post-operative assessment compared with the pre-operative assessment (P 0.05). Asymptomatic cement leakage occurred in three cases. New vertebral fracture occurred in one case. Conclusion: The study suggests that balloon kyphoplasty is a safe and effective procedure in the treatment of severe osteoporotic vertebral compression fractures. (authors)

  10. The thoracolumbar fascia: anatomy, function and clinical considerations

    Science.gov (United States)

    Willard, F H; Vleeming, A; Schuenke, M D; Danneels, L; Schleip, R

    2012-01-01

    In this overview, new and existent material on the organization and composition of the thoracolumbar fascia (TLF) will be evaluated in respect to its anatomy, innervation biomechanics and clinical relevance. The integration of the passive connective tissues of the TLF and active muscular structures surrounding this structure are discussed, and the relevance of their mutual interactions in relation to low back and pelvic pain reviewed. The TLF is a girdling structure consisting of several aponeurotic and fascial layers that separates the paraspinal muscles from the muscles of the posterior abdominal wall. The superficial lamina of the posterior layer of the TLF (PLF) is dominated by the aponeuroses of the latissimus dorsi and the serratus posterior inferior. The deeper lamina of the PLF forms an encapsulating retinacular sheath around the paraspinal muscles. The middle layer of the TLF (MLF) appears to derive from an intermuscular septum that developmentally separates the epaxial from the hypaxial musculature. This septum forms during the fifth and sixth weeks of gestation. The paraspinal retinacular sheath (PRS) is in a key position to act as a ‘hydraulic amplifier’, assisting the paraspinal muscles in supporting the lumbosacral spine. This sheath forms a lumbar interfascial triangle (LIFT) with the MLF and PLF. Along the lateral border of the PRS, a raphe forms where the sheath meets the aponeurosis of the transversus abdominis. This lateral raphe is a thickened complex of dense connective tissue marked by the presence of the LIFT, and represents the junction of the hypaxial myofascial compartment (the abdominal muscles) with the paraspinal sheath of the epaxial muscles. The lateral raphe is in a position to distribute tension from the surrounding hypaxial and extremity muscles into the layers of the TLF. At the base of the lumbar spine all of the layers of the TLF fuse together into a thick composite that attaches firmly to the posterior superior iliac spine

  11. Identifying osteoporotic vertebral fracture

    Science.gov (United States)

    2015-01-01

    Osteoporosis per se is not a harmful disease. It is the sequela of osteoporosis and most particularly the occurrence of osteoporotic fracture that makes osteoporosis a serious medical condition. All of the preventative measures, investigations, treatment and research into osteoporosis have one primary goal and that is to prevent the occurrence of osteoporotic fracture. Vertebral fracture is by far and away the most prevalent osteoporotic fracture. The significance and diagnosis of vertebral fracture are discussed in this article. PMID:26435923

  12. Head segmentation in vertebrates

    OpenAIRE

    Kuratani, Shigeru; Schilling, Thomas

    2008-01-01

    Classic theories of vertebrate head segmentation clearly exemplify the idealistic nature of comparative embryology prior to the 20th century. Comparative embryology aimed at recognizing the basic, primary structure that is shared by all vertebrates, either as an archetype or an ancestral developmental pattern. Modern evolutionary developmental (Evo-Devo) studies are also based on comparison, and therefore have a tendency to reduce complex embryonic anatomy into overly simplified patterns. Her...

  13. A mechanical perspective on vertebral segmentation

    NARCIS (Netherlands)

    Truskinovsky, L.; Vitale, G.; Smit, T.H.

    2014-01-01

    Segmentation is a characteristic feature of the vertebrate body plan. The prevailing paradigm explaining its origin is the 'clock and wave-front' model, which assumes that the interaction of a molecular oscillator (clock) with a traveling gradient of morphogens (wave) pre-defines spatial

  14. 128 MULTIPLE CERVICAL VERTEBRAL FUSION WITH ...

    African Journals Online (AJOL)

    GARGI

    fusion. Fusion may be complete or incomplete involving the body of the vertebra or neural arches alone. Complete vertebral fusion may be of no clinical significance but frequently disc degeneration develops above or below the fused vertebrae due to altered mechanics in the spine (Renton, 2009). CASE REPORT.

  15. THE TREATMENT OF OSTEOPOROTIC VERTEBRAL FRACTURES USING KYPHOPLASTY

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky

    2010-01-01

    Full Text Available In article results of treatment of 20 patients more senior 60 years with osteoporotic fractures of thoracolumbar spine. To all patients has been executed percutaneous kyphoplasty. In process kyphoplasty restoration of ventral departments of the broken vertebra on 15+6.2 % is reached. Correction of a local kyphosis angle is reached in limits 5-10e (7,3+2,5e. Recourse of a painful syndrome with 7,1+1,9 to 2,1+1,7 on a visual analogue scale is noted. In the remote period it is noted increases in a painful syndrome, increase of a local kyphosis angle and deformations of a body of a vertebra. Thus, percutaneous kyphoplasty, being a minimally invasive astabilisation technique, allows to restore strengthening characteristics of bodies of vertebras, to increase height ventral departments of bodies, correction of the biomechanical infringements resulting fracture thereby is reached.

  16. Progressive non-infectious anterior vertebral fusion in a baby with Saethre-Chotzen-acrocephalosyndactyly type III syndrome

    Directory of Open Access Journals (Sweden)

    Али Аль-Каисси

    2015-09-01

    Full Text Available We report on a 3-months old baby of Austrian origin and product of non-consanguineous parents. Abnormal craniofacial contour was the main deformity. The overall clinico-radiographic features were consistent with Saether-Chotzen-acrocephalosyndactyly type III syndrome. Bi-directional sequencing of the exon 8 and of the FGFR3-genes, exons 7 of FGFR3 (Fibroblast growth factor receptor3 genes, the exon 5 of the FGFR1 gene, revealed no mutations. Sagittal MRI imaging of the spine showed anterior vertebral fusion along the thoraco-lumbar vertebrae compatible with the non-infectious type.

  17. Reduced thoracolumbar fascia shear strain in human chronic low back pain

    Science.gov (United States)

    2011-01-01

    Background The role played by the thoracolumbar fascia in chronic low back pain (LBP) is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP). Methods We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity. Results Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p fascia shear strain and the following variables: perimuscular connective tissue thickness (r = -0.45, p fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function. PMID:21929806

  18. Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices.

    Science.gov (United States)

    Ragel, Brian T; Allred, C Dain; Brevard, Sid; Davis, Richard T; Frank, Edmund H

    2009-10-15

    Retrospective analysis. To analyze the types of orthopedic spine fractures sustained by North Atlantic Treaty Organization soldiers when vehicles are attacked by improvised explosive devices (IEDs), with specific focus on the flexion-distraction type thoracolumbar fracture (Chance fracture). Operation Enduring Freedom is the North Atlantic Treaty Organization's effort in Afghanistan. IED attacks on armored vehicles are common and account for high proportion of soldiers' deaths and injuries. Retrospective record review was accomplished on soldiers admitted to a military hospital with orthopedic spine fractures after IED attacks on vehicles from January 1, 2008 to May 15, 2008. Thoracolumbar fractures were classified using the McAfee classification system. Twelve male patients with 16 thoracolumbar fractures were identified (3 patients with multiple fractures). The 16 thoracolumbar fractures included 6 flexion-distraction fractures in 5 patients (38%, 6/16: two T12, two L1, one L3, and one L4), 7 compression fractures in 5 patients (44%, 5/16; one T7, one T8, two L1, one L2, one L3, and one L4), and 3 burst fractures (19%, 3/16; two L1 and one L2). The incidence of flexion-distraction thoracolumbar (Chance) fractures has been reported to be between 1.0% and 2.5% in most spine fracture series. In this small study, Chance fractures represented 38% of all tho-racolumbar fractures sustained after IED attack on armored vehicles. The blast pattern associated with IED explosion may be responsible for the high rate of these injuries in vehicle occupants.

  19. Reduced thoracolumbar fascia shear strain in human chronic low back pain.

    Science.gov (United States)

    Langevin, Helene M; Fox, James R; Koptiuch, Cathryn; Badger, Gary J; Greenan-Naumann, Ann C; Bouffard, Nicole A; Konofagou, Elisa E; Lee, Wei-Ning; Triano, John J; Henry, Sharon M

    2011-09-19

    The role played by the thoracolumbar fascia in chronic low back pain (LBP) is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP). We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity. Thoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function.

  20. Influence of physical activity on vertebral strength during late adolescence.

    Science.gov (United States)

    Junno, Juho-Antti; Paananen, Markus; Karppinen, Jaro; Tammelin, Tuija; Niinimäki, Jaakko; Lammentausta, Eveliina; Niskanen, Markku; Nieminen, Miika T; Järvelin, Marjo-Riitta; Takatalo, Jani; Tervonen, Osmo; Tuukkanen, Juha

    2013-02-01

    Reduced vertebral strength is a clear risk factor for vertebral fractures. Men and women with vertebral fractures often have reduced vertebral size and bone mineral density (BMD). Vertebral strength is controlled by both genetic and developmental factors. Malnutrition and low levels of physical activity are commonly considered to result in reduced bone size during growth. Several studies have also demonstrated the general relationship between BMD and physical activity in the appendicular skeleton. In this study, we wanted to clarify the role of physical activity on vertebral bodies. Vertebral dimensions appear to generally be less pliant than long bones when lifetime changes occur. We wanted to explore the association between physical activity during late adolescence and vertebral strength parameters such as cross-sectional size and BMD. The association between physical activity and vertebral strength was explored by measuring vertebral strength parameters and defining the level of physical activity during adolescence. The study population consisted of 6,928 males and females who, at 15 to 16 and 19 years of age, responded to a mailed questionnaire inquiring about their physical activity. A total of 558 individuals at the mean age of 21 years underwent magnetic resonance imaging (MRI) scans. We measured the dimensions of the fourth lumbar vertebra from the MRI scans of the Northern Finland Birth Cohort 1986 and performed T2* relaxation time mapping, reflective of BMD. Vertebral strength was based on these two parameters. We analyzed the association of physical activity on vertebral strength using the analysis of variance. We observed no association between the level of physical activity during late adolescence and vertebral strength at 21 years. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Thoracolumbar spine clearance: Clinical examination for patients with distracting injuries.

    Science.gov (United States)

    Cason, Ben; Rostas, Jack; Simmons, Jon; Frotan, Mohammed A; Brevard, Sidney B; Gonzalez, Richard P

    2016-01-01

    The purpose of this study was to prospectively assess the sensitivity of clinical examination to screen for thoracolumbar spine (TLS) injury in awake and alert blunt trauma patients with distracting injuries. From December 2012 to June 2014, all blunt trauma patients older than 13 years were prospectively evaluated as per standard TLS examination protocol at a Level 1 trauma center. Awake and alert patients with Glasgow Coma Scale (GCS) score of 14 or greater underwent clinical examination of the TLS. Clinical examination was performed regardless of distracting injuries. Patients with no complaints of pain or tenderness on examination of the TLS were considered clinically cleared of injury. Patients with distracting injuries, including those clinically cleared and those with complaints of TLS pain or tenderness, underwent computed tomographic scan of the entire TLS. Patients with minor distracting injuries were not considered to have a distracting injury. A total of 950 blunt trauma patients were entered, 530 (56%) of whom had at least one distracting injury. Two hundred nine patients (40%) with distracting injuries had a positive TLS clinical examination result, of whom 50 (25%) were diagnosed with TLS injury. Three hundred twenty-one patients (60%) with distracting injuries were initially clinically cleared, in whom 17 (5%) TLS injuries were diagnosed. There were no missed injuries that required surgical intervention, with only four injuries receiving TLS orthotic bracing. This yielded an overall clinical clearance sensitivity for injury of 75% and sensitivity for clinically significant injury of 89%. In awake and alert blunt trauma patients with distracting injuries, clinical examination is a sensitive screening method for significant TLS injury. Radiologic assessment may be unnecessary for safe clearance of the asymptomatic TLS in patients with distracting injuries. These findings suggest significant potential reduction of both health care cost and patient

  2. Innervation changes induced by inflammation of the rat thoracolumbar fascia.

    Science.gov (United States)

    Hoheisel, U; Rosner, J; Mense, S

    2015-08-06

    Recently, the fascia innervation has become an important issue, particularly the existence of nociceptive fibers. Fascia can be a source of pain in several disorders such as fasciitis and non-specific low back pain. However, nothing is known about possible changes of the fascia innervation under pathological circumstances. This question is important, because theoretically pain from the fascia cannot only be due to increased nociceptor discharges, but also to a denser innervation of the fascia by nociceptive endings. In this histological study, an inflammation was induced in the thoracolumbar fascia (TLF) of rats and the innervation by various fiber types compared between the inflamed and intact TLF. Although the TLF is generally considered to have proprioceptive functions, no corpuscular proprioceptors (Pacini and Ruffini corpuscles) were found. To obtain quantitative data, the length of fibers and free nerve endings were determined in the three layers of the rat TLF: inner layer (IL, adjacent to the multifidus muscle), middle layer (ML) and outer layer (OL). The main results were that the overall innervation density showed little change; however, there were significant changes in some of the layers. The innervation density was significantly decreased in the OL, but this change was partly compensated for by an increase in the IL. The density of substance P (SP)-positive - presumably nociceptive - fibers was significantly increased. In contrast, the postganglionic sympathetic fibers were significantly decreased. In conclusion, the inflamed TLF showed an increase of presumably nociceptive fibers, which may explain the pain from a pathologically altered fascia. The meaning of the decreased innervation by sympathetic fibers is obscure at present. The lack of proprioceptive corpuscular receptors within the TLF does not preclude its role as a proprioceptive structure, because some of the free nerve endings may function as proprioceptors. Copyright © 2015 IBRO. Published

  3. The pattern and prevalence of vertebral artery injury in patients with ...

    African Journals Online (AJOL)

    Other important risk factors for vertebral artery injury include facet joint dislocations and fractures of the first to the third cervical vertebral bodies. The aim of this study was to determine the pattern and prevalence of vertebral artery injury on CT angiography (CTA) in patients with cervical spine fractures. Method.

  4. Multiple vertebral fractures associated with glucocorticoid-induced osteoporosis treated with teriparatide followed by kyphosis correction fusion: a case report.

    Science.gov (United States)

    Uei, Hiroshi; Tokuhashi, Yasuaki; Maseda, Masafumi; Nakahashi, Masahiro; Nakayama, Enshi

    2018-02-23

    Surgical treatment of multiple vertebral fractures in patients with glucocorticoid-induced osteoporosis is difficult because of a high rate of secondary fracture postoperatively. A case is described in which initial treatment with teriparatide to improve osteoporosis followed by treatment of kyphosis with correction fusion achieved a favorable outcome. Secondary fracture frequently occurs after treatment of vertebral fracture with vertebroplasty and balloon kyphoplasty in patients with glucocorticoid-induced osteoporosis, but effective treatment of multiple vertebral fractures has rarely been reported. Thus, a treatment of kyphosis following multiple vertebral fractures associated with glucocorticoid-induced osteoporosis is required. The patient was a 24-year-old woman diagnosed with glucocorticoid-induced osteoporosis who was under treatment with oral alendronate, vitamin D, and elcatonin injection. Secondary multiple vertebral fractures occurred despite these treatments and low back pain gradually aggravated. Vertebroplasty or balloon kyphoplasty was not performed in the early phase. Instead, treatment with teriparatide was used for initial improvement of osteoporosis. Kyphosis in the center of the residual thoracolumbar junction was then treated with posterior correction fusion. At 2 years after surgery, the corrected position has been maintained and no new fracture has occurred. There is no established method for treatment of multiple vertebral fractures caused by glucocorticoid-induced osteoporosis. Initial treatment with teriparatide to improve osteoporosis followed by treatment of kyphosis with correction fusion may result in a more favorable outcome.

  5. Incorporation of CT-based measurements of trunk anatomy into subject-specific musculoskeletal models of the spine influences vertebral loading predictions.

    Science.gov (United States)

    Bruno, Alexander G; Mokhtarzadeh, Hossein; Allaire, Brett T; Velie, Kelsey R; De Paolis Kaluza, M Clara; Anderson, Dennis E; Bouxsein, Mary L

    2017-10-01

    We created subject-specific musculoskeletal models of the thoracolumbar spine by incorporating spine curvature and muscle morphology measurements from computed tomography (CT) scans to determine the degree to which vertebral compressive and shear loading estimates are sensitive to variations in trunk anatomy. We measured spine curvature and trunk muscle morphology using spine CT scans of 125 men, and then created four different thoracolumbar spine models for each person: (i) height and weight adjusted (Ht/Wt models); (ii) height, weight, and spine curvature adjusted (+C models); (iii) height, weight, and muscle morphology adjusted (+M models); and (iv) height, weight, spine curvature, and muscle morphology adjusted (+CM models). We determined vertebral compressive and shear loading at three regions of the spine (T8, T12, and L3) for four different activities. Vertebral compressive loads predicted by the subject-specific CT-based musculoskeletal models were between 54% lower to 45% higher from those estimated using musculoskeletal models adjusted only for subject height and weight. The impact of subject-specific information on vertebral loading estimates varied with the activity and spinal region. Vertebral loading estimates were more sensitive to incorporation of subject-specific spinal curvature than subject-specific muscle morphology. Our results indicate that individual variations in spine curvature and trunk muscle morphology can have a major impact on estimated vertebral compressive and shear loads, and thus should be accounted for when estimating subject-specific vertebral loading. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2164-2173, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  6. Vertebroplasty for adjacent vertebral fracture following lumbar interbody fusion.

    Science.gov (United States)

    Ahn, Yong; Lee, Sang-Ho

    2011-02-01

    Adjacent segment vertebral compression fracture after lumbosacral instrumented fusion has been reported to be a significant complication. Recently, percutaneous vertebroplasty (PVP) has been widely used for the treatment of non-traumatic osteoporotic vertebral fracture. However, the clinical effect of this minimally invasive treatment option to the post-fusion vertebral fracture has rarely been reported. We analysed characteristics of adjacent vertebral fractures following lumbar fusion and evaluated the clinical outcome of PVP. A total of 202 consecutive patients underwent PVP for compression fracture in our institute between January 2007 and December 2008. Among them, nine symptomatic adjacent vertebral fractures following lumbar fusion were identified. We randomly selected 50 control patients undergoing vertebroplasty for osteoporotic compression fracture in single level. We analysed the clinical data according to age, height, body weight, body mass index (BMI), and bone mineral density (BMD). Clinical outcome was assessed by a visual analogue scale (VAS) score and the rate of overall satisfaction. Fractures occurred at the cranial adjacent vertebra after fusion surgery in all cases. The mean BMD score for the spine and femur were significantly higher than the control group (p adjacent segment disease. The increased stress around the fusion segment can cause vertebral fracture even with a relatively higher BMD score. Vertebroplasty for the post-fusion vertebral fracture can be as effective as it is for the usual osteoporotic vertebral fracture.

  7. Body

    OpenAIRE

    Riggs, Christina

    2010-01-01

    The human body is both the physical form inhabited by an individual “self” and the medium through which an individual engages with society. Hence the body both shapes and is shaped by an individual’s social roles. In contrast to the cognate fields of archaeology, anthropology, and classics, there has been little explicit discussion or theorization of the body in Egyptology. Some recent works, discussed here, constitute an exception to this trend, but there is much more scope for exploring anc...

  8. The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs.

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Vleeming, A; Stoeckart, R.; Wingerden, Jan Paul; Snijders, Chris

    1996-01-01

    STUDY DESIGN: The superficial and deep lamina of the posterior layer of the thoracolumbar fascia have been studied anatomically and biomechanically. In embalmed human specimens, the posterior layer has been loaded by simulating the action of various muscles. The effect has been studied using raster

  9. Accuracy of ultrasound-guided injections of thoracolumbar articular process joints in horses

    DEFF Research Database (Denmark)

    Fuglbjerg, Vibeke; Nielsen, J.V.; Thomsen, Preben Dybdahl

    2010-01-01

    in the literature. Objectives: To evaluate factors of affecting the accuracy of intra-articular injections of the APJs in the caudal thoracolumbar region. Method: One-hundred-and-fifty-four injections with blue dye were performed on APJs including the T14-L6 region in 12 horses subjected to euthanasia for reasons...

  10. The effect of induced hindlimb lameness on thoracolumbar kinematics during treadmill locomotion.

    NARCIS (Netherlands)

    Gomez Alvarez, C.B.; Bobbert, M.F.; Lamers, L.; Johnston, C.; Back, W.; van Weeren, P.R.

    2008-01-01

    Reasons for performing study: There are no detailed studies describing a relationship between hindlimb lameness and altered motion of the back. Objectives: To quantify the effect of induced subtle hindlimb lameness on thoracolumbar kinematics in the horse. Methods: Kinematics of 6 riding horses were

  11. Treatment of traumatic thoracolumbar spine fractures : A multicenter prospective randomized study of operative versus nonsurgical treatment

    NARCIS (Netherlands)

    Siebenga, Jan; Leferink, Vincent J. M.; Segers, Michiel J. M.; Elzinga, Matthijs J.; Bakker, Fred C.; Haarman, Henk J. Th. M.; Rommens, Pol M.; ten Duis, Henk-Jan; Patka, Peter

    2006-01-01

    Study Design. Multicenter prospective randomized trial. Objective. To test the hypotheses that thoracolumbar AO Type A spine fractures without neurologic deficit, managed with short-segment posterior stabilization will show an improved radiographic outcome and at least the same functional outcome as

  12. The effect of induced forelimb lameness on thoracolumbar kinematics during treadmill locomotion

    NARCIS (Netherlands)

    Alvarez, C.B.; Wennerstrand, J.; Bobbert, M.F.; Lamers, L.; Johnston, C.; Back, W.; van Weeren, P.R.

    2007-01-01

    Reasons for performing study: Lameness has often been suggested to result in altered movement of the back, but there are no detailed studies describing such a relationship in quantitative terms. Objectives: To quantify the effect of induced subtle forelimb lameness on thoracolumbar kinematics in the

  13. Vertebral Fracture Prediction

    DEFF Research Database (Denmark)

    2008-01-01

    Vertebral Fracture Prediction A method of processing data derived from an image of at least part of a spine is provided for estimating the risk of a future fracture in vertebraeof the spine. Position data relating to at least four neighbouring vertebrae of the spine is processed. The curvature...

  14. Imaging of vertebral trauma

    International Nuclear Information System (INIS)

    Daffner, R.H.

    1999-01-01

    This translation of the toolbook published in the 'US-ART' series, offers invaluable help to medical radiologists in the diagnostic imaging and evaluation of complex vertebral traumas which are on the rise, inter alia due to increasingly dangerous leisure sports. (orig./CB) [de

  15. Risk Factors in Osteporotic Vertebral Fractures

    Directory of Open Access Journals (Sweden)

    Rezzan Günaydın

    2002-09-01

    Full Text Available The aim of this study was to investigate the risk factors for osteoporotic vertebral fractures in postmenopausal women. 44 postmenopausal women whose L 2-L4 T scores were £ -2.5 SD with a mean age of 66.38+ 6.47 years were included in this study. Age, postmenopausal years, body mass index, milk consumption (before and after age 50, family history of osteoporosis and osteoporotic fracture, patient’s previous fracture history, tobacco use, number of pregnancies, surgical menopause were questioned in all patients. DEXA was used to evaluate bone mineral density . Kleerekoper method was used to evaluate the fractures between T4 and L5 vertebra on lateral thoracal and lumbar X rays. When 25 patient with vertebral fractures compared with 19 patients without fracture ,only patient’s age showed statistically significant difference between groups ( p=0.035. Of the 5 risk factors chosen (age, L2-L4 BMD, L2-L4 T score, body weight <57 kg, milk consumption before age 50 only patient’s age was found to be statistically important in estimating vertebral fracture risk (p=0.032.There was statistically significant positive correlation between vertebral deformity score (evaluated according to Kleerekoper method and patient’s age and postmenopausal years (respectively p=0.001, p=0.006.

  16. Acute Thoracolumbar Spinal Cord Injury: Relationship of Cord Compression to Neurological Outcome.

    Science.gov (United States)

    Skeers, Peta; Battistuzzo, Camila R; Clark, Jillian M; Bernard, Stephen; Freeman, Brian J C; Batchelor, Peter E

    2018-02-21

    Spinal cord injury in the cervical spine is commonly accompanied by cord compression and urgent surgical decompression may improve neurological recovery. However, the extent of spinal cord compression and its relationship to neurological recovery following traumatic thoracolumbar spinal cord injury is unclear. The purpose of this study was to quantify maximum cord compression following thoracolumbar spinal cord injury and to assess the relationship among cord compression, cord swelling, and eventual clinical outcome. The medical records of patients who were 15 to 70 years of age, were admitted with a traumatic thoracolumbar spinal cord injury (T1 to L1), and underwent a spinal surgical procedure were examined. Patients with penetrating injuries and multitrauma were excluded. Maximal osseous canal compromise and maximal spinal cord compression were measured on preoperative mid-sagittal computed tomography (CT) scans and T2-weighted magnetic resonance imaging (MRI) by observers blinded to patient outcome. The American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades from acute hospital admission (≤24 hours of injury) and rehabilitation discharge were used to measure clinical outcome. Relationships among spinal cord compression, canal compromise, and initial and final AIS grades were assessed via univariate and multivariate analyses. Fifty-three patients with thoracolumbar spinal cord injury were included in this study. The overall mean maximal spinal cord compression (and standard deviation) was 40% ± 21%. There was a significant relationship between median spinal cord compression and final AIS grade, with grade-A patients (complete injury) exhibiting greater compression than grade-C and D patients (incomplete injury) (p compression as independently influencing the likelihood of complete spinal cord injury (p compression. Greater cord compression is associated with an increased likelihood of severe neurological deficits (complete injury) following

  17. Determinants and heterogeneity of mechanical competence throughout the thoracolumbar spine of elderly women and men.

    Science.gov (United States)

    Eckstein, Felix; Fischbeck, Markus; Kuhn, Volker; Link, Thomas M; Priemel, Matthias; Lochmüller, Eva-Maria

    2004-08-01

    Vertebral fractures represent the hallmark of osteoporosis. Here, we test the hypotheses that (sub)cortical bone strength and density predict failure better than trabecular core strength and density, and that elderly women display lower failure stress of thoracic vertebrae than men. We examined the vertebral bodies T3 to L5 in 39 spines from elderly donors (23 women; 16 men; age 79 +/- 11 years). Peripheral quantitative computed tomography was used to measure total, trabecular, and (sub)cortical bone density. Mechanical tests were performed in functional spinal units, planoparallel sections of vertebrae, trabecular cores, and (sub)cortical ring specimens. The failure stress decreased with descending vertebral level. Failure stress was highest for the (sub)cortical rings and planoparallel sections and lowest for the trabecular core. The failure stress did not differ significantly between men and women. Mechanical strength of the functional unit was more strongly correlated with the strength of the (sub)cortical ring (r = 0.78) than with that of the trabecular core (r = 0.62). However, total density was more highly correlated with mechanical strength of the same and remote vertebrae (r = 0.63) than trabecular (r = 0.50) or (sub)cortical density (r = 0.36), respectively. The results show that vertebral strength is similar in elderly women and men. Strength of (sub)cortical bone provides significantly better prediction of strength of functional spinal units than that of the trabecular core. However, total density predicts functional segment failure stress with higher accuracy than (sub)cortical or trabecular density and is thus recommended for predicting fracture strength clinically.

  18. Relationship between clinical symptoms of osteoporotic vertebral fracture with intravertebral cleft and radiographic findings.

    Science.gov (United States)

    Nakamae, Toshio; Fujimoto, Yoshinori; Yamada, Kiyotaka; Hiramatsu, Takeshi; Hashimoto, Takashi; Olmarker, Kjell; Adachi, Nobuo

    2017-03-01

    With aging of the population, the numbers of osteoporotic vertebral fractures with intravertebral cleft have been increasing. However, the details of clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft are poorly understood. The purpose of this study was to evaluate the relationship between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings. Two hundred seventeen patients with single-level osteoporotic vertebral fractures with intravertebral cleft were examined. Clinical symptoms were evaluated using Numerical Rating Scale for back pain and the Oswestry Disability Index for physical disability. The presence of delayed neurologic deficit was also detected. Radiography and computed tomography were used to measure local kyphotic angle and vertebral instability and to detect the presence of posterior wall fracture of the vertebral body. Correlations between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings were investigated. Mean Numerical Rating Scale and Oswestry Disability Index were 7.4 and 58.0%, respectively. Delayed neurologic deficit occurred in 41 patients (19%). The mean local kyphotic angle, vertebral instability, and rate of posterior wall fracture of the vertebral body were 19.4°, 7.3°, and 91%, respectively. Numerical Rating Scale and Oswestry Disability Index were statistically correlated with vertebral instability but not with local kyphotic angle and presence of posterior wall fracture. In the patients with delayed neurologic deficit, vertebral instability was significantly higher and posterior wall fractures were significantly more frequent than in the patients without delayed neurologic deficit. Local kyphotic angle was not correlated with delayed neurologic deficit. Vertebral instability is a factor causing symptoms of osteoporotic vertebral fractures with intravertebral cleft. In addition, vertebral

  19. Osteomielitis vertebral piógena Pyogenic vertebral osteomyelitis

    Directory of Open Access Journals (Sweden)

    Pedro P. Perrotti

    2009-10-01

    Full Text Available La osteomielitis vertebral piógena (OVP es una localización poco frecuente (2-7% Se confirma con el aislamiento de un microorganismo de una vértebra, disco intervertebral, absceso epidural o paravertebral. Se describe una serie de casos por la infrecuente presentación de esta enfermedad, que puede ser consulta inicial en los servicios de clínica médica y por su sintomatología inespecífica que supone una dificultad diagnóstica. Tanto la columna lumbar como la dorsal fueron los sitios más afectados. El dolor dorsolumbar y la paraparesia fueron los síntomas más frecuentes de presentación. En ocho pacientes se aislaron Staphylococcus aureus, en uno Escherichia coli y en el restante Haemophylus sp. Se observó leucocitosis sólo en tres pacientes, y en dos velocidad de sedimentación globular mayor de 100 mm/h. Los diez pacientes presentaron imágenes características de osteomielitis vertebral piógena en la resonancia nuclear magnética. Dentro de las complicaciones, los abscesos paravertebrales y epidurales fueron los más frecuentes (en cinco enfermos. Además, un paciente presentó empiema pleural. De los diez pacientes de esta serie, siete recibieron inicialmente tratamiento médico empírico y luego específico para el germen aislado. En los restantes el tratamiento fue guiado de acuerdo al antibiograma. A dos enfermos fue necesario realizarles laminectomía descompresiva por compromiso de partes blandas y a otros dos estabilización quirúrgica por inestabilidad espinal, observándose buena evolución en todos los casos. Esta serie demuestra que, ante un paciente con dolor dorsolumbar y síntomas neurológicos se deberá tener en cuenta esta entidad para evitar un retraso en el tratamiento.Pyogenic osteomyelitis seldom affects the spine (2-7%. It is diagnosed by the isolation of a bacterial agent in the vertebral body, the intervertebral disks or from paravertebral or epidural abscesses. We report a retrospective study of ten

  20. Quantitative vertebral CT scan imaging in 105 women with osteoporosis

    Energy Technology Data Exchange (ETDEWEB)

    Laval-Jeantet, A.M.; Miravet, L.; Bergot, C.; Vernejoul, M.C. de; Kuntz, D.; Laval-Jentet, M.

    Quantitative vertebral CT scan imaging is a method developed to provide direct measurements of mineralization of vertebral body spongy tissue, and is presently the most precise procedure for the early detection of spinal osteoporosis. A fracture threshold has been defined below which are found 95% of patients with a crushed vertebra: it is situated at 70% of the value for mineralization normal for the age of patients. Patients with marked reductions in their level of mineralization can be kept under surveillance before the onset of fracture. In patients with vertebral collapses the density is correlated significantly with the number of crush fractures. In addition, measurement of vertebral spongy bone density has allowed the importance of the vertebral lesion to be determined in various osteoporotic disorders, including those with only cortical fractures, and in this way to differentiate them.

  1. Subcutaneous fluid collection: An imaging marker for treatment response of infectious thoracolumbar spondylodiscitis

    International Nuclear Information System (INIS)

    Kakigi, Takahide; Okada, Tomohisa; Sakai, Osamu; Iwamoto, Yoshitaka; Kubo, Soichi; Yamamoto, Akira; Togashi, Kaori

    2015-01-01

    Highlights: • No imaging marker for treatment response of spondylodiscitis (SD) has been proposed. • Volume changes of subcutaneous fluid collection (SFC) had significant correlation with changes of C-reactive protein (CRP). • SFC can be used as an imaging marker for treatment response of SD on magnetic resonance imaging (MRI). - Abstract: Purpose: To evaluate prevalence of subcutaneous fluid collection (SFC) in infectious thoracolumbar spondylodiscitis (SD) compared with control patients and to investigate correlation between volume changes of SFC and treatment response of SD. Materials and methods: This retrospective study was approved by our institutional review board. From April 2011 to March 2012, 49 patients (24 SD and 25 non-SD patients) were enrolled. Prevalence of SFC was evaluated respectively for SD and non-SD patients using magnetic resonance imaging (MRI) on the sagittal short tau inversion recovery (STIR) imaging or fat-saturated T2-weighted imaging (T2WI), and compared. In SD patients with SFC, correlation was investigated between SFC volume on the 1st MRI and initial clinical status. The same analysis was conducted also for SFC volume changes from the 1st to 2nd or last MRI. Results: SFC was found in 20 patients with SD (83.3%) and 3 non-SD patients (12%) with significant difference (p < .001). In 20 SD patients with SFC, 17 patients had follow-up MRI. For the 1st MRI, no significant correlation was found between volume of SFC and initial status of patients, including body weight, body mass index (BMI), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). However, significant positive correlations were found between changes of C-reactive protein (CRP) and SFC volume from the 1st to 2nd as well as from the 1st to the last MRI (each p < .05). Conclusion: SD patients had significantly higher prevalence of SFC than non-SD patients. Volume changes of SFC had significant correlation with changes of CRP, which can be used as an imaging

  2. Subcutaneous fluid collection: An imaging marker for treatment response of infectious thoracolumbar spondylodiscitis

    Energy Technology Data Exchange (ETDEWEB)

    Kakigi, Takahide, E-mail: tkakigi@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan); Okada, Tomohisa, E-mail: tomokada@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan); Sakai, Osamu, E-mail: osamu.sakai@bmc.org [Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118 (United States); Iwamoto, Yoshitaka, E-mail: iwacame@hotmail.co.jp [Department of General Internal Medicine, Rakuwakai Otowa Hospital, 2 Otowachoinji-cho, Yamashina-ku, Kyoto 607-8062 (Japan); Kubo, Soichi, E-mail: kubo-s@mbox.kyoto-inet.or.jp [Department of Radiology, Rakuwakai Otowa Hospital, 2 Otowachoinji-cho, Yamashina-ku, Kyoto 607-8062 (Japan); Yamamoto, Akira, E-mail: yakira@kuhp.kyoto-u.ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan); Togashi, Kaori, E-mail: nmdioffice@kuhp.kyoto-ac.jp [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 (Japan)

    2015-07-15

    Highlights: • No imaging marker for treatment response of spondylodiscitis (SD) has been proposed. • Volume changes of subcutaneous fluid collection (SFC) had significant correlation with changes of C-reactive protein (CRP). • SFC can be used as an imaging marker for treatment response of SD on magnetic resonance imaging (MRI). - Abstract: Purpose: To evaluate prevalence of subcutaneous fluid collection (SFC) in infectious thoracolumbar spondylodiscitis (SD) compared with control patients and to investigate correlation between volume changes of SFC and treatment response of SD. Materials and methods: This retrospective study was approved by our institutional review board. From April 2011 to March 2012, 49 patients (24 SD and 25 non-SD patients) were enrolled. Prevalence of SFC was evaluated respectively for SD and non-SD patients using magnetic resonance imaging (MRI) on the sagittal short tau inversion recovery (STIR) imaging or fat-saturated T2-weighted imaging (T2WI), and compared. In SD patients with SFC, correlation was investigated between SFC volume on the 1st MRI and initial clinical status. The same analysis was conducted also for SFC volume changes from the 1st to 2nd or last MRI. Results: SFC was found in 20 patients with SD (83.3%) and 3 non-SD patients (12%) with significant difference (p < .001). In 20 SD patients with SFC, 17 patients had follow-up MRI. For the 1st MRI, no significant correlation was found between volume of SFC and initial status of patients, including body weight, body mass index (BMI), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). However, significant positive correlations were found between changes of C-reactive protein (CRP) and SFC volume from the 1st to 2nd as well as from the 1st to the last MRI (each p < .05). Conclusion: SD patients had significantly higher prevalence of SFC than non-SD patients. Volume changes of SFC had significant correlation with changes of CRP, which can be used as an imaging

  3. Sex reversal in vertebrates

    OpenAIRE

    2016-01-01

    This special topic issue of Sexual Development gives an overview of sex reversal in vertebrates, from fishes naturally changing their sex, to rodents escaping the mammalian SRY-determining system. It offers eight up-to-date reviews on specific subjects in sex reversal, considering fishes, amphibians, reptiles, birds, marsupials, and placental mammals, including humans. The broad scope of represented animals makes this ideal for students and researchers, especially those interested in the...

  4. Origins of vertebrate hematiopoiesis

    OpenAIRE

    Svoboda, Ondřej

    2015-01-01

    (ENGLISH) Hematopoiesis is dependent on the actions of hematopoietic stem cells (HSCs). This process is tightly controlled through a complex array of extrinsic and intrinsic factors. Even though the hematopoiesis seems to be well conserved across the disparate vertebrate animals, erythroid and thrombocytic differentiation have changed during the evolution of mammals. Specifically, adult mammalian red blood cells have the unique feature of being enucleated, and mammalian thrombocytes are not i...

  5. Vertebroplasty and Kyphoplasty Can Restore Normal Spine Mechanics following Osteoporotic Vertebral Fracture

    Science.gov (United States)

    Luo, Jin; Adams, Michael A.; Dolan, Patricia

    2010-01-01

    Osteoporotic vertebral fractures often lead to pain and disability. They can be successfully treated, and possibly prevented, by injecting cement into the vertebral body, a procedure known as vertebroplasty. Kyphoplasty is similar, except that an inflatable balloon is used to restore vertebral body height before cement is injected. These techniques are growing rapidly in popularity, and a great deal of recent research, reviewed in this paper, has examined their ability to restore normal mechanical function to fractured vertebrae. Fracture reduces the height and stiffness of a vertebral body, causing the spine to assume a kyphotic deformity, and transferring load bearing to the neural arch. Vertebroplasty and kyphoplasty are equally able to restore vertebral stiffness, and restore load sharing towards normal values, although kyphoplasty is better at restoring vertebral body height. Future research should optimise these techniques to individual patients in order to maximise their beneficial effects, while minimising the problems of cement leakage and adjacent level fracture. PMID:20981329

  6. Prótesis de cuerpo vertebral JR: dispositivo modular, anatómico y expandible, con función de jaula y placa diseñada ad hoc para estabilizar la columna después de corpectomía Prótese do corpo vertebral JR: dispositivo modular, anatômico e expansível, com função de jaula e placa desenhada ad hoc para estabilizar a coluna depois da corpectomia JR vertebral body prosthesis: a modular, anatomical and expandable device, with cage function and plate dual designed ad hoc for spine stabilization after corpectomy

    Directory of Open Access Journals (Sweden)

    Juan José Ramírez Jiménez

    2009-06-01

    função de jaula e placa separadamente, uma vez que o desenho da prótese permite aplicar força axial e fixação lateral ao mesmo tempo, por meio de um só implante. Os resultados da colocação do implante no paciente foram satisfatórios.INTRODUCTION: due to the unsatisfactory results obtained with posterior instrumentations in cases of vertebral tumors and to the economical limitations of our patients for acquiring the systems available in the market, a vertebral body prosthesis to stabilize the spine after corpectomy was designed. OBJECTIVE: to describe the structural and functional characteristics of the JR prosthesis, the biomechanical assays in cadaver and the surgical technique on the patient. METHODS: firstly, it was performed a detailed anatomical study of the vertebral bodies. A design of a modular, anatomical and expandable device was obtained. Its components once assembled make an implant with expandable cage and plate dual function. Afterwards, a biomechanical assay was performed in a cadaver and the device was implanted in a patient with vertebral body metastasis. RESULTS: the radiographs extracted from the cadaver after implant location did not show loss of fixation. When the cadaver was raised, flexion moments were generated laterally with levers 80 cm long; therefore, the prosthesis was demanded in its most vulnerable point with a force of approximately 588 N. With rotation, flexion and extensions forced, stability was preserved and no movement was observed. The device was implanted in a 50-year-old woman with metastatic thyroid cancer affecting L3. Pain improved in the postoperative immediate, as well as its motor function, which allowed her to walk with a stable and painless spine for seven years. No implant failure was observed. CONCLUSION: the dual cage function and plate integrated in a single device offers a mechanical advantage, compared with the cages and plates used separately, since the prosthesis design permits to apply a distraction

  7. Vertebral involvement in SAPHO syndrome: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Nachtigal, A.; Cardinal, E.; Bureau, N.J. [Dept. of Radiology, Univ. de Montreal, QC (Canada); Sainte-Marie, L.G. [Dept. of Internal Medicine, Univ. de Montreal, QC (Canada); Milette, F. [Department of Pathology, Univ. de Montreal, QC (Canada)

    1999-03-01

    We report on the MRI findings in the vertebrae and surrounding soft tissues in two patients with the SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis). The MRI findings include abnormal bone marrow signal, either focal or diffuse, of the vertebral bodies and posterior elements; hyperintense paravertebral soft tissue swelling and abnormal signal of the intervertebral discs. These changes are consistent with discitis and osteitis. (orig.) With 6 figs., 17 refs.

  8. Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience.

    Science.gov (United States)

    Nakajima, Hideaki; Uchida, Kenzo; Honjoh, Kazuya; Sakamoto, Takumi; Kitade, Makoto; Baba, Hisatoshi

    2016-01-01

    Low lumbar osteoporotic vertebral collapse (OVC) has not been well documented compared with OVC of the thoracolumbar spine. The differences between low lumbar and thoracolumbar lesions should be studied to provide better treatment. The aim of this study was to clarify the clinical and imaging features as well as outcomes of low lumbar OVC and to discuss the appropriate surgical treatment. Thirty patients (10 men; 20 women; mean age 79.3 ± 4.7 years [range 70-88 years]) with low lumbar OVC affecting levels below L-3 underwent surgical treatment. The clinical symptoms, morphological features of affected vertebra, sagittal spinopelvic alignment, neurological status before and after surgery, and surgical procedures were reviewed at a mean follow-up period of 2.4 years. The main clinical symptom was radicular leg pain. Most patients had old compression fractures at the thoracolumbar level. The affected vertebra was flat-type and concave or H-shaped type, not wedge type as often found in thoracolumbar OVC. There were mismatches between pelvic incidence and lumbar lordosis on plain radiographs. On CT and MR images, foraminal stenosis was seen in 18 patients (60%) and canal stenosis in 24 patients (80%). Decompression with short fusion using a posterior approach was performed. Augmentations of vertebroplasty, posterolateral fusion, and posterior lumbar interbody fusion were performed based on the presence/absence of local kyphosis of lumbar spine, cleft formation, and/or intervertebral instability. Although the neurological and visual analog scale scores improved postoperatively, 8 patients (26.7%) developed postoperative complications mainly related to instrumentation failure. In patients with postoperative complications, lumbar spine bone mineral density was significantly low, but the spinopelvic alignment showed no correlation when compared with those without complications. The main types of low lumbar OVC were flat-type and concave type, which resulted in neurological

  9. Vertebral column aggressive osteoblastoma: two cases report and literature review

    International Nuclear Information System (INIS)

    Sabedotti, Ismail Fernando; Sabedotti, Valdir

    2007-01-01

    Osteoblastoma is a bone neoplasy that in most circumstances present a low aggressive aspect on radiographic studies, but in some cases may acquire an aggressive pattern, rupturing the bone cortex and invading nearby structures. Most cases occur on the vertebral column, especially at the posterior arch and occasionally involving the vertebral body. Differential diagnosis of the aggressive form is made with osteosarcomas. This review reports two cases of osteoblastomas involving vertebral column, with an aggressive pattern on radiologic studies, and their histologic confirmation. (author)

  10. The pattern and prevalence of vertebral artery injury in patients with cervical spine fractures

    Directory of Open Access Journals (Sweden)

    Farzanah Ismail

    2013-06-01

    Full Text Available Aim: It is not uncommon for vertebral artery injury to occur when there are fractures through the transverse foraminae of the first to the sixth vertebral bodies. Other important risk factors for vertebral artery injury include facet joint dislocations and fractures of the first to the third cervical vertebral bodies. The aim of this study was to determine the pattern and prevalence of vertebral artery injury on CT angiography (CTA in patients with cervical spine fractures.Method: A retrospective review of patients who had undergone CTA of the vertebral arteries was undertaken. Reports were reviewed to determine which patients met the inclusion criteria of having had both cervical spine fractures and CTA of the vertebral arteries. Images of patients who met the inclusion criteria were analysed by a radiologist.Results: The prevalence of vertebral artery injury was 33%. Four out of the 11 patients who had vertebral artery injury, had post-traumatic spasm of the artery, with associated thrombosis or occlusion of the vessel. In terms of blunt carotid vertebral injury (BCVI grading, most of the patients sustained grade IV injuries. Four patients who had vertebral artery injury had fractures of the upper cervical vertebrae, i.e. C1 to C3. Fifteen transverse process fractures were associated with vertebral artery injury. No vertebral artery injury was detected in patients who had facet joint subluxations.Conclusion: Patients with transverse process fractures of the cervical spine and upper cervical vertebral body fractures should undergo CTA to exclude vertebral artery injury.

  11. Percutaneous vertebral augmentation for painful osteolytic vertebral metastasis: a case report

    Directory of Open Access Journals (Sweden)

    Anselmetti GC

    2012-03-01

    Full Text Available Giovanni C Anselmetti1, Sean M Tutton2, Francis R Facchini3, Larry E Miller4,5, Jon E Block51Institute for Cancer Research and Treatment, Turin, Italy; 2Medical College of Wisconsin in Milwaukee, Froedtert Memorial Lutheran Hospital, Milwaukee, WI, USA; 3Interventional Radiology, Interventional Oncology, VIR Chicago, Hinsdale, IL, USA; 4Miller Scientific Consulting, Inc, Arden, NC, USA; 5The Jon Block Group, San Francisco, CA, USAIntroduction: Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this population due to a poor risk-benefit profile, particularly if life expectancy is short. Percutaneous vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have higher risk of serious complications, notably cement extravasation. Described in this report is a case of a painful osteolytic vertebral metastasis that was successfully treated by a novel percutaneous vertebral augmentation system.Case presentation: A 42-year-old Caucasian female presented with a history of metastatic lung cancer unresponsive to radiation and chemotherapy with symptoms inadequately controlled by opiates over the previous 6 months. Magnetic resonance imaging and spiral computed tomography with two-dimensional reconstruction showed an osteolytic vertebral metastasis with complete involvement of the T10 vertebral body, extending to the cortical vertebral wall anteriorly and posteriorly. The patient was treated with percutaneous vertebral augmentation (Kiva® VCF Treatment System, Benvenue Medical, Inc, Santa Clara, CA utilizing a novel coil-shaped polyetheretherketone implant designed to minimize the risk of cement extravasation. After the minimally invasive procedure, bone cement distribution within the vertebral body was ideal, with no observed cement extravasation. No

  12. SU-F-T-106: A Dosimetric Study of Intensity Modulated Radiation Therapy to Decrease Radiation Dose to the Thoracic Vertebral Bodies in Patients Receiving Concurrent Chemoradiation for Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    DiCostanzo, Dominic; Barney, Christian L.; Bazan, Jose G. [The Ohio State University, Columbus, Ohio (United States)

    2016-06-15

    Purpose: Recent clinical studies have shown a correlation between radiation dose to the thoracic vertebral bodies (TVB) and the development of hematologic toxicity (HT) in patients receiving chemoradiation (CRT) for lung cancer (LuCa). The feasibility of a bone-marrow sparing (BMS) approach in this group of patients is unknown. We hypothesized that radiation dose to the TVB can be reduced with an intensity modulated radiation therapy(IMRT)/volumetric modulated arc radiotherapy(VMAT) without affecting plan quality. Methods: We identified LuCa cases treated with curative intent CRT using IMRT/VMAT from 4/2009 to 2/2015. The TVBs from T1–T10 were retrospectively contoured. No constraints were placed on the TVB structure initially. A subset were re-planned with BMS-IMRT/VMAT with an objective or reducing the mean TVB dose to <23 Gy. The following data were collected on the initial and BMS plans: mean dose to planning target volume (PTV), lungs-PTV, esophagus, heart; lung V20; cord max dose. Pairwise comparisons were performed using the signed rank test. Results: 94 cases received CRT with IMRT/VMAT. We selected 11 cases (7 IMRT, 4 VMAT) with a range of initial mean TVB doses (median 35.7 Gy, range 18.9–41.4 Gy). Median prescription dose was 60 Gy. BMS-IMRT/VMAT significantly reduced the mean TVB dose by a median of 10.2 Gy (range, 1.0–16.7 Gy, p=0.001) and reduced the cord max dose by 2.9 Gy (p=0.014). BMS-IMRT/VMAT had no impact on lung mean (median +17 cGy, p=0.700), lung V20 (median +0.5%, p=0.898), esophagus mean (median +13 cGy, p=1.000) or heart mean (median +16 cGy, p=0.365). PTV-mean dose was not affected by BMS-IMRT/VMAT (median +13 cGy, p=0.653). Conclusion: BMS-IMRT/VMAT was able to significantly reduce radiation dose to the TVB without compromising plan quality. Prospective evaluation of BMS-IMRT/VMAT in patients receiving CRT for LuCa is warranted to determine if this approach results in clinically significant reductions in HT.

  13. Early prenatal diagnosis of a lumbo-costo-vertebral syndrome.

    Science.gov (United States)

    Pristavu, Anda Ioana; Furnica, Cristina; Ifrim, Mona Mihaela; Popovici, Razvan Mihai

    2017-09-13

    Lumbo-costo-vertebral syndrome (LCVS) is a rare type of lumbar hernia with associated abnormalities of the vertebral bodies, ribs, and trunk muscles. Only a few cases have been reported in the literature, all of which were diagnosed after birth. We present a case of LCVS diagnosed early in the second trimester of pregnancy using two- and three-dimensional ultrasound. In our case, the associated anomalies were: multiple costovertebral anomalies, lumbar hernia, anal imperforation, left hand supernumerary digit, and clubfoot.

  14. X-ray image segmentation for vertebral mobility analysis

    International Nuclear Information System (INIS)

    Benjelloun, Mohammed; Mahmoudi, Said

    2008-01-01

    The goal of this work is to extract the parameters determining vertebral motion and its variation during flexion-extension movements using a computer vision tool for estimating and analyzing vertebral mobility. To compute vertebral body motion parameters we propose a comparative study between two segmentation methods proposed and applied to lateral X-ray images of the cervical spine. The two vertebra contour detection methods include (1) a discrete dynamic contour model (DDCM) and (2) a template matching process associated with a polar signature system. These two methods not only enable vertebra segmentation but also extract parameters that can be used to evaluate vertebral mobility. Lateral cervical spine views including 100 views in flexion, extension and neutral orientations were available for evaluation. Vertebral body motion was evaluated by human observers and using automatic methods. The results provided by the automated approaches were consistent with manual measures obtained by 15 human observers. The automated techniques provide acceptable results for the assessment of vertebral body mobility in flexion and extension on lateral views of the cervical spine. (orig.)

  15. Do exercises with the Foam Roller have a short-term impact on the thoracolumbar fascia? - A randomized controlled trial.

    Science.gov (United States)

    Griefahn, Annika; Oehlmann, Jan; Zalpour, Christoff; von Piekartz, Harry

    2017-01-01

    Due to new research results in the past few years, interest in the fascia of the human body has increased. Dysfunctions of the fascia are indicated by various symptoms, amongst others, musculoskeletal pain. As a result stronger focus has been put on researching therapeutic approaches in this area. The main aim of this study was to investigate the effect of Foam Roll exercises on the mobility of the thoracolumbar fascia (TLF). Study has been conducted in a randomized and controlled trial which sampled 38 healthy athletic active men and women. The subjects were randomly assigned to a Foam Roll Group (FMG), a Placebo Group (PG) and a Control Group (CG). Depending on the assigned group the volunteers were either instructed to do exercises with the Foam Roll, received a pseudo treatment with the Foam Roll or received no treatment. A total of three measurements were carried out. The most important field of research was the mobility of the TLF, which was determined using a sonographic assessment. In addition the lumbar flexion and the mechanosensivity of relevant muscles were determined. After the intervention, the FMG showed an average increase of 1.7915 mm for the mobility of the TLF (p fascia in a healthy young population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. TREATMENT OF THORACOLUMBAR BURST FRACTURES FIXED WITH INTERMEDIATE PINS BY THE POSTERIOR APPROACH

    Directory of Open Access Journals (Sweden)

    Henrique Motizuki

    2015-09-01

    Full Text Available Objective:Radiographic evaluation of patients with thoracolumbar burst fractures treated with unconvencional transpedicular fixation, which includes additional fixation of the fractured vertebra associated with transverse connector - Crosslink clamp.Methods:Retrospective study evaluating a total of 68 patients operated at the Hospital do Trabalhador de Curitiba, Orthopedics Service, of which 15 were eligible for the study. All patients were treated with posterior pedicle fixation and intermediate screw. The assessment by the Cobb angle method was performed on preoperative, immediate postoperative and one year after surgery radiographs.Results:It was observed an average reduction of kyphosis of 8.3o (77%, with a loss of 1.34o in late postoperative compared to the immediate postoperative period.Conclusion:The method of fixation of burst-type fractures of the thoracolumbar spine by the posterior approach with intermediate screw was effective in maintaining the reduction achieved in the immediate postoperative period and after one year of evolution.

  17. Surgical Site Infection Following Posterior Instrumented Surgery for Thoracolumbar Burst Fractures

    Directory of Open Access Journals (Sweden)

    A Zulkefli

    2009-11-01

    Full Text Available OBJECTIVES: To study the prevalence and the risk factors for surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures. METHODOLOGY: Retrospective review of cases operated between year 2006 and 2007. The final end point is the detection of surgical site infection within one year. RESULTS: A total of 38 cases were reviewed. Surgical site infection occurred in 5 cases. Only one had deep infection. The onset of infection occurred within one month in all cases. The risk factors studied were smoking, timing of surgery, duration of surgery, neurological deficit, associated injuries and high dose methylprednisolone administration. None of them were statistically significant as risk factors for surgical site infection. CONCLUSION: The prevalence of surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures was 13%.

  18. Thoracolumbar Injury Classification and Severity Score in children: a reliability study.

    Science.gov (United States)

    Dawkins, Ross L; Miller, Joseph H; Ramadan, Omar I; Lysek, Michael C; Kuhn, Elizabeth N; Rocque, Brandon G; Conklin, Michael J; Tubbs, R Shane; Walters, Beverly C; Agee, Bonita S; Rozzelle, Curtis J

    2018-03-01

    OBJECTIVE There are many classification systems for injuries of the thoracolumbar spine. The recent Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a reliable tool for adult patients. The aim of this study was to assess the reliability of the TLICS system in pediatric patients. The validity of the TLICS system is assessed in a companion paper. METHODS The medical records of pediatric patients with acute, traumatic thoracolumbar fractures at a single Level 1 trauma center were retrospectively reviewed. A TLICS was calculated for each patient using CT and MRI, along with the neurological examination recorded in the patient's medical record. TLICSs were compared with the type of treatment received. Five raters scored all patients separately to assess interrater reliability. RESULTS TLICS calculations were completed for 81 patients. The mean patient age was 10.9 years. Girls represented 51.8% of the study population, and 80% of the study patients were white. The most common mechanisms of injury were motor vehicle accidents (60.5%), falls (17.3%), and all-terrain vehicle accidents (8.6%). The mean TLICS was 3.7 ± 2.8. Surgery was the treatment of choice for 33.3% of patients. The agreement between the TLICS-suggested treatment and the actual treatment received was statistically significant (p reliability of the TLICS system ranged from moderate to very good, with a Fleiss' generalized kappa (κ) value of 0.69 for the TLICS treatment suggestion among all patients; however, interrater reliability decreased when MRI was used to contribute to the TLICS. The κ value decreased from 0.73 to 0.57 for patients with CT only vs patients with CT/MRI or MRI only, respectively (p reliability among physicians assessing thoracolumbar fracture treatment in pediatric patients. Physicians should be cautious when using MRI to aid in the surgical decision-making process.

  19. Residual mobility of instrumented and non-fused segments in thoracolumbar spine fractures

    OpenAIRE

    Yurac, Ratko; Marré, Bartolomé; Urzua, Alejandro.; Munjin, Milan; Lecaros, Miguel A.

    2006-01-01

    The surgical management of thoracolumbar fractures presents potential benefits. However, the surgery solve the instability by fusion of mobile segments. We incorporate in our treatment algorithms, the use of restricted arthrodesis at injured levels, regardless of longer instrumentations, as well as the use of non-fused transitory stabilizations, based on the conviction that in non-fused segments without traumatic disc injury, mobility persists once the instrumentation is removed. The goals of...

  20. Reliability and reproducibility analysis of the AOSpine thoracolumbar spine injury classification system by Chinese spinal surgeons.

    Science.gov (United States)

    Cheng, Jie; Liu, Peng; Sun, Dong; Qin, Tingzheng; Ma, Zikun; Liu, Jingpei

    2017-05-01

    The objective of this study was to analyze the interobserver reliability and intraobserver reproducibility of the new AOSpine thoracolumbar spine injury classification system in young Chinese orthopedic surgeons with different levels of experience in spinal trauma. Previous reports suggest that the new AOSpine thoracolumbar spine injury classification system demonstrates acceptable interobserver reliability and intraobserver reproducibility. However, there are few studies in Asia, especially in China. The AOSpine thoracolumbar spine injury classification system was applied to 109 patients with acute, traumatic thoracolumbar spinal injuries by two groups of spinal surgeons with different levels of clinical experience. The Kappa coefficient was used to determine interobserver reliability and intraobserver reproducibility. The overall Kappa coefficient for all cases was 0.362, which represents fair reliability. The Kappa statistic was 0.385 for A-type injuries and 0.292 for B-type injuries, which represents fair reliability, and 0.552 for C-type injuries, which represents moderate reliability. The Kappa coefficient for intraobserver reproducibility was 0.442 for A-type injuries, 0.485 for B-type injuries, and 0.412 for C-type injuries. These values represent moderate reproducibility for all injury types. The raters in Group A provided significantly better interobserver reliability than Group B (P < 0.05). There were no between-group differences in intraobserver reproducibility. This study suggests that the new AO spine injury classification system may be applied in day-to-day clinical practice in China following extensive training of healthcare providers. Further prospective studies in different healthcare providers and clinical settings are essential for validation of this classification system and to assess its utility.

  1. Inpatient costs and blood transfusion rates of sarcopenic patients following thoracolumbar spine surgery.

    Science.gov (United States)

    Bokshan, Steven L; Han, Alex; DePasse, J Mason; Marcaccio, Stephen E; Eltorai, Adam E M; Daniels, Alan H

    2017-12-01

    OBJECTIVE Sarcopenia, the muscle atrophy associated with aging and disease progression, accounts for nearly $18.5 billion in health care expenditures annually. Given the high prevalence of sarcopenia in patients undergoing orthopedic surgery, the goal of this study was to assess the impact of sarcopenia on inpatient costs following thoracolumbar spine surgery. METHODS Patients older than 55 years undergoing thoracolumbar spine surgery from 2003 to 2015 were retrospectively analyzed. Sarcopenia was measured using total psoas area at the L-4 vertebra on perioperative CT scans. Hospital billing data were used to compare inpatient costs, transfusion rate, and rate of advanced imaging utilization. RESULTS Of the 50 patients assessed, 16 were sarcopenic. Mean total hospital costs were 1.75-fold greater for sarcopenic patients compared with nonsarcopenic patients ($53,128 vs $30,292, p = 0.04). Sarcopenic patients were 2.1 times as likely to require a blood transfusion (43.8% vs 20.6%, p = 0.04). Sarcopenic patients had a 2.6-fold greater usage of advanced imaging (68.8% vs 26.5%, p = 0.002) with associated higher diagnostic imaging costs ($2452 vs $801, p = 0.01). Sarcopenic patients also had greater pharmacy, laboratory, respiratory care, and emergency department costs. CONCLUSIONS This study is the first to show that sarcopenia is associated with higher postoperative costs and rates of blood transfusion following thoracolumbar spine surgery. Measuring the psoas area may represent a strategy for predicting perioperative costs in spine surgery patients.

  2. Dorsal spondylodesis of unstable thoracolumbar fractures by a far-lateral approach to the disc.

    Science.gov (United States)

    Rieger, A; Rainov, N G; Sanchin, L; Burkert, W

    1997-12-01

    This paper describes a modified and less traumatic approach to the thoracolumbar spine and compares it with standard techniques for instrumented spinal fusion. Ten patients with unstable fractures of the thoracolumbar spine were included in the open prospective investigation, and were treated by a surgical technique consisting of a dorsolateral approach to the injured segment, filling the disk space and the fractured vertebra with autologous bone, and transpedicular fixation with an AO internal fixator. All patients were followed for 6 to 12 months after surgery by clinical tests and spinal X-rays. Excellent short-term and long-term results were obtained. A stable bony fusion was achieved in all cases, and a minimal mean decrease of 2 degrees in the kyphosis angle was found at late follow-up. No major complications related to the procedure were encountered, and no worsening of neurological deficits occurred after surgery. In conclusion, the far-lateral approach to the thoracolumbar spine yields results which are equivalent or better than those of standard techniques. Major advantages of our procedure, as evaluated in this rather small group of patients, are selective immobilization of the injured segment without involvement of functionally intact spinal levels, no manipulations within the spinal canal boundaries, and relatively limited exposure of the spine.

  3. Diagnosing vertebral fractures: missed opportunities.

    Science.gov (United States)

    Borges, João Lindolfo Cunha; Maia, Julianne Lira; Silva, Renata Faria; Lewiecki, Edward Michael

    2015-01-01

    Vertebral fractures are the single most common type of osteoporotic fracture. Postmenopausal women are at increased risk for osteoporotic vertebral fractures compared with women of childbearing age. Vertebral fractures are associated with an increase in morbidity, mortality, and high risk of a subsequent vertebral fracture, regardless of bone mineral density. Despite the common occurrence and serious consequences of vertebral fractures, they are often unrecognized or misdiagnosed by radiologists. Moreover, vertebral fractures may be described by variable terminology that can confuse rather than enlighten referring physicians. We conducted a survey of spine X-ray reports from a group of postmenopausal women screened for participation in a study of osteoporosis at Centro de Pesquisa Clínica do Brasil. A descriptive analysis evaluated the variability of reports in 7 patients. Four independent general radiologists issued reports assessing vertebral fractures through a blinded analysis. The objective of this study was to evaluate for consistency in these reports. The analysis found marked variability in the diagnosis of vertebral fractures and the terminology used to describe them. In community medical practices, such variability could lead to differences in the management of patients with osteoporosis, with the potential for undertreatment or overtreatment depending on clinical circumstances. Accurate and unambiguous reporting of vertebral fractures is likely to be associated with improved clinical outcomes. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  4. Prophylactic adjacent-segment vertebroplasty following kyphoplasty for a single osteoporotic vertebral fracture and the risk of adjacent fractures: a retrospective study and clinical experience.

    Science.gov (United States)

    Eichler, Martin C; Spross, Christian; Ewers, Alexander; Mayer, Ryan; Külling, Fabrice A

    2016-10-01

    OBJECTIVE This study investigated the benefit of prophylactic vertebroplasty of the adjacent vertebrae in single-segment osteoporotic vertebral body fractures treated with kyphoplasty. METHODS All patients treated with kyphoplasty for osteoporotic single-segment fractures between January 2007 and August 2012 were included in this retrospective study. The patients received either kyphoplasty alone (kyphoplasty group) or kyphoplasty with additional vertebroplasty of the adjacent segment (vertebroplasty group). The segmental kyphosis with the rate of adjacent-segment fractures (ASFs) and remote fractures were studied on plain lateral radiographs preoperatively, postoperatively, at 3 months, and at final follow-up. RESULTS Thirty-seven (82%) of a possible 45 patients were included for the analysis, with a mean follow-up of 16 months (range 3-54 months). The study population included 31 women, and the mean age of the total patient population was 72 years old (range 53-86 years). In 21 patients (57%), the fracture was in the thoracolumbar junction. Eighteen patients were treated with additional vertebroplasty and 19 with kyphoplasty only. The segmental kyphosis increased in both groups at final follow-up. A fracture through the primary treated vertebra (kyphoplasty) was found in 4 (22%) of the vertebroplasty group and in 3 (16%) of the kyphoplasty group (p = 0.6). An ASF was found in 50% (n = 9) of the vertebroplasty group and in 16% (n = 3) of the kyphoplasty group (p = 0.03). Remote fractures occurred in 1 patient in each group (p = 1.0). CONCLUSIONS Prophylactic vertebroplasty of the adjacent vertebra in patients with single-segment osteoporotic fractures as performed in this study did not decrease the rate of adjacent fractures. Based on these retrospective data, the possible benefits of prophylactic vertebroplasty do not compensate for the possible risks of an additional cement augmentation.

  5. Vertebral fractures and role of low bone mineral density in Crohn's disease.

    Science.gov (United States)

    Siffledeen, Jesse S; Siminoski, Kerry; Jen, Ho; Fedorak, Richard N

    2007-06-01

    Vertebral fractures in Crohn's (CD) patients with low bone mineral density (BMD) have been documented as between 14%-22%. Vertebral fractures in CD patients with normal BMD have not been reported. The objectives were to identify the prevalence of vertebral fractures in CD patients and associated predictive factors. Two hundred twenty-four CD patients underwent vertebral BMD analysis and radiographs. Fractures were identified by using quantitative height reduction morphometry, and severity was assessed by spinal fracture index. Mean age was 40.6 +/- 11.0 years. Sixty percent reported corticosteroid use during the preceding year. Forty-five of 224 (20.0%) patients had 88 vertebral fractures. Sixteen of 45 patients with vertebral fractures had normal BMD (19.0% of all patients with normal BMD). Analysis of patients with or without vertebral fractures did not demonstrate significant differences in BMD or in corticosteroid use. Linear regression analysis demonstrated that elevations in body mass index, C-reactive protein, and parathyroid hormone were significantly predictive of vertebral fractures (r = 0.415, P 20% (r = 0.417, P < .05). This study demonstrates that vertebral fractures in CD patients occur with an equal frequency in those with low and with normal BMD, regardless of corticosteroid use. The mean age of CD patients with vertebral fractures was much lower than that reported in the general population for these fractures. Elevations in body mass index and C-reactive protein and parathyroid hormone levels were predictive of vertebral fractures.

  6. microRNAs reveal the interrelationships of hagfish, lampreys, and gnathostomes and the nature of the ancestral vertebrate

    OpenAIRE

    Heimberg, Alysha M.; Cowper-Sallari, Richard; Semon, Marie; Donoghue, Philip C. J.; Peterson, Kevin J.

    2010-01-01

    Hagfish and lampreys are the only living representatives of the jawless vertebrates (agnathans), and compared with jawed vertebrates (gnathostomes), they provide insight into the embryology, genomics, and body plan of the ancestral vertebrate. However, this insight has been obscured by controversy over their interrelationships. Morphological cladistic analyses have identified lampreys and gnathostomes as closest relatives, whereas molecular phylogenetic studies recover a monophyletic Cyclosto...

  7. Progression of trunk imbalance in adolescent idiopathic scoliosis with a thoracolumbar/lumbar curve: is it predictable at the initial visit?

    Science.gov (United States)

    Hwang, Chang Ju; Lee, Choon Sung; Lee, Dong-Ho; Cho, Jae Hwan

    2017-11-01

    OBJECTIVE Progression of trunk imbalance is an important finding during follow-up of patients with adolescent idiopathic scoliosis (AIS). Nevertheless, no factors that predict progression of trunk imbalance have been identified. The purpose of this study was to identify parameters that predict progression of trunk imbalance in cases of AIS with a structural thoracolumbar/lumbar (TL/L) curve. METHODS This study included 105 patients with AIS and a structural TL/L curve who were followed up at an outpatient clinic. Patients with trunk imbalance (trunk shift ≥ 20 mm) at the initial visit were excluded. All patients were followed up for more than 2 years. Patients were divided into the following groups according to progression of trunk imbalance: 1) Group P, trunk shift ≥ 20 mm at the final visit and degree of progression ≥ 10 mm; and 2) Group NP, trunk shift < 20 mm at the final visit or degree of progression < 10 mm. Radiological parameters included Cobb angle, upper end vertebrae and lower end vertebrae (LEV), LEV tilt, disc wedge angle between LEV and LEV+1, trunk shift, apical vertebral translation, and apical vertebral rotation (AVR). Each parameter was compared between groups. Radiological parameters were assessed at every visit using whole-spine standing anteroposterior radiographs. RESULTS Among the 105 patients examined, 13 showed trunk imbalance with progression ≥ 10 mm at the final visit (Group P). Multivariate logistic regression analysis identified a lower Risser grade (p = 0.002) and a greater initial AVR (p = 0.020) as predictors of progressive trunk imbalance. A change in LEV tilt during follow-up was associated with trunk imbalance (p = 0.001). CONCLUSIONS Risser grade and AVR measured at the initial visit may predict progression of trunk imbalance. Surgeons should consider the risk of progressive trunk imbalance if patients show skeletal immaturity and a greater AVR at the initial visit.

  8. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma.

    Science.gov (United States)

    Tannoury, Chadi; Degiacomo, Anthony

    2015-01-01

    Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5-C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  9. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

    Directory of Open Access Journals (Sweden)

    Chadi Tannoury

    2015-01-01

    Full Text Available Study Design. This case illustrates complications to a vertebral artery injury (VAI resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  10. A Dosimetric Evaluation of The Eclipse and Pinnacle Treatment Planning Systems in Treatment of Vertebral Bodies Using IMRT and VMAT with Modeled and Commissioned Flattening Filter Free (FFF) Fields

    Science.gov (United States)

    Ajo, Ramzi, Jr.

    Modern treatment planning systems (TPS's) utilize different algorithms in computing dose within the patient medium. The algorithms rely on properly modeled clinical setups in order to perform optimally. Aside from various parameters of the beam, modifiers, such as multileaf collimators (MLC's), must also be modeled properly. That could not be more true today, where dynamic delivery such as intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are being increasingly utilized due to their ability to deliver higher dose precisely to the target while sparing more surrounding normal tissue. Two of the most popular TPS's, Pinnacle (Philips) and Eclipse (Varian), were compared, with special emphasis placed on parameterization of the dosimetric leaf gap (DLG) in Eclipse. The DLG is a parameter that accounts for Varian's rounded MLC leaf ends. While Pinnacle accounts for the rounded leaf end by modeling the MLC's, Eclipse uses a measured parameter. This study investigated whether a single value measured DLG is sufficient for dynamic delivery. Using five planning volumes for vertebral body SBRT treatments, each prescribed for 3000 cGy in 5 fractions, an array of 20 treatment plans was generated using varying energies of 6MV-FFF and 10MV-FFF. Treatment techniques consisted of 9-field Step-and-shoot IMRT, and dual-arc VMAT using patient specific optimization criteria in the Pinnacle TPS v9.8. Each plan was normalized to ensure coverage of 3000cGy to 95% of the target volume. The dose was computed in Pinnacle v9.8, with the Collapsed Cone Convolution Superposition algorithm and Eclipse v11, with the Acuros XB algorithm, using a dose grid resolution of 2 mm in both systems. Dose volume histograms (DVH's) were generated for a comparison of max and mean dose to the targets and spinal cord, as well as 95% coverage of the targets and the volume of the spinal cord receiving 14.5 Gy (V14.5). Patient specific quality assurance (PSQA) fields were

  11. Static histomorphometry of human iliac crest and vertebral trabecular bone: a comparative study

    DEFF Research Database (Denmark)

    Thomsen, Jesper Skovhus; Ebbesen, Ebbe Nils; Mosekilde, Lis

    2002-01-01

    the histomorphometric measures at the iliac crest and the vertebral body. The material comprised matched sets of unilateral transiliac crest bone biopsies and lumbar vertebral bodies (L-2) from 24 women (19-96 years) and 24 men (23-95 years) selected from a larger autopsy material. Three female subjects (80, 88, and 90...... years) had a known vertebral fracture of L-2. The iliac crest biopsies and 9-mm-thick mediolateral slices of half the entire vertebral bodies were embedded in methylmetacrylate, stained with aniline blue, and scanned into a computer with a flatbed image scanner at a high resolution. With a custom....... In addition, connectivity density was measured (ConnEulor method). The results showed that the age-related changes in the static histomorphometric measures are generally similar in the iliac crest and the vertebral body, and that these age-related changes are independent of gender. An exception, however...

  12. Importance of MRI in the diagnosis of vertebral involvement in generalized cystic lymphangiomatosis

    International Nuclear Information System (INIS)

    Renjen, Pooja; Kovanlikaya, Arzu; Brill, Paula W.; Narula, Navneet

    2014-01-01

    A 9-year-old boy presented with the sudden onset of pleuritic chest pain and on CT was found to have a large pleural effusion, mediastinal fluid, splenic lesions and multiple apparently sclerotic vertebral bodies. Subsequent MRI showed that those vertebral bodies that appeared sclerotic were in fact normal, and the vertebral bodies initially interpreted as normal had an abnormal T1 and T2 hyperintense signal on MRI and were relatively lucent on CT. MRI also demonstrated abnormal heterogeneous T2 hyperintense paraspinal tissue and several multicystic soft tissue masses. Biopsy of two adjacent vertebral bodies, one relatively sclerotic and one lucent, demonstrated findings of bony remodeling without a specific diagnosis. Biopsy of an infiltrative mediastinal mass confirmed the diagnosis of generalized cystic lymphangiomatosis. MRI should be included in the assessment of vertebral involvement in this condition because CT and biopsy findings may be nonspecific. (orig.)

  13. Rotations in a Vertebrate Setting

    Science.gov (United States)

    McCollum, Gin

    2003-05-01

    Rotational movements of the head are often considered to be measured in a single three dimensional coordinate system implemented by the semicircular canals of the vestibular system of the inner ear. However, the vertebrate body -- including the nervous system -- obeys rectangular symmetries alien to rotation groups. At best, nervous systems mimic the physical rotation group in a fragmented way, only partially reintegrating physical movements in whole organism responses. The vestibular canal reference frame is widely used in nervous systems, for example by eye movements. It is used to some extent even in the cerebrum, as evidenced by the remission of hemineglect -- in which half of space is ignored -- when the vestibular system is stimulated. However, reintegration of space by the organism remains incomplete. For example, compensatory eye movements (which in most cases aid visual fixation) may disagree with conscious self-motion perception. In addition, movement-induced nausea, illusions, and cue-free perceptions demonstrate symmetry breaking or incomplete spatial symmetries. As part of a long-term project to investigate rotation groups in nervous systems, we have analyzed the symmetry group of a primary vestibulo-spinal projection.

  14. [Spasmodic torticollis and vertebral hemangioma].

    Science.gov (United States)

    Durán, E; Chacón, J R

    Spasmodic torticollis in young patients should give rise to a clinical suspicion that this is secondary to another primary disorder. Therefore a series of diagnostic tests should be carried out before it is labelled as idiopathic. The patient was a thirty year old man who had had difficulty in writing with his right hand since childhood. At the age of 20 years he was diagnosed as having writer's cramp and idiopathic spasmodic torticollis. On general physical examination no abnormalities were found. On neurological examination he had: absence of reflexes of both arms, limited but painless rotation of the neck towards the left and hypertrophy of the left trapezius muscle. Laboratory, neurophysiological and neuroimaging investigations seeking a secondary cause for the torticollis were all normal. There were no Keyser-Fleischer rings. Chest X-ray showed, dorsal scoliosis with convexity to the left. CAT and MR of the spine showed a hemangioma in the body of T1. On arteriography of the supra-aortic and vertebral trunks a hemangioma was found at T1 which received contrast material via a branch of the right thyro-bi-cervico-scapular trunk. Various treatments were tried (diazepam, Botox, Dysport, tetrabenazine, baclofen, etc.) with no improvement. A definite diagnosis of secondary torticollis could not be made since the hemangioma was supplied by a very narrow vascular pedicle, so embolization was contraindicated. Cervical spinal cord alterations may cause focal dystonia due to increased excitability of the spinal motor neurone, due to dysfunction of the disinhibitory descending reciprocal paths.

  15. Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury.

    Science.gov (United States)

    Abdelgawaad, Ahmed Shawky; Ezzati, Ali; Govindasamy, Ramachandran; Krajnovic, Branko; Elnady, Belal; Said, Galal Zaki

    2017-11-14

    Cement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers. The primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty (BKP). Secondarily, physiological results, pain relief, complication rates, and non-posterior cement leakage were also evaluated. This is a prospective cohort study done in a high-volume spine center in Germany. Eighty-two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 2012 to 2016. The following were the outcome measures: (1) physiological measures: standing plain x-rays (anteroposterior and lateral views), with the following parameters evaluated: cement leak behind the posterior vertebral body border, Cobb angle for local sagittal deformity, vertebral wedge angle, and anterior vertebral height; (2) cement volume injected in each vertebra; and (3) self-report measures: visual analog scale (VAS). All patients underwent BKP using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain x-rays, computed tomography scans and magnetic resonance imaging. The average follow-up period was 18 months. No cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in the Cobb angle, the vertebral wedge angle, and the anterior vertebral height in all cases. The mean preoperative VAS was 8.1, and this improved to 2.3 on the third postoperative day. Balloon kyphoplasty is a viable option

  16. Total motion generated in the unstable thoracolumbar spine during management of the typical trauma patient: a comparison of methods in a cadaver model.

    Science.gov (United States)

    Prasarn, Mark L; Zhou, Haitao; Dubose, Dewayne; Rossi, Gianluca Del; Conrad, Bryan P; Horodyski, Marybeth; Rechtine, Glenn R

    2012-05-01

    The proper prehospital and inpatient management of patients with unstable spinal injuries is critical for prevention of secondary neurological compromise. The authors sought to analyze the amount of motion generated in the unstable thoracolumbar spine during various maneuvers and transfers that a trauma patient would typically be subjected to prior to definitive fixation. Five fresh cadavers with surgically created unstable L-1 burst fractures were tested. The amount of angular motion between the T-12 and L-2 vertebral segments was measured using a 3D electromagnetic motion analysis device. A complete sequence of maneuvers and transfers was then performed that a patient would be expected to go through from the time of injury until surgical fixation. These maneuvers and transfers included spine board placement and removal, bed transfers, lateral therapy, and turning the patient prone onto the operating table. During each of these, the authors performed what they believed to be the most commonly used versus the best techniques for preventing undesirable motion at the injury level. When placing a spine board there was more motion in all 3 planes with the log-roll technique, and this difference reached statistical significance for axial rotation (p = 0.018) and lateral bending (p = 0.003). Using logrolling for spine board removal resulted in increased motion again, and this was statistically significant for flexion-extension (p = 0.014). During the bed transfer and lateral therapy, the log-roll technique resulted in more motion in all 3 planes (p ≤ 0.05). When turning the cadavers prone for surgery there was statistically more angular motion in each plane for manually turning the patient versus the Jackson table turn (p ≤ 0.01). The total motion was decreased by almost 50% in each plane when using an alternative to the log-roll techniques during the complete sequence (p ≤ 0.007). Although it is unknown how much motion in the unstable spine is necessary to cause

  17. Does 'Kinesio tape' alter thoracolumbar fascia movement during lumbar flexion? An observational laboratory study.

    Science.gov (United States)

    Tu, Shihfan Jack; Woledge, Roger C; Morrissey, Dylan

    2016-10-01

    Changes in thoracolumbar fascial thickness, structure and shear strain are associated with lower back pain (LBP). Therapeutic taping techniques such as Kinesio-Taping (KT) are increasingly used to treat LBP, albeit with variable effects and unclear mechanisms. However, evidence for quantifying how treatment effects in vivo fascia properties is inadequate. We therefore aimed to explore taping mechanisms using an in vivo ultrasound measurement. Thoracolumbar ultrasound videos of known orientations and positions were taken from 12 asymptomatic participants (8 males and 4 females, aged 22.9 ± 3.59) while performing velocity-guided lumbar flexion with and without KT applied. An automated algorithm using cross-correlation to track contiguous tissue layers across sequential frames in the sagittal plane, was developed and applied to two movements of each subject in each taping condition. Differences of inter-tissue movements and paracutaneous translation at tissue boundaries were compared. Significant reduction in the mean movement of subcutaneous tissue during lumbar flexion before and after taping was found. There was no difference in other observed tissue layers. Tissue paracutaneous translations at three boundaries were significantly reduced during lumbar flexion when KT was applied (skin-subcutaneous: 0.25 mm, p < 0.01; subcutaneous-perimuscular tissue: 0.5 mm, p = 0.02; and perimuscular-muscle: 0.46, p = 0.05). No overall reduction in lumbar flexion was found (p = 0.10). KT reduced subcutaneous inter-tissue movement and paracutaneous translation in the superficial thoracolumbar fascia during lumbar flexion, and the relationship of such difference to symptomatic change merits exploration. Combining ultrasound data with muscle activation information may be useful to reveal potential mechanisms of therapeutic taping in patients with LBP. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Radiological diagnosis of chronic spinal cord compressive lesion at thoraco-lumbar junction

    International Nuclear Information System (INIS)

    Koyanagi, Izumi; Isu, Toyohiko; Iwasaki, Yoshinobu; Akino, Minoru; Abe, Hiroshi; Tashiro, Kunio; Miyasaka, Kazuo; Abe, Satoru; Kaneda, Kiyoshi

    1988-01-01

    Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here. MRI is also a useful method for diagnosing a compressive lesion at the thoraco-lumbar junction. (author)

  19. Radiological diagnosis of chronic spinal cord compressive lesion at thoraco-lumbar junction

    Energy Technology Data Exchange (ETDEWEB)

    Koyanagi, Izumi; Isu, Toyohiko; Iwasaki, Yoshinobu; Akino, Minoru; Abe, Hiroshi; Tashiro, Kunio; Miyasaka, Kazuo; Abe, Satoru; Kaneda, Kiyoshi

    1988-10-01

    Radiological findings in five cases with chronic spinal cord compressive lesion at thoraco-lumbar junction were reported. Three cases had spondylosis and two cases had ossification of yellow ligament (OYL). The levels of the lesions were T12/L1 in three cases and T11/12 in two cases. Two out of three spondylotic patients had also OYL at the same level. The five cases consisted of three men and two women. The ages ranged from 42 to 60 years old with a mean age of 53 years old. Neurologically, every patient showed flaccid paresis and sensory disturbance of the legs. Two cases had sensory disturbance of stocking type. The intervals from the onset of the symptoms to the final diagnosis were 6 months, 7 years, 8 years, 11 years and 12 years. Myelography showed anterior spinal cord compression by bony spur in spondylotic patients, and posterior compression by OYL in other cases. Myelography in flexion posture disclosed the cord compression by bony spur more clearly in two out of three spondylotic patients. Delayed CT-myelography showed intramedullary filling of contrast material in two cases, which indicated degenerative change or microcavitation due to long term compression of the spinal cord. MRI was taken in three spondylotic patients and could directly show compression of the spinal cord. Difficulty in detecting abnormality at thoraco-lumbar junction on plain roentgenogram, and similarity of the symptoms to peripheral nerve disease often lead to a delay in diagnosis. The significance of dynamic myelography and delayed CT-myelography when dealing with such a lesion was discussed here. MRI is also a useful method for diagnosing a compressive lesion at the thoraco-lumbar junction.

  20. Thoracolumbar kyphoscoliosis with unilateral subluxation of the spine and postoperative lumbar spondylolisthesis in Hunter syndrome.

    Science.gov (United States)

    Roberts, Simon B; Tsirikos, Athanasios I

    2016-03-01

    Surgical correction for kyphoscoliosis is increasingly being performed for patients with mucopolysaccharidosis (MPS). Reported case series have predominantly included patients with Type I (Hurler) and Type IV (Morquio) MPS. To their knowledge, the authors describe the first case report of surgical management of thoracolumbar kyphoscoliosis in Hunter syndrome (MPS Type II) and the rare occurrence of lumbar spondylolisthesis following surgical stabilization. A 12-year-old boy with Hunter syndrome presented with severe thoracolumbar kyphoscoliosis and no associated symptoms. Spinal radiographs demonstrated kyphosis of 48° (T11-L3) and scoliosis of 22° (T11-L3) with an anteriorly hypoplastic L-1 vertebra. The deformity progressed to kyphosis of 60° and scoliosis of 42° prior to surgical intervention. Spinal CT scans identified left T12-L1 facet subluxation, causing anterior rotatory displacement of the spine proximal to L-1 and bilateral L-5 isthmic spondylolysis with no spondylolisthesis. A combined single-stage anterior and posterior instrumented spinal arthrodesis from T-9 to L-4 was performed. Kyphosis and scoliosis were corrected to 4° and 0°, respectively. Prolonged ventilator support and nasogastric feedings were required for 3 months postoperatively. At 2.5 years following surgery, the patient was asymptomatic, mobilizing independently, and had achieved a solid spinal fusion. However, he had also developed a Grade II spondylolisthesis at L4-5; this was managed nonoperatively in the absence of symptoms or further deterioration of the spondylolisthesis to the 3.5-year postoperative follow-up visit. Satisfactory correction of thoracolumbar kyphoscoliosis in Hunter syndrome can be achieved by combined anterior/posterior instrumented arthrodesis. The risk of developing deformity or instability in motion segments adjacent to an instrumented fusion may be greater in patients with MPS related to the underlying connective tissue disorder.

  1. Early recurrence of thoracolumbar intervertebral disc extrusion after surgical decompression: a report of three cases

    Directory of Open Access Journals (Sweden)

    Jäderlund Karin H

    2010-02-01

    Full Text Available Abstract Thoracolumbar disc extrusions were diagnosed in three chondrodystrophic dogs with paraparesis of up to three days duration. All cases were managed by hemilaminectomy and removal of extruded disc material. In one dog, fenestration of the herniated disc space was also performed. Initially neurological function improved or was unchanged, but from two to ten days postoperatively clinical signs of deterioration became apparent. In all the dogs, recurrence of disc extrusion at the same location as the initial extrusion was diagnosed by computer tomography and at a second surgery abundant disc material was found at the hemilaminectomy site between the dura and an implanted graft of autogenous fat.

  2. COMPARISON BETWEEN SHORT AND LONG SEGMENT TRANSPEDICULAR FIXATION OF THORACOLUMBAR BURST FRACTURES

    Directory of Open Access Journals (Sweden)

    Makkena

    2016-03-01

    Full Text Available BACKGROUND Transpedicular instrumentation systems have distinct advantages such as rigid segmental fixation, stabilization of the three columns, least failure at bone metal interface, early post-operative mobilization with efficient nursing care and least complications in the management of thoracolumbar burst fractures. The aim of this study was to analyze and compare the clinical and radiological outcome of thoracolumbar burst fractures treated by short segment and long segment transpedicular instrumentation. METHODS 34 patients who underwent posterior spinal stabilization with transpedicular instrumentation and posterolateral fusion for unstable thoracolumbar burst fractures with or without neurological deficit were included in the study. Load sharing classification (Gaines scoring was used retrospectively to correlate fracture comminution and displacement with progression of the deformity and implant failure. Neurological evaluation was done and patients were graded according to ASIA (American Spinal Cord Injury Association impairment scale as a part of physical examination. RESULTS The mean intra-operative correction in the short segment group was 14.4° and the loss of correction observed at the last follow-up evaluation was 7.48° with a final gain of 6.92°. The mean intra-operative correction in the long segment group was 19.77° and the loss of correction observed at the last follow-up evaluation was 6.61°. Final gain was 13.16°. On radiological evaluation, mean correction loss of 7.48 degrees and 3.4% implant failure was noted in the short segment group while the long segment group had 6.61 degrees of mean correction loss and no implant failure. There was no positive correlation found between Gaines score with progression of deformity. CONCLUSION Transpedicular fixation is a stable, reliable and less surgically extensive construct for addressing thoracolumbar burst fractures. About 6-8° loss of correction was observed with both

  3. Fluoroscopic-guided intradiscal oxygen-ozone injection therapy for thoracolumbar intervertebral disc herniations in dogs.

    Science.gov (United States)

    Han, Hyun-Jung; Kim, Joon-Young; Jang, Ha-Young; Lee, Bora; Yoon, Jung-Hee; Jang, Sang-Keun; Choi, Seok Hwa; Jeong, Soon-Wuk

    2007-01-01

    To investigate the effect of oxygen-ozone (O2-O3) injection on thoracolumbar intervertebral disc herniation (IVDH) in dogs. Ten herniated discs of five dogs were treated with percutaneous injection of an O2-O3 gas mixture with O3 concentration of 32 microg/microl intradiscally (1.5-2 microl) under fluoroscopy guidance. Five weeks after treatment, the mean size of herniated discs was measured by computed tomography and showed significant reduction of disc volumes in all animals (8.8%+/-3.82%). The degree of shrinkage was negatively linearly correlated with disc mineralization (correlation coefficient=-0.636) and statistically significant at pdiscs by disc shrinkage.

  4. Neurologic improvement after thoracic, thoracolumbar, and lumbar spinal cord (conus medullaris) injuries.

    Science.gov (United States)

    Harrop, James S; Naroji, Swetha; Maltenfort, Mitchell Gil; Ratliff, John K; Tjoumakaris, Stavropoula I; Frank, Brian; Anderson, D Greg; Albert, Todd; Vaccaro, Alexander R

    2011-01-01

    Retrospective. With approximately 10,000 new spinal cord injury (SCI) patients in the United States each year, predicting public health outcomes is an important public health concern. Combining all regions of the spine in SCI trials may be misleading if the lumbar and sacral regions (conus) have a neurologic improvement at different rates than the thoracic or thoracolumbar spinal cord. Over a 10-year period between January 1995 to 2005, 1746 consecutive spinal injured patients were seen, evaluated, and treated through a level 1 trauma referral center. A retrospective analysis was performed on 150 patients meeting the criteria of T4 to S5 injury, excluding gunshot wounds. One-year follow-up data were available on 95 of these patients. Contingency table analyses (chi-squared statistics) and multivariate logistic regression. Variables of interest included level of injury, initial American Spinal Injury Association (ASIA), age, race, and etiology. A total of 92.9% of lumbar (conus) patients neurologically improved one ASIA level or more compared with 22.4% of thoracic or thoracolumbar spinal cord-injured patients. Only 7.7% of ASIA A patients showed neurologic improvement, compared with 95.2% of ASIA D patients; ASIA B patients demonstrated a 66.7% improvement rate, whereas ASIA C had a 84.6% improvement rate. When the two effects were considered jointly in a multivariate analysis, ASIA A and thoracic/thoracolumbar patients had only a 4.1% rate of improvement, compared with 96% for lumbar (conus) and incomplete patients (ASIA B-D) and 66.7% to 72.2% for the rest of the patients. All of these relationships were significant to P spinal cord have a greater neurologic improvement rate, which might be related to a greater proportion of lower motor neurons. Thus, defining the exact region of injury and potential for neurologic improvement should be considered in future clinical trial design. Combining all anatomic regions of the spine in SCI trials may be misleading if

  5. Relation of the vertebral artery segment from C1 to C2 vertebrae: An ...

    African Journals Online (AJOL)

    Ayman Ahmad Khanfour

    2014-06-20

    Jun 20, 2014 ... The atlas vertebra (C1) has unique anatomy due to the absence of the vertebral body and its ring-like shape which makes it dif- ferent from other cervical vertebrae. Absence of the vertebral. * Corresponding author. Tel.: +20 01223815866. E-mail addresses: aymn222@hotmail.com. (A.A. Khanfour),.

  6. Cadmium-induced vertebral-column ankylosis in whitefish

    Energy Technology Data Exchange (ETDEWEB)

    Henschke, E.; Pesch, H.J.; Wunder, W.

    1982-01-01

    In two healthy and two diseased whitefish (Coregonus Wartmanni) taken from Lake Constance (FRG), ankylosis of the vertebral column was investigated both roentgenologically and histologically. Subsequent to the collapse and necrosis of the 'residual' spinal cord within the intervertebral spaces, the outside edges of the vertebral bodies come into direct contact. The compression and tensile forces that occur to an increased extent as a result of the instability, lead not only to a remodelling of the vertebral bodies, but also to the formation of spondylotic osteophytes at the edges of the vertebrae and, as a result of periosteal stimulation, to the development of cellular hyaline cartilage, which fills the intervertebral spaces. Finally, as a result of perichondral ossification, a bony ankylosis develops. The humping of the spine of the fish due to the stiffening and shortening of the vertebral column, is accompanied by a restriction in the animal's freedom of movement. Muscular atrophic processes and disordered food uptake give rise of poor growth and a reduction in the weight of the diseased fish. These remodelling processes in the spine resulting from instability are specific to the periosteum and may be equated with the changes seen in man in spondylosis deformans. The possible cause of this vertebral column ankylosis is cadmium poisoning. The accumulation of this heavy metal obviously leads primarily to an irreversible toxic degeneration of the cells of the chorda dorsalis.

  7. Retrospective analysis of whole-body multislice computed tomography findings taken in trauma patients

    Directory of Open Access Journals (Sweden)

    Ozlem Bingol

    2015-09-01

    Full Text Available Objectives: Using whole-body multislice computed tomography (MSCT excessively or with irrelevant indications can be seen in many centers. The aim of this study was to analyze retrospectively the MSCT findings in trauma patients admitted to the emergency department. Methods: Records of the patients who have applied to the emergency department due to blunt trauma in a 12 month period and whose whole body MSCT images have been taken, were evaluated using the “Nucleus Medical Information System”. Results: The most frequent type of trauma was traffic accidents in 61.4%, falling down from the height in 22.4%, and motorcycle accidents in 11.4% of patients. Of the patients, 25.2% were discharged from the emergency, while 73.8% were hospitalized. At least one CT findings associated with trauma was present in 61.4% of our patients. Pathological findings in MSCT were most frequently detected in the head and face (35.3% and thoracic (28.6% regions, respectively. The most common finding in the head and face region was fractures. The most common pathological findings in the thoracic region were pulmonary contusion and rib fractures. A significant relationship was detected between trauma type and spinal MSCT result (p < 0.001. In a large percentage of the patients, MSCT findings were normal in the abdominal region and genitourinary system. Vertebral fractures were most frequently detected in the thoracolumbar region. Conclusions: In our study, our rate of negative CT was found to be 38.6%, which is a higher ratio compared to other studies conducte on this topic. Keywords: Emergency, Trauma, Whole-body multislice computed tomography

  8. The pattern and prevalence of vertebral artery injury in patients with cervical spine fractures

    Directory of Open Access Journals (Sweden)

    Farzanah Ismail

    2013-06-01

    Method: A retrospective review of patients who had undergone CTA of the vertebral arteries was undertaken. Reports were reviewed to determine which patients met the inclusion criteria of having had both cervical spine fractures and CTA of the vertebral arteries. Images of patients who met the inclusion criteria were analysed by a radiologist. Results: The prevalence of vertebral artery injury was 33%. Four out of the 11 patients who had vertebral artery injury, had post-traumatic spasm of the artery, with associated thrombosis or occlusion of the vessel. In terms of blunt carotid vertebral injury (BCVI grading, most of the patients sustained grade IV injuries. Four patients who had vertebral artery injury had fractures of the upper cervical vertebrae, i.e. C1 to C3. Fifteen transverse process fractures were associated with vertebral artery injury. No vertebral artery injury was detected in patients who had facet joint subluxations. Conclusion: Patients with transverse process fractures of the cervical spine and upper cervical vertebral body fractures should undergo CTA to exclude vertebral artery injury.

  9. Nonsurgical Corrective Union of Osteoporotic Vertebral Fracture with Once-Weekly Teriparatide

    Directory of Open Access Journals (Sweden)

    Naohisa Miyakoshi

    2015-01-01

    Full Text Available Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12° and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.

  10. Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature

    NARCIS (Netherlands)

    P.P. Oprel (Pim); W.E. Tuinebreijer (Wim); P. Patka (Peter); D. den Hartog (Dennis)

    2010-01-01

    textabstractAbstract: Study Design: A systematic quantitative review of the literature. Objective: To compare combined anterior-posterior surgery versus posterior surgery for thoracolumbar fractures in order to identify better treatments. Summary of Background Data: Axial load of the anterior and

  11. Balloon kyphoplasty for aged osteoporotic vertebral compressive fractures using instruments made in China

    International Nuclear Information System (INIS)

    Sun Gang; Jin Peng; Yi Yuhai; Xie Zhiyong; Zhang Kangli; Zhang Xuping

    2006-01-01

    Objective: To evaluated the efficacy and safety of balloon kyphoplasty in treatment of painful osteoporosis vertebral compressive fractures using instruments made in China. Methods: Sixteen cases of painful osteoporotic vertebral compressive fractures, involved 19 vertebrae. Under X-ray fluoroscopy monitoring, the inflatable balloon were inserted into the fractured vertebral body via transpedieular route bilaterally. The balloon was inflated with injected contrast agent, restored vertebral height and formed a cavity within vertebral body. The cavity was than filled with bone cement in toothpaste period. The postoperative symptoms and the radiographic finding of vertebral height were observed. Results: Balloon kyphoplasty was successful in all 16 cases with dramatic pain relief within 48 hours after the procedure. No clinical complication was found. The posttreatment mean anterior and mid portion of the vertebral body heights were (10.7±3.5) mm and (5.4±2.7) mm respectively, while that of the pretreatment were (14.8±4.1) mm and (10.4±4.4) mm, respectively (t=3.96, 5.37; P<0.01). Before the procedure, the mean Kyphosis was (22.4±5.8) degree, after the procedure, the mean kyphosis was measured (12.1± 5.3) degree (t=5.93, P<0.01). Leakage of a small quantity of bone cement occurred at one level. Conclusion: kyphoplasty using instruments made in China for painful osteoporotic vertebral compressive fractures was effective and safe. (authors)

  12. Optimal patient positioning for ligamentotaxis during balloon kyphoplasty of the thoracolumbar and lumbar spine.

    LENUS (Irish Health Repository)

    Cawley, D T

    2011-06-01

    Percutaneous balloon kyphoplasty aims to restore vertebral height, correct angular deformity and stabilize the spine in the setting of vertebral compression fractures. The patient is positioned prone with supports under the iliac crests and upper thorax to allow gravity to extend the spine. In the treatment of lumbar fractures, we evaluated patient positioning with the contribution of hip extension to increase anterior ligamentotaxis, thus facilitating restoration of vertebral height. Our positioning technique created a mean anterior height increase from 72% to 78% of the average height of the cranial and caudal vertebrae (p=0.037). Balloon inflation did not significantly further increase anterior or posterior vertebral height, or Cobb angle.

  13. Shark-bitten vertebrate coprolites from the Miocene of Maryland

    Science.gov (United States)

    Godfrey, Stephen J.; Smith, Joshua B.

    2010-05-01

    Coprolites (fossilized feces) preserve a wide range of biogenic components, from bacteria and spores to a variety of vertebrate tissues. Two coprolites from the Calvert Cliffs outcrop belt (Miocene-aged Chesapeake Group), MD, USA, preserve shark tooth impressions in the form of partial dental arcades. The specimens are the first known coprolites to preserve vertebrate tooth marks. They provide another example of trace fossils providing evidence of prehistoric animal behaviors that cannot be directly approached through the study of body fossils. Shark behaviors that could account for these impressions include: (1) aborted coprophagy, (2) benthic or nektonic exploration, or (3) predation.

  14. Shark-bitten vertebrate coprolites from the Miocene of Maryland.

    Science.gov (United States)

    Godfrey, Stephen J; Smith, Joshua B

    2010-05-01

    Coprolites (fossilized feces) preserve a wide range of biogenic components, from bacteria and spores to a variety of vertebrate tissues. Two coprolites from the Calvert Cliffs outcrop belt (Miocene-aged Chesapeake Group), MD, USA, preserve shark tooth impressions in the form of partial dental arcades. The specimens are the first known coprolites to preserve vertebrate tooth marks. They provide another example of trace fossils providing evidence of prehistoric animal behaviors that cannot be directly approached through the study of body fossils. Shark behaviors that could account for these impressions include: (1) aborted coprophagy, (2) benthic or nektonic exploration, or (3) predation.

  15. Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

    Science.gov (United States)

    Gupta, Lucky; Mala, Tariq Ahmed; Gupta, Rahul; Malla, Shahid Amin

    2014-01-01

    Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.

  16. Caudal lumbar vertebral fractures in California Quarter Horse and Thoroughbred racehorses.

    Science.gov (United States)

    Collar, E M; Zavodovskaya, R; Spriet, M; Hitchens, P L; Wisner, T; Uzal, F A; Stover, S M

    2015-09-01

    To gain insight into the pathophysiology of equine lumbar vertebral fractures in racehorses. To characterise equine lumbar vertebral fractures in California racehorses. Retrospective case series and prospective case-control study. Racehorse post mortem reports and jockey injury reports were retrospectively reviewed. Vertebral specimens from 6 racehorses affected with lumbar vertebral fractures and 4 control racehorses subjected to euthanasia for nonspinal fracture were assessed using visual, radiographic, computed tomography and histological examinations. Lumbar vertebral fractures occurred in 38 Quarter Horse and 29 Thoroughbred racehorses over a 22 year period, primarily involving the 5th and/or 6th lumbar vertebrae (L5-L6; 87% of Quarter Horses and 48% of Thoroughbreds). Lumbar vertebral fractures were the third most common musculoskeletal cause of death in Quarter Horses and frequently involved a jockey injury. Lumbar vertebral specimens contained anatomical variations in the number of vertebrae, dorsal spinous processes and intertransverse articulations. Lumbar vertebral fractures examined in 6 racehorse specimens (5 Quarter Horses and one Thoroughbred) coursed obliquely in a cranioventral to caudodorsal direction across the adjacent L5-L6 vertebral endplates and intervertebral disc, although one case involved only one endplate. All cases had evidence of abnormalities on the ventral aspect of the vertebral bodies consistent with pre-existing, maladaptive pathology. Lumbar vertebral fractures occur in racehorses with pre-existing pathology at the L5-L6 vertebral junction that is likely predisposes horses to catastrophic fracture. Knowledge of these findings should encourage assessment of the lumbar vertebrae, therefore increasing detection of mild vertebral injuries and preventing catastrophic racehorse and associated jockey injuries. © 2014 EVJ Ltd.

  17. Minimal invasive stabilization of osteoporotic vertebral compression fractures. Methods and preinterventional diagnostics

    International Nuclear Information System (INIS)

    Grohs, J.G.; Krepler, P.

    2004-01-01

    Minimal invasive stabilizations represent a new alternative for the treatment of osteoporotic compression fractures. Vertebroplasty and balloon kyphoplasty are two methods to enhance the strength of osteoporotic vertebral bodies by the means of cement application. Vertebroplasty is the older and technically easier method. The balloon kyphoplasty is the newer and more expensive method which does not only improve pain but also restores the sagittal profile of the spine. By balloon kyphoplasty the height of 101 fractured vertebral bodies could be increased up to 90% and the wedge decreased from 12 to 7 degrees. Pain was reduced from 7,2 to 2,5 points. The Oswestry disability index decreased from 60 to 26 points. This effects persisted over a period of two years. Cement leakage occurred in only 2% of vertebral bodies. Fractures of adjacent vertebral bodies were found in 11%. Good preinterventional diagnostics and intraoperative imaging are necessary to make the balloon kyphoplasty a successful application. (orig.) [de

  18. Thoracolumbar intradural disc herniation in eight dogs: clinical, low-field magnetic resonance imaging, and computed tomographic myelography findings.

    Science.gov (United States)

    Tamura, Shinji; Doi, Shoko; Tamura, Yumiko; Takahashi, Kuniaki; Enomoto, Hirokazu; Ozawa, Tsuyoshi; Uchida, Kazuyuki

    2015-01-01

    Intradural disc herniation is a rarely reported cause of neurologic deficits in dogs and few published studies have described comparative imaging characteristics. The purpose of this retrospective cross sectional study was to describe clinical and imaging findings in a group of dogs with confirmed thoracolumbar intradural disc herniation. Included dogs were referred to one of four clinics, had acute mono/paraparesis or paraplegia, had low field magnetic resonance imaging (MRI) and/or computed tomographic myelography, and were diagnosed with thoracolumbar intradural disc herniation during surgery. Eight dogs met inclusion criteria. The prevalence of thoracolumbar intradural disc herniation amongst the total population of dogs that developed a thoracolumbar intervertebral disc herniation and that were treated with a surgical procedure was 0.5%. Five dogs were examined using low-field MRI. Lesions that were suspected to be intervertebral disc herniations were observed; however, there were no specific findings indicating that the nucleus pulposus had penetrated into the subarachnoid space or into the spinal cord parenchyma. Thus, the dogs were misdiagnosed as having a conventional intervertebral disc herniation. An intradural extramedullary disc herniation (three cases) or intramedullary disc herniation (two cases) was confirmed during surgery. By using computed tomographic myelography (CTM) for the remaining three dogs, an intradural extramedullary mass surrounded by an accumulation of contrast medium was observed and confirmed during surgery. Findings from this small sample of eight dogs indicated that CTM may be more sensitive for diagnosing canine thoracolumbar intradural disc herniation than low-field MRI. © 2014 American College of Veterinary Radiology.

  19. The relationship of older age and perioperative outcomes following thoracolumbar three-column osteotomy for adult spinal deformity: an analysis of 300 consecutive cases.

    Science.gov (United States)

    Lau, Darryl; Osorio, Joseph A; Deviren, Vedat; Ames, Christopher P

    2018-04-06

    OBJECTIVE Three-column osteotomies are increasingly being used in the elderly population to correct rigid spinal deformities. There is hesitation, however, in performing the technique in older patients because of the high risk for blood loss, longer operative times, and complications. This study assesses whether age alone is an independent risk factor for complications and length of stay. METHODS All patients with thoracolumbar adult spinal deformity (ASD) who underwent 3-column osteotomy (vertebral column resection or pedicle subtraction osteotomy) performed by the senior author from 2006 to 2016 were identified. Demographics, clinical baseline, and surgical details were collected. Outcomes of interest included perioperative complication, ICU stay, and hospital stay. Bivariate and multivariate analyses were used to assess the association of age with outcomes of interest. RESULTS A total of 300 patients were included, and 38.3% were male. The mean age was 63.7 years: 10.3% of patients were younger than 50 years, 36.0% were 50-64 years, 45.7% were 65-79 years, and 8.0% were 80 years or older. The overall mean EBL was 1999 ml. The overall perioperative complication rate was 24.7%: 18.0% had a medical complication and 7.0% had a surgical complication. There were no perioperative or 30-day deaths. Age was associated with overall complications (p = 0.002) and medical-specific complications (p column osteotomy for ASD. Comorbidities and other unknown variables that come with age are likely what put these patients at higher risk for complications. Older age, however, is independently associated with longer ICU and hospital stays.

  20. Clinical features, outcomes, and survival factor in patients with vertebral osteomyelitis infected by methicillin-resistant staphylococci.

    Science.gov (United States)

    Shoji, Hirokazu; Urakawa, Takaaki; Watanabe, Kei; Hirano, Toru; Katsumi, Keiichi; Ohashi, Masayuki; Sato, Tsuyoshi; Yamazaki, Akiyoshi; Yajiri, Yoichi; Kikuchi, Ren; Hosaka, Noboru; Sawakami, Kimihiko; Miura, Kazuto; Nakamura, Ichiro; Fujikawa, Ryuta; Wakasugi, Masashi; Endo, Naoto

    2016-05-01

    To elucidate clinico-radiological features, therapeutic outcomes, and survival factors of vertebral osteomyelitis patients infected by methicillin-resistant staphylococci (MRS). Vertebral osteomyelitis patients admitted to the orthopaedic department between 2007 and 2011 (n = 248) were selected for this multicenter study. We compared patients' backgrounds, therapeutic course, and in-hospital mortality between MRS and methicillin-susceptible staphylococci (MSS). We also examined survival factors of vertebral osteomyelitis due to MRS. Sixteen patients of MRS vertebral osteomyelitis and 55 patients of MSS were included in this study. In MRS vertebral osteomyelitis, the rates of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and operation of surgical debridement were higher compared to those in MSS vertebral osteomyelitis. Univariate analysis showed that operation of surgical debridement was a factor related to survival in MRS patients. Higher rate of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and performing surgical debridement are peculiar features of MRS vertebral osteomyelitis compared to MSS vertebral osteomyelitis. If patients with MRS vertebral osteomyelitis respond poorly to antibiotic therapy, it might be better to consider surgical debridement not to lose an opportunity of operation due to exacerbation of systemic conditions. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  1. Estimation of stature from radiologic anthropometry of the lumbar vertebral dimensions in Chinese.

    Science.gov (United States)

    Zhang, Kui; Chang, Yun-feng; Fan, Fei; Deng, Zhen-hua

    2015-11-01

    The recent study was to assess the relationship between the radiologic anthropometry of the lumbar vertebral dimensions and stature in Chinese and to develop regression formulae to estimate stature from these dimensions. A total of 412 normal, healthy volunteers, comprising 206 males and 206 females, were recruited. The linear regression analysis were performed to assess the correlation between the stature and lengths of various segments of the lumbar vertebral column. Among the regression equations created for single variable, the predictive value was greatest for the reconstruction of stature from the lumbar segment in both sexes and subgroup analysis. When individual vertebral body was used, the heights of posterior vertebral body of L3 gave the most accurate results for male group, the heights of central vertebral body of L1 provided the most accurate results for female group and female group with age above 45 years, the heights of central vertebral body of L3 gave the most accurate results for the groups with age from 20-45 years for both sexes and the male group with age above 45 years. The heights of anterior vertebral body of L5 gave the less accurate results except for the heights of anterior vertebral body of L4 provided the less accurate result for the male group with age above 45 years. As expected, multiple regression equations were more successful than equations derived from a single variable. The research observations suggest lumbar vertebral dimensions to be useful in stature estimation among Chinese population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Vertebrate pressure-gradient receivers

    DEFF Research Database (Denmark)

    Christensen-Dalsgaard, Jakob

    2011-01-01

    The eardrums of all terrestrial vertebrates (tetrapods) are connected through Eustachian tubes or interaural canals. In some of the animals, these connections create pressure-gradient directionality, an enhanced directionality by interaction of sound arriving at both sides of the eardrum and stro......The eardrums of all terrestrial vertebrates (tetrapods) are connected through Eustachian tubes or interaural canals. In some of the animals, these connections create pressure-gradient directionality, an enhanced directionality by interaction of sound arriving at both sides of the eardrum....... Recent vertebrates form a continuum from perfect interaural transmission (0 dB in a certain frequency band) and pronounced eardrum directionality (30-40 dB) in the lizards, over somewhat attenuated transmission and limited directionality in birds and frogs, to the strongly attenuated interaural...

  3. Anterior surgical management of the cervicothoracic junction lesions at T1 and T2 vertebral bodies Manejo cirúrgico via anterior das lesões da junção cérvico-torácica nos corpos vertebrais de T1 e T2

    Directory of Open Access Journals (Sweden)

    Asdrubal Falavigna

    2008-06-01

    Full Text Available Lesions of the cervicothoracic junction have a high propensity for causing instability and present unique challenges in the surgical treatment. Several surgical approaches to this region have been described in the literature. We report our experience in the surgical treatment of six patients with unstable lesions involving the cervicothoracic junction at T1 and T2 vertebral bodies. The patients underwent an anterior left Smith-Robinson approach and manubriotomy. Mesh and cervical plate system were used for stabilization and reconstruction of the region. No complication related to the surgical procedure was observed. In our experience, in injuries involving the T1 and T2 vertebral bodies, the transmanubrial approach offers good working room to remove the lesions and anterior reconstruction.Lesões da junção cérvico-torácica têm alta tendência em causar instabilidade e apresentam grandes desafios ao tratamento cirúrgico. Diversas abordagens cirúrgicas a esta região foram descritas na literatura. Relatamos nossa experiência no tratamento cirúrgico de seis pacientes com lesões instáveis envolvendo a junção cérvico-torácica em corpos vertebrais de T1 e T2. Os pacientes foram submetidos a uma abordagem anterior de Smith-Robinson pela esquerda e manubriotomia. Mesh e placa cervical foram utilizados para estabilização e reconstrução da região. Nenhuma complicação relacionada ao procedimento cirúrgico foi observada. Em nossa experiência, em lesões que envolvem os corpos vertebrais de T1 e T2, a abordagem transmanubrial oferece bom campo de trabalho para remoção das lesões e estabilização anterior.

  4. Zone-dependent changes in human vertebral trabecular bone: clinical implications

    DEFF Research Database (Denmark)

    Thomsen, Jesper Skovhus; Ebbesen, Ebbe Nils; Mosekilde, Lis

    2002-01-01

    We have previously shown that there are pronounced age-related changes in human vertebral cancellous bone density and microarchitecture. However, the magnitude of these changes seemed to be dependent on zone location in the vertebral body-the central third vs. the areas adjacent to the endplates...... shows that the human vertebral body can be described as two distinct zones with very specific age-related changes in density and microstructure. This zone-specificity is important for the correct interpretation of clinical data....

  5. Vertebral abnormality without spine-curvature deformity on prenatal ultrasonography: sonographic findings and postnatal radiographic correlations.

    Science.gov (United States)

    Song, Mi Jin; Kim, Young-Hwa

    2018-01-01

    To evaluate prenatal US features and postnatal radiographic findings of fetuses with a sonographically detected vertebral abnormality (VA) without spine-curvature deformity (SCD). Twenty-six fetuses showing a VA without SCD on prenatal US at our ultrasound center for a 5-year period were retrospectively identified and evaluated for sonographic data and coexisting anomalies. Medical records and postnatal radiographs of all 16 live births were reviewed. Coexisting major anomalies were suspected prenatally in 8/26 fetuses (30.8%). Sonographic abnormalities were noted in the vertebral body in 27/31 (87.1%) and in the posterior element in 4/31 (12.9%). US features were absent (n = 2) or small vertebral body echo (n = 21), two separate vertebral body echoes (n = 4), or smaller or lobulated posterior arch echoes (n = 4). Among 16 live-born neonates, postnatal radiographs revealed a vertebral abnormality in 20 (95.2%) of 21 prenatally detected VA without SCD. The abnormalities were vertebral body hypoplasia (18/19) with an incomplete sagittal cleft, asymmetric/unilateral hypoplasia, or hypoplasia with a complete sagittal cleft; or abnormalities in the spinous process (2/2). Most fetuses with prenatally detected VA without SCD had hypoplastic vertebrae on postnatal radiographs. Prenatal recognition of VA without SCD can lead to an early postnatal diagnosis of a vertebral abnormality and guidance for follow-up.

  6. Vertebral Fractures and Spondylosis in Men - Original Investigation

    Directory of Open Access Journals (Sweden)

    Selmin Gülbahar

    2008-04-01

    Full Text Available Aim: The aim of this study was to investigate the relationship between vertebral fractures and spondylosis and bone mineral density in men older than 60 years. Material and Method: Thirty-two men with back and low back pain aged over 60 years were included into the study. Thoracic and lumbar spine radiographs were taken and, anterior, central and posterior heights of each vertebral body from T4 to L5 was measured and than the number of vertebral fractures was assessed. Osteophyte and disc scores were used for evaluation of spondylosis. Bone mineral density was measured by dual-energy-X-ray absorptiometry. Measurements were obtained from lumbar vertebrae and proximal femoral region. Results: Significant positive correlations were found between vertebral fracture and osteophyte score and bone mineral density of total femoral region. When osteophyte score and total femoral bone mineral density were taken into consideration, there were no significant correlations between other parameters and vertebral fracture. Significant positive correlations were observed between osteophyte score and bone mineral density and t scores of L1-4. Also there were significant positive correlations between disc score and both bone mineral density and t scores of L1-4. Significant positive correlation was also found between femoral bone density and body weight. Conclusion: Finally, lumbar bone mineral density increases with spinal degenerative changes, but the increase in bone mineral density can not prevent sub clinic vertebral fractures. Especially, in the men who have intensive spinal degenerative changes, the measurement of lumbar bone mineral density is not enough for determining the fracture risk. Measurement of femoral bone mineral density and evaluation of clinic risk factors are more important for determining the fracture risk. (From the World of Osteoporosis 2008;14:1-6

  7. The influence of spine surgeons' experience on the classification and intraobserver reliability of the novel AOSpine thoracolumbar spine injury classification system : an international study

    NARCIS (Netherlands)

    Sadiqi, Said; Oner, F. Cumhur; Dvorak, Marcel F.; Aarabi, Bizhan; Schroeder, Gregory D.; Vaccaro, Alexander R.

    2015-01-01

    Study Design. International validation study. Objective. To investigate the influence of the spine surgeons' level of experience on the intraobserver reliability of the novel AOSpine Thoracolumbar Spine Injury Classification system, and the appropriate classification according to this system.

  8. Primary bone lymphoma with multiple vertebral involvement

    Directory of Open Access Journals (Sweden)

    Showkat Hussain Dar

    2013-01-01

    Full Text Available A 20-year-old student presented with 2 months history of fever and night sweats, 15 days history of low backache, progressive weakness of both limbs of 7 days duration, and urinary retention for last 24 h. Examination revealed a sensory level at D 10 dermatome and grade two power in both the lower limbs with absent reflexes. Examination of spine revealed a knuckle at T8 level, which was tender on palpation. MRI spine showed erosion of D11-12 and L1 in vertebral bodies with destruction of left pedicles, transverse processes and lamina, and a prominent psoas abscess. Post gadolinium study revealed ring-enhancing lesions in the D11-12 and L1 vertebrae as well as the dural sac. Fine needle aspiration cytology (FNAC and bone biopsy demonstrated a non-Hodgkin′s lymphoma (NHL, large cell high-grade of the spine (primary, which as per age is the youngest case of NHL ever reported in literature with multiple vertebral involvement.

  9. Vertebral column aggressive osteoblastoma: two cases report and literature review; Osteoblastomas agressivos da coluna vertebral: relato de dois casos e revisao da literatura

    Energy Technology Data Exchange (ETDEWEB)

    Sabedotti, Ismail Fernando; Sabedotti, Valdir [Santa Casa de Ponta Grossa, PR (Brazil). Servico de Residencia e Pos-graduacao]. E-mail: ismailsabedotti@uol.com.br; Toigo, Felipe Tietbohl; Ferrarini, Ideval [Santa Casa de Ponta Grossa, PR (Brazil). Radiologia; Montemor Netto, Mario Rodrigues [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil)

    2007-01-15

    Osteoblastoma is a bone neoplasy that in most circumstances present a low aggressive aspect on radiographic studies, but in some cases may acquire an aggressive pattern, rupturing the bone cortex and invading nearby structures. Most cases occur on the vertebral column, especially at the posterior arch and occasionally involving the vertebral body. Differential diagnosis of the aggressive form is made with osteosarcomas. This review reports two cases of osteoblastomas involving vertebral column, with an aggressive pattern on radiologic studies, and their histologic confirmation. (author)

  10. Vertebral Malformations in French Bulldogs

    Directory of Open Access Journals (Sweden)

    Mária KURICOVÁ

    2017-07-01

    Full Text Available The aim of this study was to detect vertebral malformations among French Bulldogs admitted between the years 2011 – 2016 due to the high popularity of the breed and the intentions to increase the breed welfare by reducing the occurrence of congenital anomalies. Besides, we aimed to look for gender predisposition, possible vertebral predisposition, occurrence of clinical symptoms and radiographic findings. A total of 73 French Bulldogs met the inclusion criteria (radiographs of the whole spine. In 67.12% (49 dogs we confirmed a vertebral anomaly and 32.88% (24 dogs were free of any vertebral anomaly. We identified a total of 67 abnormal vertebrae in 49 dogs, 13 cervical vertebrae (19.4%, 43 thoracic vertebrae (64.2%, and 11 abnormal lumbar vertebrae (16.4%. In this study, we found 44 hemivertebrae (65.7% out of 67 abnormal vertebrae. We identified 64.4% (47/73 dogs with clinical signs (30 males, 17 females and 36.6% (26/73 dogs without clinical signs (19 males, 7 females. Although the incidence of male dogs was higher in this study, the statistical evaluation did not confirm any predisposed gender, and we found no statistically significant predisposition for any particular abnormal vertebra.

  11. Learning about Vertebrate Limb Development

    Science.gov (United States)

    Liang, Jennifer O.; Noll, Matthew; Olsen, Shayna

    2014-01-01

    We have developed an upper-level undergraduate laboratory exercise that enables students to replicate a key experiment in developmental biology. In this exercise, students have the opportunity to observe live chick embryos and stain the apical ectodermal ridge, a key tissue required for development of the vertebrate limb. Impressively, every…

  12. Correlation of plain radiographic and lumbar myelographic findings with surgical findings in thoracolumbar disc disease

    International Nuclear Information System (INIS)

    Oldby, N.J.; Dyce, J.; Houlton, J.E.F.

    1994-01-01

    The results of a prospective study to compare the plain radiographic and lumbar myelographic findings with the surgical findings in 70 cases of suspected thoracolumbar disc protrusion in the dog are reported. The aim was to assess the relative accuracy of disc lesion localisation using plain and contrast radiography. From the plain radiographs, the affected disc space was correctly identified in 40 cases (57.1 per cent), and incorrectly identified in seven. More than one site was identified in 11; in eight of these dogs, the affected disc space was strongly suspected. It was not possible to identify an affected disc in 12 cases. The site of disc protrusion was accurately identified by myelography in 60 dogs (85.7 per cent). In four dogs, myelography was helpful in identifying an adjacent disc and, in a further two, cord swelling was found at surgery. In one dog, neither disc material nor cord swelling was identified. Three myelograms were non-diagnostic

  13. Thoraco-lumbar fractures with blunt traumatic aortic injury in adult patients: correlations and management.

    Science.gov (United States)

    Santoro, Giorgio; Ramieri, Alessandro; Chiarella, Vito; Vigliotta, Massimo; Domenicucci, Maurizio

    2018-04-16

    Traumatic thoraco-lumbar spine fracture spine with a concomitant blunt aortic injury is uncommon but potentially a fatal association. Our aim was to clarify: morphology of spinal fractures related to vascular damages and vice versa, diagnostic procedures and decision-making process for the best treatment options for spine and vessels. We enrolled 42 cases culled from the literature and five personal ones, reviewing in detail by AO Spine Classification, Society of Vascular Surgery classification and Abbreviated Injury Scale for neurological evaluation. Most fractures were at T11-L2 (29 cases; 62%) and type C (17; 70%). 17 (38%) were neurological. Most common vascular damage was the rupture (20; 43%), followed by intimal tear (13; 28%) and pseudoaneurysm (9; 19%). Vascular injury often required open or endovascular repair before spinal fixation. Distraction developed aortic intimal damage until rupture, while flexion-distraction lumbar artery pseudoaneurysm and rotation-torsion full laceration of collateral branches. CT and angio-CT were investigations of choice, followed by angiography. Neurological condition remained unchanged in 28 cases (90%). Overall mortality was 30%, but it was higher in AIS A. Relationship between thoraco-lumbar fracture and vascular lesion is rare, but potentially fatal. Comprehension of spinal biomechanics and vascular damages could be crucial to avoid poor results or decrease mortality. Frequently, traction of the aorta and its vessels is realized by C-dislocated fractures. CT and angio-CT are recommended. Spine stabilization should always follow the vascular repair. Early severe deficits worse the prognosis related to neurological recovery and survival. These slides can be retrieved under Electronic Supplementary Material.

  14. Feasibility and Accuracy of Thoracolumbar Minimally Invasive Pedicle Screw Placement With Augmented Reality Navigation Technology.

    Science.gov (United States)

    Elmi-Terander, Adrian; Nachabe, Rami; Skulason, Halldor; Pedersen, Kyrre; Söderman, Michael; Racadio, John; Babic, Drazenko; Gerdhem, Paul; Edström, Erik

    2017-12-19

    Cadaveric laboratory study. To assess the feasibility and accuracy of minimally invasive thoracolumbar pedicle screw placement using augmented reality (AR) surgical navigation SUMMARY OF BACKGROUND DATA.: Minimally invasive spine (MIS) surgery has increasingly become the method of choice for a wide variety of spine pathologies. Navigation technology based on AR has been shown to be feasible, accurate and safe in open procedures. AR technology may also be used for MIS surgery. The AR surgical navigation was installed in a hybrid operating room (OR). The hybrid OR includes a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D imaging capabilities, integrated optical cameras for AR navigation and patient motion tracking using optical markers on the skin. Navigation and screw placement was without any X-ray guidance. Two neurosurgeons placed 66 Jamshidi needles (2 cadavers) and 18 cannulated pedicle screws (1 cadaver) in the thoracolumbar spine. Technical accuracy was evaluated by measuring the distance between the tip of the actual needle position and the corresponding planned path as well as the angles between the needle and the desired path. Time needed for navigation along the virtual planned path was measured. An independent reviewer assessed the postoperative scans for the pedicle screws' clinical accuracy. Navigation time per insertion was 90 ± 53 seconds with an accuracy of 2.2 ± 1.3 mm. Accuracy was not dependent on operator. There was no correlation between navigation time and accuracy. The mean error angle between the Jamshidi needles and planned paths was 0.9 ± 0.8°. No screw was misplaced outside the pedicle. Two screws breached 2 to 4 mm yielding an overall accuracy of 89% (16/18). MIS screw placement directed by AR with intraoperative 3D imaging in a hybrid OR is accurate and efficient, without any fluoroscopy or X-ray imaging during the procedure. 4.

  15. Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury

    Science.gov (United States)

    Mabray, Marc C.; Whetstone, William D.; Dhall, Sanjay S.; Phillips, David B.; Pan, Jonathan Z.; Manley, Geoffrey T.; Bresnahan, Jacqueline C.; Beattie, Michael S.; Haefeli, Jenny

    2016-01-01

    Abstract Literature examining magnetic resonance imaging (MRI) in acute spinal cord injury (SCI) has focused on cervical SCI. Reproducible systems have been developed for MRI-based grading; however, it is unclear how they apply to thoracic SCI. Our hypothesis is that MRI measures will group as coherent multivariate principal component (PC) ensembles, and that distinct PCs and individual variables will show discriminant validity for predicting early impairment in thoracic SCI. We undertook a retrospective cohort study of 25 patients with acute thoracic SCI who underwent MRI on admission and had American Spinal Injury Association Impairment Scale (AIS) assessment at hospital discharge. Imaging variables of axial grade, sagittal grade, length of injury, thoracolumbar injury classification system (TLICS), maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were collected. We performed an analytical workflow to detect multivariate PC patterns followed by explicit hypothesis testing to predict AIS at discharge. All imaging variables loaded positively on PC1 (64.3% of variance), which was highly related to AIS at discharge. MCC, MSCC, and TLICS also loaded positively on PC2 (22.7% of variance), while variables concerning cord signal abnormality loaded negatively on PC2. PC2 was highly related to the patient undergoing surgical decompression. Variables of signal abnormality were all negatively correlated with AIS at discharge with the highest level of correlation for axial grade as assessed with the Brain and Spinal Injury Center (BASIC) score. A multiple variable model identified BASIC as the only statistically significant predictor of AIS at discharge, signifying that BASIC best captured the variance in AIS within our study population. Our study provides evidence of convergent validity, construct validity, and clinical predictive validity for the sampled MRI measures of SCI when applied in acute thoracic and thoracolumbar SCI. PMID:26414451

  16. Correlation of outcome measures with epidemiological factors in thoracolumbar spinal trauma

    Directory of Open Access Journals (Sweden)

    Upendra Bidre

    2007-01-01

    Full Text Available Background : The epidemiological data of a given population on spinal trauma in India is lacking. The present study was undertaken to evaluate the profile of patients with thoracolumbar fractures in a tertiary care hospital in an urban setup. Materials and Methods : Four hundred forty patients with thoracolumbar spinal injuries admitted from January 1990 to May 2000 to the All India Institute of Medical Sciences were included in the analysis. Both retrospective data retrieval and prospective data evaluation of patients were done from January 1998 to May 2000. Epidemiological factors like age, sex and type of injury, mode of transport, time of reporting and number of transfers before admission were recorded. Frankel′s grading was used to assess neurological status. Functional assessment of all patients was done using the FIM™ instrument (Functional Independence Measure. Average follow-up was 33 months (24-41 months. Results : Of the 440 patients, females comprised 17.95% (n=79, while 82.04% (n=361 were males. As many as 40.9% (n=180 of them were in the third decade. Fall from height remained the most common cause 52.3% (n=230. Two hundred sixty (59.1% patients reported within 48 hours. Thirty-two (7.27% patients had single transfer, and all 32 showed complete independence for mobility at final follow-up. 100 of 260 (38.5% patients reporting within 48 hours developed pressure sores, while 114 of 142 (80.28% patients reporting after 5 days developed pressure sores. Conclusion : The present study highlights the magnitude of the problems of our trauma-care and transport system and the difference an effective system can make in the care of spinal injury patients. There is an urgent need for epidemiological data on a larger scale to emphasize the need for a better trauma-care system and pave way for adaptation of well-established trauma-care systems from developed countries.

  17. Classification-related approach in the surgical treatment of thoracolumbar fractures

    Directory of Open Access Journals (Sweden)

    Lukas R

    2007-01-01

    Full Text Available Background: Advanced diagnostic tools, classification systems and accordingly selected surgical approaches are essential requirements for the prevention of failure of surgical treatment of thoracolumbar fractures. The present study is designed to evaluate the contribution of classification to the choice of a surgical approach using the current fracture classification systems. Materials and Methods: We studied prospectively a group of 64 patients (22 females, 42 males of an average age of 43 years, all operated on for thoracolumbar fractures during the year 2001. The AO-ASIF classification was used preoperatively with all imaging studies (X-ray, computed tomography (CT and magnetic resonance imaging (MRI. When the damage was detected only in the anterior column (A type, an isolated anterior stabilization (n=22 was preferred. If the MRI study disclosed an injury in the posterior column, a posterior approach (n=20 using the internal fixator was chosen. Injuries involving the posterior column (B or C type were classified additionally according to the load-sharing classification (LSC. If LSC gave six or more points, treatment was completed with an anterior fusion.. The combined postero-anterior procedure was carried out 22 times.. The minimum follow-up period was 22 months. Results: Neither implant failure and nor significant loss of correction were observed in patients treated with anterior or combined procedures. The average loss of correction (increase of kyphosis in simple posterior stabilization was 3.1 degree. Conclusion: Complex fracture classification helps in the selection of the surgical approach and helps to decrease the chances of treatment failure.

  18. Common metabolic constraints on dive duration in endothermic and ectothermic vertebrates

    Directory of Open Access Journals (Sweden)

    April Hayward

    2016-10-01

    Full Text Available Dive duration in air-breathing vertebrates is thought to be constrained by the volume of oxygen stored in the body and the rate at which it is consumed (i.e., “oxygen store/usage hypothesis”. The body mass-dependence of dive duration among endothermic vertebrates is largely supportive of this model, but previous analyses of ectothermic vertebrates show no such body mass-dependence. Here we show that dive duration in both endotherms and ectotherms largely support the oxygen store/usage hypothesis after accounting for the well-established effects of temperature on oxygen consumption rates. Analyses of the body mass and temperature dependence of dive duration in 181 species of endothermic vertebrates and 29 species of ectothermic vertebrates show that dive duration increases as a power law with body mass, and decreases exponentially with increasing temperature. Thus, in the case of ectothermic vertebrates, changes in environmental temperature will likely impact the foraging ecology of divers.

  19. Dual-Energy Computed Tomography-Based Display of Bone Marrow Edema in Incidental Vertebral Compression Fractures: Diagnostic Accuracy and Characterization in Oncological Patients Undergoing Routine Staging Computed Tomography.

    Science.gov (United States)

    Frellesen, Claudia; Azadegan, Mehrnoush; Martin, Simon S; Otani, Katharina; DʼAngelo, Tommaso; Booz, Christian; Eichler, Katrin; Panahi, Bita; Kaup, Moritz; Bauer, Ralf W; Vogl, Thomas J; Wichmann, Julian L

    2018-02-27

    The aim of this study was to evaluate the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) reconstructions enabling visualization of bone marrow edema for characterization of incidental thoracolumbar compression fractures in routine thoracoabdominal staging computed tomography (CT). We retrospectively analyzed 51 oncological patients without suspected fracture or indicative complaints presenting at least 1 thoracolumbar compression fracture on routine thoracoabdominal staging DECT who had been examined between October 2015 and June 2017 using third-generation dual-source CT, had a previous CT within 3 months before, and also had undergone additional magnetic resonance imaging within 14 days, which served as the standard of reference. Three independent and blinded radiologists initially evaluated all vertebrae on conventional grayscale DECT series; after at least 8 weeks, observers reevaluated all cases using grayscale and color-coded VNCa DECT images. The age of each fracture was determined as either acute, chronic, or inconclusive. Specificity, sensitivity, and intraobserver and interobserver agreements were calculated taking into account clustering. A total of 98 vertebral compression fractures were detected in 51 patients (20 women, 31 men; median of 1 fracture per patient). The reference standard defined 45 as acute and 53 as chronic. For identification of only acute fractures (cutoff 1), the combination of grayscale and VNCa image series showed a higher sensitivity (91% vs 47%; P higher specificity (96% vs 75%; P < 0.001) compared with evaluation of grayscale images alone. Area under the curve analysis for detection of vertebral compression fractures showed superior results for reading of grayscale and VNCa image series (0.98) compared with analysis of grayscale images alone (0.89; P < 0.001). Dual-energy CT-derived color-coded VNCa reconstructions substantially improve the characterization of incidental thoracolumbar

  20. An invertebrate stomach's view on vertebrate ecology

    DEFF Research Database (Denmark)

    Calvignac-Spencer, Sébastien; Leendertz, Fabian H.; Gilbert, Tom

    2013-01-01

    Recent studies suggest that vertebrate genetic material ingested by invertebrates (iDNA) can be used to investigate vertebrate ecology. Given the ubiquity of invertebrates that feed on vertebrates across the globe, iDNA might qualify as a very powerful tool for 21st century population...

  1. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years.

    Science.gov (United States)

    Wood, Kirkham B; Buttermann, Glenn R; Phukan, Rishabh; Harrod, Christopher C; Mehbod, Amir; Shannon, Brian; Bono, Christopher M; Harris, Mitchel B

    2015-01-07

    Studies comparing operative with nonoperative treatment of a stable burst fracture of the thoracolumbar junction in neurologically intact patients have not shown a meaningful difference at early follow-up. To our knowledge, longer-term outcome data have not before been presented. From 1992 to 1998, forty-seven consecutive patients with a stable thoracolumbar burst fracture and no neurological deficit were evaluated and randomized to one of two treatment groups: operative treatment (posterior or anterior arthrodesis) or nonoperative treatment (a body cast or orthosis). We previously reported the results of follow-up at an average of forty-four months. The current study presents the results of long-term follow-up, at an average of eighteen years (range, sixteen to twenty-two years). As in the earlier study, patients at long-term follow-up indicated the degree of pain on a visual analog scale and completed the Roland and Morris disability questionnaire, the Oswestry Disability Index (ODI) questionnaire, and the Short Form-36 (SF-36) health survey. Work and health status were obtained, and patients were evaluated radiographically. Of the original operatively treated group of twenty-four patients, follow-up data were obtained for nineteen; one patient had died, and four could not be located. Of the original nonoperatively treated group of twenty-three patients, data were obtained for eighteen; two patients had died, and three could not be located. The average kyphosis was not significantly different between the two groups (13° for those who received operative treatment compared with 19° for those treated nonoperatively). Median scores for pain (4 cm for the operative group and 1.5 cm for the nonoperative group; p = 0.003), ODI scores (20 for the operative group and 2 for the nonoperative group; p years) revealed few significant differences between the two groups, at long-term follow-up (sixteen to twenty-two years), those with a stable burst fracture who were treated

  2. Primary Ewing's sarcoma of the vertebral column

    Energy Technology Data Exchange (ETDEWEB)

    Ilaslan, Hakan; Sundaram, Murali [Department of Radiology, Mayo Clinic, Ch2-290 200 First Street, SW, Rochester, 55905, MN (United States); Unni, K.Krishnan [Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, SW, 55905, Rochester, MN (United States); Dekutoski, Mark B. [Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, 55905, Rochester, MN (United States)

    2004-09-01

    To determine the demographics, imaging findings, clinical symptoms, and prognosis of primary vertebral Ewing's sarcoma (PVES). A retrospective review of medical records and radiological studies of patients diagnosed with PVES from 1936 through 2001 in our institution and Department of Pathology consultation files was undertaken. Metastatic and soft tissue Ewing's sarcoma cases were excluded. From a total of 1,277 cases of Ewing's sarcoma, 125 (9.8%) had a primary vertebral origin. There were 48 females and 76 males. Patient ages ranged from 4 to 54 (mean 19.3, standard deviation 10.7, median 16) years. Vertebral column distribution was four cervical (3.2%), 13 thoracic (10.5%), 31 lumbar (25%), and 67 sacrum (53.2%). More than one vertebral segment was involved in ten cases (8%). Satisfactory imaging studies were available in 51 patients: 49 radiographs, 27 computerized tomography (CT), and 23 magnetic resonance imaging (MRI) studies. The majority of tumors were lytic (93%). Three cases were mixed lytic and sclerotic (6%) and one sclerotic. In the nonsacral spine, the majority of lesions (12/20) involved the posterior elements with extension into the vertebral body. Five cases were centered in the vertebral body with extension into the posterior elements. Two cases were limited to the posterior elements, and one case solely involved the vertebral body. Ala was the most frequently affected site in the sacrum (18/26). Spinal canal invasion was frequent (91%). Detailed clinical information was available in 53 patients. Duration of symptoms ranged from 1 to 30 (mean 7) months. Local pain was the first symptom and seen in all cases. Neurological deficits were present in 21 (40%) cases. All patients received radiation in various dosages; 70% additionally received chemotherapy. Twenty-five patients had surgery, and two patients received bone marrow transplantation. Forty-five patients had follow-up; the five-year disease-free survival probability is 0

  3. Open versus percutaneous instrumentation in thoracolumbar fractures: magnetic resonance imaging comparison of paravertebral muscles after implant removal.

    Science.gov (United States)

    Ntilikina, Yves; Bahlau, David; Garnon, Julien; Schuller, Sébastien; Walter, Axel; Schaeffer, Mickaël; Steib, Jean-Paul; Charles, Yann Philippe

    2017-08-01

    OBJECTIVE Percutaneous instrumentation in thoracolumbar fractures is intended to decrease paravertebral muscle damage by avoiding dissection. The aim of this study was to compare muscles at instrumented levels in patients who were treated by open or percutaneous surgery. METHODS Twenty-seven patients underwent open instrumentation, and 65 were treated percutaneously. A standardized MRI protocol using axial T1-weighted sequences was performed at a minimum 1-year follow-up after implant removal. Two independent observers measured cross-sectional areas (CSAs, in cm 2 ) and region of interest (ROI) signal intensity (in pixels) of paravertebral muscles by using OsiriX at the fracture level, and at cranial and caudal instrumented pedicle levels. An interobserver comparison was made using the Bland-Altman method. Reference ROI muscle was assessed in the psoas and ROI fat subcutaneously. The ratio ROI-CSA/ROI-fat was compared for patients treated with open versus percutaneous procedures by using a linear mixed model. A linear regression analyzed additional factors: age, sex, body mass index (BMI), Pfirrmann grade of adjacent discs, and duration of instrumentation in situ. RESULTS The interobserver agreement was good for all CSAs. The average CSA for the entire spine was 15.7 cm 2 in the open surgery group and 18.5 cm 2 in the percutaneous group (p = 0.0234). The average ROI-fat and ROI-muscle signal intensities were comparable: 497.1 versus 483.9 pixels for ROI-fat and 120.4 versus 111.7 pixels for ROI-muscle in open versus percutaneous groups. The ROI-CSA varied between 154 and 226 for open, and between 154 and 195 for percutaneous procedures, depending on instrumented levels. A significant difference of the ROI-CSA/ROI-fat ratio (0.4 vs 0.3) was present at fracture levels T12-L1 (p = 0.0329) and at adjacent cranial (p = 0.0139) and caudal (p = 0.0100) instrumented levels. Differences were not significant at thoracic levels. When adjusting based on age, BMI, and Pfirrmann

  4. A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms

    Directory of Open Access Journals (Sweden)

    Kishi S

    2012-04-01

    Full Text Available Seiji Kishi1, Kenji Kanaji2, Toshio Doi1, Tadashi Matsumura21Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, 2Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho Yamashina-ku Kyoto, JapanAbstract: Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.Keywords: vertebral artery dissection, brainstem infarction, bilateral spinal cord infarction, neck trauma

  5. Prevalent morphometric vertebral fractures in professional male rugby players.

    Directory of Open Access Journals (Sweden)

    Karen Hind

    Full Text Available There is an ongoing concern about the risk of injury to the spine in professional rugby players. The objective of this study was to investigate the prevalence of vertebral fracture using vertebral fracture assessment (VFA dual energy X-ray absorptiometry (DXA imaging in professional male rugby players. Ninety five professional rugby league (n = 52 and union (n = 43 players (n = 95; age 25.9 (SD 4.3 years; BMI: 29.5 (SD 2.9 kg.m2 participated in the research. Each participant received one VFA, and one total body and lumbar spine DXA scan (GE Lunar iDXA. One hundred and twenty vertebral fractures were identified in over half of the sample by VFA. Seventy four were graded mild (grade 1, 40 moderate (grade 2 and 6 severe (grade 3. Multiple vertebral fractures (≥2 were found in 37 players (39%. There were no differences in prevalence between codes, or between forwards and backs (both 1.2 v 1.4; p>0.05. The most common sites of fracture were T8 (n = 23, T9 (n = 18 and T10 (n = 21. The mean (SD lumbar spine bone mineral density Z-score was 2.7 (1.3 indicating high player bone mass in comparison with age- and sex-matched norms. We observed a high number of vertebral fractures using DXA VFA in professional rugby players of both codes. The incidence, aetiology and consequences of vertebral fractures in professional rugby players are unclear, and warrant timely, prospective investigation.

  6. Vertebral split fractures: Technical feasibility of percutaneous vertebroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Huwart, Laurent, E-mail: huwart.laurent@wanadoo.fr [Department of Radiology, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice (France); Foti, Pauline, E-mail: pfoti@hotmail.fr [Department of Biostatistics, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice (France); Andreani, Olivier, E-mail: andreani.olivier@gmail.com [Department of Radiology, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice (France); Hauger, Olivier, E-mail: olivier.hauger@chubordeaux.fr [Department of Radiology, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux (France); Cervantes, Elodie, E-mail: elodie.cervantes@live.fr [Department of Radiology, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice (France); Brunner, Philippe, E-mail: pbrunner@chpg.mc [Department of Radiology, Hôpital Princesse Grasse de Monaco (Monaco); Boileau, Pascal, E-mail: boileau.p@chu-nice.fr [Department of Orthopedic Surgery, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice (France); Amoretti, Nicolas, E-mail: amorettinicolas@yahoo.fr [Department of Radiology, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice (France)

    2014-01-15

    Objective: The treatment of vertebral split fractures remains controversial, consisting of either corset or internal fixation. The aim of this study was to evaluate the technical feasibility of CT- and fluoroscopy-guided percutaneous vertebroplasty in the treatment of vertebral split fractures. Materials and methods: Institutional review board approval and informed consent were obtained for this study. Sixty-two consecutive adult patients who had post-traumatic vertebral split fractures (A2 according to the AO classification) without neurological symptoms were prospectively treated by percutaneous vertebroplasty. All these procedures were performed by an interventional radiologist under computed tomography (CT) and fluoroscopy guidance by using only local anaesthesia. Postoperative outcome was assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI) scores. Results: Vertebroplasty was performed on thoracic and lumbar vertebrae, creating a cement bridge between the displaced fragment and the rest of the vertebral body. Seven discal cement leakages (11%) were observed, without occurrence of adjacent vertebral compression fractures. The mean VAS measurements ± standard deviation (SD) significantly decreased from 7.9 ± 1.5 preoperatively to 3.3 ± 2.1 at 1 day, 2.2 ± 2.0 at 1 month, and 1.8 ± 1.4 at 6 months (P < 0.001). The mean ODI scores ± SD had also a significant improvement: 62.3 ± 17.2 preoperatively and 15.1 ± 6.0 at the 6-month follow-up (P < 0.001). Conclusion: This study suggests that type A2 vertebral fractures could be successfully treated by CT- and fluoroscopy-guided percutaneous vertebroplasty.

  7. Vertebral split fractures: Technical feasibility of percutaneous vertebroplasty

    International Nuclear Information System (INIS)

    Huwart, Laurent; Foti, Pauline; Andreani, Olivier; Hauger, Olivier; Cervantes, Elodie; Brunner, Philippe; Boileau, Pascal; Amoretti, Nicolas

    2014-01-01

    Objective: The treatment of vertebral split fractures remains controversial, consisting of either corset or internal fixation. The aim of this study was to evaluate the technical feasibility of CT- and fluoroscopy-guided percutaneous vertebroplasty in the treatment of vertebral split fractures. Materials and methods: Institutional review board approval and informed consent were obtained for this study. Sixty-two consecutive adult patients who had post-traumatic vertebral split fractures (A2 according to the AO classification) without neurological symptoms were prospectively treated by percutaneous vertebroplasty. All these procedures were performed by an interventional radiologist under computed tomography (CT) and fluoroscopy guidance by using only local anaesthesia. Postoperative outcome was assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI) scores. Results: Vertebroplasty was performed on thoracic and lumbar vertebrae, creating a cement bridge between the displaced fragment and the rest of the vertebral body. Seven discal cement leakages (11%) were observed, without occurrence of adjacent vertebral compression fractures. The mean VAS measurements ± standard deviation (SD) significantly decreased from 7.9 ± 1.5 preoperatively to 3.3 ± 2.1 at 1 day, 2.2 ± 2.0 at 1 month, and 1.8 ± 1.4 at 6 months (P < 0.001). The mean ODI scores ± SD had also a significant improvement: 62.3 ± 17.2 preoperatively and 15.1 ± 6.0 at the 6-month follow-up (P < 0.001). Conclusion: This study suggests that type A2 vertebral fractures could be successfully treated by CT- and fluoroscopy-guided percutaneous vertebroplasty

  8. Two-Nation Comparison of Classification and Treatment of Thoracolumbar Fractures: An Internet-Based Multicenter Study Among Spine Surgeons.

    Science.gov (United States)

    Pishnamaz, Miguel; Curfs, Inez; Balosu, Stephan; Willems, Paul; van Hemert, Wouter; Pape, Hans-Christoph; Kobbe, Philipp

    2015-11-01

    Web-based multicenter study. The aim of the study was to assess and compare the management strategy for traumatic thoracolumbar fractures between German and Dutch spine surgeons. To date, there is no evidence-based treatment algorithm for thoracolumbar spine fractures, thereby an international controversy concerning optimal treatment exists. In this web-based multicenter study (www.spine.hostei.com), computed tomography scans of traumatic thoracolumbar fractures (T12-L2) were evaluated by German and Dutch spine surgeons. Supplementary case-specific information such as age, sex, height, weight, neurological status, and injury mechanism were provided.By using a questionnaire, fractures were classified according to the AO-Magerl Classification, followed by 6 questions concerning the treatment algorithm. Data were analyzed using SPSS (Version 21, 76, Chicago, IL). The interobserver agreement was determined by using Cohen κ. Statistical significance was defined as P spine surgeons was found. Overall German spine surgeons had a lower threshold concerning the indication for surgical treatment (Ger 87% vs. NL 30%; P < 0.05). There was a consensus about operative stabilization of AO Type B and C injuries and injuries with neurologic deficit, whereas a discrepancy in the therapeutic algorithm for AO Type A fractures was observed. This difference was most pronounced regarding the indication for posterior (Ger 96.6%; NL 41.2%; P < 0.05) and circumferential stabilization (Ger 53.4%; NL 0%; P < 0.05) for burst fractures. There is a consensus to stabilize AO Type B and C fractures, whereas country-specific differences in the treatment of Type A fractures, especially in case of burst fractures, occur. Prospective, controlled multicenter outcome studies may provide more evidence in optimal treatment for thoracolumbar fractures. 2.

  9. Contaminant exposure in terrestrial vertebrates

    International Nuclear Information System (INIS)

    Smith, Philip N.; Cobb, George P.; Godard-Codding, Celine; Hoff, Dale; McMurry, Scott T.; Rainwater, Thomas R.; Reynolds, Kevin D.

    2007-01-01

    Here we review mechanisms and factors influencing contaminant exposure among terrestrial vertebrate wildlife. There exists a complex mixture of biotic and abiotic factors that dictate potential for contaminant exposure among terrestrial and semi-terrestrial vertebrates. Chemical fate and transport in the environment determine contaminant bioaccessibility. Species-specific natural history characteristics and behavioral traits then play significant roles in the likelihood that exposure pathways, from source to receptor, are complete. Detailed knowledge of natural history traits of receptors considered in conjunction with the knowledge of contaminant behavior and distribution on a site are critical when assessing and quantifying exposure. We review limitations in our understanding of elements of exposure and the unique aspects of exposure associated with terrestrial and semi-terrestrial taxa. We provide insight on taxa-specific traits that contribute, or limit exposure to, transport phenomenon that influence exposure throughout terrestrial systems, novel contaminants, bioavailability, exposure data analysis, and uncertainty associated with exposure in wildlife risk assessments. Lastly, we identify areas related to exposure among terrestrial and semi-terrestrial organisms that warrant additional research. - Both biotic and abiotic factors determine chemical exposure for terrestrial vertebrates

  10. Vertebral development and amphibian evolution.

    Science.gov (United States)

    Carroll, R L; Kuntz, A; Albright, K

    1999-01-01

    Amphibians provide an unparalleled opportunity to integrate studies of development and evolution through the investigation of the fossil record of larval stages. The pattern of vertebral development in modern frogs strongly resembles that of Paleozoic labyrinthodonts in the great delay in the ossification of the vertebrae, with the centra forming much later than the neural arches. Slow ossification of the trunk vertebrae in frogs and the absence of ossification in the tail facilitate the rapid loss of the tail during metamorphosis, and may reflect retention of the pattern in their specific Paleozoic ancestors. Salamanders and caecilians ossify their centra at a much earlier stage than frogs, which resembles the condition in Paleozoic lepospondyls. The clearly distinct patterns and rates of vertebral development may indicate phylogenetic separation between the ultimate ancestors of frogs and those of salamanders and caecilians within the early radiation of ancestral tetrapods. This divergence may date from the Lower Carboniferous. Comparison with the molecular regulation of vertebral development described in modern mammals and birds suggests that the rapid chondrification of the centra in salamanders relative to that of frogs may result from the earlier migration of sclerotomal cells expressing Pax1 to the area surrounding the notochord.

  11. Temporal trends in vertebral size and shape from medieval to modern-day.

    Directory of Open Access Journals (Sweden)

    Juho-Antti Junno

    Full Text Available Human lumbar vertebrae support the weight of the upper body. Loads lifted and carried by the upper extremities cause significant loading stress to the vertebral bodies. It is well established that trauma-induced vertebral fractures are common especially among elderly people. The aim of this study was to investigate the morphological factors that could have affected the prevalence of trauma-related vertebral fractures from medieval times to the present day. To determine if morphological differences existed in the size and shape of the vertebral body between medieval times and the present day, the vertebral body size and shape was measured from the 4th lumbar vertebra using magnetic resonance imaging (MRI and standard osteometric calipers. The modern samples consisted of modern Finns and the medieval samples were from archaeological collections in Sweden and Britain. The results show that the shape and size of the 4th lumbar vertebra has changed significantly from medieval times in a way that markedly affects the biomechanical characteristics of the lumbar vertebral column. These changes may have influenced the incidence of trauma- induced spinal fractures in modern populations.

  12. A new classification for cervical vertebral injuries: influence of CT

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H.; Brown, R.R.; Goldberg, A.L. [Department of Diagnostic Radiology, Allegheny University Hospitals, Allegheny General, Pittsburgh, PA (United States)

    2000-03-30

    Objective. Computed tomography (CT) has been demonstrated to be superior to radiography in identifying cervical vertebral injuries. However, many of these injuries may not be clinically significant, and require only minimal symptomatic and supportive treatment. It is therefore imperative that radiologists and spine surgeons have criteria for distinguishing between those injuries requiring surgical stabilization and those that do not. The authors propose a new classification of cervical vertebral injuries into two categories: major and minor.Design and patients. A data base, acquired on 1052 separate cervical injuries in 879 patients seen between 1983 and 1998, was reviewed. Four categories of injury based on mechanism [hyperflexion (four variants), hyperextension (two variants), rotary (two variants), and axial compression (five variants)] were identified. ''Major'' injuries are defined as having either radiographic or CT evidence of instability with or without associated localized or central neurologic findings, or have the potential to produce the latter. ''Minor'' injuries have no radiographic and/or CT evidence of instability, are not associated with neurologic findings, and have no potential to cause the latter.Results and conclusions. Cervical injury should be classified as ''major'' if the following radiographic and/or CT criteria are present: displacement of more than 2 mm in any plane, wide vertebral body in any plane, wide interspinous/interlaminar space, wide facet joints, disrupted posterior vertebral body line, wide disc space, vertebral burst, locked or perched facets (unilateral or bilateral), ''hanged man'' fracture of C2, dens fracture, and type III occipital condyle fracture. All other types of fractures may be considered ''minor''. (orig.)

  13. Production of regulatory factors in the respiratory system of vertebrates

    OpenAIRE

    Montuenga, L.M. (Luis M.); Villaro, A.C. (Ana Cristina); Bodegas, M.E. (María Elena); Beorlegui, C. (Carmen); Guembe, L. (L.); Sesma, M.P. (María Pilar)

    1994-01-01

    Among the different cell types present in the respiratory tract of the vertebrates, some (epithelial, endothelial, neural) specialise in the production of regulatory factors. Endocrine cells occur either single, spread throughout the epithelial lining, or in innervated groups, called 'neuroepithelial bodies' (NEBs). In mammals, these endocrine cells may be involved in lung maturation during perinatal life and in chemoreception. A neuroendocrine diffuse system is present in the respiratory org...

  14. Sensory findings after stimulation of the thoracolumbar fascia with hypertonic saline suggest its contribution to low back pain.

    Science.gov (United States)

    Schilder, Andreas; Hoheisel, Ulrich; Magerl, Walter; Benrath, Justus; Klein, Thomas; Treede, Rolf-Detlef

    2014-02-01

    Injection of hypertonic saline into deep tissues of the back (subcutis, muscle, or the surrounding fascia) can induce acute low back pain (LBP). So far, no study has analyzed differences in temporal, qualitative, and spatial pain characteristics originating from these tissues. The current study aimed to investigate the role of the thoracolumbar fascia as a potential source of LBP. In separate sessions, 12 healthy subjects received ultrasound-guided bolus injections of isotonic saline (0.9%) or hypertonic saline (5.8%) into the erector spinae muscle, the thoracolumbar fascia (posterior layer), and the overlying subcutis. Subjects were asked to rate pain intensity, duration, quality, and spatial extent. Pressure pain thresholds were determined pre and post injection. Injections of hypertonic saline into the fascia resulted in significantly larger area under the curve of pain intensity over time than injections into subcutis (Pfascia or subcutis. Pain radiation and pain affect evoked by fascia injection exceeded those of the muscle (Pfascia injection (burning, throbbing, and stinging) suggested innervation by both A- and C-fiber nociceptors. These findings show that the thoracolumbar fascia is the deep tissue of the back that is most sensitive to chemical stimulation, making it a prime candidate to contribute to nonspecific LBP but not to localized pressure hyperalgesia. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  15. Transforaminal decompression and interbody fusion in the treatment of thoracolumbar fracture and dislocation with spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Ai-Min Wu

    Full Text Available A retrospective clinical study.To evaluate the efficacy and safety of transforaminal decompression and interbody fusion in the treatment of thoracolumbar fracture and dislocation with spinal cord injury.Twenty-six spinal cord injured patients with thoracolumbar fracture and dislocation were treated by transforaminal decompression and interbody fusion. The operation time, intraoperative blood loss, and complications were recorded; the Cobb angle and compressive rate (CR of the anterior height of two adjacent vertebrae were measured; and the nerve injury was assessed according to sensory scores and motor scores of the American Spinal Injury Association (ASIA standards for neurological classification of spinal cord injury.The operative time was 250±57 min, and intraoperative blood loss was 440±168 ml. Cerebrospinal leakage was detected and repaired during the operation in two patients. A total of 24 of 26 patients were followed up for more than 2 years. ASIA sensory scores and motor scores were improved significantly at 3 months and 6 months after operation; the Cobb angle and CR of the anterior height of two adjacent vertebrae were corrected and showed a significant difference at post-operation; and the values were maintained at 3 months after operation and the last follow-up.We showed that transforaminal decompression together with interbody fusion is an alternative method to treat thoracolumbar fracture and dislocation.

  16. Complete fracture-dislocation of the thoracolumbar spine without neurological deficit: A case report and review of the literature.

    Science.gov (United States)

    Zeng, Junfeng; Gong, Quan; Liu, Hao; Rong, Xin; Ding, Chen

    2018-03-01

    Traumatic fracture of the thoracolumbar junction (T10-L2) is the most common fracture of the spinal column. Due to the disruption of the entire vertebrae column, the fracture-dislocation of the thoracolumbar spine is almost invariably associated with neurological injury. A complete fracture-dislocation of the thoracolumbar spine without neurological deficit is a rare entity. A 38-year-old man presented with severe low back pain after an accident when he was building a house. Comprehensive neurological examinations revealed intact neurological function. The plain X-ray and computed tomography revealed a complete facture-dislocation of the L1 to L2 vertebrae. The patient underwent posterior reduction and internal fixation with screws and rods. The neurological function was preserved postoperatively. The patient returned to work after 6 months. Early diagnosis is important before performing any dangerous maneuvers. Given the results of this case and the relevant literature, the prognosis of these patients is promising following surgical intervention.

  17. Risk Factors and Compression and Kyphosis Rates after 1 Year in Patients with AO type A Thoracic, Thoracolumbar, and Lumbar Fractures Treated Conservatively.

    Science.gov (United States)

    Guzey, Feyza Karagoz; Eren, Burak; Tufan, Azmi; Aktas, Ozgur; Isler, Cihan; Vatansever, Mustafa; Tas, Abdurrahim; Cetin, Eyup; Yucel, Murat; Ornek, Mustafa

    2018-01-01

    Conservative treatment is a frequently used treatment modality for traumatic thoracolumbar fractures. However, not many studies evaluating radiological and clinical results of conservative treatment are found. The aim of this study was to determine the risk factors, and compression and kyphosis rates after 1 year in patients with AO type A thoracic, thoracolumbar, and lumbar fractures treated conservatively. Radiological and clinical results of 79 thoracolumbar fractures in 57 patients, who were treated conservatively, were evaluated one year after trauma. Fractures were classified according to thoracolumbar injury classification and severity (TLICS) score and AO spinal trauma classification system. Compression rate, wedge and kyphosis angles, and sagittal index were calculated in early and late periods after trauma. Female/male ratio was 25/32, and mean age was 41.7±16.7 years. They were followed for 15.2±4.9 months. Mean compression rates were 19.6% and 25.2%; wedge angles were 10.1 and 12.7 degrees; kyphosis angles were 5.82 and 8.9 degrees; and sagittal indexes were 8.01 and 10.13 in all patients just after trauma and after one year, respectively. Fractures in older patients ( > 60 years of age) and in patients with osteopenia or osteoporosis, located in the thoracolumbar junction, AO type A2 and A3 fractures, and solitary fractures had higher compression and kyphosis rates at last follow-up. Early mobilization without bed rest for stable thoracolumbar fractures according to the TLICS system is a good treatment option, and radiological and clinical results are usually acceptable. However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis and may require a closer follow-up.

  18. The cervical vertebral maturation method: A user's guide.

    Science.gov (United States)

    McNamara, James A; Franchi, Lorenzo

    2018-03-01

    The cervical vertebral maturation (CVM) method is used to determine the craniofacial skeletal maturational stage of an individual at a specific time point during the growth process. This diagnostic approach uses data derived from the second (C2), third (C3), and fourth (C4) cervical vertebrae, as visualized in a two-dimensional lateral cephalogram. Six maturational stages of those three cervical vertebrae can be determined, based on the morphology of their bodies. The first step is to evaluate the inferior border of these vertebral bodies, determining whether they are flat or concave (ie, presence of a visible notch). The second step in the analysis is to evaluate the shape of C3 and C4. These vertebral bodies change in shape in a typical sequence, progressing from trapezoidal to rectangular horizontal, to square, and to rectangular vertical. Typically, cervical stages (CSs) 1 and CS 2 are considered prepubertal, CS 3 and CS 4 circumpubertal, and CS 5 and CS 6 postpubertal. Criticism has been rendered as to the reproducibility of the CVM method. Diminished reliability may be observed at least in part due to the lack of a definitive description of the staging procedure in the literature. Based on the now nearly 20 years of experience in staging cervical vertebrae, this article was prepared as a "user's guide" that describes the CVM stages in detail in attempt to help the reader use this approach in everyday clinical practice.

  19. [Construction of a human cervical spine with bilateral vertebral artery fluid-solid coupling model].

    Science.gov (United States)

    Wang, Hui-hao; Shen, Zhi-bi; Deng, Zhen; Wang, Kuan; Zhan, Hong-sheng

    2015-03-01

    To construct a human cervical spine with bilateral vertebral artery fluid-solid coupling model. Helical CT images under the principle of reverse engineering and meshed in finite element model(FEM) related software were used to establish a human cervical spine with bilateral vertebral artery fluid-solid coupling model. In the process of modeling of vertebral body, vertebral artery, ligament, intervertebral disc, cartilage and endplate large anatomic data and cadaver experiments results were referenced. From the morphology and function the simulation of model with real physiological status was tested. The study showed that the stress concentration on the surface of vertebral body and the blood wall of the bilateral vertebral artery, and the result of the volume flow rate-time curve of bilateral vertebral artery of the model were consistent with the published literatures. This model was well consistent with the clinical phenomenon. The three-dimensional FEM of the human cervical spine established by the introduced method has been effectively verified. The modeling method would provide a new tool for research on the cervical spine biomechanics.

  20. Pain reduction after percutaneous vertebroplasty for myeloma-associated vertebral fractures

    DEFF Research Database (Denmark)

    Simony, Ane; Hansen, Emil Jesper; Gaurilcikas, Marius

    2014-01-01

    INTRODUCTION: Percutaneous vertebroplasty (PVP) is a minimally invasive procedure with cement augmentation of vertebral fractures. It was introduced in 1987 as a treatment for painful haemangiomas and is today mostly used for painful osteoporotic fractures of the spine. Two randomised, double......-blinded trials published in 2009 have raised a debate about the efficiency of the PVP treatment. The aim of this study was to assess the safety and efficacy of PVP for vertebral body fractures in myeloma patients. METHODS: A consecutive group of patients with multiple myeloma who underwent PVP were reviewed......: PVP is a safe and efficient procedure in the treatment of painful vertebral fractures in patients with multiple myeloma. The main advantages are the immediate stabilisation of the fractured vertebral body, reduction of the pain level and the fact that the patient can be discharged after two hours...

  1. Timing Embryo Segmentation: Dynamics and Regulatory Mechanisms of the Vertebrate Segmentation Clock

    Directory of Open Access Journals (Sweden)

    Tatiana P. Resende

    2014-01-01

    Full Text Available All vertebrate species present a segmented body, easily observed in the vertebrate column and its associated components, which provides a high degree of motility to the adult body and efficient protection of the internal organs. The sequential formation of the segmented precursors of the vertebral column during embryonic development, the somites, is governed by an oscillating genetic network, the somitogenesis molecular clock. Herein, we provide an overview of the molecular clock operating during somite formation and its underlying molecular regulatory mechanisms. Human congenital vertebral malformations have been associated with perturbations in these oscillatory mechanisms. Thus, a better comprehension of the molecular mechanisms regulating somite formation is required in order to fully understand the origin of human skeletal malformations.

  2. Conodonts, Calcichordates and the Origin of Vertebrates

    Directory of Open Access Journals (Sweden)

    J. Bergström

    1998-01-01

    Full Text Available Interpretation of early deuterostome evolution and relationships has been hampered by the lack of soft-part preservation in most groups. In addition, a recently revealed upside-down life orientation of vertebrates (the only real notoneuralians compared to other bilateral animals has been misinterpreted as evidence for a unique body design in all deuterostomes, misleading any search for relatives. Regarding echinoderms, the variety of body plans is confusing. The interpretation of some fossils with echinoderm-type calcite skeletons as “calcichordate” ancestors of chordates, however, involves a hypothetical reconstruction of an unusual body plan and a long series of hypothetical transitions. The number of necessary steps is much lower if cephalochordates (amphioxus or lancelet are derived directly from hemichordate enteropneusts. “Sensation interpretations” of fossils (Yunnanozoon, Cathaymyrus from Burgess Shale type deposits have added further confusion. Soft-part preservation of conodont animals, with V-shaped myomeres and a notochord, shows that they were segmented chordates, while probable eyes and teeth suggest that they were already on the vertebrate side. Die Interpretation früher Deuterostomia hinsichtlich ihrer Evolution und verwandtschaftlichen Beziehungen ist in den meisten Gruppen durch den Mangel an Weichkörpererhaltung sehr erschwert. Die kürzlich entdeckte Tatsache, daß Vertebraten, d. h. die einzigen echten Notoneuralia, im Gegensatz zu anderen bilateral symmetrischen Organismen eine mit ihrer ursprünglichen Oberseite nach unten gerichtete Lebensstellung einnehmen, hat zu der irrtümlichen Ansicht geführt, daß alle Deuostomia über einen im Tierreich einzigartigen Bauplan verfügen. Diese Interpretation brachte naturgemäß jede Suche nach Verwandtschaftsverhältnissen auf Abwege. Hinsichtlich der Echinodermata ist die bauplanmäßige Variation in der Tat verwirrend. Die Interpretation einiger Fossilien mit

  3. Comparison of lidocaine, levobupivacaine or ropivacaine for distal paravertebral thoracolumbar anesthesia in ewes.

    Science.gov (United States)

    Oliveira, Alice R; Araújo, Marcelo A; Jardim, Paulo Ha; Lima, Stephanie C; Leal, Paula V; Frazílio, Fabrício O

    2016-11-01

    To compare the effects of lidocaine, levobupivacaine, or ropivacaine on the onset time and duration of anesthesia of the flank of ewes, using the distal paravertebral thoracolumbar approach. Randomized experimental study. Twenty-six healthy mixed-breed ewes (46 ± 3.1 kg). Thoracolumbar paravertebral nerve blocks were performed using the distal approach in sheep for ruminal fistulation. The 13th thoracic (T13), first lumbar (L1) and second lumbar (L2) nerves were infiltrated with 2% lidocaine (group GLI, n = 9), 0.5% levobupivacaine (group GLE, n = 8) or 0.5% ropivacaine (group GRO, n = 9); 1.5 mL on the dorsal branch and 2.5 mL on the ventral branch, total volume of 12 mL per ewe. Anesthesia onset time and duration were assessed by application of superficial and deep pin pricks, and skin clamping with a hemostat. Heart rate, respiratory rate, rectal temperature and systemic arterial pressures were recorded prior to nerve block (T0), after the anesthetic agent injection and onset time (T1) and predetermined time points during the surgical procedure (T2-T6). Incomplete nerve blocks were present in five of the 26 ewes enrolled in the study and they were not included in the statistical analyzes. Onset times in GLI, GLE and GRO were 1.5 ± 0.5, 3.1 ± 1.5 and 2.1 ± 0.8 minutes, respectively, with GLE significantly longer than GLI. The durations of anesthesia for GLI, GLE and GRO were 80 ± 27, 649 ± 68 and 590 ± 40 minutes, respectively, with the duration of GLI significantly shorter than GLE and GRO. There were no clinically important changes in cardiopulmonary variables. Administration of levobupivacaine and ropivacaine at the distal paravertebral site to block nerves T13, L1 and L2 produced a longer duration of anesthesia of the ewe's flanks compared with lidocaine. © 2016 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  4. Vertebral pedicle anatomy in relation to pedicle screw fixation: a cadaver study.

    Science.gov (United States)

    Chaynes, P; Sol, J C; Vaysse, P; Bécue, J; Lagarrigue, J

    2001-01-01

    New techniques to stabilize and correct the thoracic and lumbar spine have been developed in recent years. In view of the wide variety and complexity of fixation devices, the optimum configuration of spinal instrumentation systems needs to be defined. Linear and angular measurements of both vertebral pedicles were made in ten complete thoracic and lumbar cadaveric spines using callipers and a goniometer. The vertical interpedicular distance gradually increased along the spine up to L5. The transverse interpedicular distance was larger at both ends of the spine. Pedicular height gradually increased from T1 to L5, plateauing between T3 and T9, being widest at the thoracolumbar junction. Pedicular width was greatest at the three junctional regions of the spine. The sagittal pedicular angle decreased along the length of the spine to zero at L5. The transverse pedicular angle decreased from T1 to T12 and then increased to L5. Of the pedicular measurements only width limits the diameter of fixation screws. The vertical interpedicular distance determines the distance between the holes of plates, while the length of the transfixator is related to the transverse interpedicular distance. The pedicular angles enable triangulation of screws and determine the stability of the fixation.

  5. Computer aided diagnosis for osteoporosis based on vertebral column structure analysis

    Science.gov (United States)

    Takahashi, Eiji; Kawata, Yoshiki; Niki, Noboru; Nakano, Yasutaka; Harada, Masafumi; Moriyama, Noriyuki

    2012-03-01

    Patients of osteoporosis are comprised of about 11 million people in Japan and it is one of the problems that have gained society. For preventing the osteoporosis, obtaining early detection and treatment are necessary. Multi-slice CT technology has been improving for three dimensional (3D) image analysis, higher body axis resolution and shorter scan time. 3D image analysis using multi-slice CT images of thoracic vertebra can be used for supporting diagnosis of osteoporosis. Simultaneously, this analysis can be used for lung cancer diagnosis which may lead to early detection. We develop automatic extraction and partitioning algorithm for spinal column by analyzing vertebral body structure, and the analysis algorithm of the vertebral body using shape analysis and a bone density measurement for the diagnosis of osteoporosis. An effective result was provided for the case including an insufficient complicated vertebral body bone fracture by the conventional method.

  6. Musculoskeletal simulations to investigate the influence of vertebral geometrical parameters on lumbar spine loading

    DEFF Research Database (Denmark)

    Putzer, Michael; Rasmussen, John; Penzkofer, Rainer

    Body Modeling System and a parameterized musculoskeletal lumbar spine model for four different postures: upright standing, flexion (50°), torsion (10°) and lateral bending (15°). The linear dimensions of the vertebral body, the posterior parts of the vertebrae as well as the disc height, the orientation...... of the facet joints and the curvature of the lumbar spine have been varied. Figure 1 depicts the used musculoskeletal model in the flexed posture and a lumbar vertebra labeled with all relevant linear dimensions except the disc height. Additionally, all combinations of the three parameters vertebral body...... are consistent with the corresponding results of Han et al. (2012) and Niemeyer et al. (2012). As mentioned above, the vertebral body depth showed a recognizable effect for the flexed and lateral bended postures, too. These characteristics can be justified with increasing moments due to the changed offset...

  7. Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review.

    Science.gov (United States)

    Ghobrial, George M; Maulucci, Christopher M; Maltenfort, Mitchell; Dalyai, Richard T; Vaccaro, Alexander R; Fehlings, Michael G; Street, John; Arnold, Paul M; Harrop, James S

    2014-01-01

    Thoracolumbar spine injuries are commonly encountered in patients with trauma, accounting for almost 90% of all spinal fractures. Thoracolumbar burst fractures comprise a high percentage of these traumatic fractures (45%), and approximately half of the patients with this injury pattern are neurologically intact. However, a debate over complication rates associated with operative versus nonoperative management of various thoracolumbar fracture morphologies is ongoing, particularly concerning those patients presenting without a neurological deficit. A MEDLINE search for pertinent literature published between 1966 and December 2013 was conducted by 2 authors (G.G. and R.D.), who used 2 broad search terms to maximize the initial pool of manuscripts for screening. These terms were "operative lumbar spine adverse events" and "nonoperative lumbar spine adverse events." In an advanced MEDLINE search of the term "operative lumbar spine adverse events" on January 8, 2014, 1459 results were obtained. In a search of "nonoperative lumbar spine adverse events," 150 results were obtained. After a review of all abstracts for relevance to traumatic thoracolumbar spinal injuries, 62 abstracts were reviewed for the "operative" group and 21 abstracts were reviewed for the "nonoperative" group. A total of 14 manuscripts that met inclusion criteria for the operative group and 5 manuscripts that met criteria for the nonoperative group were included. There were a total of 919 and 436 patients in the operative and nonoperative treatment groups, respectively. There were no statistically significant differences between the groups with respect to age, sex, and length of stay. The mean ages were 43.17 years in the operative and 34.68 years in the nonoperative groups. The majority of patients in both groups were Frankel Grade E (342 and 319 in operative and nonoperative groups, respectively). Among the studies that reported the data, the mean length of stay was 14 days in the operative group

  8. The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture

    Science.gov (United States)

    Anderson, D. E.; Demissie, S.; Allaire, B. T.; Bruno, A. G.; Kopperdahl, D. L.; Keaveny, T. M.; Kiel, D. P.

    2013-01-01

    Summary We examined how spinal location affects the relationships between quantitative computed tomography (QCT)-based bone measurements and prevalent vertebral fractures. Upper spine (T4–T10) fractures appear to be more strongly related to bone measures than lower spine (T11–L4) fractures, while lower spine measurements are at least as strongly related to fractures as upper spine measurements. Introduction Vertebral fracture (VF), a common injury in older adults, is most prevalent in the mid-thoracic (T7–T8) and thoracolumbar (T12–L1) areas of the spine. However, measurements of bone mineral density (BMD) are typically made in the lumbar spine. It is not clear how the associations between bone measurements and VFs are affected by the spinal locations of both bone measurements and VF. Methods A community-based case–control study includes 40 cases with moderate or severe prevalent VF and 80 age- and sex-matched controls. Measures of vertebral BMD, strength (estimated by finite element analysis), and factor of risk (load:strength ratio) were determined based on QCT scans at the L3 and T10 vertebrae. Associations were determined between bone measures and prevalent VF occurring at any location, in the upper spine (T4–T10), or in the lower spine (T11–L4). Results Prevalent VF at any location was significantly associated with bone measures, with odds ratios (ORs) generally higher for measurements made at L3 (ORs=1.9–3.9) than at T10 (ORs=1.5–2.4). Upper spine fracture was associated with these measures at both T10 and L3 (ORs=1.9–8.2), while lower spine fracture was less strongly associated (ORs=1.0–2.4) and only reached significance for volumetric BMD measures at L3. Conclusions Closer proximity between the locations of bone measures and prevalent VF does not strengthen associations between bone measures and fracture. Furthermore, VF etiology may vary by region, with VFs in the upper spine more strongly related to skeletal fragility. PMID:23925651

  9. Height restoration of osteoporotic vertebral compression fractures using different intravertebral reduction devices: a cadaveric study.

    Science.gov (United States)

    Krüger, Antonio; Oberkircher, Ludwig; Figiel, Jens; Floßdorf, Felix; Bolzinger, Florent; Noriega, David C; Ruchholtz, Steffen

    2015-05-01

    The treatment of osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly during the past two decades. Balloon kyphoplasty was developed to restore vertebral height and improve sagittal alignment. Several studies have shown these theoretical improvements cannot be transferred universally to the clinical setting. The aim of the current study is to evaluate two different procedures used for percutaneous augmentation of vertebral compression fractures with respect to height restoration: balloon kyphoplasty and SpineJack. Twenty-four vertebral bodies of two intact, fresh human cadaveric spines (T6-L5; donor age, 70 years and 60 years; T-score -6.8 points and -6.3 points) were scanned using computed tomography (CT) and dissected into single vertebral bodies. Vertebral wedge compression fractures were created by a material testing machine (Universal testing machine, Instron 5566, Darmstadt, Germany). The axial load was increased continuously until the height of the anterior edge of the vertebral body was reduced by 40% of the initial measured values. After 15 minutes, the load was decreased manually to 100 N. After postfracture CT, the clamped vertebral bodies were placed in a custom-made loading frame with a preload of 100 N. Twelve vertebral bodies were treated using SpineJack (SJ; Vexim, Balma, France), the 12 remaining vertebral bodies were treated with balloon kyphoplasty (BKP; Kyphon, Medtronic, Sunnyvale, CA, USA). The load was maintained during the procedure until the cement set completely. Posttreatment CT was performed. Anterior, central, and posterior height as well as the Beck index were measured prefracture and postfracture as well as after treatment. For anterior height restoration (BKP, 0.14±1.48 mm; SJ, 3.34±1.19 mm), central height restoration (BKP, 0.91±1.04 mm; SJ, 3.24±1.22 mm), and posterior restoration (BKP, 0.37±0.57 mm; SJ, 1.26±1.05), as well as the Beck index (BKP, 0.00±0.06 mm; SJ, 0

  10. Dose-volume effects in rat thoracolumbar spinal cord: an evaluation of NTCP models.

    Science.gov (United States)

    Philippens, Marielle E P; Pop, Lucas A M; Visser, Andries G; Schellekens, Suzanne A M W; van der Kogel, Albert J

    2004-10-01

    To evaluate models for normal-tissue-complication probability (NTCP) on describing the dose-volume effect in rat thoracolumbar spinal cord. Single-dose irradiation of four field lengths (4, 1.5, 1.0, and 0.5 cm) was evaluated by the endpoints paresis and white-matter necrosis. The resulting dose-response data were used to rank phenomenological and tissue architecture NTCP models. The 0.5-cm field length showed a steep increase in radiation tolerance. Statistical analysis of the model fits, which included evaluation of goodness of fit (GOF) and confidence intervals, resulted in the rejection of all the models considered. Excluding the smallest field length, the Schultheiss (D(50) = 21.5 Gy, k = 26.5), the relative seriality (D(50) = 21.4 Gy, s = 1.6, gamma(50) = 6.3), and the critical element (D(50,FSU) = 26.6 Gy, gamma(50,FSU) = 2.3, n = 1.3) model gave the best fit. A thorough statistical analysis resulted in a serial or critical-element behavior for the field lengths of 1.0 cm and greater. Including the 0.5-cm field length, the radiation response markedly diverged from serial properties, but none of the models applied acceptably described this dose-response relationship. This study suggests that the commonly assumed serial behavior of the spinal cord might be valid for daily use in external- beam irradiation.

  11. Burst fracture of t