Effect of screw insertion depth into fractured vertebrae in the treatment of thoracolumbar fractures.

PURPOSE: The study's objective was to assess the effect of the screw insertion depth into fractured vertebrae in treating thoracolumbar fractures. MATERIALS AND METHODS: This was a retrospective analysis of 92 patients with thoracolumbar fractures from December 2018 to February 2020. Patients had AO type A2, A3 thoracolumbar fractures. The patients were divided into two groups according to the screw insertion depth. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were compared preoperatively and at one week and 12 months postoperatively. The correlation between Vertebral height loss and potential risk factors, such as sex, age, BMD and BMI was evaluated. RESULTS: Compared with the preoperative data, the postoperative clinical and radiographic findings were significantly different in both groups, But no significant difference between the two groups at 1 week. At 1 year postoperatively, there was a significant difference in the CA (p < 0.0001), VWA (p = 0.047), AVBH (p < 0.0001), MVBH (p < 0.0001), VAS score (p < 0.0001), and ODI (p < 0.0001) between the two groups, Except for age, bone density and other influencing factors the long screw group had better treatment results than the short screw group. CONCLUSION: A longer screw provides greater grip on the fractured vertebral body and stronger support to the vertebral plate. The optimal screw placement depth exceeds 60% of the vertebral body length on the lateral view.

Bilateral lumbar pedicle fracture in a patient receiving long-term bisphosphonate therapy: a case report with pathological evaluation.

BACKGROUND: Bilateral pedicle fractures of the lumbar spine are uncommon and are typically associated with strenuous activities, traumatic events, or previous spinal surgery. This study reported a case of bilateral pedicle fracture in a patient with a long history of osteoporosis treatment with bisphosphonate and included a histological evaluation of the bone. CASE PRESENTATION: An 82-year-old woman with no history of trauma presented to our hospital with back pain that had worsened over the previous month. Computed tomography and magnetic resonance imaging revealed bilateral pedicle fractures of the third lumbar vertebra. She had osteoporosis and had been taking bisphosphonates for 9 years. The patient underwent posterior lumbar fusion, and her symptoms improved. Bone biopsy results from the spinous process revealed few osteoblasts and an absence of osteoclasts, indicating low bone turnover. CONCLUSIONS: Long-term use of bisphosphonates may contribute to the development of atypical bilateral pedicle fractures in patients with osteoporosis.

Clinical Effect of Percutaneous Kyphoplasty and Percutaneous Vertebroplasty in Managing Osteoporotic Vertebral Compression Fractures: A Single-Center Propensity Score-Matched Study.

AIM: This study aims to evaluate the clinical effectiveness of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in managing osteoporotic vertebral compression fractures (OVCFs). METHODS: This retrospective study included 268 elderly OVCF individuals, and 144 individuals were selected after propensity score matching. General patient information, perioperative conditions, vertebral height and Cobb angle, lumbar spinal function, degree of pain, incidence of complications, and fracture recurrence rates were compared and analyzed for the patients. RESULTS: The PKP group exhibited longer surgical duration, greater intraoperative blood loss, and more frequent X-ray fluoroscopy during the perioperative period compared to the PVP group (p < 0.05). However, there was no significant difference in the length of hospital stay between the two groups. Furthermore, PKP surgery significantly improved vertebral height, corrected spinal posture, and enhanced lumbar spinal function while mitigating pain levels within the 12-month postoperative period (p < 0.05). Additionally, the PKP group showed substantially lower rates of bone cement leakage, nerve injury, and fracture recurrence than the PVP group (p < 0.05). CONCLUSIONS: Compared to PVP, PKP demonstrates better clinical effectiveness with lower incidence of complications in managing OVCF. However, surgical time and intraoperative trauma should be considered.

Using QCT for the prediction of spontaneous age- and gender-specific thoracolumbar vertebral fractures and accompanying distant vertebral fractures.

PURPOSE: To investigate the value and age- and gender-specific threshold values of bone mineral density (BMD) by quantitative computed tomography (QCT) for the prediction of spontaneous thoracolumbar vertebral fractures and thoracolumbar junction fractures accompanying distant vertebral fractures. METHODS: Among the 556 patients included, 68 patients had thoracolumbar vertebral fractures (12 patients with distant vertebral fractures, 56 patients without distant vertebral fractures) and 488 patients had no vertebral fractures. All patients were grouped by gender and age. According to the principle of Youden index, the threshold values were calculated from receiver operating characteristic (ROC) curves. RESULTS: The threshold values for predicting thoracolumbar vertebral fractures were 89.8 mg/cm3 for all subjects, 90.1 mg/cm3 for men, and 88.6 mg/cm3 for women. The threshold values for men aged < 60 years old and ≥ 60 years old were 117.4 mg/cm3 and 87.5 mg/cm3, respectively. The threshold values for women aged < 60 years old and ≥ 60 years old were 88.6 and 68.4 mg/cm3, respectively. The threshold value for predicting spontaneous thoracolumbar junction fractures with distant vertebral fractures was 62.7 mg/cm3. CONCLUSIONS: QCT provides a good ability to predict age- and gender-specific spontaneous thoracolumbar vertebral fractures, and to further predict spontaneous thoracolumbar junction fractures with distant vertebral fractures.

Feasibility study in quantitative identification of fresh and old osteoporotic vertebral compression fracture by vertebral CT value and CT value difference.

BACKGROUND: This study aims to assess the diagnostic utility of vertebral CT value and CT value difference in distinguishing between fresh and old osteoporotic vertebral compression fractures (OVCF). METHODS: A retrospective analysis was conducted on 118 patients with OVCF who underwent both MRI and CT examinations at our hospital. The nature of the fractured vertebra was determined according to MRI. The CT value of the fractured vertebrae and the mean CT value of the adjacent normal vertebrae were measured separately, and the differences between these values were calculated. Independent samples t-tests were used to compare CT value and CT value difference among all groups. The receiver operating characteristic (ROC) curve was employed to determine the optimal cut-off value for both CT value and CT value difference in differentiating fresh and old fractures. RESULTS: The study included a total of 163 fractured vertebrae from 118 patients. The CT value of fresh fractured vertebrae was significantly higher than those of adjacent normal vertebrae, which was statistically different (P < 0.001). In contrast, the difference between CT value of old fractured vertebrae and those of adjacent normal vertebrae was not statistically significant (P > 0.05). There were significant differences in CT value and CT value difference between fresh fractured vertebrae and old fractured vertebrae (P < 0.001). The ROC curve analysis showed that the optimal cut-off value of CT value for fresh fractures and old fractures was 103.40 HU. The optimal cut-off value of CT value difference was 39.81 HU. CONCLUSION: Vertebral CT value and CT value difference offer a certain reference value for distinguishing between fresh and old OVCF. These parameters can serve as a rapid diagnostic tool when MRI is unavailable or impractical, aiding in the timely assessment of OVCF.

Traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures management in adult patients: A single-center experience.

BACKGROUND: This study aimed to describe our clinical experience with surgical approaches and patient management for traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures. METHODS: We retrospectively evaluated patients with continuous and noncontinuous multiple-level thoracolumbar fractures who were operated on by the same surgical team from 2019 to 2021. These patients were divided into two groups: Group 1 (n=12, continuous fractures) and Group 2 (n=14, noncontinuous fractures). We assessed the patients' age, gender, fracture levels, fracture type, classification according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine Thoracolumbar Fracture Classification, status of posterior ligament damage, presence of additional traumatic pathology, status of decompression via laminectomy, levels of stabilization and fusion, preoperative and postoperative neurological status, presence of cervical trauma, duration of operation, amount of blood loss, duration of hospitalization, and lordosis and kyphosis angles in terms of fusion status and postoperative follow-up over two years. The study excluded patients over the age of 65, those with single-level fractures, and pathological fractures caused by osteoporosis, infection, or spinal tumors. RESULTS: Gender, age, neurological status, application of laminectomy, surgical complications, status of cervical fracture, duration of operation, amount of blood loss, duration of hospitalization, lordosis, and kyphosis angles were uniformly distributed between the groups. All patients underwent fusions, ranging from three to eight, with a median of two (range 2-4) fracture levels, and a median of five instrumented vertebrae, ranging from four to seven. Significant differences between the two groups were observed in terms of operation duration (p=0.001), blood loss (p=0.010), duration of hospitalization (p=0.003), number of fusions (p<0.001), and instrumented vertebral segments (p=0.011). CONCLUSION: Thus, a surgical approach involving decompression, vertebral fusion screws, allografts, and bone substitutes can enhance surgical outcomes for patients with continuous and noncontinuous vertebral fractures.

Surgical management of traumatic spondyloptosis: a case series.

BACKGROUND: Traumatic spondyloptosis is a rare and severe spinal injury characterized by complete anterior translation of one vertebra over another, often resulting in debilitating neurological deficits. CASE PRESENTATION: We present two cases of traumatic spondyloptosis and elaborate on the clinical presentation, management, and follow-up improvement. The first case is a 30-year-old Nepalese man who sustained traumatic spondyloptosis following a blunt force injury to his back while engaged in tree-cutting activities. The patient presented with severe back pain, left lower limb paralysis, and neurological deficits (consistent with American Spinal Injury Association grade C). Radiographic evaluation revealed total anterior dislocation of the L4 vertebral body over L5, accompanied by fractures of the superior endplates of both vertebrae. The second case is a 35-year-old Nepalese female who presented with back pain and lower limb paralysis following a fall from a 300-m cliff, exhibiting tenderness and ecchymosis in the mid-back region. Radiological examination revealed D12 vertebra translation over L1 with fracture, categorized as American Spinal Injury Association grade A. Both cases were surgically managed and stabilized. CONCLUSION: These cases emphasize the importance of a comprehensive approach to trauma management as well as prompt recognition, and early surgical management in optimizing outcomes for patients with traumatic spondyloptosis.

A novel unilateral extrapedicular approach applied to percutaneous vertebral augmentation to treat thoracic and lumbar Osteoporotic Vertebral Compression Fracture: a retrospective study.

OBJECTIVE: To design and apply a novel puncture method, named P TO P technique, and to evaluate its efficacy and safety. METHOD: The data of patients treated with PVA in medical institution from January 2020 to December 2022 were reviewed and analyzed. The degree of pain relief and recovery from daily activities were evaluated using VAS and LAS scores, and radiological parameters were evaluated using local kyphosis angle and excellent cement distribution. Complications such as cement leakage and recurrent vertebral fractures were also recorded. RESULTS: 157 patients with thoracolumbar OVCF were successfully treated with novel puncture techniques. All postoperative clinical and radiological parameters significantly decreased in all patients, except for an increase in local kyphosis angle at the last follow-up compared to postoperative. All other above indicators remained statistically significant at the last follow-up compared to postoperative improvement. Except for 2 patients with poor cement distribution, the remaining 155 patients successfully achieved satisfactory results in unilateral puncture and bilateral cement distribution, achieving an excellent rate of 98.73%. In addition, 18 cases (11.46%) of cement leakage occurred during the operation, fortunately none of them were uncomfortable. During the postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred. No other serious complications such as neurologic or named vascular injuries occurred. CONCLUSION: The application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling.

Effects of Lumbar Spine Vertebral Fractures on Trabecular Bone Score (TBS): The Manitoba BMD Registry.

Trabecular bone score (TBS) is a BMD-independent risk factor for fracture. During BMD reporting, it is standard practice to exclude lumbar vertebral levels affected by structural artifact. It is uncertain whether TBS is affected by lumbar spine fractures. The current study examined the effect of lumbar spine compression fractures on TBS measurements. We identified 656 individuals with vertebral fractures (mean age 75.8 ± 7.9 years, 90.9% female) who had lumbar spine DXA, TBS measurements from L1-L4 and vertebral fracture assessment (VFA) for identifying vertebral fractures. There were 272 cases with lumbar spine fractures and 384 controls with only thoracic spine fractures. L1 TBS and BMD were significantly greater in those with than without lumbar fractures (p< 0.001) but did not significantly differ for other vertebral levels or for L1-L4 combined. TBS and BMD measurements were then renormalized to remove level-specific differences (denoted rTBS and rBMD). The mean difference (all fractured minus all non-fractured vertebrae) was +0.040 (+3.3%) for rTBS and +0.088 g/cm2 (+9.5%) for rBMD (both p <0.001). The largest effect was for L1 with mean difference +0.058 (+4.9%) for rTBS and +0.098 g/cm2 (+10.6%) for rBMD (both p <0.001). The mean difference between fractured and non-fractured levels for rTBS was +0.028 (+2.4%) for grade 1, +0.036 (+3.0%) for grade 2 and +0.059 (+5.0%) for grade 3 fractures; for rBMD +0.051 (+5.5%), +0.076 (+8.2%) and +0.151 (+16.4%) g/cm2, respectively. The impact of excluding lumbar vertebral levels with fracture from the L1-L4 TBS measurement overall was small (-0.011 [-1.0%]; p<0.001) and was also small for grade 3 fractures (-0.020 [-1.7%]; p<0.001). In summary, TBS is mildly increased by VFA-confirmed lumbar vertebral fractures, but the percentage effect is much smaller (less than half) than seen for BMD and minimally affects TBS measured from L1-L4. This would support the use of L1-L4 without exclusions in individuals with lumbar vertebral fractures.

Characteristics of Lumbar Pars Interarticularis and Pedicle Stress Injuries by Sport in 902 Pediatric and Adolescent Athletes: A Retrospective Study.

BACKGROUND: Recent studies utilizing magnetic resonance imaging (MRI) for the evaluation of symptomatic lumbar spondylolysis in pediatric and adolescent athletes have indicated that upper level lumbar involvement has a higher incidence than previously reported. There has been a paucity of literature evaluating sport-specific patterns of lumbar spondylolysis, specifically upper versus lower level involvement. PURPOSE: To assess the potential risk factors for upper level stress injuries of the lumbar spine in pediatric and adolescent athletes. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The medical records of 902 pediatric and adolescent athletes (364 female, 538 male; mean age, 14.5 ± 2.1 years) diagnosed with symptomatic pedicle and pars interarticularis stress injuries at 2 academic medical centers (July 2016 to June 2021) were reviewed. All patients had undergone MRI at the time of diagnosis. Only patients with pars/pedicle edema on MRI were included. Data regarding single-sport specialization, sport participation, sport category by biomechanics (axial rotation vs extension/axial loading), and vertebral level of injury over the 5-year period were analyzed. Stress reaction or active spondylolysis (SRAS) was the terminology used to designate grade 1, 2a, or 3 stress injuries according to the adapted Hollenberg classification system on MRI. Upper level vertebrae were defined as L3 or superior, whereas lower level vertebrae included L4 or inferior. RESULTS: Of the 902 patients with SRAS injuries, most (n = 753 [83.5%]) had exclusively single-level lower stress injuries, while 67 (7.4%) had multilevel stress injuries. There were 82 athletes (9.1%) who had single-level upper stress injuries. Athletes with upper level pars/pedicle stress injuries were older at the time of diagnosis (15.8 ± 1.9 vs 14.3 ± 2.1 years, respectively; P < .001), had a shorter duration of low back pain before presentation (2.50 ± 2.70 vs 4.14 ± 6.73 months, respectively; P < .001), were more likely to specialize in a single sport (43.9% vs 32.3%, respectively; P = .046), and had a lower incidence of active spondylolysis on MRI at the time of diagnosis (42.7% vs 59.8%, respectively; P = .004) compared with athletes with lower level stress injuries. Athletes with lumbar stress injuries who specialized in a single sport had nearly twice the odds of having upper level involvement compared with multiple-sport athletes (adjusted odds ratio, 1.80 [95% CI, 1.06-3.04]; P = .03). Athletes with active spondylolysis on MRI at the time of diagnosis had nearly half the odds of having upper level involvement (adjusted odds ratio, 0.55 [95% CI, 0.33-0.91]; P = .02). CONCLUSION: Age at the time of diagnosis, duration of low back pain, single-sport specialization, and presence/absence of active spondylolysis on MRI at the time of diagnosis were primary predictors of whether an athlete's lumbar stress injury was classified as either upper or lower level involvement. Overall, the variables included in multivariate analysis were modest predictors, explaining only 15.1% of the variance in the rates of lumbosacral stress injuries classified by spinal level. These specific biomechanical factors and other potential contributors to these findings warrant further investigation.

An unusual case of recurrent traumatic spinal epidural hematoma accompanied by osteoporotic vertebral compression fractures: Case report.

RATIONALE: Traumatic spinal epidural hematoma (SEH) is a rare clinical condition. Here, we present an extraordinary case of recurrent SEH accompanied by thoracolumbar spine fractures resulting from minor trauma, and provide evidence-based recommendations for the surgical management strategies in this unique scenario. PATIENT CONCERNS: A 71-year-old female patient presented with back pain after a fall. Magnetic resonance imaging revealed an SEH with L2 vertebral compression fracture. Following unsuccessful conservative treatment, percutaneous vertebroplasty was performed at the 2nd lumbar vertebra under local anesthesia. Two years later, the patient experienced another fall and was diagnosed with spinal hematoma with L1 vertebral compression fractures. DIAGNOSES: The patient was diagnosed with recurrent osteoporotic vertebral compression fracture accompanying SEH. OUTCOMES: After 1 week of conservative treatment, notable improvement of limbs numbness was observed. The patient ultimately underwent L1 vertebroplasty surgery. The patient was discharged smoothly on the third postoperative day and made a full recovery after 4 months. LESSONS: SEH is a rare clinical finding that can occur even after a minor trauma in the elderly. It is worth noting that osteoporotic vertebral compression fractures with asymptomatic or stable intraspinal hematoma, is not considered to be a contraindication for percutaneous vertebroplasty. And percutaneous vertebroplasty is a safe and effective treatment for osteoporotic compression fractures with asymptomatic SEH.

Suboptimal osteoporosis care in hospitalized patients: a retrospective analysis of vertebral compression fractures detected on computed tomography.

Vertebral compression fractures (VCFs) are the most common osteoporotic fractures. Only 1/3 of patients with VCFs are clinically diagnosed. In our institution, the Fracture Liaison Service (FLS) was launched in 2017 to improve osteoporosis management for hospitalized patients. (1) To assess osteoporosis awareness among medical providers for emergency department (ED)/hospitalized patients aged 50 or greater; (2) To estimate the rate of FLS consults or referrals to primary care providers (FLS/PCP) by primary teams. A centralized radiology system was used to examine all thoracic and lumbar computed tomography (CT) scans conducted between June 1, 2017 and June 1, 2022. 449 studies were identified with the radiologic impression "compression fracture". 182 studies were excluded after manual chart review. 267 hospitalizations/ED visits with lumbar and/or thoracic spine CT scans were included. Referrals to FLS (26) or PCP (27) were made in 53 cases (~ 20% of the total). In the ED subgroup (131 hospitalizations), only 17 patients had FLS/PCP referrals. The "compression fracture" was mentioned in 227 (85%) discharge notes (any part), while "osteoporosis" was mentioned in only 74 (28%) hospitalizations. A statistically significant difference was found between the two groups when "osteoporosis" was mentioned in the "assessment and plan" section (p = 0.02). Our data show that the overall osteoporosis care for affected patients is suboptimal. Medical providers often overlook the presence of osteoporosis, leading to a lack of consultation with the FLS of referral to PCPs for further evaluation and treatment.

Subject-level spinal osteoporotic fracture prediction combining deep learning vertebral outputs and limited demographic data.

Automated screening for vertebral fractures could improve outcomes. We achieved an AUC-ROC = 0.968 for the prediction of moderate to severe fracture using a GAM with age and three maximal vertebral body scores of fracture from a convolutional neural network. Maximal fracture scores resulted in a performant model for subject-level fracture prediction. Combining individual deep learning vertebral body fracture scores and demographic covariates for subject-level classification of osteoporotic fracture achieved excellent performance (AUC-ROC of 0.968) on a large dataset of radiographs with basic demographic data. PURPOSE: Osteoporotic vertebral fractures are common and morbid. Automated opportunistic screening for incidental vertebral fractures from radiographs, the highest volume imaging modality, could improve osteoporosis detection and management. We consider how to form patient-level fracture predictions and summarization to guide management, using our previously developed vertebral fracture classifier on segmented radiographs from a prospective cohort study of US men (MrOS). We compare the performance of logistic regression (LR) and generalized additive models (GAM) with combinations of individual vertebral scores and basic demographic covariates. METHODS: Subject-level LR and GAM models were created retrospectively using all fracture predictions or summary variables such as order statistics, adjacent vertebral interactions, and demographic covariates (age, race/ethnicity). The classifier outputs for 8663 vertebrae from 1176 thoracic and lumbar radiographs in 669 subjects were divided by subject to perform stratified fivefold cross-validation. Models were assessed using multiple metrics, including receiver operating characteristic (ROC) and precision-recall (PR) curves. RESULTS: The best model (AUC-ROC = 0.968) was a GAM using the top three maximum vertebral fracture scores and age. Using top-ranked scores only, rather than all vertebral scores, improved performance for both model classes. Adding age, but not ethnicity, to the GAMs improved performance slightly. CONCLUSION: Maximal vertebral fracture scores resulted in the highest-performing models. While combining multiple vertebral body predictions risks decreasing specificity, our results demonstrate that subject-level models maintain good predictive performance. Thresholding strategies can be used to control sensitivity and specificity as clinically appropriate.

Risk Factors for Nonunion After Nonoperative Treatment for Pediatric Lumbar Spondylolysis: A Retrospective Case-Control Study.

BACKGROUND: Pediatric lumbar spondylolysis, a stress fracture of the lumbar spine, frequently affects young athletes, and nonoperative treatment is often the first choice of management. Because the union rate in lumbar spondylolysis is lower than that in general fatigue fractures, identifying risk factors for nonunion is essential for optimizing treatment. PURPOSE: To determine the risk factors for nonunion after nonoperative treatment of acute pediatric lumbar spondylolysis through multivariate analysis. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We analyzed 574 pediatric patients (mean age, 14.3 ± 1.9 years) with lumbar spondylolysis who underwent nonoperative treatment between 2015 and 2022. Nonoperative treatment included the elimination of sports activities, bracing, and weekly athletic rehabilitation, with follow-up computed tomography. Patient data, lesion characteristics, sports history, presence of spina bifida occulta at the lamina with a lesion or at the lumbosacral spine excluding the lesion level, and lumbosacral parameters were examined. Differences between the union and nonunion groups were investigated using multivariate analysis to determine the risk factors for nonunion. RESULTS: Of the 574 patients, 81.7% achieved bone union. Multivariate analysis revealed that an L5 lesion and the progression of the main and contralateral lesion stages were significant independent risk factors for nonunion. An L5 lesion had a lower union rate than non-L5 lesions. As the main lesion progressed, the likelihood of nonunion increased significantly, and the progression of the contralateral lesion also showed a similar trend. Spina bifida occulta and lumbosacral parameters were not significant predictors of nonunion in this study. CONCLUSION: We identified the L5 lesion level and the progression of the main and contralateral lesion stages as independent risk factors for nonunion in pediatric lumbar spondylolysis after nonoperative treatment. These findings aid in treatment decision-making. When bone union cannot be expected with nonoperative treatment, symptomatic treatment is required without prolonged external fixation and rest, and without aiming for bone union. Individualized treatment plans are crucial based on identified risk factors.

L5-S1 facet joint pathology in pelvic ring injuries.

BACKGROUND: The authors believe that the L5-S1 facet joint injury in the setting of pelvic fractures is underappreciated by orthopedic traumatologists. The purpose of this study was to draw attention to the L5/S1 facet joint in the setting of pelvic ring injuries. METHODS: This was a retrospective comparative study of all patients greater than or equal to 18 years of age with an acute pelvic ring injury (AO/OTA 62 B to C) presenting to a single level I trauma center. The primary objective was to determine demographic and injury characteristics associated with L5-S1 facet joint injuries in patients with pelvic ring injuries. The secondary objective was to determine the proportion of L5-S1 facet joint injuries that were missed on initial radiographic workup. RESULTS: There were 476 patients included in the analysis, 53 (11.1%) of whom had an L5-S1 facet joint injury. Patients with an L5-S1 injury were more likely to be younger (44.1 vs. 53.2 years, p = 0.001) and experience a high energy mechanism of injury (95.0% vs. 78.0%, p = 0.002). Certain injury patterns were associated with L5-S1 facet joint injuries: any sacral fracture (96.2% vs. 73.8%, p < 0.001), Denis zone 2 fractures (43.4% vs. 20.1%, p < 0.001), Denis zone 3 fractures (34.0% vs. 4.7%, p < 0.001), bilateral displaced sacral fractures (18.9% vs. 3.5%, p < 0.001), and L5 transverse process fractures (64.2% vs. 18.0%, p < 0.001). Only 16.0% of radiology reports identified an L5-S1 injury. CONCLUSIONS: Orthopedic traumatologists should scrutinize imaging for L5-S1 facet joint injuries in the presence of pelvic ring injuries, especially in patients with certain sacral fracture patterns.

Expanded Combined Loading Injury Criterion for the Human Lumbar Spine Under Dynamic Compression.

Contemporary injury tolerance of the lumbar spine for under-body blast references axial compression and bending moments in a limited range. Since injuries often occur in a wider range of flexion and extension with increased moment contribution, this study expands a previously proposed combined loading injury criterion for the lumbar spine. Fifteen cadaveric lumbar spine failure tests with greater magnitudes of eccentric loading were incorporated into an existing injury criterion to augment its applicability and a combined loading injury risk model was proposed by means of survival analysis. A loglogistic distribution was the most representative of injury risk, resulting in optimized critical values of Fr,crit = 6011 N, and My,crit = 904 Nm for the proposed combined loading metric. The 50% probability of injury resulted in a combined loading metric value of 1, with 0.59 and 1.7 corresponding to 5 and 95% injury risk, respectively. The inclusion of eccentric loaded specimens resulted in an increased contribution of the bending moment relative to the previously investigated flexion/extension range (previous My,crit = 1155 Nm), with the contribution of the resultant sagittal force reduced by nearly 200 N (previous Fr,crit = 5824 N). The new critical values reflect an expanded flexion/extension range of applicability of the previously proposed combined loading injury criterion for the human lumbar spine during dynamic compression.

Optimizing the distal anchorage in stabilization for the traumatic adjacent lumbar vertebra fracture in an adolescent idiopathic scoliosis patient who had posterior spinal fusion: a novel surgical technique.

The incidence of traumatic spine fractures (TSF) is increasing worldwide, with a reported annual incidence of up to 32.8 per 100000 persons. However, there are only a few cases of spine fractures reported in adolescent idiopathic scoliosis (AIS) patients after posterior spinal fusion (PSF) in the literature. Fractures adjacent to fusion blocks that extend into the lower lumbar spine pose a unique challenge as stabilization of such fractures might require an extension of instrumentation to L5 or the pelvis. We report a novel surgical technique where bilateral pedicle and cortical screws at L4 and supplementary rods that connect the cortical screws to the main rods via dominos were implemented for optimizing the distal anchorage for TSF stabilization following an L3 Chance fracture in an AIS patient who had undergone T4-L2 posterior spinal fusion.

Factors associated with loss of vertebral height and kyphosis correction after intermediate screws in short segment pedicular fixation for type-A fractures of the thoracolumbar spine: A retrospective study.

In this article, we attempted to identify risk factors affecting the loss of vertebral height and kyphosis correction on type A thoracolumbar fractures. Patients with type A thoracolumbar fractures who underwent short segments with intermediate screws at the fracture level management between 2017 and 2022 were included in this study. Clinical factors including patients' demographic characteristics (age, sex), history (smoking, hypertension and/or diabetes), value of height/kyphosis correction, the thoracolumbar injury classification and severity score (TLICS), the load sharing classification (LSC) scores and bone mineral density were collected. Correlation coefficient, simple linear regression analysis and multivariate regression analysis were performed to identify the clinical factors associated with the loss of vertebral height/kyphosis correction. Finally, 166 patients were included in this study. The mean height and kyphosis correction were 21.8% ±â€…7.5% and 9.9°â€…±â€…3.8°, respectively, the values of the loss were 6.5% ±â€…4.0% and 3.9°â€…±â€…1.9°, respectively. Simple linear regression analysis and multivariate regression analysis showed that age, value of height correction, LSC scores and bone mineral density were significantly associated with the loss of vertebral height and kyphosis correction (P < .01) We could draw the conclusion that patients with older age, lower bone mineral density, higher LSC scores and diabetes are at higher risk of vertebral height and kyphosis correction loss increase. For these patients, appropriate clinical measures such as long segment fixation, control of blood glucose, and increase of bone density must be taken to reduce the loss of correction.